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PubMed1977

[Sexuality, psychiatric institution and normalization of the mentally ill.].

The author sets three objectives: to determine the status of sexuality in pedagogical institutions; to examine the means used to control sexuality; and to trace a global interpretation of the links between sexuality and the institution. The development of the asylum saw the appearance of moral treatment which sought to promote certain social values and to repress those behaviours such as sexual activity which opposed the fundamental bourgeois social virtues. These notions were presented in the guise of an ethical standard and a normative scientific current (eg. sexuality is a symptom to be eliminated; it is a cause of insanity.) Now, while no longer attacked in the institution, sexuality is nonetheless perceived as lacking any inherent value and is worthwhile only in terms of its therapeutic utility* The same phenomenon is observable in the school. To illustrate the second point the author analyses the phenomenon of masturbation. The 18th century saw masturbation cited as the cause of insanity and numerous physical disorders. Viewed as a diversion of the child's natural forms, and as bringing into question the substitutive educational system, masturbation was excluded from the school of the period. At present, masturbation is permitted but there is no recognition of the child's free enjoyment. Instead a system of exercises has been developped which permit the child greater body control. This masturbation has become a therapeutic technique to obtain a normative level of pleasure.Touching on the third point, the author states that society regulates sexual life with a complex normative system in order to incorporate it within an identification with sexual institutions and no longer with judicial sanctions. Applying this analysis to the situation of the mentally ill, the author argues that the latter's sexuality is socially normalized by the definition and utilisation of illegal areas where it's actualization is permitted.

English Abstract↗
PubMed2005

The ethical education of ophthalmology residents: an experiment.

PURPOSE: To demonstrate the effect of ethics education on a resident's ability to answer questions that relate to moral dilemmas and on the clinical evaluations of residents by faculty. METHODS: The curriculum for the ethics education that was used for this study was designed by the author and consisted of 10 lectures of 1.5 hours each. Five residencies were included in the project. One residency received one lecture, two residencies received three lectures, and two residencies received 10 lectures. To evaluate the moral skills of the residents at the beginning of the course and at the end, the residents were given the Defining Issues Test (DIT-2) developed by James Rest, which involves answering standardized questions about four moral dilemmas. Faculty evaluations were completed before and after the ethics lectures were given. At the beginning of the ethics course, each resident was given a social survey that was designed to assess participation in community, religious, political, and societal activities as well as attitudes about these activities. All residents were also asked demographic information, including their age, gender, and year of residency. RESULTS: The results of the DIT-2 taken before and after the ethics lectures were compared. No correlations were found in faculty evaluations of clinical performance of the residents before and after the course (P = .052). Associations between DIT-2 scores and questions on community and religion in the social survey were noted. CONCLUSION: The finding that the effect of an ethics course on residents' ability to answer moral dilemmas did not achieve statistical significance should be accepted with the understanding that this was a first attempt at standardization of many variables, especially the format of the curriculum and materials used. The use of faculty evaluations to assess clinical performance needs to be standardized, and the faculty members need additional training to ensure validity of the results. The social survey was also the first attempt to assess an association between a resident's response to moral dilemmas, attending evaluations, and residents' opinions that relate to community, society, politics, and religion.

Clinical Competence↗
PubMed2002

Germline engineering: the moral challenges.

Not only is the use of germline genetic engineering likely in the long run to be inevitable, there are also no convincing secular moral grounds to forbid this technology in principle. Instead, the general secular moral constraints on the use of germline genetic engineering are either procedural or without predetermined content. Nor can one develop a coherent distinction between eliminating disease and enhancing human abilities. At best, in secular morality one can establish the principle to proceed with care, though the invocation of the precautionary principle argues as much in favor of the development of germline genetic engineering as against its use. Because germline genetic engineering, by eliminating certain genetic defects, offers the prospect of decreasing human suffering and decreasing the use of prenatal diagnosis and abortion, there is an obligation, all else being equal, to change the human genome. In a post-modern world, humans face the challenge of directing their own evolution, although they share no common understanding of human destiny and purpose. Such understandings, though available within religious contexts, are not available to secular bioethics.

Bioethics↗
PubMed2005

Human embryos in the original position?

Two different discussions in John Rawls' A Theory of Justice lead naturally to a rather conservative position on the moral status of the human embryo. When discussing paternalism, he claims that the parties in the original position would seek to protect themselves in case they end up as incapacitated or undeveloped human beings when the veil of ignorance is lifted. Since human embryos are examples of such beings, the parties in the original position would seek to protect themselves from their embryonic stages onward. When discussing the basis of equality, Rawls claims that the parties in the original position would guarantee basic rights for all those with the capacity to take part in this original position. To guarantee the basic rights of infants and young children, he goes on to interpret this capacity as a "potentiality that is ordinarily realized in due course." Since human embryos have this potentiality, they too should have basic rights.

Bioethics↗
PubMed1992

Policy arguments in a public church: Catholic social ethics and bioethics.

