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PubMed1990

Medical house officers' knowledge, attitudes, and confidence regarding medical ethics.

As part of a trial of ethics education in a university-based, categorical, internal medicine training program, we surveyed all medical house officers at our institution regarding their knowledge of medical ethics, their attitudes and beliefs about selected issues in medical ethics, and their confidence in dealing with ethical problems. In a multivariate linear regression model, house officer knowledge scores were negatively correlated with postgraduate year, and positively correlated with age and with reporting a Jewish religious identity. A multivariate linear regression model predicting house officer confidence in dealing with ethical issues revealed a positive correlation with self-reported quality of ethics training in medical school and with being in the experimental group of house officers receiving ethics education. Attitudes and beliefs were largely uncorrelated with training or demographic characteristics. These results have implications for ethics education of both medical students and residents.

Attitude of Health Personnel↗
PubMed1988

Residency ethics teaching. A critique of current trends.

There is a growing effort to formalize ethics teaching for medical residents. Currently, this effort is overemphasizing a single approach--the clinical ethics consultation or ethics case conference--at the expense of several other important options. While the clinical ethics approach has many benefits, it also has harmful side effects when it is made the single method for residency ethics teaching: it constricts ethics teaching within too narrow a view of medical ethics, and it forfeits an opportunity for ethics to challenge some problematic features of residency education itself.

Clinical Clerkship↗
PubMed1987

An ethical committee for general practice in the west for Scotland: proposals received in the first year.

The particular ethical problems of research in general practice and pressure from local general practitioners and hospital ethical committees led to the development of an ethical committee for general practice in the west of Scotland. The workload of this ethical committee in its first year of existence is described.Despite the fact that many of the studies considered by the committee were sponsored by pharmaceutical companies and were often sophisticated, the ethical issues of a general practice setting had not always been fully appreciated. Of the 21 study proposals submitted over the year 13 showed areas of ethical uncertainty. However, all the studies were eventually approved. Most of the problems encountered were easily overcome and might have been avoided if the general practitioners undertaking the research had been able to seek advice from those with experience of research in general practice and in particular of the ethical issues involved. Local ethical committees for general practice, made up largely of general practitioners but with at least one lay member, might provide one such source of advice.

Ethics Committees, Research↗
PubMed1985

Relevance and utility of courses in medical ethics. A survey of physicians' perceptions.

In the last decade the teaching of medical ethics has become almost universal in American medical schools. Its effectiveness is, however, just beginning to be evaluated. A stratified random sample of 3,000 practicing physicians who were graduated between 1974 and 1978 was surveyed to evaluate their perceptions of the utility and relevance of medical ethics teaching. Those who had courses in medical ethics perceived it to be of substantial benefit in confronting the actual ethical issues they encountered in daily practice. They favored the continuation and expansion of the teaching of medical ethics and had suggestions for its improvement. Data were also obtained on the relative frequency of specific ethical issues in practices and on the relative influence of home, personal values, medical education, medical practice, and ethics courses on respondents' approaches to ethical issues.

Attitude of Health Personnel↗
PubMed1993

An assessment of ethical sensitivity: implications for interdisciplinary education.

The purpose of this study was to examine the relationship between discipline-specific knowledge and ethical sensitivity among health professions students, as related to different levels of education. Specifically, the study addressed the question, do health professions students, grouped according to their disciplines and levels of education, differ in their ethical sensitivity to selected discipline-specific ethical dilemmas? Subjects included 48 senior students from the disciplines of dental assisting, dental hygiene, and dentistry, and the disciplines of surgical technology, respiratory therapy, and medicine. Dental and nondental disciplinary groups represented the certificate, associate degree, and graduate levels of education. Differences between and among groups' ethical sensitivity scores, as derived from the Dental Ethical Sensitivity Test (DEST), were statistically analyzed. Results of the study indicated that, given dental-related case studies, students with discipline-specific knowledge in dentistry did not differ in ethical sensitivity from students who did not possess discipline-specific knowledge in that field. However, the results also demonstrated that students enrolled at different levels of education did differ significantly in ethical sensitivity, regardless of discipline-specific knowledge in dentistry. These findings have implications for teaching applied professional ethics in health professions education, from an interdisciplinary perspective.

