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PubMed1994

Ethics decision-making in Australian hospitals.

OBJECTIVE: To describe the methods used to resolve ethical issues in hospitals throughout Australia. DESIGN: A descriptive study from data collected by a questionnaire survey of Australian public and private hospitals. PARTICIPANTS: Hospital administrators and employees nominated by hospital administrators. RESULTS: Completed questionnaires were received from 739 (74%) hospitals. Methods used to resolve ethical issues included personal reflection, discussion between health professionals and discussion between health professionals and patients. A variety of committees were identified as having some role in the discussion of ethical issues, but only a small number of hospitals had established ethics committees. CONCLUSION: Doctor-patient interaction and discussion between practitioners are the most common methods used to resolve ethical issues. Various committees are also used and, of these, ethics committees are not the most commonly consulted.

Australia↗
PubMed1994

Institutional ethics committees and the shield of immunity.

Institutional ethics committees have been hailed as a good resource for physicians confronting complex ethical issues in patient care. Physicians may seek ethics committee consultations to receive impartial assistance in decision making, to resolve conflicts, and to avoid cumbersome court procedures and unwieldy litigation. The endorsement of ethics committees by the President's Commission, the American Hospital Association, the American Medical Association, and the Department of Health and Human Services, along with recent state legislation governing committees in Maryland, New Jersey, and Hawaii, raises questions about the proper scope and authority of ethics committees. We examined the accountability of institutional ethics committees and argue against immunity-conferring statutes that shield physicians who follow a committee's advice from civil and criminal liability.

Decision Making, Organizational↗
PubMed2005

Ethics manual: fifth edition.

Medicine, law, and social values are not static. Reexamining the ethical tenets of medical practice and their application in new circumstances is a necessary exercise. The fifth edition of the College's Ethics Manual covers emerging issues in medical ethics and revisits old ones. It reflects on many of the ethical tensions faced by internists and their patients and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared obligations and duties of the medical profession.

Biomedical Research↗
PubMed1992

Ethics committees in Japanese medical schools.

The present features and functions of ethics committees in 80 Japanese medical schools were surveyed by employing questionnaires. Seventy-nine schools had already established committees on each campus (however, the ethics committee at Kitasato Medical University was formally established after the completion of this survey). The major role of Japanese ethics committees may be said roughly to correspond to that of Institutional Review Boards (IRB) in the U.S., although ethics committees have other functions as well. Among the ethics committees' many problems, two significant weaknesses should be underscored. The first is the inappropriate composition of the membership of the committees: more non-campus members, younger professionals, and women should be invited to participate. The second concern is the committees' essentially closed review process: this process has not been adequately open to the public even in cases in which the issue of the patient's confidentiality does not arise. However, several schools are now preparing to open their meetings to non-members and this policy should improve the present situation. It is fortunate, however, that the ethics committees in Japan's medical schools were established by members from each campus and not as a response to national directives or legislation.

Community Participation↗
PubMed1991

Nursing ethics: current state of the art.

... The essays in this issue of the Journal highlight the types of insights that nursing ethics brings to health care ethics, in general, and attempt to address questions about the adequacy of the conceptual and theoretical foundations of bioethics for a practice discipline like nursing. The essays are written by nurses and non-nurses and bring a surprising balance to the discussion of important issues in nursing ethics from several perspectives. The essays do not represent the full scope of philosophical thought and normative judgements in nursing ethics at the present time, but they do provide a view of nursing ethics through the lens of nursing ethics research, past and present. [Introductions follow to essays by Joy H. Penticuff, Joan Liaschenko and Anne J. Davis, Nancy S. Jecker and Donnie J. Self, Betty J. Winslow and Gerald R. Winslow, Robert J. Connelly, Patricia A. Roth and Janet K. Harrison, and Kevin Wildes].

Aged↗
PubMed1987

Ethics and cancer: a survey of the literature.