This paper is an analysis of the relationship of social ethics and bioethics in Roman Catholic theology. The argument of the paper is that the character of both Catholic moral theology and ecclesiology shape the broadly defined interest of the church in bioethics. The paper examines the common elements of social ethics and bioethics in Catholic teaching, describes how ecclesiology shapes Catholic public policy and uses the examples of abortion and health care to illustrate the relationship of Catholic social thought and bioethics. In developing the relationship of these two dimensions of Catholic moral argument the article highlights how the appeal to natural law categories differs in social ethics and bioethics and how the two topics are received differently in the theological community. It also seeks to illustrate how the premises of Catholic social ethics remain central to public positions taken on bioethics.

Abortion, Induced↗
PubMed1991

Medical ethics committees in Hungary.

Hungarian medical ethics committees were established at the end of the 1950s. They came into being on the Communist Party's initiative. They could hardly be called "interdisciplinary" since their membership was made up of high-ranking physicians and a few head nurses. Their main task was to counter the practice of "tipping." Medical ethics and "tipping" were practically synonymous. These committees did not confront or try to resolve ethical problems concerning such issues as patient rights, informed consent, refusal of treatment, human experimentation, abortion, etc. These committees - whether it is believable or not - belonged to the Physicians Health Workers Trade Union. They were under the guidance and supervision of this social organization. The public was excluded from their meetings, and the committees' duty was to follow the health laws which were supposed to have given excellent ethical guidance. Even in a textbook on medical ethics used at one of the medical universities, written by a psychiatrist, the health laws were presented and explained back and forth. Of the 88 pages only 23 dealt with morals in general and the Hippocratic tradition. The Hungarian National Health Service as well as its medical ethics committees are similar in many respects to the Soviet and Eastern European countries' health care system and ethics committees. Since radical changes have taken place in these so-called "former" communist countries, it can only be hoped that these committees will eventually develop into groups who will deal directly with the moral questions or medicine and health care.

Communism↗
PubMed1994

A century and a half of psychiatric rehabilitation in the United States.

Psychiatric rehabilitation, which is aimed at helping persons who have long-term mental illness to develop their capacities to the fullest possible extent, has been an integral part of psychiatric treatment in the U.S. since the beginnings of moral treatment in the early 19th century. The author outlines broad historical developments and prominent current modalities and models of psychiatric rehabilitation, including the introduction of family care, the day hospital, social skills training, psychoeducation, and the Fountain House model. He discusses the conceptual underpinnings of the field, such as the need to work with the healthy part of the patient and changes in views on vocational rehabilitation. Current concerns include the possibility of overselling rehabilitation and of misusing the term "recovery."

Day Care, Medical↗
PubMed2005

Identity and moral responsibility of healthcare organizations.

In this paper the moral responsibility of a Healthcare Organization (HCO) is conceived as an inextricable aspect of the identity of the HCO. We attempt to show that by exploring this relation a more profound insight in moral responsibility can be gained. Referring to Charles Taylor we explore the meaning of the concept of identity. It consists of three interdependent dimensions: a moral, a dialogical, and a narrative one. In section two we develop some additional arguments to apply his concept of personal identity to organizations. The final section works out the relationship of three dimensions of identity to some actual issues in contemporary HCOs: the tension between care and justice, the importance of dialogues about the diversity of goods, and the relevance of becoming familiar with the life-story of the HCO. Identity of an HCO is established and developed in commitments to and identification with certain goods that are central for a HCO. However, many of these goods are interwoven with everyday practices and policies. Therefore, moral responsibility asks for articulation of goods that often stay implicit and should not be reduced to a merely procedural approach. However difficult this articulation may be, if it is not tried at all HCOs run the risk of drifting away from their very identity as healthcare institutions: to offer care to patients and to do this in accordance with demands of social justice.

Delivery of Health Care↗
PubMed1998

A four-level clinical ladder.

A clinical ladder identifies nursing competence, provides recognition and financial reward for bedside nursing practice, promotes responsibility, accountability, project and committee involvement, and enhances self-worth and positive morale. Because of the program's blend of skill levels, it develops a climate for clinical learning while promoting professional growth and confidence.

Career Mobility↗
PubMed1986

Ethical dilemmas in workplace health promotion.

In less than a decade, workplace health promotion programs designed to promote employee health and help reduce the high cost of health insurance premiums paid by business and industry have proliferated. Notwithstanding the latent benefits and cost savings that corporate management expects to gain from the investment in such programs, it is argued that workplace health promotion is not without potential misuse and that its goals and methods ought not to be above ethical scrutiny. Drawing on earlier work, we discuss how workplace health promotion may pose ethical problems related to social justice, protection of privacy, and social control. The attendant moral dilemmas for the professional whose responsibility it is to develop and implement such programs are also presented.

Ethics↗
PubMed2002

Assessing homeland chemical hazards outside the military gates: industrial hazard threat assessments for department of defense installations.

