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PubMed2001

Necessity of adapting psychiatric treatment to relevant ethical guidelines.

In this article the author investigates to what extent most psychiatric professionals act according to international and national psychiatric ethical guidelines. It seems that many psychiatrists and psychotherapists do not know the international and national ethical guidelines for psychiatric conduct, and as a consequence they frequently do not act according to these ethical codes. The problem is that ignoring of ethical guidelines often does not have legal consequences, because these psychiatric ethical codes are not specifically enshrined in the law. I have discussed how we can improve relevant psychiatric ethical knowledge and related more responsible behavior in psychiatric staff members. Suggestions are made to improve psychiatric treatment in the light of ethical guidelines.

Ethics, Medical↗
PubMed2001

Ethical issues identified by rehabilitation clinicians.

OBJECTIVES: To quantify systematically and to characterize the range of ethics issues affecting rehabilitation professionals' day-to-day clinical practice, and to assess the preferences of rehabilitation clinicians for ethics education. DESIGN: Survey of clinicians and admitting office personnel in an acute rehabilitation hospital with open-ended questions about the ethical issues they found most troubling in daily practice. SETTING: A 175-bed free-standing, urban rehabilitation hospital. PARTICIPANTS: A total of 411 clinicians and admitting office personnel, of whom 217 responded (53%) and generated a total of 547 ethics issues. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Ethical issues were coded by 2 independent raters into 24 different categories and a reconciliation session was used to resolve discrepancies. RESULTS: The largest response (24%) was categorized as pressures resulting from health care reimbursement changes. The second most common problem (17%) involved conflicts among patients, physicians, team members, or families around goal setting. Difficulty assessing decision-making capacity was third (7%). The respondents favored discussion groups or interdisciplinary in-services and lectures over self-instructional materials as formats for ethics education. CONCLUSIONS: Ethical issues in the rehabilitation setting are common, and reflect both the dynamic nature of the health care environment and the team model of care. Ongoing, interactive educational interventions are warranted to address these issues.

Adult↗
PubMed1998

Pediatricians' experience of ethical dilemmas in practice: implications for education.

OBJECTIVE: To determine Canadian pediatricians' experience with ethical dilemmas, to relate this information to proposed curriculum for residency training in Canada, and to determine pediatricians' self-assessment of adequacy of training in ethical issues and the means used in practice to resolve dilemmas. METHOD: A single-pass questionnaire was mailed to all 1,220 pediatrician members of the Canadian Pediatric Society. RESULTS: From the 363 questionnaires (30 per cent) that were returned, 43 per cent of respondents had received formal ethics education in their training. Approximately half of respondents judged their training as adequate. Responses confirmed the themes of futile treatment, demands for and refusal of treatment by parents, uncertainty regarding withdrawing or withholding treatments, conflicts over judgments about the right thing to do, and dilemmas regarding the role of the child and adolescent. Respondents relied mainly on informal discussion with colleagues to resolve their dilemmas in practice. CONCLUSIONS: Core residency and continuing physician education need a valid epidemiological description of ethical issues encountered in practice. Educational approaches to the development of ethical knowledge, skills, and attitudes must be validated as there is a tendency to rely on case precedent and peer judgment. Perceived competence in handling ethical issues and dilemmas must be tested against accepted standards. Emerging ethical issues such as resource allocation, peer review, managed care, and technological and scientific advances must be regularly incorporated into both residency education and continuing medical education.

Canada↗
PubMed2003

Ethics and human rights issues experienced by nurses in leadership roles.

