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[Ethical considerations on animal experiments]

The current state of the controversy on experimentation with animals is presented in overview in three chapters. The authors define 4 categories of personal involvement. There is the wholehearted "advocate", for whom experiments using animals are always necessary and who will only acknowledge well-founded scientific evidence against using them; next, the "defender" of animal experiments, who accepts that ethical evaluation of each experiment is necessary; then the "critic", who will challenge the majority of experiments for either ethical or scientific reasons; finally, there is the "opponent" of animal experiments, who for ethical reasons rejects animal experiments totally. Following this categorisation, one author (Scharmann) counts himself as "defender", while the other (Teutsch) is an "opponent" of animal experimentation. In the second chapter, guidelines are given for ethical evaluations based on the expected gain for man and animal on the one hand and the burden on the experimental animals on the other hand. In the third chapter, which deals with the outcome of deliberations on gain versus burden, each author presents his views separately, depending on his own conclusions. Scharmann takes into account the principle of "closeness", which allows him to find justification for certain animal experiments, because the suffering human is closer to him than the suffering animal. In basic scientific research, Scharmann can only accept experiments with a small burden of discomfort. On the other hand, for ethical reasons, Teutsch rejects experiments with animals even if there is a strong likelihood of an advantage for the human being. He explains this by claiming that there is no ethically relevant reason for treating animals any differently from humans. The fact that animals lack certain qualities, such as abstract thought, self reflection, or a sense of morality, cannot be regarded as being an ethically relevant argument for treating animals differently.

Journal Article↗

[Man and his fellow-creatures under ethical aspects]

Since in 1995, ALTEX offered the literary report a kind of journalistic home and - being a scientific journal - opened up even more in the direction of the Arts, the ethical dialogue could gain in shape as well as in colour. To deepen this co-operation even further every fourth issue of the quarterly has "ethics" as its emphasis. This provides the chance to give access in one issue to topical texts which were mentioned in the report but could not be cited in full length. Aside from the consideration of valued personal contacts at this point, the co-operation between ALTEX and the archives for ethics in animal -, nature - and environmental protection at Karlsruhe gains in efficacy. The goal shared by both is the animal report on the development of ethical thought about the relationship between us as humans and our animated environment as it is mirrored in literature. The proximity to ethics is not the only particularity of our project. We also aim to maintain a platform within German professional scientific writing and, at the same time inform through examples form developments in the Anglo-Saxon sphere. A structure of presentation of these topics has developed over the years which still shows features of "happening by chance". Still, it is meant to facilitate access to requested topics. As in former reports, ethical themes predominate. At times, one can get the impression that finding generally acceptable criteria is of particular importance. These criteria are supposed to provide the possibility to divide animals into two groups: The highly developed ones which are to be highly regarded and the others, remaining widely outside of our ethical attention. But this is not all - further arguments are at stake which would permit us to exercise preference regarding human wishes in cases of conflict over the welfare - and survival interests of the animals. In this way, two restrictive models add up in the following manner: First, the scope of animals which have to be paid moral respect is being narrowed and secondly, human interest regarding the use of such animals is allowed clearly higher priority, so that in the balance, the animal hardly has a chance. The tightening of texts will be continued as announced in the preliminary remarks preceding the last report. Its first victim is the realm of biotechnology which could be referred to in a fragmentary manner. In its expanding scope and specialisation it simply cannot be mastered any more. Since personnel cannot be increased proportionally to the growing number of related issues the only remaining choice is the limitation of projects to a manageable level.

Journal Article↗

Professional competence and palliative care: an ethical perspective.

The aim of this article is to explore an ethical view of professional competence by examining the professional competence of physicians in the context of palliative care. A discussion of the four dimensions of professional competence--knowledge, technical skills, relationships, and affective and moral attitude--leads us to the conclusion that "habits of mind" are important in every aspect of professional competence. This observation is then considered in the context of virtue ethics and ethics of care. Virtue ethics focuses on personal qualities and moral attitudes, while the ethics of care concentrates on the way these qualities are lived out in specific care relationships. Our conclusion points up the importance of education in ethics in the development of professional competence, and argues that because palliative care involves intense human interactions, integrating palliative care into the medical curriculum may improve the ethical culture of health care as a whole.

Health Knowledge, Attitudes, Practice↗

Broadening the ethical focus: a community perspective on patient autonomy.

