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Building bridges: teaching ward-based ethics.

Ethics has traditionally been taught in the 'ivory towers' of academia. Recent developments and reforms in nurse education have given ethics a prominent position in most curricula. However, the vast majority of ethics teaching continues to take place in academic departments. This approach fuels the practitioner's views that nursing is a pragmatic activity whilst ethics is a cognitive endeavour; such perspectives entrench ethics firmly in the traditional gap between theory and practice. The focus of this paper presents an argument that the teaching of ethics must be versed in clinical reality if bridges are ever to be built and the theory-practice gap crossed.

Bioethical Issues↗

The need for scientists and judges to work together: regarding a new European network.

Is it always true to say that science is, by definition, universal whilst laws and the courts which apply them are a classic state and national expression? Yes and no. In recent years a new scenario has opened all over the world. Courts intervene more and more in disputes on matters related to scientific procedures in the biological field. In doing so the courts' decisions are affected by scientific issues and ways of reasoning and, on the other hand, affect the scientific field and its way of reasoning. While the old matter of bioethics was still alive and while judges were improving their skill in dealing with hard matters, like refusal of medical treatments, abortion, euthanasia et cetera, a new challenge appeared on the horizon, the challenge of biological sciences, and especially of the most troubled field of human genetics. A completely new awareness is developing among judges that they belong to an international judiciary community, as informal as it is real. Such a community is, even at an embryonic stage, sufficiently universal to be able to come together with the international scientific community. The authors maintain we are in urgent need for new interaction between judges and scientists and of new international means in the light of such cooperation. Judges and jurists need to become better acquainted with scientific questions and learn to exchange ideas with scientists. They also need to set themselves against the latters' conceptual systems and be willing to put their own up for discussion. A European Network for Life Sciences, Health and the Courts is taking its first steps, and judges and scientists are working side by side to tackle the new challenges. The provisional headquarters are located at the University of Pavia (I), Laboratorio di Biologia dello Sviluppo and Collegio Ghislieri (e-mail: enlsc@unipv.it). ENLSC activity is inspired by the following idea: to be against science is as much antiscientific as to be acritically pro-science.

Bioethical Issues↗

Continuing the dialogue: a reply to Bernard Gert.

Continuing the dialogue begun in the March 2006 issue of the Kennedy Institute of Ethics Journal, I suggest that Bernard Gert's response to my paper does not adequately address the criticisms I make of his theory's application to bioethics cases.

Bioethical Issues↗

A methodology for making ethical health care decisions.

Medical professionals have no alternative to using an ethical methodology in their practice if they are to retain public confidence and resist public pressure for more legal oversight of medical practice. The method presented here for making ethical decisions points toward objectivity, is rigorous, and aims at publicly defensible choices. It involves four major stages: Expository, descriptive phase. The decision maker investigates medical and human factors and then identifies the involved parties' interests and feelings. Rational, analytic phase. The professional identifies medical ethics categories, conceptual distinctions (e.g., direct and indirect killing), principles and moral guidelines, and legal decisions or professional codes, as they apply to the situation. Volitional, decisional phase. The person then turns to making a defensible decision. This involves ordering goods and values, choosing the governing principles, and finally making a decision that considers the effect on all concerned. Public, reflective phase. The professional defends choices by making assumptions explicit, correlating reasons and feelings, and organizing reasons for public communication.

Bioethical Issues↗

A data-generated basis for medical ethics education: categorizing issues experienced by students during clinical training.

PURPOSE: To use issues identified by students in order to establish an experience- and evidence-based approach to medical ethics education. METHOD: A total of 628 sophomore and senior students at the State University of New York at Buffalo School of Medicine and Biomedical Sciences were asked to identify incidents during their clinical training that had raised ethical concerns. The sophomores were surveyed during two time periods: 1979-80, and 1991-92 and 1992-93; the seniors were surveyed in 1991-92 and 1992-93. Responses were analyzed and categorized through content analysis. RESULTS: In all, 249 students (45% of the sophomores and 20% of the seniors) responded. The categories of issues identified were professional norms, limits of intervention, defensive shielding of professional colleagues, respect toward patients, communication, and student boundaries (situations where the student feels uncomfortable). The most frequently reported incidents reflected the students' perceptions of lapses in level of care (under- or over-treatment), communication, respect toward patients, and maintenance of professional norms. The seniors and the 1979-80 sophomores reported respect toward patients as an issue less often than did the 1991-92 and 1992-93 sophomores. The seniors most often identified concerns raised over limits of intervention and resource allocation. CONCLUSION: The differences between the responses of the sophomores and seniors tend to support other research suggesting a retardation of moral sensitivity in the course of medical education. It may be that clinical teaching and faculty behavior model values at odds with what is taught in the classroom. Ethics education should focus on issues relevant to students' experience.

Ambulatory Care↗

Genetic testing for hereditary cancers: the impact of gender on interest, uptake and ethical considerations.

Genetic testing promises earlier intervention and more successful outcomes for individuals at risk for hereditary breast/ovarian and colorectal cancer. Research shows that gender influences health and access to health care services. In this paper, we review theoretical issues of gender, and research outcomes, in relation to genetic testing for hereditary cancers. We argue that integrating a gender analysis into assessment of new technologies and health programs is necessary to improve appropriateness, accessibility and effectiveness. Attention to gender is also critical to developing a deeper understanding of the ethical issues (both benefits and harms) raised by new genetic technologies.

Bioethical Issues↗

Examining ethics in practice: health service professionals' evaluations of in-hospital ethics seminars.

This article reviews practitioners' evaluations of in-hospital ethics seminars. A qualitative study included 11 innovative in-hospital ethics seminars, preceded and followed by interviews with most participants. The settings were obstetric, neonatal and haematology units in a teaching hospital and a district general hospital in England. Fifty-six health service staff in obstetric, neonatal, haematology, and related community and management services participated; 12 attended two seminars, giving a total of 68 attendances and 59 follow-up evaluation interviews. The 11 seminars facilitated by an ethicist addressed the key local concerns of staff about the social and ethical consequences of advances in genetics and their impact on professional policies and practice. Seminar agendas were drawn from prior interviews with 70 staff members. During evaluation interviews, participants commented on general aspects that they had enjoyed, how the sessions could be improved, timing, the mix of participants, the quality of the facilitation, whether sessions should be more challenging, after-effects of sessions, and interest in attending seminars and contacting the ethicist in future. Participants valued the increased interprofessional understanding and coherent discussion of many pressing issues that addressed important though seldom discussed ethical questions. The seminars worked well in the different hospitals and specialties.

Bioethical Issues↗

Life and death matters: losing a sense of the value of human beings.

The essay combines a specific and a more general theme. In attacking 'the doctrine of the sanctity of human life' Singer takes himself thereby to be opposing the conviction that human life has special value. I argue that this conviction goes deep in our lives in many ways that do not depend on what Singer identifies as central to that 'doctrine', and that his attack therefore misses its main target. I argue more generally that Singer's own moral philosophy affords only an impoverished and distorted sense of the value of human life and human beings. In purporting to dig below the supposedly illusion-ridden surface of our thinking about value, Singer in fact often leads us away from the robust terrain of our lived experience into rhetorical, and sometimes brutal, fantasy.

Australia↗