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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↗

The Baylor experience in teaching medical ethics.

This paper describes the activities of the Center for Ethics, Medicine, and Public Issues, a joint project of Baylor College of Medicine, the Institute of Religion of the Texas Medical Center, and Rice University. The center focuses on the clinical teaching of medical ethics, collaborative teaching and research involving ethicists and clinicians, and the training of future practitioners in the field. Problems as well as achievements in each of these areas are discussed.

Bioethical Issues↗

Conflict of interest from a Romanian geneticist's perspective.

This paper examines Romanian bioethics regulations for biomedical sciences, looking in particular at the genetics area as a source for conflict of interest. The analysis is focused on the organizational level, national regulations, the sources for generating conflicts of interest, and management of conflicts. Modern biotechnology and gene technology are among the key technologies of the twenty-first century. The application of gene technology for medical and pharmaceutical purposes is widely accepted by society, but the same cannot be said of the development and application of gene technology in agriculture and food processing. Because the use of a technology in the production and processing of food is regarded more sceptically than in the production of biomedical products, there can be areas of conflict in many cases when communication is undertaken about gene technology in the agro-food sector. Ethical concerns play an important factor in this, but a society's attitude to a developing technology is an amalgam of many effects which are beyond ethics as such. This paper contains a study carried out by the author for the Romanian Association for Consumer Protection about the attitudes of consumers towards genetically modified (GM) foods. This study revealed that in Romania more than 98% of consumers did not know anything about GM foods and frequently were confused about the definitions of these terms. In conclusion, it is necessary to say that there is a low level of knowledge regarding biotechnology in Romania and this is an important reason why there is neither public acceptance of gene technology products nor is there a rejection.

Animal Experimentation↗

Medical ethics in the German Democratic Republic.

Medical ethics has been developing in the German Democratic Republic (GDR) since the 1970's on the basis of the traditional ethics of physicians and the socio-economic fundamentals of our socialist state. Medical care provided in the framework of Marxist-Leninist medical ethics is based on rationality and humanity.

Attitude to Death↗

New Danish law: human life begins at conception.

A new law has been passed by the Danish Parliament, establishing an ethical council. The law has caused considerable debate in Denmark, particularly because it states that 'the work of the council shall build on the basis that human life takes its beginning at the time of conception'.

Advisory Committees↗

Moving from codes of ethics to ethical relationships for midwifery practice.

This discussion examines the emergence of professional codes of ethics, influences that shape contemporary midwifery ethics, and the adequacy of codes to actualize values embedded in the midwifery ethics discourse. It considers the traditions of professional practice, the impact of institutionalization on health care, the application of a code of practice as a recent addition to those traditions, and the strengths and weaknesses of codes of ethics as models for ethical responses. That is, it sets out to articulate and deconstruct existing frames of ethical response. The ethics of strangers (normative theory and abstract principles) are rejected as inadequate, and the ethics of intimates (feminist-relational ethics) are proposed as a more adequate guide for well-woman centred midwifery practice.

Bioethical Issues↗

Making the morally relevant features explicit: a response to Carson Strong.

Carson Strong criticizes the application of my moral theory to bioethics cases. Some of his criticisms are due to my failure to make explicit that both the irrationality or rationality of a decision and the irrationality or rationality of the ranking of evils are part of morally relevant feature 3. Other criticisms are the result of his not using the two-step procedure in a sufficiently rigorous way. His claim that I come up with a wrong answer depends upon his incorrectly regarding a weakly justified violation as one that all impartial rational persons would agree was permitted, rather than as one about which rational persons disagree.

Bioethical Issues↗

"Ethical workup" guides clinical decision making.

Shared decision making, along with an explosion in costs and the alternatives associated with the technological revolution in medicine, has moved medical ethics from the status of a professional etiquette to that of a rigorous new discipline. A model for an "ethical workup," which medical professionals can use in healthcare setting, has four phases: expository, rational, volitional, and public. The expository phase includes medical factors, which are the most important for determining the right or wrong thing to do for a patient; ethical factors, which involve the interests, intuitions, and feelings of all those involved in a case; and socioeconomic factors, in which costs that create burdens on others become important, and in some cases decisive, considerations. The rational phase includes medical ethics categories, which determine the type of case one is facing; principles and moral guidelines, which justify decisions; and legal decisions and professional codes, which synthesize accepted wisdom about appropriate ethical behavior. The volitional phase includes ordering goods and values, which involves establishing priorities and weighing certain factors; ordering the principles, which reflect personal or institutional character and is influenced by religious and philosophical beliefs; and decision making, in which professionals consider a decision's impact on their profession, their facility, and themselves. The public phase includes making assumptions explicit, which means professionals should try to recognize underlying beliefs, admit their influence on preferred positions, and be sensitive to other perspectives and preferences; correlating initial feelings about right and wrong with the reasons supporting a decision; and organizing reasons for public communication.

Bioethical Issues↗