Allied Health Personnel↗
PubMed1995

[Considerations on education and formation in health care ethics in Belgium].

Codes of medical ethics summarize the most important duties of the medical profession; but the field of medical ethics encompasses more problems than are treated in the codes, and the management of many health care problems necessitates the collaboration of non-medical personnel. This state of affairs has led to the broader notion of health care ethics. All important problems of health care have ethical aspects, and during the last decennia progress in many branches of biology and medicine has brought with it new ethical problems. This renders teaching and education in health care ethics all the more important. The time allotted to the formal teaching of health care ethics is very limited. Therefore, whoever is responsible for teaching and education of medical students should contribute by his(her) example, his(her) advice and supervision, where appropriate, to the ethical education of the younger generation. As new problems will surely arise during the later professional life, their explanation and discussion should, more than is currently being done, be integrated in the programs of continued medical education.

Belgium↗
PubMed1998

Ethical considerations in contemporary medicine.

Numerous benefits brought along by the impressive technological progress of the contemporary world are also accompanied by potential hazards of dehumanization of life. As neither medicine has been skipped over by the technological progress, there is a risk for the physician to become dependent on it rather than master it. Therefore, there is the risk of deprivation of medical ethics norms, ever more frequently transforming the patient's position of the subject of medical activities into the position of an object. This pending risk is especially present in surgery, a medical discipline characterized by the highest technological and technical differentiation. If the surgeon is to preserve high ethical standards in his work, he should strictly follow the basic medical ethics norm, that proclaim full respect of the patient's will, forbid doing harm to the patient, and point to equity and compassion on providing medical aid. These ethical norms should be respected not only on performing surgical procedures, but also on making indications for the procedure. The future development of medicine and surgery, with a substantial impact of new, technical and technological advances, will open new, presently unknown ethical issues. All this will require through sociophilosophical and humane-ethical considerations in order to preserve the basic medical ethics norms warranting humaneness and ethics of medicine.

Ethics, Medical↗
PubMed1998

[Contribution of Professor Armando Roa to humanities and medical ethics at the University of Chile's School of Medicine].

Dr. Roa was the first professor of the Faculty of Medicine of the University of Chile to give an ethics course to medical students, even when the importance of formal teaching of medical ethics was not yet recognized internationally. His efforts contributed to the creation of the Center for Bioethical and Humanistic Studies in 1988 and to the creation of official ethics courses for first and sixth year medical students in 1993. During 20 years, be chaired the Ethics Committee of the Faculty of Medicine of the University of Chile. He also promoted a diffusion program about medical ethics through meetings, conferences and symposia. He was responsible for the Ministry of Health's decision to create ethics committees in public hospitals in 1988 and for the Presidental decision about organ transplantation in 1995. He carried out anthropology courses and gave numerous lectures on humanistic aspects of medicine. His ethical principles are resumed in what he called the "ethics of generosity", in which the dignity of human beings is respected above all, in his opinion, the way civilizations see goodwill has been preponderant in the course of history. The recent proposal to teach humanistic fundamentals to medical students is a tribute to the memory of Professor Roa.

Chile↗
PubMed1991

Hospital ethics committees in Quebec: an overview.