Health care ethics has a 'cultural' bias that is patterned on the organizational culture of our health care system. The ethical issues that are identified and debated within our institutions often are shaped by this organizational culture, and as with any culture to which one has been socialized, its influences remain, to a large extent, indistinct and unrecognized. In the field of health care ethics, these influences can direct teaching, regulate common practices, and determine what is or is not considered to be an ethical issue. The movement of health care outward from the hospital into the community provides an opportunity to explore some of the unexamined assumptions that guide our ethical deliberations. By stepping outside of the hospital culture and viewing ethical issues from a community perspective, the authors examine some of the presumptions and beliefs that lie beneath the usual institutional approach to respecting patient autonomy. Two case stories provide concrete examples of how institutional traditions can direct ethical practice.

Community Health Services↗

Some ethical dilemmas faced by Jewish doctors during the Holocaust.

The discourse on physicians and ethics in the Nazi regime usually refers to the violation of medical ethics by Nazi doctors who as a guild and as individuals applied their professional knowledge, training and status in order to facilitate murder and medical "experimentation". In the introduction to this article I will give a brief outline of this vast subject. In the main article I wish to bear witness to the Jewish physicians in the ghettos and the camps who tried to the best of their ability to apply their professional training according to ethical principles in order to prolong life as best as they could, despite being forced to exist and work under the most appalling conditions. These prisoner doctors were faced with impossible existential, ethical and moral dilemmas that they had not encountered beforehand. This paper addresses some of these ethical quandaries that these prisoner doctors had to deal with in trying to help their patients despite the extreme situations they found themselves in. This is an overview of some of these ethical predicaments and does not delve into each one separately for lack of space, but rather gives the reader food for thought. Each dilemma discussed deserves an analysis of its own in the context of professionalism and medical ethics today.

History, 20th Century↗

Children's Hospital ethics committees. A first estimate.

Special committees are being formed in hospitals to help deal with ethical problems presented by seriously ill infants and children. The functions of these multidisciplinary groups are to recommend policy and educate staff members about ethical matters and provide ethical consultation to parties involved in the care of these patients. This article provides a historical background of the formation of these committees and describes the development, constitution, and practices of the recently formed ethics committee of the Children's Hospital National Medical Center, Washington, DC. Ethical decision-making for the sick incompetent child requires determining his or her best interest. The committee's problems related to this determination and other questions are discussed to inform those working in pediatric health care and to help guide them in their future efforts in ethical decision making for minors.

Child↗

Ethical aspects of clinical practice.

HYPOTHESIS: Clinical ethics is grounded in the belief that medicine is an inherently moral enterprise. Sick persons ask physicians to help them get better and physicians profess to be morally committed and technically competent to help the sick. DATA SOURCES: MEDLINE literature search and review of published works on medical ethics, and the references cited therein. STUDY SELECTION: Critical studies containing supporting evidence were selected. DATA SYNTHESIS: The central ethical aspects of modern medical practice are clinical competence, respect for patients and their health care decisions, and maintaining the primacy of patient's need in the face of external pressure in a changing social, economic, and political climate. There is a need to teach both the cognitive and behavioral aspects of ethics. Development of these skills, in turn, depends on the character of the physician who will be applying these skills. CONCLUSIONS: The outcome of patient care can be improved by efforts made to secure informed consent of the patient. This also helps avoid ethical conflicts, confusion, and misunderstanding between patients and physicians. Clinical ethics should be an integral part of medical education at all levels in medical school, in the residency, and in continuing education.

Clinical Competence↗

A legacy of Osler. Teaching clinical ethics at the bedside.

The teaching of clinical medicine at the bedside is an enduring legacy of the Oslerian revolution in American education. The advantages of teaching clinical ethics at the bedside including dealing with actual cases to maximize personal accountability, reinforcing the relationship between technical competence and ethical decisions, involving the entire health care team, and possibly decreasing the resistance of the medical profession to formal medical ethics. The proposal to teach clinical ethics at the bedside is intended to indicate a primary role for ethicists and clinicians at different stages in the medical curriculum. During the preclinical years of medical school, ethicist-philosophers, assisted by clinicians, should assume primary responsibility for teaching medical ethics. During the clinical years, physicians, assisted by clinically informed ethicist-philosophers, should accept the primary obligation to teach clinical ethics at the bedside.

Bioethical Issues↗

Biology, ethics, and public policy: deliberations at an unstable intersection.

