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PubMed1994

The effect of a class in medical ethics on first-year medical students.

PURPOSE: To assess the effect of a class in medical ethics on first-year medical students. METHOD: A test instrument was developed to measure the attitudes of medical students toward certain ethical questions and to assess their factual knowledge regarding particular legal and ethical issues. The instrument was administered in 1992-93 to 110 first-year students at the University of Virginia School of Medicine before and after the students took a required course in medical ethics. The instrument employed clinical vignettes as well as multiple-choice, true-false, and Likert-scale questions. Its reliability and validity were assessed. RESULTS: The required course in medical ethics had little influence on the students. There was only one significant change (p = .05) in the pattern of responses to any of the clinical vignettes. In a few of the attitude-oriented queries, there were statistically significant changes (p < .05) after the course. Although there were statistically significant changes for only four of the factual-knowledge questions, for all such questions more students identified the correct answers after the class (before the course the range of correct answers was 43% to 99% compared with 64% to 100% after the course). CONCLUSION: The class in medical ethics seemed to have little effect on the first-year students, probably because students arrive at medical school with well-established ethical perspectives.

Adult↗
PubMed1995

Knowledge, confidence, and attitudes regarding medical ethics: how do faculty and housestaff compare?

BACKGROUND: It has been suggested that faculty members' inadequate knowledge of and unfavorable attitudes toward ethics may present barriers to effective education in ethics for house officers. METHOD: To test this hypothesis, the authors administered a questionnaire assessing the knowledge, confidence, and attitudes regarding ethics of the 73 house officers and 73 full-time faculty members in the Department of Medicine at the Georgetown University Medical Center in 1992-93. Statistical analysis of the responses was performed using chi-square, two-tailed t-tests, and linear regression. RESULTS: Fifty-five house officers (75%) and 57 faculty (78%) responded. The knowledge scores were similarly low for both groups (53% correct for the faculty and 50% for the house officers). However, the faculty were significantly more confident than the house officers regarding ability to address ethical issues (mean ratings of 3.9 vs 3.4 on a scale from 1, very low, to 5, very high; p = .0001). Seventy-five percent of the faculty and 65% of the house officers believed that ethics training should be mandatory during residency. CONCLUSION: The attitudes of the faculty per se do not appear to represent a barrier to teaching ethics. However, the gap between the faculty members' confidence and knowledge could interfere with their abilities to model and teach ethics to house officers.

Academic Medical Centers↗
PubMed1996

Characteristics of the informal curriculum and trainees' ethical choices.

In October 1995, the Association of American Medical Colleges held its first Conference on Students' and Residents' Ethical and Professional Development. In a plenary session and break-out sessions, the 150 participants, representing a wide variety of medical and professional specialties and roles, discussed the factors and programs that affect medical trainees' development of ethical and professional standards of behavior. The main challenge of addressing students' professional development is the enormous range of influences on that development, many of which, such as the declines in civic responsibility and good manners throughout the United States, fall outside the scope of academic medicine. Nonetheless, many influences fall within reach of medical educators. In a pre-conference survey, participants ranked eight issues related to graduating ethical physicians. The respondents ranked highest the inadequacy of the understanding of how best to influence students' ethical development, followed by faculty use of dehumanizing coping mechanisms, and the "business" of medicine's taking precedence over academic goals. The plenary speakers discussed the "informal curriculum" and the "hidden curriculum" and the need for medical faculty to take seriously the great influence they have on students' and residents' moral and professional development as they become physicians. Whether consciously or not, medical education programs are producing physicians who do not meet the ethical standards the profession has traditionally expected its members to meet. In three series of break-out sessions, the participants analyzed the nature of the ethical dilemmas that medical students and residents face from virtually the first day of their training, the use of role playing in promoting ethical development, and ways to improve policies and overcome barriers to change.

Clinical Clerkship↗
PubMed1996

Residents' ethical disagreements with attending physicians: an unrecognized problem.

PURPOSE: To evaluate the frequency and nature of ethical disagreements over patient care between housestaff and attending physicians. METHOD: During the spring of 1994, a cross-sectional survey about ethical disagreements was conducted of all 42 internal medicine housestaff at the West Virginia University Hospitals and all 51 faculty in the Department of Medicine at the West Virginia University School of Medicine. Chi-square analysis was used to compare categorical variables. RESULTS: Thirty-six (86%) of the residents and 41 (80%) of the faculty responded. The housestaff recounted 127 ethical disagreements between attending physicians and housestaff in the previous year; the attending physicians reported 19. A total of 32 residents reported at least one ethical disagreement with an attending physician during the previous year. When asked about their most troubling disagreement, 27 (84%) of these residents reported they had been distressed because they considered the treatment ordered by the attending physician to be futile. Only 11 residents (34%) had discussed their most troubling disagreement with the attending physician. Of the 24 residents who correctly identified that a formal process to resolve ethical disagreements with a physician did not exist, 17 desired one. CONCLUSION: The residents' disagreements with attending physicians over ethical aspects of patient care were common and usually concerned issues of overtreatment. Since most of the housestaff did not express their concerns, the attending physicians were largely unaware of them. The findings suggest that residency directors need to encourage housestaff to discuss their ethical conflicts with attending physicians.