The aims of this study were to identify (1) the ethics and human rights issues experienced by nurses in leadership roles (NLs); (2) how frequently these issue occurred in the NLs'practices; and (3) how disturbed the NLs were by the issues. Dillman's Total Design Method (1978) for mailed surveys guided the study design. Data analysis was performed on 470 questionnaires from New England RNs in nursing leadership roles. The most frequently experienced ethics and human rights issues during the previous 12 months were (1) protecting patient right and human dignity; (2) respecting or not respecting informed consent to treatment; (3) use or nonuse of physical or chemical restraints; (4) providing care with possible risks to the RN's health; (5) following or not following advance directives; and (6) staffing patterns that limit patient access to nursing care. The most disturbing ethics and human rights issues experienced by the NLs were staffing patterns that limited patient access to nursing care, prolonging the dying process with inappropriate measures, working with unethical, incompetent, or impaired colleagues, implementing managed care policies that threaten quality of care, not considering quality of the patient's life, and caring for patients and families who are uninformed or misinformed about treatment, prognosis, or medical alternatives. Nearly 39% of the NLs reported experiencing ethics and human rights issues one to four times a week or more, and more than 90% handled their most recent ethics issue by discussing it with nursing peers. Study findings have implications for ethics education and resource support for nurses in leadership roles, and for further research on how NLs handle ethics and human rights issues in the workplace.

Adaptation, Psychological↗
PubMed2003

A model for assessing the ethical environment in academic dentistry.

Weber's "Institutional Ethics Audit" model was designed as a tool for assessment of an organization's effort to institutionalize ethics into its operations. In this model, the overall ethical environment of an organization is evaluated through an assessment of its 1) ethical cultures, 2) ethics policy, 3) enforcement mechanisms, and 4) ethical training. Assessment of these components allows the organization to be placed along a continuum that spans aethical firms, compliance firms, emerging firms, and integrity firms. This paper presents the conceptual framework for this model. We propose that application of this model to academic institutions, including dental schools, could provide appropriate information to improve the ethical climate of the institution.

Ethical Review↗
PubMed2006

An empirical study of tissue banking in Australia: navigating regulatory and ethical challenges.

Collections of tumour samples can be an invaluable resource for medical research. There are, however, numerous ethical and legal challenges associated with tumour banking. While there has been extensive discussion of these issues in the legal and ethical literature, there are few available empirical data in relation to the activities of tumour banks in Australia, their practices around ethically charged issues, and their success in implementing complex regulatory guidelines. The aim of this study was to gain more information about the activities of tumour banks in New South Wales, Australia, with a particular focus on their management of, and attitudes towards, ethical and regulatory issues. A survey of 27 tumour collection and research facilities was conducted using a 55-item questionnaire. There is significant heterogeneity of research methodologies as well as of methods for gaining consent and ensuring donor privacy, and there is general concern among the research community about ethical and regulatory issues related to tumour banking. Heterogeneity of practice and uncertainty about ethical and regulatory requirements is problematic in its potential to hinder research and its potential to generate the space for unethical practice, whether intentional or unintentional. There is a pressing need to address these issues so that tumour banks can be used in the most ethical and efficient way possible.

Academies and Institutes↗
PubMed1989

Brain resuscitation. Ethical perspectives.

Brain resuscitation is the newest in a long line of treatment protocols that is designed to aid us in sustaining not just life, but quality life in the critical care setting. Like other, previously established protocols, it is not value free. Its implementation brings ethical considerations that must be addressed. If the issues are not addressed, there is the real danger that the resulting moral dilemmas will overwhelm the nurse. In brain resuscitation, there are at least three ethical issues that must be recognized. These are the role of resuscitation in the life process, allocation of scarce resources, and participation in research. To address these issues, nurses will have to be aware of the ethical principle and/or perspectives involved. For some of these issues, the solutions will have to come from nursing's national organizations, such as the American Association of Critical Care Nurses. Other solutions presented will require the nurse to come to an individual decision regarding the ethics of brain resuscitation. The journey to the conclusion of this discussion will end with disappointment for those who sought an algorhythm or decision tree with which to make definitive decisions in regard to ethical decisions about brain resuscitation. To have assumed that such an absolute discussion in regard to the ethical perspectives related to brain resuscitation is possible or even desirable would have been to deny the moral/ethical responsibilities of the nurse who practices in a critical care setting. While these ethical responsibilities can be overwhelmingly burdensome, they can also be opportunities. They can be positive opportunities for our health care colleagues, our patients, and ourselves.

