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PubMed1993

Ethical decision-making processes used by health care providers.

This paper reports the results of a study conducted with 18 health care providers (HCPs) in two Toronto hospitals. The study examined and assessed how these HCPs make clinical-ethical decisions in the light of a theoretical model of clinical-ethical decision making. Nine nurses and nine doctors were interviewed through two-phased, in-depth, semi-structured interviews. The results suggest that, in relation to the two major elements of the model, namely the ethical component and the decision theory component, the HCPs did not follow a consistent and systematic pattern of ethical decision making. Differences emerged between their actual self-reported behaviour and their potential more capability (i.e. their abstract thought process). The general picture that emerged was that decisions were made in a narrow, habitual manner, through the elimination of the most significant and demanding elements of the process. HCPs' ethical approaches affected the entire process of the decision making: their perception of the problem, their search for and selection of information and evidence, and their development of alternatives and resultant consequences. It is suggested to (a) further investigate and understand the subjective realities of the individuals involved in the decision making processes, their values and the meaning they ascribe to their choices, and (b) to establish extensive educational programmes to enhance HCPs' decision-making capacity and subsequently promote an effective and responsible professional practice.

Adult↗
PubMed2000

Holding the present and future accountable to the past: history and the maturation of clinical ethics as a field of the humanities.

Clinical ethics, like bioethics more generally, until recently has tended to focus on the present and future, with little attention to the history of moral thought about health care that preceded bioethics. As a consequence, clinical ethics and bioethics lack maturity as fields of the humanities. The papers in this year's clinical ethics issue of the Journal put contemporary clinical ethics in critical dialogue with the past, making the former accountable to the latter. The six papers in this issue of the Journal are briefly described, with an emphasis on how they contribute to the maturation of clinical ethics as a field of the humanities.

Bioethics↗
PubMed1990

An ethnomedical perspective of medical ethics.

Ethnomedicine is the field that analyzes medical traditions comparatively. An ethnomedical approach is used in the essay to analyze the topic of medical ethics. General properties of medical ethics as realized in different societies are outlined. These pertain to the healer's relations with clients, with other healers, and with the group or society. The conditions of medical practice and the influence of social and political factors that affect them are discussed in relation to medical ethical questions. Unique developments of contemporary medical science that affect and condition practice and raise new ethical questions are examined in light of ethnomedical generalizations. The essay aims to clarify the cultural bases of medicine generally and ethical aspects of medical practice and care more specifically.

Attitude to Health↗
PubMed1996

Darren's case: narrative ethics in Perri Klass's Other Women's Children.

During the past fifteen years, the relationship between literature and medical ethics has evolved from the occasional use of stories as a substitute for the traditional case study in medical ethics to the emergence of a narrative approach to ethical analysis and decision making. Thus far, literary theory has been more important to narrative medical ethics than have works of literature themselves. Perri Klass's novel Other Women's Children deserves special scrutiny, however, because an analysis of it demonstrates ways that a narrative approach could enhance traditional philosophical and legal approaches to resolving ethical dilemmas in medicine.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Casuistry, care, compassion, and ethics data analysis.

Traditional approaches to descriptive ethics data analysis do not explicate the nature of ethical dilemmas in critical care and emergency nursing. Using sensitizing concepts of causes of nurse compassion, 168 stories of ethical dilemmas were categorized. They were analyzed from the theoretical perspective of an ethic of care using casuistry. Paradigm cases for each sensitizing concept were constructed. The nature of ethical dilemmas is in the disparity between actual and ideal nursing practice.

Adult↗
PubMed1999

Power and the teaching of medical ethics.

This paper argues that ethics education needs to become more reflective about its social and political ethic as it participates in the construction and transmission of medical ethics. It argues for a critical approach to medical ethics and explores the political context in medical schools and some of the peculiar problems in medical ethics education.

Codes of Ethics↗
PubMed1996

Ethical dilemmas experienced by hospital and community nurses: an Israeli survey.

The objective of this survey was to assess the extent to which nurses encounter and identify dilemma-generating situations in the light of the publication and circulation of the Israeli code of ethics for nurses in 1994. The results are being used as a basis for a programme aimed at promoting nurses' decision-making skills in coping with ethical dilemmas. In this era of major advances in medicine, the nurse's role as the protector of patient rights may bring about conflicts with physicians' orders, with institutional policies, or with patients' families. Nurses will then become confronted with ethical and moral dilemmas. A nationwide survey was carried out to identify and describe the ethical conflicts with which nurses in Israel are confronted in the course of their work. A third of the enumerated dilemmas were encountered by more than 50% of the nurses. The major determinant influencing encounters with dilemmas, as perceived by the participating nurses, was their work setting, namely, the hospital versus the community. It was shown that nurses seek support mainly among their peers, they are barely familiar with the Israeli Code, and they consider their own families as the predominant factor in shaping their ethical attitudes.