Attitude of Health Personnel↗
PubMed2001

Residents' preparation for and ability to manage ethical conflicts in Korean residency programs.

The doctor-patient relationship in Korea has been deteriorating, and the numbers of malpractice suits and other medical disputes have been increasing annually for the past decade. Part of the problem may be physicians' lack of ethics education. The author and colleagues surveyed Korean residents from 14 university hospitals and found that most regularly experienced serious ethical dilemmas and had difficulty appropriately managing them. Few were familiar with medical law, and many resolved ethical conflicts either on their own or by talking with colleagues. Many did not follow guidelines for obtaining informed consent. Few had ethics committees or consultants available to them, and most did not discuss ethical dilemmas with attending physicians. The author describes the kinds of dilemmas faced by Korean residents and how they manage them, and he offers recommendations for improving ethics education and the ethics environment for Korean medical students and residents.

Adaptation, Psychological↗
PubMed2002

Clinical ethics in rehabilitation medicine: core objectives and algorithm for resident education.

Described as the balance of values on either side of a moral dilemma, ethics and ethical issues are of increasing importance in the changing practice of rehabilitation medicine. Because the substance of ethics and true ethical issues can be difficult to identify, the education of rehabilitation residents in ethics can similarly be challenging. This article discusses topics pertinent to an understanding of clinical ethics in rehabilitation medicine and provides a method of teaching residents through an algorithm of ethical issues, learning objectives, and illustrative cases.

Algorithms↗
PubMed1995

Design elements of professional ethics courses.

Optometrists face ethical dilemmas daily in the practice of their profession. Students training to become optometrists also face ethical dilemmas, some of which are unique in their role as students. The focus on ethical practice has been heightened by the increasing scope of optometric practice, the greater demand of society for professional accountability, the greater diversity of membership and viewpoints, the decrease in available dollars for health care delivery, and the conflicting roles of ophthalmology and opticianry with optometry. These factors have led to the addition or expansion of professional ethics courses in optometry programs. This paper examines the difficulties inherent in defining professional ethics and designing ethics courses. Curricular issues are examined, including course objectives, instructors, content, evaluation, timetabling, teaching strategies, student assessment, and resource implications. Much of the research in this area has been done in medical education. Although the content of ethical dilemmas encountered by medical students and physicians may not be applicable to optometry, the process by which they learn to approach the dilemmas is the same.

Curriculum↗
PubMed2005

Can the study of ethics enhance nursing practice?

AIM: The aim of this paper is to suggest that the study of ethics and ethical theories can enhance nursing practice. DISCUSSION: Knowledge of ethical theories can be of practical use to nurses in at least three ways. First, it can help nurses uncover to what extent a problem is an ethical one. The questions faced in practice can be empirical, formal or philosophical. Very often, a practical decision requires us to tackle all three types. In the example of a 'Do not attempt resuscitation' order, deciding on whether such an order is appropriate requires us to answer empirical questions such as how likely any attempt is to achieve success. It also requires us to answer formal questions such as whether the law permits such an order in the present circumstance. Finally, it requires us to answer ethical/philosophical questions, such as how we should weigh up quality of life against quantity. Second, it can enable practitioners to develop skills and tools to tackle ethical/philosophical questions. In this paper I describe two such tools: Socratic questioning and Aristotelian dialectic. Third, it can help practitioners to develop the soundness of their ethical values and beliefs. All ethical reasoning requires us to use our values and beliefs, and attending to them enhances the quality of our reasoning. CONCLUSION: The study of ethics can enhance nursing practice.

Attitude of Health Personnel↗
PubMed1992

Teaching of medical ethics in Sri Lanka.

Medical ethics as taught by members of the Department of Forensic Medicine in three of five medical colleges in Sri Lanka is a 'rule ethic' ('normative ethic') based on 'traditional' or 'classical' ethics. Instruction includes the teaching of moral principles, illustrated with examples. Also included are aspects concerning the functions of the Sri Lanka Medical Council. The topic is evaluated in the essay, multiple choice question and oral components of the third MBBS (Part II) examination (end of fourth year). As presently taught the syllabus is thoroughly inadequate for dealing with modern (medical) ethical issues. The shortcomings and limitations in the present programme are pointed out and requisite improvements suggested. A case is made for an eclectic view of ethics, in which a 'situation ethic' would play a part. Finally, the training of a highly moral responsible medical professional is emphasized.

