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PubMed2003

Ethics on the floor.

The work of the 'Human Research Ethics Committee' (HREC) is expanding as the dimensions of ethical practice and research grow in the clinical arena. Over the past five years, the demands on practitioners and ethics committee members have expanded, as the general public demands accountability on the part of clinical and other researchers. This paper presents a case study of an ethics committee in an Area Health Service in Sydney. It represents the views of the members as to why they see their job as important, what aspects are difficult, how they delineate between ethical/legal and scientific issues, and what are the major stumbling blocks for them in enacting their membership of a HREC. The data for the case study was collected using interviews with nine out of eleven members. The audio taped interviews were transcribed, the text thematically analysed for commonalities and contrasts, and a description of the members' perspective on various issues written. Issues emerging include: amount of material members read prior to the committee meeting, the difficulty in educating practitioners (all researchers) to write information sheets that are simple and comprehensible to laypersons, the payment of subjects for their time, the appropriate amount of monitoring to be applied on each project, the difficulty in letting researchers know that the ethics committee is committed to encouraging research and that its questions are intended to ensure the best possible project answering the researchers' questions/aims is conducted, and the slow or no response by researchers to ethics committee questions. The findings imply that reviewing research proposals for their ethical value is individual and members of human research ethics committees need to synthesise these in a committee context to make informed decisions.

Humans↗

PubMed2003

Ethical issues arising from a research, technology and development project to support frail older people and their family carers at home.

The present paper provides an overview of the application of the key ethical issues which arose in an EU-funded research, technology and development project, Assisting Carers using Telematics Interventions to meet Older Persons' Needs (ACTION). The primary aim of the ACTION project was to support frail older people and their family carers in their own homes across England, Northern Ireland, the Republic of Ireland, Sweden and Portugal via the use of user-friendly information and communication technology. Ethical guidelines were developed in the project and used as a tool to enable the multidisciplinary project team to increase their awareness of ethical issues in their everyday work, and to act as a useful ethical framework for regular team discussions at international and local meetings across the partner countries. A range of ethical issues arose during the field-study phases of the project when the ACTION services were introduced into a number of families' own homes. It can be argued that these ethical issues reflect factors relating both to the application of research into practice, as well as those relating more directly to the use of new technology by families and care professionals. Key issues centre upon the ethical concepts of autonomy, independence, quality of life, beneficence, non-maleficence and justice, and more specifically, on ethical issues of security, privacy and confidentiality, increased expectations, and withdrawal of the service. This paper is intended to facilitate dialogue and debate in the area of enabling (assistive) technology in home care for older people and their families.

Activities of Daily Living↗

PubMed2001

Ethical issues for psychologists in pain management.

Pain management is relatively young as a specialty. Although increasing attention is being paid to issues such as pain at the end of life and pain in underserved populations, only recently has an open discussion of ethical issues in chronic pain treatment come to the fore. Psychologists specializing in pain management are faced with a myriad of ethical issues. Although many of these problems are similar to those faced by general clinical psychologists or other health psychologists, they are often made more complex by the multidisciplinary nature of pain management and by the psychologists' relationships to third-party payers (health maintenance organizations, workers' compensation), attorneys, or other agencies. An open forum exploring ethical issues is needed. This article outlines major ethical considerations faced by pain management psychologists, including patient autonomy and informed consent, confidentiality, reimbursement and dual relationships, patient abandonment, assessment for medical procedures, clinical research, and the interface of psychology and medicine. American Psychological Association ethical principles and principles of biomedical ethics need to be considered in ethical decision making. Further exploration and discussion of ethics for pain management psychologists are recommended.

Journal Article↗

PubMed2004

Ethical, legal, and social aspects of farm animal cloning in the 6th Framework Programme for Research.

Cloned livestock have potential importance in the provision of improved medicine as well as in the development of livestock production. The public is, however, increasingly concerned about the social and ethical consequences of these advances in knowledge and techniques. There is unevenness throughout Europe in different Member States' attitudes to research into livestock cloning. Although there is EU legislation controlling the use of animals for research purposes, there is no legislation specifically governing cloning in livestock production. The main EU reference is the 9th Opinion of the European Group on Ethics, which states "Cloning of farm animals may prove to be of medical and agricultural as well as economic benefit. It is acceptable only when the aims and methods are ethically justified and when carried out under ethical conditions." The ethical justification includes the avoidance of suffering, the use of the 3Rs principle and a lack of better alternatives. The Commission addresses these issues in the 6th Framework Programme by promoting the integration of ethical, legal and social aspects in all proposals where they are relevant, by fostering ethical awareness and foresight in the proposals, by encouraging public dialogue, and by supporting specific actions to promote the debate. Research must respect fundamental ethical principles, including animal welfare requirements.

