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PubMed1994

Experiences with committees dealing with the issues of ethics.

Ethics committees have been active in Germany for 15 years now. Since 1983, such committees, which were established under public law with medical schools, medical associations and representatives of the Federal Health Office among their members, have established a working group with a growing membership of currently some 45 committees. The group's functions include the exchange of experience, the discussion of relevant ethical issues as well as the harmonization and standardization of their internal procedures. In addition, it serves as a point of contact for members of Parliament. Government and journalists. Since 1990, the group has published four yearbooks under the title of 'Medizin-Ethik' [1]. Germany's ethics committees are bodies serving no other purpose than that of biomedical research on human beings (scientific experiments, diagnostic and therapeutic methods, clinical trials involving drugs). They are intended to protect test persons and patients against acts which must not be permitted for ethical and/or legal reasons. Ethics committees fulfil the task of counselling the medically responsible researcher and of examining in advance whether relevant scientific, legal, medical and ethical standards will be met by the biomedical project envisaging scientific research on human beings and whether such a project will not violate accepted values. The ethical and legal standards to be adhered to in this connection have been laid down in the declaration issued by the World Medical Association in Helsinki/Tokyo/Venice/Hong Kong, they have been codified in human rights declarations and in a great number of national legal provisions and have been included in scientific standards.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1991

Ethical decision-making in epidemiology: the case study approach.

The experience of other health professions that have been concerned with professional ethics over the past number of years can be directly applied in epidemiology. A schematicized model, adapted from Storch and based on the nursing experience, provides a synthesis of those considerations necessary for ethical decision-making. An example demonstrates the process by which the model can be used. While a checklist procedure is regarded as neither useful nor appropriate for making an ethical decision, the existence of professional ethics guidelines is deemed a prerequisite, because it embodies the profession's values and social responsibilities. The place of professional ethics guidelines in making an ethical decision is central to the model and is shown to be fundamental to continued ethical conduct among epidemiologists.

Decision Making↗
PubMed2006

The need for evidence-based research ethics: a review of the substance abuse literature.

Participants in substance abuse research may be vulnerable for multiple reasons. International research ethics guidelines and policy statements require that researchers provide extra protections when conducting research with vulnerable subjects, but it is uncertain which measures best protect vulnerable individuals. Concerns about vulnerability have been translated into only the vaguest regulatory requirements, and very little empirical data exist to guide researchers and ethics review committee members who want to protect participants. This article reviews two bodies of substance abuse research ethics literature. First, "normative" articles, that is, articles that discuss ethical issues that may arise in substance abuse research, are discussed. The resulting taxonomy of ethical issues then guides a review of empirical studies on issues like the informed consent process and the use of financial incentives in substance abuse research. While the ethical issues in substance abuse research are numerous and well-documented, the evidentiary base for addressing these issues is inadequate. If any one major theme emerged from the existing studies, it is that many well-intentioned, protectionist concerns--about recruitment incentives, consent comprehension, and drug administration studies--are not supported by empirical data. While these findings are at best tentative, they suggest how research on research ethics might ultimately benefit participants.

Behavioral Research↗
PubMed1996

Evaluation of an ethics consultation service: patient and family perspective.

PURPOSE: The purpose of this study was to determine whether patients and their families found ethics consultations to be helpful and whether they were satisfied with the treatment decisions that were made in those cases where ethics consultation was requested. METHODS: Interviews were conducted with each patient (or surrogate) concerning whom an ethics consultation had been provided during a 1-year period at Loma Linda University Medical Center, excepting those who met exclusion criteria. The interview was done by telephone a few weeks after hospital discharge. It included multiple choice and open-ended questions. A content analysis was done on the solicited and spontaneous comments. RESULTS: Eighty-six ethics consultations were provided and interviews were completed for 56 of them (65%). Fifty-seven percent of interviewees found the ethics consultation to have been helpful, and only 4% found them to have been detrimental. Interviewees were more likely to have found the consultation helpful when they perceived that it had resulted in a significant change in treatment, and were less likely to have found it helpful when the patients were more seriously ill. In addition, 77% were satisfied with the treatment decisions made, and 11% showed some degree of dissatisfaction. CONCLUSIONS: Patients and families found ethics consultation provided by clinical ethicists at Loma Linda University Medical Center to be helpful in a majority of instances, and rarely found them detrimental. Based on an analysis of their comments, we believe ethics consultations were perceived as helpful in 7 ways: increased clinical clarity, increased moral or legal clarity, motivation to do what they believe is right, facilitation of the process of decision-making, implementation of a decision, interpretation of technical language, and consolation and support.