Biology, ethics, and politics intersect in many public policy issues. The unique features of the meeting point in each case are affected by changes in scientific and technological knowledge, moral analysis in a pluralistic society, and political relations. No one of the three can be ignored without repercussions. This essay, however, concentrates on ethics. The ethical dimension must allow for genuine differences in fundamental moral stance, which always persist alongside scientific developments. Two scientific/medical issues with considerable ethical and political implications are discussed: (1) application of human embryonic stem cell research in regenerative medicine and (2) neuroscientific reductionism in the context of behavioral research and moral responsibility. Public advisory committees and other governmental structures for pursuing public policy should not rely merely on cost-benefit analysis to form policy, as if it were uniquely objective, but should also recognize the necessity of considering science and ethics together as two separate yet complementary foundations of policy. Minimizing the distinctness of the biological and ethical dimensions will make any conclusions unstable and their later implementation more difficult.

Animals↗

Ethics issues in security hospitals.

The term 'security hospital' is used for a variety of facilities including forensic hospitals and prison hospitals, which, because of their mission, the nature of their work, and the populations they serve-or because of the authority under which they operate-place the staff at considerable risk of ethical violations related to either clinical care or to forensic activities. The problem of divided loyalties is of special concern in security hospitals. Ethics principles particularly at risk are confidentiality and informed consent. Where there are cultural disparities between the staff and the patients, differences in background, socioeconomic class, education, and other types of diversity, cultural awareness is required and must be reflected in appropriate treatment and evaluation. To counteract the risks of ethical violations, a security hospital should create an ethical climate and develop means to anticipate, prevent, and deal with ethical violations. These might include detailed and specific policies and procedures, programs of orientation, education, consultation, and liaison as well as its own ethics committee.

Ethics, Institutional↗

Exploring the role of the ethics committee psychiatrist.

Healthcare ethics committees (HEC) have emerged as institutional forums for addressing bioethical dilemmas. Psychiatrists have important roles to play on these committees. Their skills in group process assessment, mental status examination, and character assessment have diverse applications. Psychiatrists can facilitate communication within the committee and as HEC-based clinical ethics consultants. HECs must be concerned with how they arrive at ethical decisions, guarding against political influence or individual monopolization. Psychiatrists can assist these efforts as organizational consultants to HECs. The perception of psychiatrists as reflective, tolerant of ambiguity, humanizing, and approachable about ethical aspects of health care suggests they would make excellent committee leaders. Psychiatrists also have important committee roles to play as ethics educators and policy makers. More demographic data is needed to investigate psychiatrist participation on HECs. Studies of how they are perceived by their ethics committee colleagues may reveal new roles and potential pitfalls for HEC psychiatrists.

Decision Making, Organizational↗

[Independence, consciously accepted dependency, self-responsibility and shared responsibility as key categories of an ethical analysis of old age].

This contribution begins with a brief introduction into some seminal problems of ethics: the search for the essential being of things, the attitude of value consciousness in the context of ethical reflections, and the reflection on models of a 'good life' and on decisions as well as actions in significant moral situations. These introductory statements are illustrated by the example of stoic philosophy. In a second step, independence, consciously accepted dependency, self-responsibility and shared responsibility are discussed as highly significant categories for an ethical analysis of all ages. However these categories must be specified with reference to specific ages. In this contribution, such a specification is carried out for old age focussing on the particular relevance of the four categories for ethical analysis. In a third step, each of the four categories is discussed in detail in the context of basic ethical approaches. In this context, ethical analysis proceeds from the perspectives of the individual, the environment, and the society. Concerning the perspective of the society special interest is offered to societal models of good life in old age which might have an impact on the potential development of a pro-aging culture and shared responsibility in older people. Moreover, these models contribute to older people's ability to use the necessary means of support in cases of dependency and to consciously accept dependency.

Activities of Daily Living↗

Institutional culture and individual behavior: creating an ethical environment.

Much of the work in professional ethics sees ethical problems as resulting from ethical ignorance, ethical failure or evil intent. While this approach gets at real and valid concerns, it does not capture the whole story because it does not take into account the underlying professional or institutional culture in which moral decision making is imbedded. My argument in this paper is that this culture plays a powerful and sometimes determinant role in establishing the nature of the ethical debate, i.e., it helps to define what are viable action options, what is the organization's genuine mission, and what behaviors will be rewarded or criticized. Given these conclusions, I also argue that consulting ethicists need more than an understanding of ethics theory, concepts and principles; they also need a sufficiently rich understanding of organizational culture and a willingness and an ability to critique that culture.

