Graduating medical residents: will they be ethical, wise, strong, rich and honorable?
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A postal questionnaire was used to investigate general practitioners' attitudes to several issues of medical ethics: artificial insemination, contraception, termination of pregnancy, euthanasia and criteria for brain death. The 500 doctors surveyed were all practising in the west of Scotland; 301 forms were returned (60 per cent response).
The roles of various organizations in ethical decision making are considered. Such organizations include local and national ethical committees, professional organizations, religious organizations and governments, and their respective strengths and limitations are discussed in turn. The practising individual scientist or doctor must decide where he or she stands on specific issues, and how he or she will work within the framework established by such organizations. The role of the individual in introducing new concepts or studies under these circumstances is discussed.
Details of the work leading to the introduction of human IVF, animal and human stem cells, and the preimplantation diagnosis of inherited characteristics in blastocysts are outlined briefly in this paper. The progress of these studies is related to ethical issues emerging during these years. The current status of these studies is outlined, together with a brief moral philosophy as practised by the original investigators.
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OBJECTIVE: To understand the kinds of clinical situations physicians and nurses regard as "ethics problems." DESIGN: The authors prospectively studied physicians' and nurses' perceptions of ethics problems using paired interviews. Individual interviews were conducted with physicians and nurses as they cared for the same patients during a six-week period. Each was asked whether any ethics problems had arisen in the care of his or her patients and, if so, to give a brief description of each problem. SETTING: Three general medical services in a 497-bed community teaching hospital. PARTICIPANTS: 13 physicians (mostly family medicine residents) and 42 nurses caring for 142 patients. MAIN RESULTS: The physicians and nurses thought ethics problems were present in 75 of the 142 patients cases. Physicians and nurses identified ethics problems with similar frequencies; however, they often identified ethics problems in different patient cases or identified different ethics problems in the same case. Physicians and nurses described a variety of problem types. Physicians identified more problems related to quality of life, inappropriate hospital admissions, and cost of care; nurses identified more problems related to patient preferences, family wishes, pain management, implementing treatments, and discharge planning. A fourth of the ethics problems identified by physicians and nurses involved interstaff conflicts. CONCLUSIONS: The physicians and nurses studied considered a broad range of clinical situations to be "ethics problems," and they perceived them to occur frequently. Systematic differences were found between physicians' and nurses' perceptions of ethics problems, and many ethics problems generated interstaff conflicts. Incorporating this kind of information into clinical ethics education programs, and into hospital policies, may represent a useful approach toward improving physician-nurse interaction.
STUDY OBJECTIVES: To examine emergency medicine resident training and understanding of general bioethics and resident and faculty attitudes and behavior regarding professional interactions with the biomedical industry. DESIGN: Two companion questionnaire surveys. SETTING: Annual resident in-service examination and written director survey with telephone follow-up. PARTICIPANTS: Emergency medicine residents and program directors. INTERVENTIONS: chi 2 analysis was used for questions involving relationships among variables with dichotomous or categorical response. An analysis of variance or Pearson Product Moment Correlation was calculated for questions with continuous variables. MEASUREMENTS AND MAIN RESULTS: The surveys were completed by 1,385 of 1,836 (75%) residents and 80 of 81 (99%) residency directors. On average, residents receive eight hours of bioethical instruction per year but believe that they need 12 hours per year. Seventy-five percent of residents believe that company representatives sometimes cross ethical boundaries. The amount of resident understanding of bioethical concepts correlated with the number of hours of bioethics training they received. A sensitivity to bioethical conflicts index was correlated with the residents' behavior. CONCLUSION: There is wide variation in beliefs and practices regarding the interaction between emergency medicine residents and directors and the biomedical industry. Our results suggest that residents need training regarding conflicts of interest, accepted standards of practice, and dealing with potential conflicts with the biomedical industry.
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The first section of this paper asks why the notion of consensus has recently come to the fore in the medical humanities, and suggests that the answer is a function of growing technological and professional complexity. The next two sections examine the concept of consensus analytically, citing some of the recent philosophical literature. The fourth section looks at committee deliberations and their desirable outcomes, and questions the degree to which consensus serves those outcomes. In the fifth and last section it is suggested that if I am to subscribe to a consensual outcome responsibly I must be personally committed to it, and that this requires a form of knowledge I call 'fiduciary', in this case knowledge of the competence and trustworthiness of other participants in deliberation whose expertise may have influenced my agreement.
Recent discussions of the doctrine of double effect have contained improved versions of the doctrine not subject to some of the difficulties of earlier versions. There is no longer one doctrine of double effect. This essay evaluates four versions of the doctrine: two formulations of the traditional Catholic doctrine, Joseph Boyle's revision of that doctrine, and Warren Quinn's version of the doctrine. I conclude that all of these versions are flawed.
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In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that the bishops seek to protect.
Hospital Ethics Committees (HECs), a well-established component of institutional healthcare in the United States (US), are beginning to take root in Asia. A major function of HECs is to provide ethics consultation in the clinical setting. Whereas the modus operandi for ethics consultation is reasonably uniform in the US, one should anticipate significant structural and functional deviations in Asia. For HECs to be effective in Asia, substantive and procedural modifications are necessary to accommodate fundamental cultural and attitudinal differences including differences within Asia itself.