Animals↗

PubMed2005

Ethical challenges in the care of older people and risk of being burned out among male nurses.

AIM: The aim of this study was to illuminate the meaning of being in ethically difficult situations when caring for older people, as experienced by male nurses. BACKGROUND: Nurses and physicians are frequently faced with ethical issues and challenges in their work with older people in hospitals. Male nurses are a minority group in the nursing profession, thus it is important to listen to their lived experiences of the ethical challenges they are faced with in their work. METHOD: The study is part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experiences of being in ethically difficult care situations in the care of older people. Five male nurses working at gerontology wards at a university hospital in Norway participated in the study. A phenomenological hermeneutical method was applied. RESULTS: The narratives revealed that the nurses were focusing on good nursing, emphasizing what meeting the patient entails. They highlighted what they perceived as barriers to good nursing. A third theme was ethical challenges, which lead to emotional and moral strain and a fear of becoming burned out. CONCLUSIONS: Continuous stress, little degree of autonomy and high expectations of oneself are causing the male nurses much moral strain. These factors place them at risk of being burned out. The nurses emphasized that burn out can be counteracted by clinical supervision. RELEVANCE TO CLINICAL PRACTICE: It is suggested that the male nurses feeling of doing an important and rewarding job may be essential for protection against becoming burned out and why they can endure being in ethically difficult care situations. Other institutional support structures like ethics education and ethics rounds are suggested to reduce the level of moral strain.

Burnout, Professional↗

PubMed2006

Ethical boundary-work in the embryonic stem cell laboratory.

Most accounts of the ethics of stem cell research are de- contextualised reviews of the ethical and legal literature. In this chapter we present a socially embedded account of some of the ethical implications of stem cell research, from the perspectives of scientists directly involved in this area. Based on an ethnography of two leading embryonic stem cell laboratories in the UK, our data form part of the findings from a larger project mapping the scientific, medical, social and ethical dimensions of innovative stem cell treatment, focusing on the areas of liver cell and pancreatic islet cell transplantation. We explore three key issues: what individual scientists themselves view as ethical sources of human embryos and stem cells; their perceptions of human embryos and stem cells; and how scientists perceive regulatory frameworks in stem cell research. We argue that these dimensions of laboratory practice are all examples of 'ethical boundary-work', which is becoming an integral part of the routine practice and performance of biomedical science. Our work adds to the relatively few sociological studies that explore ethics in clinical settings and to an even smaller body of work that explores scientists' views on the ethical issues relating to their research.

Anthropology, Cultural↗

PubMed2003

Ethical problems experienced by school nurses.

This study explored school nurses' experience of ethical conflict in school nursing through interviews with six school nurses. The study examined how school nurses resolved ethical problems and the rationale used to resolve them. Emergent themes of ethical problems were professional relationship conflicts, delegation to and supervision of health assistants, child protection reporting, maintaining confidentiality, Do Not Resuscitate policy, and pressure to work outside of nursing practice standards. School nurses did not use ethical decision-making models in resolving conflict but demonstrated the use of professional standards, ethical principles, and personal values as rationale to resolve ethical problems. Results of this study suggested that school nurses would benefit from additional knowledge about ethical decision-making models. School nurses would also profit from hearing each other's voices through dialogue about ethical problems and decision making.

Adaptation, Psychological↗

PubMed2005

An ethical framework for cardiac report cards: a qualitative study.

