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PubMed1998

Medical ethics research between theory and practice.

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illness of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.

Anthropology, Cultural↗
PubMed1989

Preparing students to be moral agents in clinical nursing practice. Report of a national study.

Various types of teaching and learning strategies can be effectively employed to assist students' professional development in ethical decision-making skills. To be prepared to act as a moral agent in clinical practice, a terminal goal upon completion of the baccalaureate program is the student's ability to develop and consistently use a systematic approach/framework when confronted by an ethical dilemma. Eleven skill steps not necessarily exclusive or in sequence were outlined as selected activities that can be considered for the ethical decision process. Specific ethical issues that are germane and applicable to many patient care situations were investigated and identified as frequently occurring in clinical practice. Course work about these issues prior to completion of their nursing programs may be beneficial in preparing students with basic knowledge and skill about them as they enter or return to clinical practice.

Attitude of Health Personnel↗
PubMed1993

Education in medical ethics.

Since ethics is an integral part of practice of medicine, its study should parallel that of study of medicine. It should proceed in an orderly fashion from undergraduate into postgraduate study, starting with an understanding of principal moral values governing medical ethics. It should subsequently develop awareness of frequent existence of ethical issues and dilemmas, help develop the capacity for resolution of these issues through ethical reasoning, and acquire understanding of the function of institutional bodies concerned with ethics. Clinical real life situations and case studies should be extensively used as an educational tool. The exact design of the curriculum may vary to reflect the medical curriculum of a particular institution, but common objectives to all systems must be to achieve familiarity with moral values underlying the practice of medicine and with methodology of ethical reasoning. Some form of examination and evaluation of the course should be a standard feature of all teaching programs of medical ethics.

Curriculum↗
PubMed2001

Practice nursing: an evaluation of a training practice initiative.

Globally, health care is moving towards a primary care approach. In the UK initiatives for nurses wishing to gain experience in primary and community care may be crucial with the advent of Primary Care Groups (PCGs) and Primary Care Trusts (PCTs). This paper outlines an initiative in practice nursing, developed as a pilot study by a Health Authority. The training practice initiative was aimed at nurses returning to practice and offered them an experiential and supportive career pathway into primary care. The evaluation (carried out over 1 year), highlighted that those primarily involved in the initiative--the trainees, educators and general practitioners--felt it had been successful, especially in relation to professional development issues. The funding bodies for the initiative, who previously had concerns over the recruitment and retention of practice nurses, were also optimistic that the support networks which developed as a result of the initiative had raised morale. The paper suggests several educational, organizational and professional issues which arose from the evaluation exercise. Further, it suggests how this initiative, in an extended form, could provide an effective basis for the training and development of nursing staff in PCGs/PCTs.

Community Health Nursing↗
PubMed2004

Profitable gifts: a history of the Merck Mectizan donation program and its implications for international health.

A unique public/private partnership situated around a pharmaceutical, Merck's Mectizan donation program stands out as an example of corporate philanthropy in the history of the pharmaceutical industry and provides insight into future public/private partnerships in public health. This paper considers the issues Merck faced in the decision to donate Mectizan (ivermectin) and in the subsequent development of the Mectizan donation program, delineating the moral and financial debates that arose within the company. Coming after almost 15 years of donation, this assessment of the program's strengths and shortcomings suggests how the pharmaceutical industry can better serve as a viable partner in improving international health.

Community Health Planning↗
PubMed1988

[Mental hygiene of family and marital relationships].

On the basis of clinical, specialized, and sociological examination of 1771 individuals (627, 430, and 714 respectively) the authors have attempted to determine factors and tendencies which adversely affect the durability of marriage, familial and marital harmony, and mental development of children. It is concluded that from the mental hygiene standpoint and with regard to primary psychoprophylaxis of borderline diseases it is necessary to improve moral and sexual education of children and adolescents, to further develop the general education of young people about to be married, to perfect the organization of psychologic and hygienic aid to young families, to initiate scientific and methodological development of the system of lectures aimed at propagation of mental hygiene knowledge among the population.

Adolescent↗
PubMedDate not supplied

Confronting deep moral disagreement: the President's Council on Bioethics, moral status, and human embryos.

The report of the President's Council on Bioethics, Human Cloning and Human Dignity, addresses the central ethical, political, and policy issue in human embryonic stem cell research: the moral status of extracorporeal human embryos. The Council members were in sharp disagreement on this issue and essentially failed to adequately engage and respectfully acknowledge each others' deepest moral concerns, despite their stated commitment to do so. This essay provides a detailed critique of the two extreme views on the Council (i.e., embryos have full moral status or they have none at all) and then gives theoretical grounding for our judgment about the intermediate moral status of embryos. It also supplies an account of how to address profound moral disagreements in the public arena, especially by way of constructing a middle ground that deliberately pays sincere respect to the views of those with whom it has deep disagreements.

Advisory Committees↗
PubMed1990

Personality correlates of logical and sociomoral judgment.

