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PubMed1999

Adoption of a pharmacist conscience clause by Professional Associations and Boards of Pharmacy in the United States.

OBJECTIVE: To determine the number of professional associations and boards of pharmacy in the United States that have adopted or are considering to adopt a conscience clause as part of their codes of ethics, rules, laws or regulations. BACKGROUND: Pharmacists are often exposed to ethical dilemmas in their day-to-day practice and their response depends on a number of factors, including the personal beliefs and values of those involved. This has lead some professional associations to address whether their members have the right to refuse to participate in procedures which are contrary to their conscience or moral convictions. The outcome of these discussions is usually the development and adoption of a conscience clause. METHODS: A one-page self-administered questionnaire was sent by Fax to the highest ranking officer of 108 pharmacy organizations in the United States. RESULTS: Thirty-five completed questionnaires were received for a 32.4% response rate. In general, it was found that there is a lack of knowledge as to what a conscience clause is. Only two state associations and one board of pharmacy responded that they have a conscience clause as part of their code of ethics or regulations. Reasons given for not having a conscience clause included lack of interest and low priority. Nevertheless, four state associations, one national association and one board of pharmacy responded that they are considering developing a pharmacist conscience clause. More professional associations than boards of pharmacy expressed interest to obtain information about conscience clauses. CONCLUSION: Although many state associations and boards of pharmacy that responded do not have a conscience clause as part of their codes of ethics, laws or regulations, this survey shows an increasing interest to learn about it. This is expected as the pharmacist assumes increasing responsibility in patient care.

Ethics, Pharmacy↗
PubMed2001

Integrating a structured ethical reflection curriculum into high school community service experiences: impact on students' sociomoral development.

It is widely accepted within the field of community service that reflection is an important factor in promoting personal and sociomoral development. The purpose of this research was to determine if a particular form of reflection--decision making with an emphasis on the ethical nature of community service--has special value in achieving service-learning goals. Three dimensions of adolescent identity development served as dependent variables: agency, social relatedness, and moral-political awareness. Four hundred seventy-six high school students were assessed on the dependent variables before and after experiencing one of three conditions: community service with an ethical reasoning component; community service with reflection, but without an ethical reasoning component; and no community service (control). After one semester, it was found that students in the first condition (ethical decision making curriculum integrated into the community service program) made greater advances on all three dimensions of identity formation when compared with students in the other two conditions. Specifically, it was found that they became more systematic in their ethical reasoning and more likely to consider situations and issues from an ethical point of view.

Adolescent↗
PubMedDate not supplied

Putting safety at the core.

To create a deeper culture of safety--an environment in which safety is the first priority of every person in the system--Mercy Health System, St. Louis, has launched a variety of safety and quality initiatives. In September 2005, Mercy began an effort to develop blame-free environments in which the reporting and gathering of data can lead to improvements in patient safety. Mercy's top executives attended Mercy's annual Pathways Leadership Development event in October and November 2005 to discuss the moral and theological imperatives for building a culture of safety. Mercy's leaders addressed six stumbling blocks that have impeded progress toward a culture of safety: production demands and time pressures, absent or inadequate processes, failure to focus on process problems, poor teamwork, inadequate communication, and fear and pride. They have identified five key elements that should enhance patient safety: improved leadership, reporting systems, measurement, best practices, and a supporting structure. For Mercy, the safety initiative is not just about policy change; it's about cultural transformation.

Medical Errors↗
PubMedDate not supplied

[History of thought tendencies in biography - a cultural historical synopsis].