Codes of Ethics↗
PubMed2001

Clinical ethics revisited.

A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems.

Bioethics↗
PubMed1999

Power and clinical psychology: a model for resolving power-related ethical dilemmas.

This article considers power in clinical psychology. It is argued that power is present at every level of clinical psychologists' practice and can be used positively and negatively. Drawing on organizational, ethical, psychological, and personal influences, a heuristic problem-solving model for the process of understanding and resolving power-related ethical dilemmas is proposed. It is contended that such a model provides a humane and systematic process of understanding and working through power-related ethical dilemmas. It is argued that resolving power-related ethical issues cannot be achieved through the statement of absolute values but rather requires a process of understanding, action, and review. The model is used to draw out implications for promoting ethical practice and preventing the abuse of power in clinical psychology.

Behavior↗
PubMedDate not supplied

Transcendental health care ethics: beyond the medical model.

Recent health care ethics literature is heavily weighted in favor [of] examining problems associated with technological and other advances. This article challenges such a narrow focus of inquiry, maintaining that a broader conceptualization of the problems in health care is warranted. In part, this problem of focus can be attributed to the labeling of the field of study as "medical ethics" which reinforces a medical model approach to the exploration of problems. This particular perspective has proven inadequate for the purpose of describing the moral problems associated with health care. The health care professions, including medicine, have responsibilities toward individuals but also have wider responsibilities to society in general. These responsibilities are reflected in their codes of ethics. Thus, the purpose of moral philosophy with regard to health care ethics issues should not be constrained to "medical ethics" but should include broader appraisals of health care and the health care context.

Bioethical Issues↗
PubMed1989

Values, moral reasoning, and ethics.

The purpose of this exchange was to explore the domains of values, moral reasoning, and ethics. Values and moral reasoning reflect the "is." Moral reasoning is the mental process that nurses set in motion to come to some decision of right or wrong in any moral dilemma. Values are motivational preferences or dispositions. Moral values are those preferences that are integral to any moral reasoning process. Ethics reflect the oughts. It is the art-science that critically evaluates the "is." As such, ethics identifies the norms or standards of behaviors that either are or can become the values that are implemented through moral reasoning. Nursing is just beginning to identify its moral values and reasoning. Nevertheless, nursing seems to be further along in the identification of the "is" than it is with the "ought." The further development of nursing ethics will be of great benefit to nurse researchers and educators. The greatest benefit will be, however, to the practicing nurse as she/he struggles with giving excellent nursing care consistent with a positive nursing ethic.

Beneficence↗
PubMed1993

Ethical dilemmas in hematologic/oncologic emergencies.

Clinicians use ethical decision making in their practice by applying professional and societal values in an organized way to solve moral dilemmas. Moral dilemmas are those situations in which a decision must be made between conflicting goods or evils or rights or wrongs. Clinicians must understand the medical profession's and society's values and be able to apply them within ethical systems. This article describes those values, basic ethical systems, a rapid ethical decision-making model, and specific ethical dilemmas faced by emergency physicians who treat patients with hematologic and oncologic emergencies.

Beneficence↗
PubMed1997

The ethics of scientific research: an analysis of focus groups of scientists and institutional representatives.

BACKGROUND: Little is known about scientists' views on normative research ethics and how these compare with the views of the institutional representatives (IRs) involved in matters of scientific conduct. We qualitatively evaluated scientist and IR perceptions of the norms of science, ethical violations and their harms, factors contributing to violations, and approaches to improve scientific conduct. METHODS: Focus groups were conducted with National Science Foundation investigators and with IRs. Themes were extracted from observation, notes, and transcripts. Consensus and contrasts within and between groups were described. RESULTS: Scientists described a rich set of norms including honesty, integrity, service, sharing, openness, mentoring, and meticulous work habits. Institutional representatives focused on good citizenship and abiding by administrative rules. Both groups listed similar ethical violations, though scientists felt that severe violations were rare, that science was self-correcting, and that the greatest harm from misconduct disclosure was the loss of public trust and funding. Institutional representatives called for increased and less confidential misconduct investigations. Reporting misconduct was strongly supported by IRs but rejected by scientists. Both scientists and IRs believed that formal research ethics education was needed for trainees. CONCLUSIONS: Scientists in these focus groups upheld a complex set of norms that mirror prior codes of science and exceed national misconduct rules. The sharply contrasting views of scientists and IRs concerning responsibility to report misconduct, the utility of misconduct investigation, and penalties for misconduct highlight areas where open discussion and constructive resolution are needed to formulate a functional mechanism to enhance the ethical conduct of science.

