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Results for “Moral Development”

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PubMed2005

The virtue of moral responsibility and the obligations of patients.

The American Medical Association has provided a list of patient responsibilities, said to be derived from patient autonomy, without providing any justification for this derivation. In this article, the virtue of moral responsibility is proposed as a way to justify these kinds of limits on respect for individual autonomy. The need for such limits is explained by examining the traditional principles of health care ethics. What is missing in health care decision making, and can be provided by the virtue of moral responsibility, is a careful consideration of the impact of individual decisions on particular others and the community, as a whole. The concept of moral responsibility as a virtue is then developed and examples of its application to health care decision making are provided. Finally, the roles of both physicians and health care ethicists in promoting the morally responsible exercise of individual autonomy are explored.

Bioethics↗
PubMed2006

Access, responsibility, and funding: A systems thinking approach to universal access to oral health.

Universal access to oral health care is a justifiable demand for a number of disparate but morally sound reasons. Nevertheless, that conclusion, however reached, has not solved the problem of the lack of access. Market forces, scarcity of funding, and lack of clarity as to who is responsible for ensuring that oral care is available seem to present insurmountable difficulties. I shall argue that these are not irresolvable problems, but the resolution has to take place through the tool of systems thinking and a systemic approach to moral imagination. Taking the lead from Susan Wolf's and Linda Emanuel's work on systems thinking, and developing ideas from work on mental models and moral imagination, I shall argue that what is often missing in discussions and demands for universal access to oral health care is a morally imaginative systemic approach that takes into account the multi-perspective dynamics involved in health care today. Moral imagination may encourage sound, broad-based, more inclusive moral thinking and moral judgment without ignoring the critical roles and responsibilities each of us has as professionals, providers, payers, or patients, without which change will not take place at all.

Dental Care↗
PubMed2006

Evidence-based guidelines, time-based health outcomes, and the Matthew effect.

BACKGROUND: Cardiovascular risk management guidelines are 'risk based'; health economists' practice is 'time based'. The 'medical' risk-based allocation model maximises numbers of deaths prevented by targeting subjects at high risk, for example, elderly and smokers. The time-based model maximises numbers of life years gained by treating the young and non-smokers, or 'the one who has will be given more' (Matthew 25:29). We explored practical consequences of risk- or time-based allocation. METHODS: We used epidemiological modelling to generate semi-quantitative scenarios comparing the distributional effects of allocating a fixed number of prescriptions of a (hypothetical) preventive cardiovascular drug ('CVStop') either to avert the maximum number of deaths (risk-based) or to save the maximum number of life years (time based) in the male Dutch population. We subsequently asked 123 Dutch guideline developers which distribution they preferred. RESULTS: Time- and risk-based allocations resulted in different distributions of the drug across the population. There were also differences in absolute numbers of life years gained and deaths averted, and in the distribution of these across the population. For example, risk-based allocation of 'CVStop' resulted in preferential treatment of elderly, leading to more deaths averted (mostly among 70 and above) but fewer life years gained, if compared with time-based allocation. The guideline developers experienced the choice dilemmas as difficult. No priority choice was dominant among the respondents. CONCLUSION: In evidence-based resource allocation the choice to save time or to avert deaths may introduce moral choices because of the various origins of increased disease risk. Evidence-based guideline development inevitably has moral implications.

Adult↗
PubMed2004

"Iceland Inc."?: On the ethics of commercial population genomics.

A detailed analysis of the Icelandic commercial population-wide genomics database project of deCODE Genetics was performed for the purpose of providing ethics insights into public/private efforts to develop genetic databases. This analysis examines the moral differences between the general case of governmental collection of medical data for public health purposes and the centralized collection planned in Iceland. Both the process of developing the database and its design vary in significant ways from typical government data collection and analysis activities. Because of these differences, the database may serve the interests of deCODE more than it serves the interests of the public, undermining the claim that presumed consent for this data collection and its proprietary use is ethical. We believe that there is an evolving consensus that informed consent of participants must be secured for population-based genetics databases and research. The Iceland model provides an informative counterexample that holds key ethics lessons for similar ventures.

Databases, Genetic↗
PubMed2001

Equipoise and international human-subjects research.