Biography, presumably, the oldest form of historiography, is rudimentally already found in the Attic comedy. Reference is made to Xenophon and his representation of leading personalities and predominance problems as well as to Aristotle through whose school the empiric exploration of the individual personality in philosophy was firmly established. To Theophrast's pictures of human weakness are added new psychological aspects under Aristoxenos. In the biographical work of Nepos the picture of the habits of famous men was shown on a subhistorical level. While Plutarch's character descriptions are fully rationalistic there can be no doubt that a moral value judgement is passed. The Concepts "experience" and "inner development" were therefore unknown in the antique biography. Herder, as the onset of the writing of scientific biographies, is considered the promotor of an objectivating biographical and autobiographical method. Reference is made to Dilthey's theory of knowledge and his theory of cognition, particularly to his cultural-historical approach, whereby a close relationship to Gruhle ("understanding psychology"), Jaspers ("The art of sympathising understanding") as well as Birnbaum ("pathographic methodology") becomes evident.

Biographies as Topic↗
PubMed1997

Physician virtues and communicating with patients.

The growth of profit-driven medicine and managed care as well as the increasingly technologic focus of Western medicine have stimulated much reflection on the fundamental values of the medical profession and on the meaning of being a "good doctor." Many patients and many in the medical community have grown concerned about the fate of the doctor-patient relationship. In practicing medicine, physicians must be guided both by the basic principles of biomedical ethics and by Beauchamp's and Childress's four fundamental virtues: compassion, trustworthiness, discernment, and moral integrity. In addition, physicians must make the commitment to develop strong communication skills, for it is through communicating with patients that we forge a relationship with them and make them feel cared for. Good communication skills not only improve patient satisfaction and facilitate resolving the difficult ethical problems that arise in critical care but have also been shown to improve certain health outcomes. Unfortunately, studies have repeatedly shown physicians to have poor communication skills. In this article we identify key elements in preserving medicine's "covenant of trust" and in establishing good communication and rapport in critical care settings. We identify specific obstacles to good communication and propose strategies for overcoming them.

Clinical Competence↗
PubMed2004

Predictive genetic test decisions for Huntington's disease: context, appraisal and new moral imperatives.

Predictive testing is one of the new genetic technologies which, in conjunction with developing fields such as pharmacogenomics, promises many benefits for preventive and population health. Understanding how individuals appraise and make genetic test decisions is increasingly relevant as the technology expands. "Lay" understandings of genetic risk and test decision-making, located within holistic life frameworks including family or kin relationships, may vary considerably from clinical representations of these phenomena. The predictive test for Huntington's disease (HD), whilst specific to a single-gene, serious, mature-onset but currently untreatable disorder, is regarded as a model in this context. This paper reports upon a qualitative Australian study which investigated predictive test decision-making by individuals at risk for HD, the contexts of their decisions and the appraisals which underpinned them. In-depth interviews were conducted in Australia with 16 individuals at 50% risk for HD, with variation across testing decisions, gender, age and selected characteristics. Findings suggested predictive testing was regarded as a significant life decision with important implications for self and others, while the right "not to know" genetic status was staunchly and unanimously defended. Multiple contexts of reference were identified within which test decisions were located, including intra- and inter-personal frameworks, family history and experience of HD, and temporality. Participants used two main criteria in appraising test options: perceived value of, or need for the test information, for self and/or significant others, and degree to which such information could be tolerated and managed, short and long-term, by self and/or others. Selected moral and ethical considerations involved in decision-making are examined, as well as the clinical and socio-political contexts in which predictive testing is located. The paper argues that psychosocial vulnerabilities generated by the availability of testing technologies and exacerbated by policy imperatives towards individual responsibility and self-governance should be addressed at broader societal levels.

Adult↗
PubMed1998

Racism and its implications in ethical-moral reasoning in nursing practice: a tentative approach to a largely unexplored topic.

Nursing as a profession seems to avoid considering the problem of racism. There is, however, a need to address this topic and to evaluate its implications for nursing practice. This article attempts to establish a rationale for nursing to address racism and introduce it into academic discourse. The results of a small-scale study by the author are analysed and the implications for ethical-moral reasoning in nursing practice are discussed in relation to professional codes of conduct developed by nurses' professional organizations in the UK and elsewhere.

Conflict, Psychological↗