In June 1989, La Direction de la Sante physique (ministere de la Sante et des Services sociaux) (MSSS) undertook a major research project focusing on ethics committees in Quebec, in cooperation with Laval University's Groupe de recherche en Ethique Medicale (GREM). Initially, three major objectives were set out: to prepare a faithful overview of ethics committees in Quebec; to inform all those involved of the available resources, and to collect the data required to eventually carry out in-depth research on ethics committees. A number of government documents refer to the existence of ethics committees, whether to request their cooperation or to entrust mandates to them; moreover, the Law Reform Commission of Canada recently published a document that proposed establishing a Canadian Advisory Council on Biomedical Ethics. The MSSS, therefore, had to study the situation in Quebec with regard to ethics committees in order to be in a position to clarify its position in future discussions. This overview is the outcome of the first stage of this research project. Essentially, it represents the first of three main sections of a single document. It [1] presents general data on ethics committees, [2] contains a description of each committee by socio-sanitary region and type of committee, and in section three it deals with the principal resources available in bioethics in Quebec, Canada, and throughout the world.

Clinical Protocols↗
PubMed1994

The possibility of ethical expertise.

Can we legitimately speak of ethics experts? Recent literature in philosophy and medical ethics addresses this important question but does not offer a satisfactory answer. Part of the problem is the absence of an examination of what it means to be an 'expert' in general. I therefore begin by reviewing my analysis of expertise which appeared earlier in this journal. We speak of two kinds of experts: persons whose expertise is in virtue of what they know ('epistemic' expertise), or what they do ('performative' expertise). Applying this analysis to the domain of ethics, I argue that we may speak of ethical expertise in three epistemic senses: a) expertise in descriptive ethics, b) expertise in metaethics, c) expertise in normative ethics, and in a performative sense: d) expertise in living a good life. I conclude with a brief description of some social roles of ethics experts.

Adult↗
PubMed2005

The contribution of Kantian moral theory to contemporary medical ethics: a critical analysis.

Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medical ethics are frequently addressed within a Kantian paradigm, at least --although not exclusively--in European medical ethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that taking concrete situations and complex relationships into account is of paramount importance in medical ethics. Encounters between medical or nursing staff and patients are rarely symmetrical relationships between autonomous and rational agents. Kantian ethics, the criticism reads, builds on the lofty ideal of such a relationship. In addition to the charge of an individualist and rationalist focus on autonomy, Kantian ethics has been accused of excluding those not actually in possession of these properties or of its rigorism. It is said to be focussed on laws and imperatives to an extent that it cannot appreciate the complex nuances of real conflicts. As a more detailed analysis will show, these charges are inadequate in at least some regards. This will be demonstrated by drawing on the Kantian notion of autonomy, the role of maxims and judgment and the conception of duties, as well as the role of emotions. Nevertheless the objections brought forward against Kantian moral theory can help determine, with greater precision, its strengths and shortcomings as an approach to current problems in medical ethics.

Emotions↗
PubMed2003

Clinical and professional ethics in the management of motor speech disorders.

The field of biomedical ethics is increasingly discussed in speech-language pathology graduate school curricula as well as in continuing education forums. The application of the principles of medical ethics can be extremely helpful to the difficult decisions sometimes facing speech-language pathologists with respect to doing good for their patients while respecting both patients' autonomy and federal and state law. Professions have increasing attempted to codify professional issues relating to moral issues through codes of ethics and codes of conduct. This article focuses on applying selected principles of medical ethics and professional codes of conduct to the practice of speech pathology specific to motor speech disorders. Case examples are provided to illustrate ethical decision making through consideration of the American Speech-Language-Hearing Association (ASHA) Code of Ethics as well as a number of principles of medical ethics.

Adult↗
PubMed2005

The critical turn in clinical ethics and its continuous enhancement.

Taking the critical turn is one of the main tools of the humanities and inculcates an intellectual discipline that prevents ossification of thinking about issues and of organizational policies in clinical ethics. The articles in this "Clinical Ethics" number of the Journal take the critical turn with respect to cherished ways of thinking in Western clinical ethics, life extension, the clinical determination of death, physicians' duty to treat even at personal risk, clinical ethics at the interface of research ethics, and the pertinence of the Hippocratic Oath to clinical ethics. These articles challenge clinical ethicists to inculcate the intellectual discipline of the critical turn into everyday practice and continuous quality enhancement of clinical ethics.

Aged↗
PubMed1996

The context of ethics in the health care industry.