Adolescent↗
PubMed1997

Claude H. Organ, Jr. Honorary/Sandoz Nutrition Lectureship. Ethics in research and surgical practice.

The topic "Ethics in Research and Surgical Practice" appears most appropriate for the 1997 Claude H. Organ, Jr. Honorary Sandoz Nutrition Lecture. With the increasing numbers of ethical problems facing clinicians today, greater emphasis on ethics is demanded. This lecture focuses primarily on the clinical applications of basic science and ethics certainly plays a major role in this regard. Ethical principles espoused by the American College of Surgeons and the American Medical Association will be emphasized. Further, the results of the deliberations of the Advisory Committee on Human Radiation experiments will be discussed. Certainly, the Tuskegee experiment debacle will be mentioned. Ethics remains important if we are to give our patients the best care. We must always keep in the vanguard of our thinking that the welfare of our patients comes first. High ethical principles emphasize our obligations and responsibilities to our patients.

Ethics, Medical↗
PubMed2002

Advancing an ethical framework for long-term care.

This article represents an effort to formulate an ethical framework for long-term care with the explicit purpose of providing a catalyst to promote further discourse and expand consideration of what an ethic of long-term care might entail. Grounding the discussion, an introduction to traditional ethical philosophy is presented, focusing mainly on the fundamentals of deontological and teleological ethical theories. Attention then shifts to a review of the more frequently cited principles found in the long-term care ethics literature, followed by a critique of the current reliance upon principlism to resolve ethical dilemmas in long-term care. In response to this criticism, an agent-driven ethical framework stressing dignity and respect for personhood, drawn from the philosophy of Immanuel Kant, is advanced.

Ethical Theory↗
PubMed1996

Meeting tragedy: interviews about situations of ethical difficulty in intensive care.

For the purpose of illuminating the meaning of being in ethically difficult situations, eight enrolled nurses, 12 registered nurses and 10 physicians (n = 30) working in intensive care units in Sweden were asked to narrate care episodes of ethical difficulty. A phenomenological-hermeneutical analysis of the 30 narratives about nine care episodes disclosed that all stories concerned meeting tragedy, which evoked a spirit of compassion that pointed to values. The 'intention of compassion' aimed at respecting these ethical values. Respecting ethical values meant being consoled, which generated confidence in life that helped the person to embrace tragedy. When values were not respected, ethical problems emerged. Communication of values facilitated realisation, while unconscious values were indirectly communicated through emotions. Such communication meant risking vulnerability and meeting oneself. Meeting self and one's vulnerability demanded abilities of being consoled, i.e. in this study giving consolation, providing realistic treatment and being faithful in one's profession. A prerequisite for expressing personal standpoints and cooperating in the struggles of respecting ethical values was holding each other in great respect. When meeting tragedy, the spirit of compassion pointed to ethical problems, to the possibilities of solving the problems, and to the fulfilment of vision through converting feelings of despair into action energy.

Communication↗
PubMed1997

From "The ethical treatment of patients in a persistent vegetative state" to a philosophical reflection on contemporary medicine.

The reflections put forward in this text concern the clinical and practical difficulties posed by the existence of patients in PVS, and the essential ethical issues raised, combining these ethical questions with practical and theoretical experience. Section 1 presents the methodology of the ethical reflection as we see it. Section 2 describes the clinical condition of patients in PVS. Section 3 develops the ethical difficulties relative to PVS from the French point of view. Section 4 illustrates the relevance of debating the ethical significance of such problematic situations, whilst defending a practical position based on a philosophical conviction. Section 5 points out the limits of ethical reflection in a biomedical context, and calls for reflection closer to the source of the problems described. For a comprehensive appraisal of biomedical rationality, the final section suggests combining the bioethical debates with traditional philosophical ethical reflection so as to get a clearer understanding of the real, if limited, relevance of these debates.

Advisory Committees↗
PubMed2000

Ethics applied to pharmacy practice.

This article tries to develop an ethical reasoning that can be applied to (the practice of) pharmacy. Only general principles, based on accepted values in western society, lead to guidelines for ethical behaviour. Such essential values are personal autonomy, democracy and solidarity. The principle of nonmaleficience can be derived from these. Results of this analysis can be applied to health care and pharmacy practice. Subchapters deal with questions such as budget limitations and the autonomy of the patient versus that of the care provider. It concludes that protocols are important tools for ethical behaviour in every day practice. The ethical problem appears to be the unequal access to the health care system. An analysis of pharmaceutical care in the light of ethics can help to formulate the pharmacist's responsibilities. The principle of nonmaleficence is strongly connected to the pharmacy profession. Pharmacists should focus more on possible negative outcomes of pharmacotherapy. Monitoring the patient's medication, identification and prevention of possible adverse effects, medication surveillance, proper communication and information about the use of medicines are therefore priority items within our profession. A definition of target groups for pharmaceutical care will facilitate this task. A suggestion for a general code of ethics for pharmacists is proposed and compared with the code of ethics as currently accepted by the International Pharmaceutical Federation (FIP)-council.