Curriculum↗
PubMedDate not supplied

Ethical dilemma and moral distress: proposed new NANDA diagnoses.

PURPOSE: To propose two NANDA diagnoses--ethical dilemma and moral distress--and to distinguish between the NANDA diagnosis decisional conflict and the proposed nursing diagnosis of ethical dilemma. SOURCES USED: Journal articles, books, and focus group research findings. DATA SYNTHESIS: Moral/ethical situations exist in health care. Nurses' experiences of ethical dilemmas and moral distress are extrapolated to the types and categories of ethical dilemmas and moral distress that patients experience and are used as the basis for development of two new nursing diagnoses. CONCLUSION: The two proposed NANDA diagnoses fill a void in current standardized terminology. PRACTICE IMPLICATIONS: It is important that nurses have the ability to diagnose ethical or moral situations in health care. Currently, NANDA does not offer a means to document this important phenomenon. The creation of two sets of nursing diagnoses, ethical dilemma and moral distress, will enable nurses to recognize and track nursing care related to ethical or moral situations.

Conflict, Psychological↗
PubMed2002

Ethical dilemmas confronting dentists in Queensland, Australia.

BACKGROUND: This paper details contemporary ethical dilemmas encountered by Queensland dentists. METHODS: An age-stratified sample of 499 dentists resident in Queensland was surveyed. The questionnaire contained scenarios of five common ethical dilemmas. In addition, open-ended questions sought the respondent's most frequent, difficult and recent ethical dilemmas, and where they would seek guidance in dealing with ethical problems. RESULTS: Respondents acknowledged the patient's rights in treatment decisions and the dentist's right to refuse demands for inappropriate treatment. However, responses varied in the extent to which dentists may influence treatment decisions. Few respondents would ignore evidence of poor dental treatment but they are evenly divided in choosing to inform the patient, the dentist or both. Poor quality treatment is the most frequent and difficult dilemma, and half have experienced this problem recently. Requests by patients for fraudulent receipts occur in a third of responses. Dentists develop ethical values from multiple sources but for help with dental ethical problems, 90 per cent of respondents would consult another dentist. CONCLUSIONS: Of the ethical dilemmas discussed in this survey, those relating to poor quality treatment confronted most respondents. Also the actions of dentists in dealing with these dilemmas were most varied.

Adult↗
PubMed1988

Teaching clinical medical ethics: a model programme for primary care residency.

Few residency training programmes explicitly require substantive exposure to issues in medical ethics and fewer still have a formal curriculum in this area. Traditional undergraduate medical ethics courses teach preclinical students to identify ethical issues and analyse them at a theoretical level. Residency training, however, is the ideal time to establish the critical behavioural link which makes ethics truly useful in clinical medicine. The General Internal Medicine Residency Training Program at Rhode Island Hospital has developed an integrated, three-year curriculum with the goals of helping residents to perceive ethical issues in clinical practice, to utilise basic philosophical principles in resolving ethical dilemmas and to communicate these issues clearly and sensitively to patients. The curriculum has been well received by residents and has had a hospital-wide impact. We believe that training residents in medical ethics and communication skills is an effective approach to developing physicians' humane qualities.

Ambulatory Care↗
PubMed1989

Islamic medical ethics in the 20th century.

While the practice of Western medicine is known today to doctors of all ethnic and religious groups, its standards are subject to the availability of resources. The medical ethics guiding each doctor is influenced by his/her religious or cultural background or affiliation, and that is where diversity exists. Much has been written about Jewish and Christian medical ethics. Islamic medical ethics has never been discussed as an independent field of ethics, although several selected topics, especially those concerning sexuality, birth control and abortions, have been more discussed than others. Islamic medical ethics in the 20th century will be characterised on the basis of Egyptian fatawa (legal opinions) issued by famous Muslim scholars and several doctors. Some of the issues discussed by Islamic medical ethics are universal: abortions, organ transplants, artificial insemination, cosmetic surgery, doctor-patient relations, etc. Other issues are typically Islamic, such as impediments to fasting in Ramadan, diseases and physical conditions that cause infringement of the state of purity, medicines containing alcohol, etc. Muslims' attitudes to both types of ethical issues often prove that pragmatism prevails and the aim is to seek a compromise between Islamic heritage and the achievements of modern medicine, as long as basic Islamic dogma is not violated.

