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PubMed2000

Challenges in teaching ethics in medical schools.

Modern medical ethics has effected dramatic changes in medicine. Yet teaching medical ethics still presents many challenges. The main teaching methods used--inpatient ethics consultations, courses, and case conferences--have notable weaknesses. In addition, the attitudes and knowledge gaps of some learners may hamper these methods further. To encourage open discussion of the challenges, we outline our current approach to teaching medical ethics. We teach with the conviction that ethics instruction gives physicians vital knowledge not available from science. Our teaching addresses ethical issues directly relevant to residents and students, emphasizes a few important concepts, and nurtures learners' critical reasoning skills. Our teaching also tries to use scarce faculty time efficiently. However, we believe successful medical ethics teaching requires medical schools to commit significant material and moral support. We hope the discussion here encourages medical ethics teachers everywhere to describe the challenges they face and to collaborate on finding solutions.

Attitude↗
PubMed1989

Teaching medical ethics during residency.

Because practicing physicians are poorly prepared to resolve many ethical issues that arise in patient care, this article proposes that residencies include practical training in medical ethics. Training in medical ethics helps physicians recognize ethical issues in patient care and resolve those issues wisely. Furthermore, such training has its maximum impact during the professionally formative years of residency. The article specifies key ethical concepts residents should know, including knowing how to obtain informed consent, knowing what to do about incompetent patients, knowing when to withhold or disclose clinical information, and knowing how to use resources properly. The article also points out that the success of residency training in ethics depends on strong commitments from the department: endorsement by the chairman and the residency program director; recruitment of several dedicated faculty; support for adequate ethics training for these faculty; dedication of conferences, rounds, and consultations to teaching ethics; and allocation of sufficient funds.

Bioethical Issues↗
PubMed1993

Overlooking ethics in the search for objectivity and misconduct in science.

The author investigates the relationship between the reliability of scientific data and the ethics of the scientist, demonstrates how attention given to misconduct in the biological sciences adversely affects the broader significance of ethics in this field, and extracts from the applications of ethics in medicine perspectives relevant to the biological sciences. As twentieth-century biological scientists applied increasingly powerful methods to diminish bias and to improve the objectivity of their work, including the replication of experimental findings to verify them, they came to believe that these methods would protect their studies from error and misleading conclusions. This assumption has been shown to be unwarranted because it cannot protect scientists from self-conscious or biased selection in reporting evidence. The canons of scientific objectivity must be grounded in something more fundamental--the canon of ethics. In the end, a commitment to the ethical standard of truthfulness, through an understanding of its meaning to science, is essential to enhance objectivity and diminish bias. Unfortunately, the ethos of concern for scientific misconduct continues to dominate the research-ethics movement. This focus is damaging because it turns the attention to seeking and finding wrong-doers and determining punishment rather than discussing generic issues of doing the right thing, preventing harms, seeking benefits, and understanding the right-making and wrong-making characteristics of actions. The focus on scientific misconduct makes ethical issues appear synonymous with legal issues and the search for ethical understanding synonymous with carrying out an investigation.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomedical Research↗
PubMed1994

Developing an ethics curriculum for a family practice residency.

PURPOSE: To develop a curriculum in ethics in family practice by studying which ethical issues physicians believe to be important based on frequency of encounter, difficulty in managing the problem, and helpfulness of discussion; to examine whether there are any important differences between faculty and residents and between genders; and to determine the preferred format(s) for teaching these issues. METHOD: Between November 1991 and June 1992 a total of 475 questionnaires were mailed to all the family practice residents (first- and second-year), graduates in their first two years of practice, and the physician faculty of the Department of Family Medicine at the McGill University Faculty of Medicine. Overall, 319 usable questionnaires were returned, for a final response rate of 67%. The questionnaire asked respondents to evaluate 14 ethical dilemmas in order to determine the importance of teaching specific ethical issues as well as to determine the preferred format for teaching. Chi-square tests, analyses of variance, and Student's t-tests were used to test the significance of differences in responses. RESULTS: No consistent pattern of interrelationship was found among frequency of encounter and difficulty and helpfulness of discussion for most items. Overall, there was little difference in how faculty and residents, men and women, perceived the importance of these ethical issues. Women reported encountering ethical issues less frequently than men [F (14,285) = 1.82, p < .04], while at the same time finding them somewhat more difficult and more deserving of discussion. Small-group, case-oriented discussion appears to have been the favored teaching format regardless of the ethical dilemma. CONCLUSION: It is difficult to narrow down the content to be included in a curriculum in ethics in family practice. Frequency of encounter, difficulty in management, and helpfulness of discussion can all be argued to be important factors for consideration; they should all be considered separately or in combination for each teaching situation if time restrictions force a choice between topics.