Ethics, Pharmacy↗
PubMed1999

Teaching medical ethics: a review of the literature from North American medical schools with emphasis on education.

Efforts to reform medical education have emphasized the need to formalize instruction in medical ethics. However, the discipline of medical ethics education is still searching for an acceptable identity among North American medical schools; in these schools, no real consensus exists on its definition. Medical educators are grappling with not only what to teach (content) in this regard, but also with how to teach (process) ethics to the physicians of tomorrow. A literature review focused on medical ethics education among North American medical schools reveals that instruction in ethics is considered to be vitally important for medical students. Agreement by medical educators on a possible "core curriculum" in ethics should be explored. To develop such a curriculum, "deliberative curriculum inquiry" by means of a targeted Delphi technique may be a useful methodology. However, the literature reveals that medical curricular change is notoriously slow. General implications for medical ethics education as a discipline are discussed.

Curriculum↗
PubMed2003

Joining the team: ethics consultation at the Cleveland Clinic.

In this paper, I describe the development of ethics consultation services and their operation at the Cleveland Clinic; my own educational experiences and background and how I came to see the importance of setting and collaboration for successfully doing clinical ethics; the unique culture of the Cleveland Clinic and its influence on the ethics consultation services provided there; and, finally, the place of personal commitments and values on the conduct of ethics consultations. I stress the point that although philosophers (and perhaps other bioethicists without health professions training) are socialized and educated to do solitary work, successfully conducting ethics consultations requires relatively high levels of collaboration and cooperation that have not been sufficiently discussed. Although this paper is more a description than an analysis of the influence of institutional setting on ethics consultation, I would claim that attention to setting, either as the local scene of the consultation or the institutional and social framework, deserves more attention by bioethicists intent on understanding ethics consultation.

Ambulatory Care Facilities↗
PubMed1999

The current state of sexual ethics training in clinical psychology: issues of quantity, quality, and effectiveness.

Given the harm caused to clients and the psychology profession by therapist sexual misconduct, sexual ethics training should be given high priority in graduate training programs. The present study surveyed sexual ethics training and student understanding of sexual ethics in clinical psychology doctoral programs from the perspectives of training directors (n=84) and students (n=451). Ninety-four percent of the students had received sexual ethics training; programs provided an average of 6 hr of training. Still, students showed significant deficits in knowledge of sexual ethics principles. Students who had discussed a client attraction with a supervisor showed the best understanding of sexual ethics. Suggestions for ensuring adequate sexual ethics training are discussed.

Curriculum↗
PubMedDate not supplied

Impact of pediatric ethics consultations on patients, families, social workers, and physicians.

OBJECTIVE: To evaluate whether health providers and families find ethics consultations helpful in identifying, analyzing, and resolving ethical problems. STUDY DESIGN: Forty consecutive pediatric ethics consultations at the San Diego Children's Hospital and Health Center were evaluated retrospectively through chart reviews and structured interviews with physicians, social workers, and family members. RESULTS: In 23 of 40 cases, physicians or social workers were successfully interviewed. Of these 23 cases, four family interviews were completed. Over 90% of physicians and social workers found the ethics consultation to be helpful and would recommend an ethics consultation to others in the same circumstances. Two of the four families were strongly dissatisfied with the consultation and identified miscommunication of the ethics consultant's role as a major problem. CONCLUSION: The disparity observed in this study between satisfaction levels of health providers and families raises concerns. More studies that evaluate ethics consultations are needed, especially those that are designed prospectively and explore both these perspectives.

Adolescent↗
PubMed2000

Beyond ethical individualism.

Contemporary ethical debate about clinical practice centres primarily on the individual resolution of dilemmas, an approach which is incompatible with the social constructionist focus on human interdependence. Many constructionists argue that virtue ethics (VE) offers a more useful perspective on ethics than either consequentialism or deontology. From this perspective, the purpose of ethics is not to specify the right act in a particular situation, but to understand ethical and unethical practices conceptually, i.e. how these are learned, and how these contribute to and develop the ethical life in an ethical environment. Criticisms of VE are considered alongside discussion of its implications for clinical practice with people who have intellectual disability.

Ethics, Professional↗
PubMed2000

Medical ethics in the 21st century.

