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To practice a training ethic, one must view giving or obtaining training regarding workplace health hazards as an ethical responsibility. Furthermore, the training itself must be carried out ethically. Here, the authors discuss the training ethic as an extension of workers' right to know and address ethical issues that arise during training.
"Manipulation" per se is not bad. The crucial question in the moral debate about genetic engineering is: When and how are we allowed to manipulate? Unfortunately, the moral discussion surrounding this question is itself being manipulated. There are moral manipulations (by those who wish to either reassure or to alarm) and there are ethical manipulations (the failed utilitarian calculus and the centering of the discussion only around rules, rights, and duties). A different ethical approach is needed: one based on virtues. The duty of ethics is to help us understand the moral possibilities in each situation, i.e., to develop our moral sensibility. In the area of genetic engineering research we are motivated by a will to know, but at the same time we fear total self knowledge. We want to control, to improve our world and ourselves, but we recoil at obtaining ultimate perfection. Therefore, we must value the unknowable, the uncontrollable. Our everincreasing capacity to mould the world and ourselves is making it more difficult to develop a sensitivity for what is given and cannot be made. It is dangerous for our ethics to assume the activistic traits of our technology. We risk losing a fundamental element of what we are, or ought to be. We should train ourselves in moral passivity.
Manchester's multi-disciplinary approach to medical ethics combines established methods and new initiatives. There is a longstanding Medical Group and also, plans are evolving for the inclusion of medical ethics teaching in the undergraduate curriculum, the start of an MA in Health Care Ethics in October 1987 and the establishment of the Centre for Social Ethics and Policy to act as a focus within the university for research and study in a wider context.
The aim of this article is to argue for the need for a context-sensitive approach to the understanding of ethical issues in nursing practice as we face the next millennium. This approach means that the idea of universalism must be questioned because ethics is an interpersonal activity, set in a specific context. This view is based on issues that arise in international collaborative research as well as in research focused on ethical problems in nursing practice. Moral values are indigenous to a particular culture and influence beliefs about health and illness as well as what priorities are to be made in providing health care. Nursing practice must include thoughtful reflection on the meaning of moral concepts and principles in terms of culture. Theoretical developments in nursing ethics must be based on empirical research focusing on contextual aspects of health care.
This article describes an approach to enhancing the value of case study material in teaching professional ethics in psychology. The mock committee approach involves a series of hearings convened by students who rotate membership on a class ethics committee. Members of the class participate randomly as psychologists accused of various ethical violations. While the class observes, formal complaint hearings occur that result in official rulings and the setting of appropriate penalties and remedial requirements. The larger class then joins in active feedback and exchange with the committee to highlight and discuss salient ethical issues. We present and discuss student evaluation data for this technique and comment on the potential advantages of this teaching approach.
The previous paper explored the meaning of ethics, especially its relationship to dentistry. Here, we examine a practical application for solving ethical problems. Together, the two articles should provide dentists with a core of relevant knowledge about ethics and a ready guide to the daily relevance of ethics.
Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.
In an invited response, the Detroit Mercy, School of Dentistry combined ethics and law four-year curriculum is analyzed. Previous models combining law and ethics have shown more success in the former than the latter. Additional concerns include the lack of an explicit measure of ethical outcomes such as moral reasoning and the assumption that ethical activities engaged in by novices such as the White Coat Ceremony and early written assignments demonstrate competence.
Preparing experimental protocols that are ethically sound, possess scientific merit, and meet institutional and national standards for human subject protections is a key responsibility of psychiatric investigators. This task has become increasingly complex due to developments in biomedical science, bioethics, and society at large. Practical and constructive approaches to help investigators in their efforts to create protocols that are ethically acceptable have nevertheless received little attention. To better address this gap, the Research Protocol Ethics Assessment Tool (RePEAT) was developed as an educational instrument to help assure that ethically important elements, including scientific design features, are explicitly addressed by investigators in their work with protocols involving human participants. The RePEAT is a brief evaluative checklist that reflects rigorous ethical standards, particularly with respect to criteria for studies that may involve individuals with compromised decisional abilities. For this reason, it may be especially beneficial as a self-assessment tool for investigators and protocol reviewers in psychiatry. To stimulate education and dialogue, this report presents the RePEAT and outlines its content, format, use, and limitations.
This article describes a new model for ethics support for Capital Health (a health region in Nova Scotia). With its emphasis on building a culture of ethics, many innovative elements are integral to this model and its future success. Particular emphasis is on organizational healthcare ethics and meaningful participation. Concerns about volunteer burden, urban and rural ethics needs, and varying exposure to prior ethics support will also be met by this model.