Examines ethics in the health care industry from the perspectives of investors, employees, patients, competitors and the environment. Ethical behaviour in the health care industry is essential and desirable; however, determining which behavioural actions are ethical and which are unethical is difficult. Although never will everyone agree on specific ethical standards, everyone should agree that setting ethical standards is vital. Therefore, administrators of health care institutions and health care providers should work together to establish codes of ethics which define boundaries for ethical behaviours in the health care industry.

Delivery of Health Care↗
PubMed1995

Moral expertise: a problem in the professional ethics of professional ethicists.

Philosophers, particularly moral philosophers, are increasingly being involved in public decision-making in areas which are seen to raise ethical issues. For example, Dame Mary Warnock chaired the 'Committee of Inquiry into Human Fertilization and Embryology' in the UK in 1982-4; the Philosophy Department at Auckland was commissioned by the Auckland Regional Authority to report on the ethical aspects of fluoridating the public water supply in 1990; and many of us are serving on ethics committees of various sorts. Not only are philosophers actually being called on or consulted, but many of us would argue that a philosophical contribution in such areas is essential. The involvement of moral philosophers in public policy decisions raises a question of professional ethics, viz, what role should a philosopher's own moral perspective or judgements play in the advice s/he gives, or contribution s/he makes, to public decision-making on ethical issues. Like most problems in professional ethics, this prompts reflection on the nature of the profession, and in particular on the expertise we take moral philosophy to offer. It also prompts reflection on how processes of public decision making in ethically problematic areas should be understood. I explore these issues in this paper.

Advisory Committees↗
PubMed1996

Resolving the ethical dilemma of nurse managers over chemically-dependent colleagues.

This paper addresses the nurse manager's role regarding chemically-dependent nurses in the workplace. The manager may intervene by: terminating the contract of the impaired colleague; notifying a disciplinary committee; consulting with a counselling committee; or referring the impaired nurse to an employee assistance programme. A dilemma may arise about which of these interventions is ethically the best. The ethical theories relevant to nursing involve ethical relativism, utilitarianism, Kantian ethics, Kohlberg's justice, and Gilligan's ethic of care. Nurse managers first need to understand these theories in order to clarify their own perceptions and attitudes towards chemical dependency, and then satisfactorily resolve this ethical dilemma. Education and social learning are routes to a better understanding of chemical dependency and to broadening the ethical dimensions of nurse managers.

Conflict, Psychological↗
PubMed1996

Resolving ethical problems in long-term care.

1. End of life ethical decision-making is complex and involves many key players, each with their individual roles, responsibilities, and ethical concepts. 2. Each long-term care ethical decision which presents itself involves alternatives and choices. These must be thoughtfully evaluated to reach the best decision possible. 3. Those involved in ethical decision-making are influenced by various ethical theories as well as factors including control, legal issues, failure, coercion, obligation, advocacy, autonomy, respect, and cost. 4. Ethics committees can play a valuable role in assisting patients, families and staff through the decision-making process by providing guidelines based on ethical principles and compatible with facility mission and philosophy.

Aged↗
PubMed2000

Health care ethics consultation: nature, goals, and competencies. A position paper from the Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation.

Patients, families, and health care providers have a right to expect that ethics consultants can deal competently with the complex issues that they are asked to address. The Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation explored core competencies and related issues in ethics consultation. This position paper summarizes the content of the resulting Task Force Report, which included nine general conclusions: 1) U.S. societal context makes "ethics facilitation" an appropriate approach to ethics consultation; 2) ethics facilitation requires certain core competencies; 3) core competencies can be acquired in various ways; 4) individual consultants, teams, or committees should have the core competencies for ethics consultation; 5) consult services should have policies that address access, patient notification, documentation, and case review; 6) abuse of power and conflicts of interest must be avoided; 7) ethics consultation must have institutional support; 8) evaluation of process, outcomes, and competencies is needed; and 9) certification of individuals and accreditation of programs are rejected.

Bioethics↗