Adult↗
PubMed2002

What can the social sciences contribute to the study of ethics? Theoretical, empirical and substantive considerations.

This article seeks to establish that the social sciences have an important contribution to make to the study of ethics. The discussion is framed around three questions: (i) what theoretical work can the social sciences contribute to the understanding of ethics? (ii) what empirical work can the social sciences contribute to the understanding of ethics? And (iii) how does this theoretical and empirical work combine, to enhance the understanding of ethics, as a field of analysis and debate, is socially constituted and situated? Through these questions the argument goes beyond the now commonly cited objection to the over-simplistic division between normative and descriptive ethics (that assigns the social sciences the 'handmaiden' role of simply providing the 'facts'). In extending this argument, this article seeks to establish, more firmly and in more detail, that: (a) the social sciences have a longstanding theoretical interest analysing the role that a concern with ethics plays in explanations of social change, social organisation and social action; (b) the explanations that are based on the empirical investigations conducted by social scientists exemplify the interplay of epistemological and methodological analyses so that our understanding of particular substantive issues is extended beyond the conventional questions raised by ethicists, and (c) through this combination of theoretical and empirical work, social scientists go beyond the specific ethical questions of particular practices to enquire further into the social processes that lie behind the very designation of certain matters as being 'ethical issues.'

Behavioral Research↗
PubMed2004

The current situation of health research and ethics in Sudan.

At the beginning of the twentieth century, health research in the Sudan developed primarily as a function of the colonial British administration. Ethical issues in the medical profession in the Sudan are governed by the Sudan Medical Council. To address these issues, the Sudan Medical Council issued Medico-legal and Ethical Guidelines in 1967. This important document has focused principally on ethical issues arising in clinical medicine. Throughout the history of health research in Sudan it is very difficult to find any reference to research ethics. Nevertheless, there have been a few attempts to articulate ethics in health research. In 1979, Sudan witnessed the establishment of the first ethical review committee, which was established by the initiative of a group of doctors and scientists from the national health research laboratory. This committee got neither political nor institutional recognition. Therefore, it was not developed and came to an end shortly after its inception. Yet, in 2000 the FMOH established an ethical review committee (ERC). The functions of this committee were to review proposals of health research to be carried out in the country for ethical issues irrespective to the funding agents. Unfortunately, the committee devoted all the jobs in reviewing only externally-sponsored health research and research carried out by expatriate researchers or international organisations.

Biomedical Research↗
PubMed2002

International variation in ethics committee requirements: comparisons across five Westernised nations.

BACKGROUND: Ethics committees typically apply the common principles of autonomy, nonmaleficence, beneficence and justice to research proposals but with variable weighting and interpretation. This paper reports a comparison of ethical requirements in an international cross-cultural study and discusses their implications. DISCUSSION: The study was run concurrently in New Zealand, UK, Israel, Canada and USA and involved testing hypotheses about believability of testimonies regarding alleged child sexual abuse. Ethics committee requirements to conduct this study ranged from nil in Israel to considerable amendments designed to minimise participant harm in New Zealand. Assessment of minimal risk is a complex and unreliable estimation further compounded by insufficient information on probabilities of particular individuals suffering harm. Estimating potential benefits/ risks ratio and protecting participants' autonomy similarly are not straightforward exercises. SUMMARY: Safeguarding moral/humane principles should be balanced with promotion of ethical research which does not impede research posing minimal risk to participants. In ensuring that ethical standards are met and research has scientific merit, ethics committees have obligations to participants (to meet their rights and protect them from harm); to society (to ensure good quality research is conducted); and to researchers (to treat their proposals with just consideration and respect). To facilitate meeting all these obligations, the preferable focus should be promotion of ethical research, rather than the prevention of unethical research, which inevitably results in the impediment of researchers from doing their work. How the ethical principles should be applied and balanced requires further consideration.