Psychiatrists routinely encounter ethical complexities in caring for patients with mental illness, and they are held to the highest levels of accountability in their ethical practices. In this article, the authors first outline skills that are essential to ethical psychiatric practice. They then articulate three domains of clinical and ethical practice that represent the foundation of clinical care for people with mental illness: informed consent, the therapeutic relationship, and confidentiality. Key concepts concerning these domains are presented and relevant empirical evidence concerning each domain is reviewed. An understanding of these clinical and ethical practices will help psychiatrists serve patients with mental illness in their everyday clinical activities in a manner that is respectful, engenders trust, and ultimately fosters optimal clinical care.
In September 1986, The American Fertility Society issued a report, Ethical Considerations of the New Reproductive Technologies, setting forth the then-held ethical position of the Society on the various new reproductive technologies. In 1987, the Congregation for the Doctrine of the Faith issued the Instruction on the Respect for Human Life and Its Origin and on the Dignity of Procreation. While both documents state that very similar moral criteria were used to derive ethical positions with respect to various reproductive procedures, the conclusions as to the ethical acceptability of the various procedures differ sharply in the two documents. The question can be raised about the procedure used by the Congregation of the Faith to derive its conclusions from the stated premises. Thus, while stating that "the individual integrally and adequately considered" is to be the basis of the moral judgment, the fact is that most conclusions are based on and referenced to past Catholic statements. While the difference in conclusion from similar premises may be troubling to society, it can be especially paralyzing to four groups: (1) those who face problems that might be solved by one or another of the new reproductive technologies; (2) those who are involved in applying them; (3) those who are responsible for institutional policies where such techniques may be applied; and (4) those who are in a position to influence public policy in a legislative or regulatory way. Because of the conflicting conclusions of the two documents, the present Ethics Committee (1986-87) of The American Fertility Society was convened and considered these guidelines in the light of the Instruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Cognitive semantics has made important empirical findings about human conceptualization. In this paper some findings concerning moral concepts are analyzed and their implications for medical ethics discussed. The key idea is that morality has to do with metaphors and imagination rather than with well-defined concepts and deduction. It is argued that normative medical ethics to be psychologically realistic should take these findings seriously. This means that an "imaginative casuistry" is to be preferred compared to principlism and to other forms of casuistry. Furthermore, the metaphorical character of central principles in medical ethics such as autonomy, utility, justice, and integrity is indicated. Such principles are interpreted as rules of thumb summarizing the collective wisdom concerning prototype cases.
Roughly 15 million of the 62 million rural U.S. residents struggle with mental illness and substance abuse. These rural dwellers have significant health care needs but commonly experience obstacles to obtaining adequate psychiatric services. Important but little-recognized ethical dilemmas also affect rural mental health care delivery. Six attributes of isolated settings with limited resources appear to intensify these ethical dilemmas: overlapping relationships, conflicting roles, and altered therapeutic boundaries between caregivers, patients, and families; challenges in preserving patient confidentiality; heightened cultural dimensions of mental health care; "generalist" care and multidisciplinary team issues; limited resources for consultation about clinical ethics; and greater stresses experienced by rural caregivers. The authors describe these features of rural mental health care and provide vignettes illustrating dilemmas encountered in the predominantly rural and frontier states of Alaska and New Mexico. They also outline constructive approaches to rural ethical dilemmas in mental health care.
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.
In this paper I aim at making a comparative analysis of The Code of Professional Ethics in Bulgaria (CPEB), The Hippocratic Oath, The Declaration of Geneva, and The World Medical Association International Code of Medical Ethics. Two problems of special interest are explored: whether the leading principles of fundamental ethical codes are presented in CPEB and whether the code itself is relevant to the current medical professional and social situation in the country. The conclusion reached after a step-by-step analysis is that CPEB attempts to cover a wide range of principles and problems in medical practice and corresponds with the fundamental ethical codes. Although the code is criticized in some points, it could be very useful, provided that it is well publicized in the profession.
Clinical ethics are an intrinsic aspect of practice in health care settings. However, health care professionals may have minimal training in ethics and communication. Clinical ethics committees, with a multidisciplinary composition, are in a position to offer clinical consultative services from a collaborative framework. Using this framework, as well as standard guidelines for conducting an ethics consultation, most often elicits essential beliefs, values, concerns, and opinions pertinent to the case at hand. Through enhancement of the communication process, group consensus is usually achieved. The framework guiding the consultation and communication process is delineated and illustrated through case analysis.
There is increasing attention paid to ethics under managed care; however, few clinical-based ethics programs are reported. This paper reports the assessment and outcomes of one such program. A quasi-experimental research design with t-tests is used to assess the outcome differences between participants and control groups. There are twenty nurses in each; they are assessed for comparability. Differences are predicted on two outcomes using reliable and valid measures: nurses' time with their patients in ethics discussions, and nurses' opinions regarding their clinical ethics environments. Results reveal a statistically significant difference (p <.05) between the two groups, with modest positive change in the participants. Additional exploratory analyses are reported on variables influential in health care services.