Bioethical Issues↗
PubMed1993

Ethics and statistical methodology in clinical trials.

Statisticians in medicine can disagree on appropriate methodology applicable to the design and analysis of clinical trials. So called Bayesians and frequentists both claim ethical superiority. This paper, by defining and then linking together various dichotomies, argues there is a place for both statistical camps. The choice between them depends on the phase of clinical trial, disease prevalence and severity, but supremely on the ethics underlying the particular trial. There is always a tension present between physicians primarily obligated to their own patients (the weight of 'individual ethics') and ethical committees responsible for the scientific merit of the trial and its long-term implications ('collective ethics'). Individual ethics, it is proposed, favour the Bayesian approach; collective ethics, the frequentist. Though in some situations the choice appears clear-cut, there remain other where both methodologies can be appropriate.

Bayes Theorem↗
PubMed2006

Mental disorder ethics: theory and empirical investigation.

Mental disorders and their care present unusual problems within biomedical ethics. The disorders themselves invite an ethical critique, as does society's attitude to them; researching the diagnosis and treatment of mental disorders also presents special ethical issues. The current high profile of mental disorder ethics, emphasised by recent political and legal developments, makes this a field of research that is not only important but also highly topical. For these reasons, the Wellcome Trust's biomedical ethics programme convened a meeting, "Investigating Ethics and Mental Disorders", in order to review some current research, and to stimulate topics and methods of future research in the field. The meeting was attended by policy makers, regulators, research funders, and researchers, including social scientists, psychiatrists, psychologists, lawyers, philosophers, criminologists, and others. As well as aiming to inspire a stronger research endeavour, the meeting also sought to stimulate an improved understanding of the methods and interactions that can contribute to "empirical ethics" generally. This paper reports on the meeting by describing contributions from individual speakers and discussion sections of the meeting. At the end we describe and discuss the conclusions of the meeting. As a result, the text is referenced less than would normally be expected in a review. Also, in summarising contributions from named presenters at the meeting it is possible that we have created inaccuracies; however, the definitive version of each paper, as provided directly by the presenter, is available at http://www.wellcome.ac.uk/doc.WTX025116.html.

Attitude to Health↗
PubMed2000

Should local research ethics committees monitor research they have approved?

The function of local research ethics committees is to consider the ethics of research proposals using human participants. After approval has been given, there is no comprehensive system in place to monitor research and ensure that recommendations are carried out. Some suggest that research ethics committees are ideally placed to fulfil this function by carrying out random monitoring of research they have reviewed. The health service guideline creating local research ethics committees is under review. This paper suggests that increasing the monitoring role of ethics committees in the present climate would be inappropriate. This is due to the large workload of the committees, their voluntary nature and the change a monitoring role might cause to the relationship between researcher and ethics committee, which might herald an increasing recourse to judicial review. A radical overhaul of the system would be necessary in order for ethics committees adequately to fulfil a monitoring function.

Clinical Protocols↗
PubMed1996

The relationship between education and ethical behavior of nursing students.

Based on the cognitive theory of moral development of Kohlberg, refined by the addition of the dimension "ethics of care" and the educational theory of Janssen, the relationship of education and ethical behavior of nursing students was examined. Ethical behavior referred not only to the ethical reasoning of students but also to the relationship between this reasoning and their behavior. This study examined the responses of 2,624 nursing students to five ethical nursing dilemmas included in the Ethical Behavior Test by relating them to four educational variables: students' level of education, level of enrollment, school, and students' perceptions of the educational process. A significant relationship between education and ethical behavior was found.

Adolescent↗
PubMed2000

Women physicians' narratives about being in ethically difficult care situations in paediatrics.

This study is part of a comprehensive investigation of ethical thinking among male and female physicians and nurses. Nine women physicians with different levels of expertise, working in various wards in paediatric clinics at two of the university hospitals in Norway, narrated 37 stories about their experience of being in ethically difficult care situations. All of the interviewees' narrations were concerned with problems relating to both action ethics and relation ethics. The main focus was on problems in a relation ethics perspective. The most common themes in an action ethics perspective were overtreatment and withholding treatment. The more experienced physicians reasoned differently from the group of less experienced physicians and they coped with pressure in different ways. The less experienced physicians disclosed their professional experience yet seemed uncertain, while putting on an air of certainty, but the more experienced physicians disclosed both their professional and personal experience of caregiving and they seemed to allow themselves to feel uncertain in their certainty. Both groups emphasized a need for deep discussion between colleagues about their being in ethically difficult care situations.

Adaptation, Psychological↗