Beneficence↗
PubMed1988

Ethical problems in the medical office.

The majority of health care in this country is provided to patients in the office setting. This study, conducted in an internal medicine office practice, describes the ethical problems encountered in medical offices. Two hundred eighty consecutive patients, a total of 562 office visits, were prospectively evaluated. Ethical problems were defined as being present when specific ethical issues came into conflict with the physician's moral obligation to benefit the patient. The majority of the patients studied were white (214) and were women (212). The mean age of the patients was 49 years, with a range from 17 to 98 years. Ethical problems were present in 84 (30%) of the patients and in 119 (21%) of the office visits. The most common ethical problems for the patients were costs of care (11.1%), psychological factors that influence preferences (9.6%), competence and capacity to choose (7.1%), refusal of treatment (6.4%), informed consent (5.7%), and confidentiality (3.2%). Ethical problems were more common in patients over 60 years of age. This study establishes an educational as well as a research base for a broad study of biomedical ethics that looks beyond the problems encountered in the hospital.

Adolescent↗
PubMed1982

Reflections: ethics and the recombinant DNA debate.

This essay is an attempt to apply a mode of ethical reflection to questions related to the recombinant DNA debate. The author suggests that adequate ethical analysis must include at least five aspects of a moral situation 1) the nature of the act itself; 2) consequences that result from an action or decision; 3) civil and criminal laws; 4) moral principles; and 5) motivation or intention. This paradigm for analysis is applied to the recombinant DNA scene, particularly as these factors relate to 1) risks vs benefits; 2) laws and regulations; 3) the marketplace; and 4) human genetic intervention. The analysis does not provide answers to these vexing questions, but attempts to raise the consciousness level of the reader concerning significant ethical issues. Undergirding the discussion is the humanistic theme of the primacy of the concern for the public good, and that freedom of inquiry can only survive in a socially conscious context. Fear of the unknown is no reason for prohibiting DNA research, but since the stakes are high as new developments emerge that pertain to the genetic restructuring of the human species, the author suggests that caution and responsible judgment are mandatory. Since ethics is concerned with ideal moral judgments, and applied ethics relates to the real world in which we function, the demand for clear and careful thought concerning the short-term and long-term consequences of our work is a primary ingredient of what it means to be responsible. In the final analysis, ethical responsibility rests on the individual; without a sense of personal integrity and what that implies about oneself and society, blatant opportunism can easily become the generally accepted mode of behavior and decision. If this occurs, traditional ethical concerns become irrelevant.

DNA, Recombinant↗
PubMed1995

[Ethical assessment of biomedical experiments in The Netherlands].

The ethical evaluation of biomedical experiments is loyally accepted in the Netherlands. It was introduced everywhere during the last 15 years. Among the targets we find not only the protection of the experimental objects--animals and humans--but also the protection of researchers who may find moral support in the approval of their projects by a Committee of Ethical Evaluation. Concerning experiments in animals, the legal framework is provided by the Law on Animal Experiments. This law was drawn up in accordance with the directive of the E.U. To be allowed to practice experiments in animals, an institute must possess a licence; the researchers are moreover obliged to be appropriately trained with regard to experiments in animals. To that end an adequately functioning organization has been set up. The intensive supervision is widely decentralized and effected for the greater part by experts working within the institutes. The "intra muros" Committees supervising the experiments in animals play an important part in the ethical evaluation. More than 50 of those Committees are active at this time. Setting the ethical standards is done in close collaboration between the Authorities and the researchers. Researchers and animal protection associations have established a "Platform for the Replacement of Experiments in Animals", in which they support development of alternative methods for research. The legislation concerning medical experiments in humans is not yet completely enforced, but in practice the ethical evaluation has been effected for many years in every hospital of the Netherlands. At present about 150 "Committees for medico-ethical evaluation" are at work. Their task may be very heavy, especially in the academic hospitals, where, mostly, over 150 projects are advised on every year. Adequate training facilities are provided for the members of the committees. The passing of the bill on experiments in humans is stagnating owing to political reasons. Besides the approval of the present practice, the bill-draft contains some elements that are difficult to accept by researchers; among other things, the researchers refuse a possible political influence on the ethical advice. Moreover, there exists a menace to see the insurers changing their rules: the legislation on privacy might also hamper the development of a research seeming too closely patient-linked. Sufficient attention is not given to the financial aspects of the evaluation-process. The real cost of the evaluation should be incorporated into the budget of research projects.