BACKGROUND: The recent proliferation of health care report cards, especially in cardiac care, has occurred in the absence of an ethical framework to guide in their development and implementation. An ethical framework is a consistent and comprehensive theoretical foundation in ethics, and is formed by integrating ethical theories, relevant literature, and other critical information (such as the views of stakeholders). An ethical framework in the context of cardiac care provides guidance for developing cardiac report cards (CRCs) that are relevant and legitimate to all stakeholders. The purpose of this study is to develop an ethical framework for CRCs. METHODS: Delphi technique - 13 panelists: 2 administrators, 2 cardiac nurses, 5 cardiac patients, 2 cardiologists, 1 member of the media, and 1 outcomes researcher. Panelists' views regarding the ethics of CRCs were analyzed and organized into themes. RESULTS: We have organized panelists' views into ten principles that emerged from the data: 1) improving quality of care, 2) informed understanding, 3) public accountability, 4) transparency, 5) equity, 6) access to information 7) quality of information, 8) multi-stakeholder collaboration, 9) legitimacy, and 10) evaluation and continuous quality improvement. CONCLUSION: We have developed a framework to guide the development and dissemination of CRCs. This ethical framework can provide necessary guidance for those generating CRCs and may help them avoid a number of difficult issues associated with existing ones.

Access to Information↗

PubMed2005

[Human care: an ethical reflexion on HIV/AIDS patients].

This descriptive-reflexive study reflects on the importance of ethics in human care and its relation with HIV/AIDS patients, identifying the main concepts of ethics in human care and ethics in care for HIV/AIDS patients. Considering the clear need for care nowadays, current ideas present care as the human essence which is present in ethics. The emergence of AIDS, an epidemic that cannot be cured yet, mobilizes society to concerns about privacy and confidentiality, including the need to reinforce ethical aspects, with a view to a better life quality for its patients. Ethical thinking is in line with scientific and technological evolution all over the world. In view of our reflections, we understood that ethics is part of our society and that human care needs to be linked up with ethics.

Acquired Immunodeficiency Syndrome↗

PubMed2005

[A philosophical inquiry into caring in nursing--based on Ricoeur's narrative ethics].

PURPOSE: This paper was aimed to inquire into Ricoeur's self-hermeneutics and narrative ethics, and apply it to personal identity constituting caring and care ethics in the practice of nursing. Its purpose is to provide a philosophical foundation for caring in nursing. METHOD: According to Ricoeur's narrative identity, ontological caring was interpreted as personal identity constituting caring. His ethics were described as care ethics, which contributed to preserving and promoting the personal dignity of the client, as self in search for the good life in the nursing practice. RESULTS: Narrative understanding of the client pointed to the ontological role of care in the constitution of personal identity. From an ethical aspect of the narrative, respect for personal identity and personal dignity of the client was crucial to an ethical caring attitude, promoting self-esteem in the nursing practice. CONCLUSION: This paper suggested that Ricoeur's ethics could provide a philosophical basis for understanding ontological and ethical caring in nursing. This contributed to protection of the client from the threat of personal identity, as well as respecting their personal dignity.

Humans↗

PubMed2000

[Man and his fellow-creatures under ethical aspects].

The attempts to reduce the volume of this report by tightening the areas of ecological ethics and practical animal protection has not been successful. To the contrary, the expansion of philosophical ethics has led to a further increase. In the face of ever growing numbers of publications in book form, attention given to articles in periodicals will have to be reduced drastically in the future. The debate about the moral status of animals continues within the philosophical discussion. Here, the central question deals with the qualities an animal species has to demonstrate in order to be recognised as worthy of protection. This dispute gains particular relevancy in facing a possible killing of animals (chapter 13). Following the still predominant anthropocentric opinion, the killing of an animal is morally questionable only if the respective animal is able to recognise being killed as a loss, even if such killing is conducted without inducing fear or pain. Animals unable to such a recognition - so the logical conclusion - cannot be harmed by any injustice, misfortune or suffering to which they are subjected. At this point, at the latest, our moral sensibility begins to react: Contrary to a rock, an animal"s life can be taken, and the preservation of life is programmed into the nature of "lower animals" as well. The philosophical discussion, though, gives rise to the impression that creatures could be divided up into groups of those where killing is ethically inadmissible, then those where killing would have to be defended and justified and finally those whose killing is ethically irrelevant. Set into practice, any standard of this kind would have to fail due the impossibility of defining these categories. A new development within animal rights (chapter 3.5) could open up if rights would be understood predominantly as the result of the attempt towards justice. Justice (chapter 3.4) far animals can be demanded with most convincing arguments because there are at best obstacles but no objections. Also, movement has reached the discussion concerning anthropocentricity in as much as "non circumventability" of anthropocentricity, supported by epistemological arguments for years, is now clearly being questioned (chapter 3.3). This new agility in ethics stands in clear contrast to the rigidity of factual conditions. Even in cases where there was hope for change, as i.e. the caged chicken decision (chapter 6.3), it now can be expected that the annulled ruling will be replaced by a new one, once again contradicting animal protection laws. Resistance does not only rise against application of morals and the law, resistance is a noticeably appearing in ethics itself. For decades, representatives of animal user organisations have reacted only defensively to ethical demands. Now, a clear change of style can be recognised going towards the development of user acceptable ethics. In this, approachments are observable as well. Thus, many demands of a species-crossing humanitarianism are being basically accepted, while factually remaining neglected. This is because anthropocentricity, in the sense of man taking precedence, has set up a virtually unassailable position: The principle of proximity in the sense that man"s responsibility for his animated environment begins at his immediate surroundings and decreases necessarily with increasing distance from the self or the own family. In this way, proximity still suffices for the family-dog but not for those animals used for dog-food.