As part of comprehensive joint medical surveillance measures outlined by the Department of Defense, the US Army Center for Health Promotion and Preventive Medicine (USACHPPM) is beginning to assess environmental health threats to continental US military installations. A common theme in comprehensive joint medical surveillance, in support of Force Health Protection, is the identification and assessment of potential environmental health hazards, and the evaluation and documentation of actual exposures in both a continental US and outside a continental US setting. For the continental US assessments, the USACHPPM has utilized the US Environmental Protection Agency (EPA) database for risk management plans in accordance with Public Law 106-40, and the toxic release inventory database, in a state-of the art geographic information systems based program, termed the Consequence Assessment and Management Tool Set, or CATS, for assessing homeland industrial chemical hazards outside the military gates. As an example, the US EPA toxic release inventory and risk management plans databases are queried to determine the types and locations of industries surrounding a continental US military installation. Contaminants of concern are then ranked with respect to known toxicological and physical hazards, where they are then subject to applicable downwind hazard simulations using applicable meteorological and climatological data sets. The composite downwind hazard areas are mapped in relation to emergency response planning guidelines (ERPG), which were developed by the American Industrial Hygiene Association to assist emergency response personnel planning for catastrophic chemical releases. In addition, other geographic referenced data such as transportation routes, satellite imagery and population data are included in the operational, equipment, and morale risk assessment and management process. These techniques have been developed to assist military medical planners and operations personnel in determining the industrial hazards, vulnerability assessments and health risk assessments to continental United States military installations. These techniques and procedures support the Department of Defense Force Protection measures, which provides awareness of a terrorism threat, appropriate measures to prevent terrorist attacks and mitigate terrorism's effects in the event that preventive measures are ineffective.

Data Collection↗
PubMed2004

Law and the sources of morality.

This paper argues that morality is a product of basic human psychological characteristics shaped over prehistorical and historical time by diachronic dialectical transactions between what individuals do and what they are supposed to do in the culture in which they live. Some principles are pancultural: individuals are motivated to look after their own interests, to be cooperative and kind to other group members and to look after their children. The moral precepts of every society are based on these principles, but may differ according to the vicissitudes that the society has experienced. Thus the basic principles can be seen as absolute; the precepts based on them may be specific to particular societies. Moral precepts, and the laws derived from them, are mostly such as to maintain the cohesion of the society, but some have been formulated to further the interests of those in power. The evidence suggests that laws have been developed, by common consent or by rulers, from generally accepted moral intuitions. In general, legal systems have been formulated to deal with the more extreme infringements of moral codes. Morality prescribes how people should behave; the law is concerned with how they should not. New laws, if not imposed by force, must generally be in tune with public conceptions of morality.

Behavior↗
PubMed1994

The forms and limits of medical ethics.

As medical ethics has evolved over the past several decades, it has come to be regarded as a domain of applied ethics, that is, the application of a rationally based, philosophical theory to moral problems in health care. But an array of difficulties arise in the attempt to apply general moral theories or norms to concrete problems, difficulties that expose the incompleteness and indeterminacy of philosophical moral theory. The doubtful ability of applied ethics to be practically helpful has led to the development of two main competitors. One is the attempt to reprise and rehabilitate the tradition of moral casuistry, which focuses on the analysis of specific cases rather than on the defense and application of theories and norms. The second is the search for moral insight and guidance in narratives or stories. These alternatives suffer from some of the same difficulties that plague applied ethics, however. Another trend in medical ethics rejects the theoretical preoccupation of applied ethics in favour of contextualism--an insistence on situating moral problems in institutional and organizational structures and in social and cultural backgrounds. Social science investigations of medical ethics pay attention to the former, while feminist critiques of medical ethics are concerned with exposing and eradicating cultural biases against women. Contemporary work in medical ethics is diverse, but these manifold approaches hold out the promise of improving our understanding of morality as a truly practical enterprise.

Ethics, Medical↗
PubMed2004

Biotechnology--a challenge to the patent system.

Biotechnology inventions raise both moral and technical dilemmas. The patent system was developed to protect inventions such as the Spinning Jenny and Stevenson's Rocket. This article looks at how this long-established and slow-moving system is coping with a modern, highly sophisticated and swiftly moving field of science. It looks at specific areas of the technology--research tools and claims that reach to the products produced using those tools, genes, stem cells and bioinformatics. It concludes that the system is having to adapt, but that it will cope.

Biomedical Research↗
PubMedDate not supplied

Good clinical practice, a transparent way of life. A review.

Investigators are regarded as central to the concept of clinical trials. Apart from bearing scientific responsibility, they will be confronted with a great number of ethical dilemma's concerning, amongst others, the justification and design of the trial, subject selection and informed consent, and presentation of the trial results. The ethical principles of biomedical research should be observed in accordance with a consistent moral code. The moral code of Good Clinical Practice (GCP) was developed in order to rule out inconsistencies. The principal tenets are that clinical trials should be good science, verifiable, monitored, well documented, and that they comply with the highest ethical standards. The principles of GCP are the protection of the rights of human subjects, integrity and reproducibility of data, and transparency of conduct.

Clinical Trials as Topic↗