Behavior↗

Teaching research ethics: can web-based instruction satisfy appropriate pedagogical objectives?

Ethical tasks faced by researchers in science and engineering as they engage in research include recognition of moral problems in their practice, finding solutions to those moral problems, judging moral actions and engaging in preventive ethics. Given these issues, appropriate pedagogical objectives for research ethics education include (1) teaching researchers to recognize moral issues in their research, (2) teaching researchers to solve practical moral problems in their research from the perspective of the moral agent, (3) teaching researchers how to make moral judgments about actions, and (4) learning to engage in preventive ethics. If web-based research ethics education is intended to be adequate and sufficient for research ethics education, then it must meet those objectives. However there are reasons to be skeptical that it can.

Computer-Assisted Instruction↗

Psychiatrists and the General Hospital Ethics Committee.

General Hospital Ethics Committees (GHECs) have emerged as institutional forums for addressing bioethical dilemmas. Hospital psychiatrists have important roles to play on these committees. Their skills in group process assessment, mental status examination, and character assessment have diverse applications. Psychiatrists can facilitate communication, both on the committee and as GHEC-based clinical ethics consultants. Ethics committees must be concerned with how they arrive at ethical decisions, guarding against political influence or individual monopolization. Psychiatrists can assist these efforts as organizational consultants to GHECs. The perception of psychiatrists as reflective, tolerant of ambiguity, humanizing, and approachable about moral aspects of health care suggests they would make excellent committee leaders. Hospital psychiatrists also have important committee roles to play as ethics educators and policy-makers. More demographic research is needed to investigate psychiatrists' participation on GHECs. Studies of how they are perceived by their ethics committee colleagues may reveal new roles and potential pitfalls for GHEC psychiatrists.

Decision Making, Organizational↗

Ethical issues in social science research with special reference to sexual behaviour research.

Social science research has long been concerned with ethical issues, but agencies that review and fund research are increasingly attentive to assuring that ethical considerations are being fully addressed. Research on sexual behaviour, a topic that has generated much recent attention worldwide as scientists confront the epidemics of adolescent pregnancy, AIDS and STDs, raises ethical issues that are worthy of special attention. Beginning with the philosophical origin of ethical principles that guide research, this paper discusses the key ethical issues to be considered when designing and conducting social science research. Included are special precautions for research on adolescents, the purpose and properties of an informed consent procedure, and the formation and function of an ethical review committee.

Adolescent↗

Practice what you teach: a case study of ethical conduct in the academic setting.

Nursing faculty teach ethics and ethical behavior in undergraduate and graduate curriculum. In this article, a case study is presented that illustrates a breach of ethical behavior and conduct in the academic setting by both faculty and students. The decision-making process used to resolve this dilemma by the chair, the associate dean, and a faculty member relied on a dialectic approach that looked at philosophical underpinnings, historical background of nursing ethics, and university- and schoolwide policies and procedures. The conversations facilitated the ethical resolution to the dilemma raised in the case study as well as the recognition of additional issues for consideration. The authors uncovered compelling questions that included, "What is meant by ethical conduct in the classroom?," "How do we teach it?," and "How do we practice it?" The purpose of this article is to begin the dialogue in search of answers to these questions.

Attitude of Health Personnel↗

Ethically justified guidelines for defining sexual boundaries between obstetrician-gynecologists and their patients.

OBJECTIVE: This article proposes ethically justified guidelines that should govern the ethical obligations of obstetrician-gynecologists when they experience sexual feelings toward patients. STUDY DESIGN: We reviewed literature on physician-patient sexual contact and related that literature to ethical principles. RESULTS: Existing guidelines that prohibit sexual contact between physicians and patients are based on an ethical argument that such relationships violate the ethical principles of respect for both autonomy and beneficence. This argument is incomplete because patients can provide valid consent for sexual relationships with their own obstetrician-gynecologists. CONCLUSION: We propose a virtues-based ethical argument that is independent of informed consent for governing sexual relationships between obstetrician-gynecologists and their patients. In the context of the physician-patient relationship the professional virtues of self-effacement and self-sacrifice obligate the obstetrician-gynecologist to set aside and never act on feelings of sexual attractiveness toward patients.

Ethics, Medical↗