Altruism↗

PubMed2003

[Xenotransplantation from a Christian-ethical perspective].

Xenotransplantation is a question of "ethics between man and animal". Because those affected in different ways by xenotransplantation (patients, relatives, medical doctors, laypeople) have different perceptions, "foreign" perspectives must be consciously considered next to one's own perspective in the ethical judgement. As xenotransplantation is still at the stage of preclinical research, this special opportunity for an early public ethical discussion should be taken. According to biblical teaching, man is responsible for his fellows before God, therefore every decision of a patient (or a doctor) in favour of a xenotransplantation made without consideration of the social environment or the society as a whole cannot be ethically justified. From the Jewish-Christian point of view, the "innate value of man's fellow creatures" should be considered. What happens to the animals used for research into transplantation may not simply "vanish" before the vision of a successful xenotransplantation. What man's responsibility to creatures should prevent commonly happens: animals are exploited as instruments or treated as objects to reach human goals, they are perceived only as their utility value. We humans, with God's biblical mandate for our fellow creatures, must remember that the unavoidable weighing up between the (proposed) welfare of man and the welfare of animals should not be decided to the detriment of the animals too easily. The effects of medical technological possibilities on the conception of man and on our value system show themselves in a special way in xenotransplantation. Are the hopes set in xenotransplantation an expression of a mechanistic understanding of the human body and a conception of man that blends out the mortality and imperfection of human life? Focussing on human-ethical aspects leads to the neglect of the animal-ethical aspects by some Protestant ethicists. However, it is necessary to forego at least extremely severe animal experiments and so also to do without the possible gain of knowledge, i.e. to consciously limit research interests for ethical reasons. The tendency towards the reduction of animal experiments should not be reverted by research into xenotransplantation. The ethical evaluation of xenotransplantation should also consider whether economic interests are placed above the welfare of humans and animals, thus supporting questionable research processes. Justice and partisanship for the disadvantaged is a central aspect of biblical tradition. The problem in deciding what is fair in xenotransplantation is multifaceted: How can fair allocation of organs be ensured when both animal and human organs are available at the same time? What effects will this medical technology have on the distribution of the (limited) resources on the national health system? And finally: can such a cost-intensive technology helping only a few be justified in the light of the lack of basic medical care in the poor regions of the earth? A technology which many experts warn will result in the opposite of the original goal, i.e. reduction of the lack of organs.

Animal Experimentation↗

PubMed2004

[Man and his fellow-creatures under ethical aspects].

The repeated attempts to tighten up the literary report are finally showing effects. This not only as a result of shorter reports but also because of the fact that less is being written and published regarding our topic. The discussion seems exhausted which, for years, dealt with the controversial moral status of animals and the--finally--constitutionally sanctioned status of animal protection in Germany. The problem of animals in ethics is becoming a rarity. Correspondingly, bio-ethics is oriented towards human problems and related borderline cases in a rather one-sided manner. This radically altered situation corresponds to an equally profound shift in the direction of our thinking. In the 1970's it was the shock in reaction to brutality towards T.V.-reports. But soon questions asking about the guilty were being posed. To direct the question from a guilt-related "who" to the "what" of the underlying reasons was a more difficult task. Just like social ethics developed out of social criticism, modern animal ethics developed out of the criticism of cruelty to animals. And, to the degree that this criticism became a common public concern, it lost its importance in comparison to the ethical questions now moving into the centre of the interest. In view of book-production this means that animal protection-related literature appears in three major groups: Husbandry, Use and Abuse, Animal Protection Law, Animal (Protection) Ethics. To collect these three groups simultaneously is becoming increasingly difficult. The concentration on, and supposedly a limitation to the sectors morals and ethics of the man-animal relationship cannot be avoided in the literary report. Morals is stressed here in particular in order to limit the excessive dominance of theoretical ethics and to preserve the priority of action-guiding morals.