This study examined the relation of the California Psychological Inventory (CPI) to stages of logical and sociomoral judgment. Logical judgment was measured using adaptations of the pendulum and correlations tasks of Inhelder and Piaget; moral judgment was scored using the standard Kohlberg interview. In a sample of 143 adults, logical and sociomoral judgment were correlated .30 to .50 with most of the Class I (Factor 2) CPI scales, those capturing social poise and interpersonal adequacy, and Class III (Factor 3) CPI scales, those capturing achievement potential and intellectual efficiency. The findings offer support for a cognitive interpretation of competence and ego development.

Humans↗
PubMed2006

The role of second health professionals under New Zealand mental health legislation.

The development of generic statutory roles in mental health care has been the subject of discussion by New Zealand nurses for the past decade. One such role is that of second health professional in judicial reviews of civil commitment. Issues identified by New Zealand nurses have also been raised in England, where it seems that nurses are likely to assume the role of Approved Mental Health Worker under English mental health law. A survey of mental health nurses found that few had received any preparation for the role of second health professional and 45% did not feel adequately prepared for the role. Some of these issues are reflected in a New Zealand inquiry which resulted in the Ministry of Health developing a written report form for second health professionals. However, the form has the potential to reduce the mental health nursing role to a narrow legal role. Statutory roles such as that of second health professional challenge mental health nurses to critically reflect on the conceptual and ethical basis of their practice. While traditional concepts such as therapeutic relationships and advocacy need to be reviewed in light of these changes, nurses need to be vigilant in articulating the moral and clinical basis of their roles. The development of guidelines for he second health professional role is suggested as a way of supporting clinical practice in this area.

Adult↗
PubMed2004

Ethics, genetics and dynamics: an emerging systematic approach to radiation protection of the environment.

There is now a general consensus of opinion that an explicit approach is necessary to demonstrate radiation protection of the environment, and that this approach needs to be developed in a systematic way. The framework that is emerging links ethical and moral issues (anthropocentric, biocentric, and ecocentric) to broad-based principles and objectives of environmental protection (sustainable development, maintaining biological diversity, and habitat protection) and then links these, in turn, to the needs of current environmental management practices, such as environmental exploitation, pollution control, and nature conservation. The relevance of this to radiation is that its effects (such as causing early mortality, morbidity, reduced reproductive success, as well as resulting in observable (scorable) cytogenetic damage) are those that may have a bearing on these same environmental management practices. The devise that would appear to be most useful to bridge the gap between our disparate data on radiation effects and the needs of environmental management, is that of adding to the concept of Reference Man in the shape of a small set of Reference Animals and Plants. This approach has now been adopted by the ICRP, adding new dynamics-the motive forces, both moral and physical-to the subject. The way is now clear for rapid progress to be made on a number of fronts.

Animals↗
PubMed1999

Influence on general practitioners of teaching undergraduates: qualitative study of London general practitioner teachers.

OBJECTIVE: To examine the perceived effect of teaching clinical skills and associated teacher training programmes on general practitioners' morale and clinical practice. DESIGN: Qualitative semistructured interview study. SETTING: General practices throughout north London. SUBJECTS: 30 general practitioners who taught clinical skills were asked about the effect of teaching and teacher training on their morale, confidence in clinical and teaching skills, and clinical practice. RESULTS: The main theme was a positive effect on morale. Within teacher training this was attributed to developing peer and professional support; improved teaching skills; and revision of clinical knowledge and skills. Within teaching this was attributed to a broadening of horizons; contact with enthusiastic students; increased time with patients; improved clinical practice; improved teaching skills; and an improved image of the practice. Problems with teaching were due to external factors such as lack of time and space and anxieties about adequacy of clinical cover while teaching. CONCLUSION: Teaching clinical skills can have a positive effect on the morale of general practitioner teachers as a result of contact with students and peers, as long as logistic and funding issues are adequately dealt with.

Anxiety↗
PubMed1975

Moral judgment and parental identification among children.

The relationship of moral judgment and parental identification was studied in 50 boys and 50 girls, all of whom were white, lower-middle-class children, aged 9 1/2 to 11 1/2 years. Two hypotheses were proposed: (1) that within each sex group, children with a higher-level parental identification attain a higher stage of moral judgment than children with a lower level of parental identification; and (2) that there are no sex differences in the stage of moral judgment attained by Ss from similar socioeconomic backgrounds. Ss were screened for socioeconomic status and age. Moral judgment was defined in terms of Piaget's "two moralities" of the child and measured by a structured interview that consisted of five subtests taken from Piaget. Parental identification was measured by means of a semantic space and differential technique, and Ss were grouped on the basis of low, medium and high levels of paternal and maternal identification. Results indicate that there are no significant sex differences in moral judgment. Within each sex group there is a clear positive relationship between high-level identification and a higher stage of moral judgment.

Age Factors↗
PubMedDate not supplied

[Deontological problems in pharmacology].

Scientific and technological progress in the XX century had a great impact on the development of pharmacology. Deontological problems are quite urgent in modern pharmacology. The philosophical, moral and ethical, social and economic concepts play a significant role in it. THe drugs in the developed countries are manufactured on a fairly large scale, medical service makes up an important part of the state expenses. The quality of the medical service affects the productive forces of the country. The modern highly active drugs have to be properly and skillfully employed. The drugs should be examined first in experiments on animals on then in clinics in accordance with the scientific and deontological principles.

Animals↗