Animal Testing Alternatives↗
PubMed1996

Why should midwives be concerned with ethics?

Is there such a thing as midwifery ethics? Yes, there is. As human beings (moral agents), midwives are to be ethical, moral, responsible persons and professionals. Midwives work in moral relationships with other persons. They serve by the moral standards of their profession as now embodied in written codes of ethics, a profession that is part of the larger health care profession. As part of the professional world, midwives participate in the general standard that to be professional is to be ethical and to be unethical is to be unprofessional. The professions, in turn, are part of what Eric Fromm calls "human ethics." If midwives are to be ethical, we suggest they need to understand ethics and to reason morally. Better health care for all is the result.

Ethics, Nursing↗
PubMed1997

Principles and methods of ethical decision making in critical care nursing.

Consideration of the ethical principles of autonomy, beneficence, nonmaleficence, and justice can help to equip critical care nurses to deal with ethical conflicts that arise in nursing practice. Properly understood, these principles do not function as inflexible absolutes, but instead serve as "moral compasses" that help the nurse to get his or her bearings in difficult or uncertain situations. Those who appeal to the four principles should recognize that other cultural traditions may regard other ethical values as central. Finally, to the extent that principlism neglects ethical concerns related to caring and personal relationships, this approach is incomplete. Nurses and others who invoke an ethic of caring can advance ethical understanding by contributing a careful analysis of this concept and its role in ethical decision making.

Critical Care↗
PubMed1997

Ethical conflicts reported by Certified Nephrology Nurses (CNNs) practicing in dialysis settings.

OBJECTIVE: The purpose of the investigators was to describe and classify ethical conflicts experienced by Certified Nephrology Nurses (CNNs) practicing in dialysis settings in four eastern states and the District of Columbia, and to explore associated demographic, educational, and practice setting factors associated with these ethical conflicts. DESIGN: A descriptive survey design was used. SAMPLE/SETTING: All members of the American Nephrology Nurses Association (ANNA) who were CNNs working in Maryland, Virginia, and the District of Columbia, and a random sample of those in New York State and Pennsylvania were contacted. METHODS: Those CNNs working in dialysis settings were asked to complete the Demographic Data Form and the Moral Conflict Questionnaire developed by Fry (1990). Eighty-eight met inclusion criteria, agreed to participate, and described ethical conflicts. RESULTS: By far the most common practice context for the described ethical conflicts were decisions about discontinuation or initiation of dialysis (69%). Participants were clear about the moral problem and ethical principles involved. CONCLUSIONS: Participants reported being involved in serious ethical conflicts about patient care. Since two-thirds were not resolved, further research should investigate whether existing mechanisms in practice settings for resolution of ethical conflicts are not working or are not being used by nurses.

Adult↗
PubMed1991

An integrative model of clinical-ethical decision making.

The purpose of this paper is to propose a model of clinical-ethical decision making which will assist the health care professional to arrive at an ethically defensible judgment. The model highlights the integration between ethics and decision making, whereby ethics as a systematic analytic tool bring to bear the positive aspects of the decision making process. The model is composed of three major elements. The ethical component, the decision making component and the contextual component. The latter incorporates the relational aspects between the provider and the patient and the organizational structure. The model suggests that in order to arrive at an ethically, justifiable sound decision one make reference to those three elements.