Animal Husbandry↗

PubMed1987

[Biotechnology and ethics].

Biotechnology confronts us with ethical questions, that cannot be satisfactorily answered on the basis of traditional ethics in every case. The reason is that the development of technology influences traditional ethical conceptions and often gives rise to a wide variety of ethical views (abortion, euthanasia). After a general discussion of the causes of ethical differences, the role of technological developments in this regard is examined. This leads to the conclusion that technology is not ethically neutral. The increase of science and technology is ethically good. This conclusion does not imply that each of science or technology is also good. After the discussion of the relationship between ethics and technology in general, the results are applied to biotechnology.

Animals↗

PubMed1991

A medical ethics issues survey of residents in five pediatric training programs.

Few pediatric training programs offer formal instruction or have ethics consultants to assist residents with ethical dilemmas. Moreover, even if such assistance were available, it is not clear that educators have an adequate understanding of (1) the range and frequency of possible ethical dilemmas residents may encounter, (2) residents' most troublesome concerns, (3) their use of resources to resolve issues, and (4) their own ethics belief systems. A sample of convenience (51 residents) at five midsouth residency programs was queried during 25-minute open-ended interviews to answer ethical questions; there were no refusals to participate. The "most troublesome" cases cited by the residents were related to life-and-death issues (withholding and withdrawing life support), child abuse and neglect cases, and disputes regarding patient care that arise between services. Two thirds of those surveyed indicated that they are still somewhat troubled by these difficult ethical problems. Surprisingly, residents stated that they relied on their peers more often than their attending physicians for effective assistance in resolving their most troublesome dilemmas. We support continuing education and research efforts to help residents and educators feel "more comfortable" in resolving ethical dilemmas.

Attitude↗

PubMed1994

Ethical beliefs and practices of AAPB members.

Ethical codes and principles and laws govern the behavior of health-care professionals. Yet, the impact that ethical codes and laws have on the actual moral behaviors of health-care professionals is relatively unknown. A survey on the ethical beliefs and practices of health-care professionals was sent to the United States membership of the Association for Applied Psychophysiology and Biofeedback. AAPB's heterogeneous membership offers a unique opportunity to compare the ethical beliefs and behaviors of professionals across various health-care professions, educational levels, licensure and certification statuses, age, years in practice, and gender. The survey examined the respondents' ethical beliefs and practices in the domains of confidentiality, dual relationships, and professional practice. Five hundred thirty-six surveys were returned completed. The results of the survey indicate that all respondents have substantially the same reported ethical beliefs and practices across the three domains. There were no statistically significant differences between the reported ethical beliefs or practices when compared across disciplines, educational levels, licensure or certification statuses, age, or years in practice. Statistically significant gender differences were found.

Adult↗

PubMed2005

The ethics activities of the World Medical Association.

Since its formation in 1947, the World Medical Association (WMA) has been a leading voice in international medical ethics. The WMA's principal ethics activity over the years has been policy development on a wide variety of issues in medical research, medical practice and health care delivery. With the establishment of a dedicated Ethics Unit in 2003, the WMA's ethics activities have intensified in the areas of liaison, outreach and product development. Initial priorities for the Ethics Unit have been the review of paragraph 30 of the Declaration of Helsinki, the expansion of the Ethics Unit section of the WMA website and the development of an ethics manual for medical students everywhere.

Ethics, Medical↗

PubMed2006

Some methodological aspects of ethics committees' expertise: the Ukrainian example.

Today local, national and international ethics committees have become an effective means of social regulation in many European countries. Science itself is an important precondition for the development of bioethical knowledge and ethics expertise. Cultural, social, historical and religious preconditions can facilitate different forms and methods of ethics expertise in each country. Ukrainian ethics expertise has some methodological problems connected with its socio-cultural, historical, science and philosophy development particularities. In this context, clarification of some common legitimacies or methodological approaches to ethics committee (EC) phenomena such as globalization, scientization and the prioritization of an ethics paradigm are very important. On the other hand, elaborate study and critical analysis of international experience by Ukraine and other Eastern European countries will provide the integration of their local and national ethics expertises into a world bioethics ethos.

Bioethics↗