OBJECTIVES: To foresee how medical ethics may develop in the 21st century. DESIGN: We have looked into our crystal ball to see what factors are likely to drive medical ethics over the next few decades. We have given examples of how such factors might affect specific issues. RESULTS: Those factors that we identified as likely to shape the future of medical ethics are: Globalization: Medical ethics is likely to have to grapple increasingly with ethical issues arising from the huge discrepancies in the level of health care available in different countries. Increase in longevity: We predict that there will be, at least amongst the richer nations, a significant increase in life expectancy. This will result in issues of resource allocation becoming increasingly problematic within medicine. Child enhancement: Developments in genetics combined with control of reproduction will make it possible to select our children for a broad range of characteristics. There are optimistic and pessimistic predictions as to how such power will be used. In either case, this area will be an important focus of concern in medical ethics. The biological determination of behaviour: Genetic research will lead to an increasing sense that undesirable behaviour is genetically determined. This will lead to a re-examination of such concepts as criminal responsibility. Therapeutic research and clinical practice: We predict that an increasing amount of clinical practice will be within the setting of clinical trials. The ethics of therapeutic research and clinical practice will need to be brought within a coherent framework.

Clinical Medicine↗
PubMedDate not supplied

The moral domain of the medical record: the routine ethics evaluation.

The structure, content, and orientation of the contemporary medical record inadequately reflect the appropriate influence of patients' rights and bioethics on health care. Most tellingly, the medical chart reveals a remarkable absence of attention to medical ethics, except in the case of crisis management. But medical ethics informs both crisis decision-making and virtually all clinical interventions. Indeed, clinical care embodies a complex array of choices influenced by individual and cultural values, themselves reflecting religious beliefs, personal histories, psychologies, and social mores. But the typical medical chart, which records clinical descriptions, analyses, and rationales for treatment, rarely identifies or accounts for this value-laden dimension of care and thus both over-simplifies and distorts the depiction of a patient's illness and its treatment. To better reflect the complex moral domain of clinical care, and assist in organizing its complex structure, a systematic procedure is proposed here to evaluate the ethical status of every patient: As a routine part of the clinical evaluation, in a designated Ethical Concerns section of the medical record, an "ethics work-up' is designed to serve as a moral 'diagnostic' analogous to its scientific counterpart. Adapted to the needs of individual patients, such evaluations should identify ethical problems, coordinate related data, resources, and opinion, and define the rationale for choices made and actions pursued. In establishing improved integration of the 'epistemologies' of care and the 'ethics' of care, the goals of a more humane, patient-centered medicine may be better met.

Boston↗
PubMed1995

The ethics of leadership in pharmacy.

The pharmacy profession's responsibility to provide ethical leadership to its members is explained, and areas where pharmacy should take a leadership role are described. Changes taking place in health care offer many opportunities for pharmacy in its transformation into a fully clinical discipline. The profession needs to address the ethical issues that will affect it as part of this revolution. The role pharmacy is taking to eliminate medication misadventuring will be a test case for the profession's ability to exert the leadership it must, as part of its new definition of itself. Pharmacy needs to define the structure, process, and outcomes necessary to improve its own practice to avoid drug misadventuring, with a clear set of practice and ethical standards, and engage medicine and nursing to adopt similar standards. Pharmacy should also take a leadership role in health care reform, working with other clinicians to ensure that the changes provide better outcomes for patients. Health care professionals are bound together by a common moral purpose: to act in the patient's best interest. Thus, each health profession is a moral community, which must determine and promote ethical behavior among its members. Pharmacy must practice ethical leadership: it must define and prove its contribution to patient outcomes, further develop legal and ethical standards, and examine its responsibilities for vulnerable patient groups such as children. It must work to overcome the traditional dominance of medicine; pharmacy, nursing, and medicine must come together in service of the patient and develop a cross-professional conception of ethics. Pharmacy also must participate in the broader debate about health care. Pharmacy has begun to take a leadership role among the health professions through its efforts to eliminate medication misadventuring. Additional leadership challenges for the profession are suggested.

Delivery of Health Care↗
PubMed2005

Ethical reasoning and mental health services with deaf clients.

Ethical problems encountered by mental health practitioners working with deaf clients are often complex and involve issues not fully addressed in professional codes of ethics. A principles-based ethical reasoning process can assist in resolving many of these ethical concerns. Principles such as beneficence, nonmaleficence, autonomy, fairness, integrity, and respect are found in the ethical codes of many disciplines; these can also create a common language or reference point when professionals from different fields attempt to deal with shared problems. This article discusses some applications of these principles in working with deaf individuals and proposes an ethical decision-making process that can provide a framework for ethical reasoning in thinking through complex problems.

Clinical Competence↗