Beneficence↗
PubMed1992

Can ethnography save the life of medical ethics?

Since its inception contemporary medical ethics has been regarded by many of its practitioners as 'applied ethics', that is, the application of philosophical theories to the moral problems that arise in health care. This 'applied ethics' model of medical ethics is, however, beset with internal and external difficulties. The internal difficulties point out that the model is intrinsically flawed. The external difficulties arise because the model does not fit work in the field. Indeed, the strengths of that work are its highly nuanced, particularized analyses of cases and issues and its appreciation of the circumstances and contexts that generate and structure these cases and issues. A shift away from a theory-driven 'applied ethics' to a more situational, contextual approach to medical ethics opens the way for ethnographic studies of moral problems in health care as well as a conception of moral theory that is more responsive to the empirical dimensions of those problems.

Anthropology, Cultural↗
PubMed1992

Intersections of Western biomedical ethics and world culture: problematic and possibility.

... What emerges from the intersection of systems of medical ethics across cultural lines is a recognition of the need for and the possibility of some form of metacultural ethic that can ameliorate cultural relativism. In medical ethics, all ethical positions are not of equal moral status -- regardless of how tightly bound they may be to a particular culture; for example, consider the nearly universal approbation for cooperative efforts of physicians who oppose the use of nuclear weapons and the condemnation of physicians who torture or experiment with prisoners of war. Even if violations of patient rights are tolerated in certain social and cultural settings, they are not tolerable in any common ethic of medicine. Growing recognition of the moral rights of patients, their special vulnerability as sick persons, and their dependency on the physician's knowledge constitute the empirical foundation of a morally defensible ethic of medicine. Those cultural systems that violate such norms cannot be given equal moral standing with systems that respect these norms, not because the cultural systems that support human and patients' rights are per se superior but because the protection of human rights is grounded in something more fundamental than culture -- the deference owed to all human beings qua human beings. This is a norm by which every culture may be judged....

Bioethics↗
PubMed2003

Balancing the perspectives. The patient's role in clinical ethics consultation.

The debate and implementation of Clinical Ethics Consultation (CEC) is still in its beginnings in Europe and the issue of the patient's perspective has been neglected so far, especially at the theoretical and methodological level. At the practical level, recommendations about the involvement of the patient or his/her relatives are missing, reflecting the general lack of quality and practice standards in CEC. Balance of perspectives is a challenge in any interpersonal consultation, which has led to great efforts to develop "technical" approaches, e.g., in psychological counseling or psychotherapeutic treatment. In ethics, unbalance or partiality is a matter of justice and has provoked significant theoretical work, also relevant for practical medical ethics. A lack of balance seems to be particularly serious in those situations, where ethical conflict is triggering a consultation and where the "parties" involved may try to persuade the consultant that their particular opinion is the most convincing; but to our knowledge the connection between patient/relatives involvement and balance has not yet been discussed in the context of CEC. Central questions of access and involvement of the patient and his/her relatives will be analysed and discussed regarding the challenge of balance and the adequate role or attitude of a Clinical Ethics Consultant. It is argued that the Clinical Ethics Consultant should have a methodological awareness regarding the concepts of "neutrality" versus "advocacy" in his/her role and try to achieve a balanced procedure that allows for an optimum of change of perspectives. The argumentation is developed along the narrative of a real case study. Recommendations concerning the involvement of (the perspectives of) the patient or the relatives are formulated for the practice of CEC.

Aged↗
PubMedDate not supplied

Ethical principles: application to an obstetric case.

This article focuses on the application of the ethical principles of double effect versus consequentialism, autonomy, beneficence, utility, and justice. An obstetrical case study is presented and discussion of each ethical principle is used to resolve the conflict. The intents of the article are to promote ethical awareness; provide topic areas to facilitate ethical discussion; enhance nurses' knowledge of the discipline of ethics; and support the necessity of interdisciplinary ethics committees.

Beneficence↗