Behavioral Research↗
PubMed2005

Action ethical dilemmas in surgery: an interview study of practicing surgeons.

BACKGROUND: The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice. METHODS: Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. RESULTS: No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests. CONCLUSION: The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.

Attitude of Health Personnel↗
PubMed2002

Ethical reasoning observed: a longitudinal study of nursing students.

All nursing courses in the UK include ethics in the curriculum, although there is considerable variation in the content of ethics courses and the teaching methods used to assist the acquisition of ethical reasoning.The effectiveness of ethics courses continues to be disputed, even when the perceptions and needs of students are taken into account in their design. This longitudinal study, carried out in the UK, but with implications for nurse education in other developed countries, explored the ethical understanding of nursing students and changes in their understanding and approaches to practice over their four years of training (1995-1999). The data collection tools were a questionnaire originally piloted prior to the 1995 study, from which the present study developed, and five vignettes describing ethical dilemmas in health care also piloted in 1995. Students' thinking progressed as they became more mature as individuals and professionals, although this progress was not necessarily in the direction of greater certainty. Suggestions are made to help nurse educators to maximize the effectiveness of ethics courses in transmitting the skills of ethical reasoning.

Adolescent↗
PubMed2006

[Legal repercussions of Clinical Ethics Committees reports].

Clinical Ethics Committees and Research Ethics Committees have their own specific roles. The Clinical Ethics Committee's pronouncements have an advisory function, whereas Research Ethics Committees' decisions are binding. This article analyzes the legal impact of the Clinical Ethics Committees' reports. Legal and medical reasoning share the same practical nature. Both can have several correct answers to the same situation. Clinical Ethics Committees deliberate about these alternatives and analyze the involved values. Their conclusions are non-compulsory recommendations. They do not replace nor diminish the doctor's personal responsibility. Even though the Clinical Ethics Committees' reports are not binding, they constitute a sort of "expert's opinion", expressed by qualified professionals, who assume their own professional responsibility as advisors. The members' behavior is necessarily subject to constitutional and legal regulations. When judges review the Clinical Ethics Committee's reports, they must realize that their nature is advisory, and also consider them an essential element to reduce the gap between the medical and legal fields. In this way, the problem of increasingly transforming medicine into a legal issue can be prevented.

Ethics Committees, Clinical↗
PubMed2004

Acute clinical ethics consultation: the practicalities.

In Australia there has been only limited experience with ethics consultation, and there are no reports of practical details. In 1999, the Institutional Clinical Ethics Committee at John Hunter Hospital, Newcastle, initiated an Acute Clinical Ethics Service (ACES) to formalise a perceived need within the hospital for ethics consultation. This need had previously been met by ad-hoc councils of "wise men". The ACES approach uses a team of people with different perspectives to provide an ethics consultation in a timely manner. Our initial experience of ACES has shown that a formal process of ethics consultation may be preferable to informal approaches in many circumstances; even when genuine consensus is not possible, an ethics consultation nevertheless provides an opportunity to share different points of view and helps to avoid practices that may be unacceptable. The specific implications of acute ethics consultations are not yet fully elucidated.

Abortion, Induced↗
PubMed1999

Ethical androcentrism and maternal substance addiction.