Biomedical Research↗
PubMed1992

Why physicians should not do ethics consults.

Increasing complexities facing physicians negotiating the bedside decision continue to fuel the debate over who is the appropriate party to offer ethics consults, should one be needed, during the decision-making process. Some very good arguments have been put forth on behalf of clinical ethicists as being the proper and best party to engage in ethics consultations. However, serious questions remain about the role of the clinical ethicist and his ability to provide the necessary level of objectivity called for in an ethics consult. I argue that the clinician's professional psyche, or mode of thinking as a professional, leaves him little room to maneuver as an objective and detached third party ethics consultant. Several factors are cited and discussed that greatly influence the analyses applied to a case problem by physicians. The most formidable of these factors are habits and the practice of defensive medicine. I conclude that clinical ethicists are less suited for the overall tasks required of an objective consultant in medical cases that appear to involve insurmountable ethical issues.

Decision Making↗
PubMed1992

Are hospital ethics committees really necessary?

CONCLUSION: Ethics committees are crucial at this point in the history of medicine. They serve as a forum where various ethical issues can be raised, discussed, critically examined, and "where a number of disciplines come together to examine the implications of contemporary medicine upon life." If ethics committees are to be helpful, there must be realistic expectations and accurate descriptions of their functions. This writer, along with most others, would conclude that ethics committees should in no way be involved in the actual decision-making process. Rather, the IEC should involve itself only through educational offerings, policy development, and voluntary consultation at the request of a provider or a patient. This type of committee will avoid certain pitfalls which could compound the process of decision making and very possibly not be of benefit to the patient. The decision-making process belongs to the physician and the patient, not to an ethics committee.

Attitude↗
PubMed1986

Codes of medical ethics: traditional foundations and contemporary practice.

The Hippocratic Coprus recognized the interaction of 'business' and patient-health moral considerations, and urged that the former be subordinated to the latter. During the 1800s with the growth of complexity in both scientific knowledge and the organization of health services, the medical ethical codes addressed themselves to elaborate rules of conduct to be followed by the members of the newly emerging national medical associations. After World War II the World Medical Association was established as an international forum where national medical associations could debate the ethical problems presented by modern medicine. The International Code of Medical ethics and the Declaration of Geneva were written as 20th century restatements of the medical profession's commitment to the sovereignty of the patient-care norm. Many ethical statements have been issued by the World Medical Association in the past 35 years; they show the variety and difficulties of contemporary medical practice. The newest revisions were approved by the General Assembly of the World Medical Association in Venice, Italy October 1983. Their content is examined and concern is voiced about the danger of falling into cultural relativism when questions about the methods of financing medical services are the subject of an ethical declaration which is arrived at by consensus in the W.M.A.

Bioethical Issues↗
PubMed1996

The ethics of death-hastening or death-causing palliative analgesic administration to the terminally ill.

Double-effect reasoning is a nonconsequentialist analysis of a hard ethical case. In a hard ethical case, one can achieve some good end only if one also causes harm. Sometimes palliative analgesic administration to a terminally ill patient is a hard ethical case, for by it one relieves pain or distress while unavoidably hastening or causing the patient's death. Is it ethically in the clear to administer an analgesic to relieve pain or distress knowing that one will hasten or cause the patient's death? Using double-effect reasoning, the author argues that death-hastening or death-causing palliative analgesic administration to a terminally ill patient is sometimes ethically in the clear and, at times, even obligatory.

Analgesics, Opioid↗
PubMedDate not supplied

Making a situational diagnosis. Psychiatrists at the interface of psychiatry and ethics in the consultation-liaison setting.

Psychiatrists bring a unique understanding to clinical ethics, but psychiatrists need a precise awareness of the difference between exercising their clinical expertise and facilitating ethical decisionmaking. The author outlines a schema for recognizing and honoring that distinction and illustrates "pseudoethics," "pseudopsychiatry," and "psychiatry/ethics" consultations. The author describes how to make a "situational diagnosis" that includes patient/family issues, staff issues, joint issues, legal/regulatory issues, and ethical issues, thus enabling the psychiatrist to institute an appropriate "hierarchy of interventions": educational, psychological, and ethical. The literature on ethics education for psychiatric practitioners is reviewed and a program is suggested.

Adult↗