This paper examines the role of equipoise in evaluating international research. It distinguishes two possible formulations of the equipoise requirement that license very different evaluations of international research proposals. The interpretation that adopts a narrow criterion of similarity between clinical contexts has played an important role in one recent controversy, but it suffers from a number of problems. An alternative interpretation that adopts a broader criterion of similarity does a better job of avoiding both exploitation of the brute fact of social deprivation and the exploitation of needy populations for the benefit of more well-off populations. It also holds out the promise of reconciling the need to find interventions that can be employed in developing world contexts with the cluster of moral values that must constrain the way such research is carried out.

Clinical Trials as Topic↗
PubMedDate not supplied

First aid: essential skills for nurses.

This article focuses on the development of first aid content in the Project 2000 curriculum in one college of nursing. It also reviews literature relevant to the nurse's legal, professional and moral duties to give first aid. The development and evaluation of a pilot first aid course for Project 2000 students is described, followed by an outline of future plans.

Curriculum↗
PubMed1997

Using patients: exploring the ethical dimension of reflective practice in nurse education.

Within nurse education there is a growing interest in the use of reflective practice as a vehicle for professional development. Additionally, clinically reflective practice is seen as an ideal way of improving performance and patient care. In this paper it will be argued that whilst this development is potentially valuable to both professionals and clients, there are major ethical issues which need to be addressed. The "how to' literature appears to focus predominately on the practitioners subjective description and interpretation of events. It is usual for these events to include details of clients: but not usual for clients to be aware that information about them is being used in this way. Within a deontological ethical framework the use of people as means rather than ends is considered to be morally wrong. However, clients have probably always been used by professionals to some extent: Things such as case conferences and clinical trials are legitimated by the intention to improve training and practice, and are regulated by various professional codes and committees. It would appear, however, that reflective practice is quantitatively and qualitatively different from the above, and thus may cross a moral boundary. Reflective practice is not simply re-examining someone's case: it involves personal interpretation and judgement. The reflector may be recording incidents, verbally or in written form, which would not otherwise be recorded, and may be controversial. This raises questions about the nature and ownership of knowledge, and the responsibilities of people who have such knowledge. Systematic and continued reflection may be akin to action research and, as such, considerations of rigour, authenticity and informed consent need to be addressed. Thus whilst reflective practice may prove to be a good thing, it cannot be seen in isolation from wider ethical concerns.

Education, Nursing↗
PubMedDate not supplied

Crisis management: strategies for building morale in uncertain times.

In economically stringent times, clinical laboratory managers face additional obstacles to boosting morale. This article describes five time-tested strategies that help strengthen morale in these tough times, including: developing a culture supportive of collaborative problem solving, controlling rumors, building a group identity, making yourself available, and projecting an attitude of hope. By using these strategies, laboratory managers will improve their chances of staying hopeful and positive during this time of crisis and change. In addition to the practical techniques described, managers will also learn that uncertain times require looking beyond the bottom line to their staffs and their needs. Managers must learn how to care and affirm others to truly succeed in building morale in these uncertain times. This article combines practical advice with stories and anecdotes from a variety of settings--from East Indian folklore to the television series "M*A*S*H" Managers will find both ways to stay positive when the joy has gone out of their work and reminders of why we must remain hopeful in the face of crises.

Laboratories, Hospital↗
PubMed2001

Out of the consulting room and into the world: hermeneutic dialogue, phronesis, and psychoanalytic theory as practice.

One of the relics of positivism has been an underappreciation of the moral and ethical dimensions of psychoanalytic theory and practice. In a positivist metapsychology, cure and therapeutic gain were often defined instrumentally, with relatively little consideration given to aspects of human experience (e.g., moral, cultural, spiritual) that did not fit within a positivist framework. Conceptual and paradigmatic shifts in psychoanalysis have occurred, in part, because of the inability of the classical model to provide a language that adequately captures deeply felt human values and beliefs. Aided by hermeneutic and postmodern influences, many contemporary psychoanalytic theories are beginning to focus greater attention on the notion that analytic therapy is empowered by a set of ethical convictions, beliefs, and commitments, which are tied to a certain understanding of the good life. Along these lines, the author argues that developing a fresh understanding of the moral and ethical dimensions of psychoanalysis requires elaborating a new ontology of human subjectivity and social life. The author offers a sketch of how this gargantuan task might be started by integrating psychoanalysis within a hermeneutic perspective on dialogue, by suggesting that it would be helpful to view psychoanalysis as promoting Aristotelian practical wisdom or phronesis, and by rethinking psychoanalytic theory and interpretation as a form of practice.

Ethics, Professional↗