In this paper, I argue that bioethics suffers from a masculinist approach--what I call "ethical androcentrism." Despite the genesis of other legitimate approaches to ethics (such as feminist, narrative, and communicative ethics), this masculinist tradition persists. The first part of my paper concerns the problem of ethical androcentrism, and how it is manifest in our typical ways of "doing" bioethics (as teachers, ethicists, policymakers, and medical practitioners). After arguing that bioethics suffers from a masculinist ethic, I consider the case of maternal substance addiction to show how this ethic negatively affects the treatment of pregnant addicts. I argue that by treatment maternal substance addiction from an androcentric approach, we fail to serve both pregnant addicts and their fetuses; furthermore, we misrepresent the intentional state of pregnant substance addicts and label them "prenatal abusers." If maternal substance addiction is to be ethically addressed--and if pregnant substance addicts are to be effectively treated--we cannot tacitly accept an androcentric ethic.

Bioethics↗
PubMedDate not supplied

A question of value. What does ethics contribute to the life and work of an organization?

In faith-based healthcare, the scope of ethics reaches beyond clinical ethics-which, up to now, has been its primary focus-to encompass the entire culture of the organization and all its relationships. Consequently, sustained attention to ethics contributes to the life of, and adds value to, the organization. Ethics' role is to articulate the beliefs and values that are to be embodied in the organization's culture, given its fundamental commitments. Ethics devises methods for shaping and nurturing the culture, and has a role in periodically assessing the state of the organization's relationships, both external-with other healthcare entities, the community, and society-and internal-with employees and patients. Further, ethics shapes the relationships the organization's associates have with each other and with the organization. Attention to ethics encourages improvement in the moral quality of the interactions within the organization; provides an opportunity for moral growth; creates a climate in which ethical issues are dealt with, not ignored; and, over time, creates a community of moral discourse.

Catholicism↗
PubMed2000

Ethics education in medical schools: the role of jurists.

Ethical thinking has always existed in the area of medicine. The oldest law case has known human experiment difficulties, but this comes from the doctor. The power of the practitioner relies on the lack of medical knowledge of the patient and often in practice, on the lack of information for the patient. The doctor has ethical difficulties when he considers the patient and the solution, in fact is dependent on his conscience. With the various medical discoveries, the doctor can create life (assisted procreation), manipulate life (gene therapy) and suppress life (abortion, suppression of frozen embroyos). These discoveries have increased the necessity for ethical reflection. Ethics committees have been created at local level (as part of special establishments or departments) rather than at national and international levels. The scope of the stakes (the development of the human race) give to this ethical reflection a multidisciplinary approach. There is a general tendency for the influence of law in these fields. Therefore, the jurist has a more and more important place on these ethics committees. Actually, the interaction from ethics to law is frequent. Also during legal proceedings, a jurist has and will have more and more need of a medical assessor. So, cooperation is necessary between doctors and jurists. The teaching of ethics in medical schools by the jurist can be important because it will recall the humanist mission of the doctor. The jurist must be able to increase the medical professions' awareness of essential notions such as respect for the fundamental rights of the human being.

Curriculum↗
PubMed2001

Medical internet ethics: a field in evolution.

As in any new field, the merger of medicine, e-commerce and the Internet raises many questions pertaining to ethical conduct. Key issues include defining the essence of the patient-provider relationship, establishing guidelines and training for practicing online medicine and therapy, setting standards for ethical online research, determining guidelines for providing quality healthcare information and requiring ethical conduct for medical and health websites. Physicians who follow their professional code of ethics are obligated not to exploit the relationship they have with patients, nor allow anyone else working with them to do so. Physicians and therapists are obligated to serve those who place trust in them for treatment, whether in face-to-face or online Internet encounters with patients or clients. This ethical responsibility to patients and clients is often in direct conflict with the business model of generating profits. Healthcare professionals involved in Medical Internet Ethics need to define the scope of competent medical and healthcare on the Internet. The emerging ethical issues facing medicine on the Internet, the current state of medical ethics on the Internet and questions for future directions of study in this evolving field are reviewed in this paper.

Confidentiality↗
PubMed2003

Curriculum evaluation of ethical reasoning and professional responsibility.