We have identified 776 articles, books, book chapters, and letters published since 1945 dealing with both ethics and cancer. Of this number, 473 (61%) were discussions in medical and scientific journal articles; they were published in 188 journals, demonstrating the scattered nature of this literature. The recent increase of writing in ethics and cancer has been dramatic, the median year of publication being 1979. Although the majority of articles addressed more than one ethical issue, the most common topic was whether patients should be told the truth about their diagnosis and prognosis (found in 241 of the items identified). The ethics of cancer research has only recently assumed importance in the medical literature, the median year of publication being 1981. The great interest in the ethics of cancer research is evident in that 255 (33%) of the 776 items dealt with research, 104 of these focusing on randomized trials. Besides truth-telling and research, 78 other issues are being discussed, among them informed consent for adults (119 items), the physician's responsibility for psychologic management of patients (79 items) and their families (68 items), responsibilities of nurses (58 items), the use and testing of laetrile (55 items), and euthanasia (38 items). Surgery was discussed in 90 items, pediatrics in 71, and radiotherapy in 44. The authors of this literature relied upon at least nine identifiable ethical positions. Only a limited number of authors were aware of the philosophic literature and of the complexities inherent in defining such terms as "benefit," "harm," and "quality of life."

Behavioral Research↗
PubMed2006

Towards a strong virtue ethics for nursing practice.

Illness creates a range of negative emotions in patients including anxiety, fear, powerlessness, and vulnerability. There is much debate on the 'therapeutic' or 'helping' nurse-patient relationship. However, despite the current agenda regarding patient-centred care, the literature concerning the development of good interpersonal responses and the view that a satisfactory nursing ethics should focus on persons and character traits rather than actions, nursing ethics is dominated by the traditional obligation, act-centred theories such as consequentialism and deontology. I critically examine these theories and the role of duty-based notions in both general ethics and nursing practice. Because of well-established flaws, I conclude that obligation-based moral theories are incomplete and inadequate for nursing practice. I examine the work of Hursthouse on virtue ethics' action guidance and the v-rules. I argue that the moral virtues and a strong (action-guiding) version of virtue ethics provide a plausible and viable alternative for nursing practice. I develop an account of a virtue-based helping relationship and a virtue-based approach to nursing. The latter is characterized by three features: (1) exercising the moral virtues such as compassion; (2) using judgement; and (3) using moral wisdom, understood to include at least moral perception, moral sensitivity, and moral imagination. Merits and problems of the virtue-based approach are examined. I relate the work of MacIntyre to nursing and I conceive nursing as a practice: nurses who exercise the virtues and seek the internal goods help to sustain the practice of nursing and thus prevent the marginalization of the virtues. The strong practice-based version of virtue ethics proposed is context-dependent, particularist, and relational. Several areas for future philosophical inquiry and empirical nursing research are suggested to develop this account yet further.

Attitude to Health↗
PubMed2006

Hospital based ethics, current situation in France: between "Espaces" and committees.

Unlike research ethics committees, which were created in 1988, the number of functioning hospital based ethical organisations in France, such as clinical ethics committees, is unknown. The objectives of such structures are diverse. A recent law created regional ethical forums, the objectives of which are education, debate, and research in relation to healthcare ethics. This paper discusses the current situation in France and the possible evolution and conflicts induced by this law. The creation of official healthcare ethics structures raises several issues.

Decision Making↗
PubMed1999

In defence of medical ethics.

A number of recent publications by the philosopher David Seedhouse are discussed. Although medicine is an eminently ethical enterprise, the technical and ethical aspects of health care practices can be distinguished, therefore justifying the existence of medical ethics and its teaching as a specific part of every medical curriculum. The goal of teaching medical ethics is to make health care practitioners aware of the essential ethical aspects of their work. Furthermore, the contention that rational bioethics is a fruitless enterprise because it analyses non-rational social events seems neither theoretically tenable nor to be borne out by actual practice. Medical ethics in particular and bioethics in general, constitute a field of expertise that must make itself understandable and convincing to relevant audiences in health care.