This exploratory study evaluated curricular content and evaluation mechanisms related to ethics and professionalism in the baccalaureate dental hygiene program at Idaho State University. Competency-based education requires enhanced student preparation in ethical reasoning, critical thinking, and decision-making. Graduates must integrate concepts, beliefs, principles, and values to fulfill ethical and professional responsibilities. Methods included 1) development of five supporting competencies defining ethics and professionalism to provide a framework for curricular evaluation; 2) assessment of all course content and evaluation methods for each supporting competency; 3) evaluation of students' clinical performance based on professional judgment grades; and 4) survey of junior (n=30) and senior (n=27) students' attitudes about dental hygiene practice related to ethics and professionalism. Results revealed that most courses include content and evaluation related to at least one supporting competency; however, authentic evaluation is weak. Clinical instructors rarely relate evaluations to ethical principles or values. Surveys showed significant differences between junior and senior students' attitudes about ethics and professionalism in six of thirty-four areas (the six were laws and regulations; communication and interpersonal skills; problem solving; professional activities/programs; integrity; and safe work environment). This article shares one approach for evaluating curricular content and evaluation methods designed to develop student competence in ethical reasoning and professionalism. Based upon the study's findings, recommendations are made for curricular enhancement via authentic evaluation and faculty training.

Adolescent↗
PubMed2005

Ethical evaluation of "retainer fee" medical practice.

This article examines the reasons that some physicians have recently opted to reduce the size of their practice rosters to allow more time for each patient in exchange for a retainer fee from patients. These physicians also offer supplementary, nonmedical amenities to patients as part of their service. Because physicians have reduced the size of their practice rosters and have increased the price tag for their services, some patients have lost access to their care. We have tried to assess the ethical propriety of such a change in the design of medical practices by weighing plausible, ethically relevant arguments favoring and opposing RFMP. Physicians are ethically obligated first and foremost to promote and protect the health of their patients. RFMP fulfills this duty directly by ensuring prompt and ample professional time for the care of patients. It does so indirectly by allowing time for physicians' continuing education, which in turn should upgrade the quality of care. It also advances the ethical goals of autonomy as it allows patients to choose their own physicians and to spend their money as they please. On the other hand, these ethical positives are offset by the cost of retainer fees that may exclude access of patients to their physicians' care. Even if ethical tradition obligates physicians primarily to patients under their specific care, as professionals and as private citizens, they also have a responsibility to support the health of the entire community. RFMP does little to advance this cause, except that by optimizing the conditions under which their own private patients receive healthcare, they call attention to shortcomings in prevailing public healthcare policies, which by comparison fall short of that standard. An assumption that health is not properly a market commodity, and that all people should receive healthcare on equal terms, would expose RFMP to moral reproof. From an ethical perspective, we find sufficient cause for concern and caution in this innovative style of practice. Nevertheless, the weight of arguments presented here does not seem to justify unequivocal moral condemnation of RFMP. As neither pro nor con views seem to have settled the ethical question, definitive moral judgment on RFMP will probably depend on the outcome of future experience and ongoing evaluation. The implications of RFMP for any future healthcare system are not clear, at least to us.

Ethical Analysis↗
PubMed1990

Survey of ethical issues in dental hygiene.

The purpose of this study was to determine the types and frequency of ethical problems encountered by dental hygienists, and to determine the type of instruction they have received in ethical theory and problem solving. A 40-item questionnaire mailed to 2,251 American Dental Hygienists' Association members resulted in a stratified random sample of 1,523 (68% response rate). The three ethical dilemmas most frequently encountered in dental hygiene practice are (1) observation of behavior in conflict with standard infection control procedures (66%); (2) failure to refer patients to a specialist such as a periodontist (60%); and (3) nondiagnosis of dental disease (58%). While almost 86% of the respondents received formal instruction in ethical theory, only 51% received formal instruction in methods for solving ethical problems. More hygienists (74%) felt their ethical principles were influenced by role models rather than by formal instruction (63%). This study indicates that serious ethical dilemmas are encountered by the majority of dental hygienists and that some modification of current entry-level education, as well as of continuing professional education, should be considered to prepare dental hygienists to recognize and resolve ethical problems.

Adult↗