Bioethics↗
PubMed1983

Research on human subjects: Australian ethics committees take tentative steps.

Australian medical researchers are attempting to formulate a response to some of the ethical issues in medical research. The debate over the in vitro fertilisation programme has highlighted some community concern about research ethics and the role of the ethics committee. While very little is known about Australian ethics committees, it appears that a two-tiered approach comprising both ethical review and scientific review is acceptable to the research community. However, this approach plus some problems with the nature of informed consent, begs the question of the role of these committees in the broader context of medical research in the community. Important aspects of a seminar for members of hospital ethics committees are reported.

Australia↗
PubMed1996

The role of virtue ethics in psychiatric nursing.

The main purpose of this article is to discuss the place of the ethics of virtues and character in nursing and health care in general, and in psychiatric nursing in particular. To attain this goal, the relationship between the ethics of duty (i.e. rule based ethics) and the ethics of virtue and character will be clarified in order to defend our main hypothesis that these two types of ethics should complement each other, since both are necessary but neither by itself is sufficient for nursing. This means that any applied ethics, as in nursing, should consider the importance of the agent's moral character. To support our arguments, we shall use cases from the empirical reality of psychiatric and mental health care.

Character↗
PubMed2003

A study of the ethical sensitivity of physicians in Turkey.

In order to prepare bioethics and clinical ethics courses for clinicians in Turkey, we needed to know the attitudes of physicians when placed in ethically difficult care situations. We presented four cases to 207 physicians who are members of the Physicians' Association in Kocaeli, Turkey. Depending on the decisions they made in each case, we determined whether they were aware of the ethical aspects of the cases and the principles they chose as a basis for their decisions. We aimed to gain information about their ethical tendencies and moral sensitivity. A small number of physicians stated that they would 'show respect for a patient's living will' in the first case, but more stated that they would 'let the patient refuse the treatment' in the second. In the third case, where medical confidentiality was the significant ethical issue, most of the physicians said that they would act in order to maintain confidentiality. For the last case, more than half the physicians chose to 'tell the truth' to the patient. The paternalism shown in the doctors' decisions on the first two cases was no longer observed in those made for the last two cases. We concluded that the physicians who participated in our study have low sensitivity to living wills (or advance directives) and patients refusing treatment. However, when issues of medical confidentiality and truth-telling are concerned, they take care to protect the autonomy of the individual an are relatively more aware of the ethical aspects of these cases.

Adult↗
PubMed1991

A systems approach to ethical problems.

Codes of professional ethics and cases designed to teach ethical decision making are written for individual professionals and ignore the systems level of analysis. They typically employ a lineal view of causality and overvalue placement of blame as a component of ethical problem solving. This article takes a systems approach to ethical problems and identifies aspects of systems that promote or impede ethical decision making. Psychological abuse of children is used as an example of a problem requiring a coordinated, systemic response to ethical issues such as autonomy, privacy, and confidentiality.

Child↗
PubMed1985

Institutional ethics committees: what, how, and why.

Because institutional ethics committees can reduce the risk of tragic mistakes by clinical decision makers and provide interdisciplinary input into decisions, they may be a requirement for all hospitals by the end of this decade. Ethics committees should not in themselves be decision-making entities, however. Their proper functions are to advise physicians, patients, and families; facilitate communication; provide in-house education; assist in policy formulation; mediate between ethical theory and concrete medical judgments as well as between the institution's values and those of the larger community; provide support for those involved in painful decisions; and minimize the institution's vulnerability to litigation. Although ethics committees have been endorsed by federal agencies, a presidential commission, and numerous health care organizations, several obstacles remain. Physicians are afraid that their decisional prerogatives will be wrested from them; a committee could become a rubber-stamp organ for one powerful member, one special-interest group, or one perspective, confidentiality policies would have to be extended to nonhospital committee members; and medical personnel feel threatened by the exposure of errors or bad judgment. Nonetheless, ethics committees are a promising structural adjustment to ethical pressures exerted by new technology and the growing number of health care disciplines.

Ethical Review↗
PubMed2003

[Time for professionalising the system of medical ethics review in the Netherlands].

In two recent papers, a radical change of the review system for medical ethics review committees was proposed. The current systems in Great Britain and Australia were described and it was suggested that the extended roles and responsibilities of the medical ethics review committees could not be fulfilled by the present committees. It was proposed that professional medical ethics committees be established with full time members who would receive an appropriate honorarium. The Netherlands has a decentralised system of medical ethics review, which is based on peer review. A radical change of the current system of medical ethics review is not warranted. There is however a need for further improvements to the current peer-review system. An important aspect of this improvement is an honorarium for the members as well as a budget for training and for the adequate scientific and administrative support of the committee by a secretariat. The fees levied for reviewing each protocol could in part finance the committee and its secretariat. However, these fees will probably not meet all of the costs. Therefore the centres involved in medical research should consider supporting their committees. It is in their interest to demonstrate their wish to protect those persons who consent to participate as research subjects. This will maintain the confidence of both the public and future participants in clinical trials. Furthermore, an efficient and adequate system of ethical review will support a balanced view towards medical research with human subjects and will also contribute to a positive image of the centre also as an attractive environment for medical professionals.

Ethics Committees↗
PubMed1995

Ethical principles in health data protection.

Ethics, especially medical ethics, is of a great importance in health data protection, and in medical informatics field ethical principles have great importance in confidentiality, security, and access to patient records. This is not as simple problem as it looks in the first sight, and-in that context-it is significant that many jurisdictions have drafted laws in this regard. As medical informatics has been developed, this ethical problem is becoming very important for medical informatics. Many efforts to make fundamental principles "according to which data protection and access to official information could be reconciled" are made. The principles described in this paper are independent of any process, as they are based on ethical principles. It avoids any kind of conflict or misunderstandings. They can be a base for making of an ethical code for informatics in health care delivery. These principles are independent of any particular "laws", and they can serve as to establish uniformity of standards in medical informatics.

Confidentiality↗
PubMedDate not supplied

Ethical review of multi-centre research: a survey of multi-centre researchers in the South Thames region.

OBJECTIVE: To generate baseline data about the experiences of researchers applying to five or more local research ethics committees (LRECs) for ethical review. The new multi-centre review system will be compared with these data. DESIGN: Ninety-seven researchers, whose status as multicentre researchers was unclear, were identified from various sources in the South Thames Region. They were each sent a questionnaire asking for their views on the substance of ethical review and their experiences of the process of ethical review. RESULTS: Of the completed questionnaires, 24 fitted the multicentre criteria of applying to five or more LRECs. Responses showed dissatisfaction with LRECs' treatment of the scientific aspects of research, but satisfaction with aspects relating to consent and protection of patients' welfare. Respondents experienced great difficulty in the administration of the process of ethical review. CONCLUSIONS: The need for a new system of ethical review for multi-centre research is beyond doubt. It remains to be seen whether it will be an improvement.

England↗
PubMed2000

Translational ethics: a perspective for the new millennium.

Modern medical care is increasingly dependent on the application of science to clinical practice, which occurs through clinical or translational research. We propose the concept of translational ethics, which incorporates the contributions of research codes of ethics that involve the protection of human subjects into the ethics of clinical practice. The modern research environment, which has contributed the scientific tools of modern medicine, has also framed the ethical environment in which medicine is practiced. The single most important contribution of research codes for protection of human research subjects to clinical practice is the doctrine of informed consent. Translational ethics, based on autonomy and informed consent, progresses beyond the narrow interpretation of those 2 concepts. It requires consensual understanding of a spectrum of clinical interventions that are increasingly complicated. Translational ethics helps navigate the ethical ramifications of technological and scientific advances that will increasingly challenge the corporate-oriented health system in the new millennium.

Ethics, Medical↗