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PubMed1997

The Ethics Committee of the General Faculty Hospital and First Medical Faculty, Charles University.

The purpose of this contribution is to inform about the activities of the local ethics commission established at one of our largest teaching (University) hospitals. In 1995 the following priorities were recognized: studying international ethical standards of research involving human subjects and strictly adhering to them; bilingual administrative agenda in Czech and English; enforcing the patients' rights in health care and emphasizing them in education of medics and other students of health related disciplines; stimulating effective communication between doctors, other health care workers and lay persons in the commission as well as between the members of the commission and authors of research projects applying for ethical evaluation. Since 1993 the commission has been revising and storing in the archives more than 600 research projects. In 1996, 181 new research projects were reviewed, which is 35% more than in 1995. Approval was granted in 154 cases (85.08%), 3 cases (1.66%) were rejected, 15 cases (8.29%) approved on condition of complying with the recommendations of the commission, 6 cases (3.31%) recommended for another commission, and in 3 cases reviewing the project was postponed for lack of necessary data. The members of the commission agree that the future activities should lead to forming a broader group of consultants of the commission and other professional and lay people interested in clinical ethics. According to their meaning, legislation concerning ethical commissions in the Czech Republic, including material and financial support and administrative help, is urgently needed.

Committee Membership↗
PubMed1999

A new doctor in the house: ethical issues in hospitalist systems.

The traditional patient-primary care physician (PCP) relationship provides many ethical protections for patients, including confidentiality, shared medical decision making, and respect for patient autonomy. Hospitalist models, which introduce a purposeful discontinuity of care, threaten these protections and raise certain ethical concerns. We analyze 2 cases that explore ethical issues arising in hospitalist systems and suggest ways to ensure ethical protection for patients. The first case examines how hospitalization can disrupt the patient-PCP relationship and raise ethical issues regarding confidentiality. In the second case, we discuss decision making when the patient's goals and preferences for care change as a result of hospitalization. Effective hospitalist systems provide a model for a trusting patient-physician relationship. Although the hospitalist must take responsibility for inpatient management, the PCP has a key role in addressing important issues in the hospital and providing care after discharge. As hospitalists assume control of inpatient care, they must also provide ethical protections to patients to supplement those currently vested in the patient-PCP relationship. An approach that keeps the patient's best interests foremost, defines a clear role for the PCP, and takes advantage of the expertise and availability of hospitalists will best serve patients and physicians.

Advance Directive Adherence↗
PubMed2007

Relationships between personal values and reported behavior on ethical scenarios for law students.

Lawyers' values might be considered to play some role in the decisions that are made in everyday legal practice. This study aimed to explore the effects of personal value hierarchies on ethical decision making within the context of several ethical dilemmas. A questionnaire was administered utilizing hypothetical situations presented in 11 ethical scenarios and including the Rokeach Value Survey. Logistic regression results suggested that different personal values were significant predictors of reported behavioral choices on respective ethical scenarios. However, the most important values associated with behavior consistent with ethical conduct in scenarios were 'honesty' and 'equality'. The implications of results are discussed in the contexts of ethics education in a tertiary educational environment and in relation to regulation for the professions.

Adolescent↗
PubMed2004

Detention and deception: limits of ethical acceptability in detention research.

The core of Australia's response to asylum seekers who arrive in an unauthorised manner has been to detain them in immigration detention centres until they are judged to engage Australia's protection obligations or, if they do not, until they are returned to their country of origin. For a number of asylum seekers this has resulted in very prolonged detention. This policy has aroused a storm of controversy with very polarised positions being taken by participants in the debate. In particular, the claim has frequently been made (including by this author) that the circumstances and duration of immigration detention cause substantial harm to the mental health of a significant number of detained asylum seekers. A rational debate on the effects of detention has been hampered by the fact that the Australian government has not allowed researchers access to the detention centres in spite of persistent requests for access by professional bodies. This paper is written in response to the following questions posed by the Journal: Is there a case to be made for individuals agreeing to participate in research studies and for the wider population of current and future detainees to be involved in research without informing either the detention provider or the host nation? Is is legitimate for a researcher to engage in potentially deceptive actions in order to obtain access to such detention facilities to undertake research? What ethical framework should underpin such research? Although there is very little guidance in the literature on the ethical conduct of research in settings such as immigration detention centres, a consideration of the ethical implications of carrying out research in the manner raised by these questions leads this author to conclude that such research cannot be ethically justified. Governments must be persuaded to allow, and to provide substantial support for, ethically conducted research on all aspects of detention. There is also a need for the development of an explicit ethical framework for the conduct of research in settings characterised by a very problematic human rights context.

Australia↗
PubMed2006

[Foundation of a Health Care Ethics Committee (HEC) in a nonconfessional hospital. Initial experiences and prospects of the future].

BACKGROUND: Whereas Health Care Ethics Committees (HECs) are well established in the USA, they are still an exception in Germany. In this study, the authors report of the implementation of an HEC at the SLK Hospital Heilbronn, Germany, and discuss the further development within the first 2 years. IMPLEMENTATION AND PROJECTS: After a 1-year preparatory period the official establishment of the HEC followed in March 2004. The hospital management was implicated in the implementation from the beginning. 17 HEC members were recruited proportionally to the own four hospital locations. An ethics forum existing besides the HEC represents an institution open to all clinic employees. After training of moderators with a specially developed training concept, an individual case consultation was established. In a next step, working groups were founded for the projects "advance directive", "dying in hospital", "limitation of treatment" and "patient advocate" in order to develop guidelines. Education in ethics is offered in the ethics forum. CONCLUSION: This report elucidates that a great readiness of committee members and a tight integration of the clinic management are essential for a successful establishment of an HEC. The structure converted within the authors' HEC permits a discussion of ethical problems beyond existing hierarchies and occupational groups. In this new institution the authors see a great potential for improvement in dealing with ethical problems within the hospital.

Advance Directives↗
PubMed1997

[Ethical conflicts during anesthesia. "Do not resuscitate" orders in the operating room].

Patients have the right to make decisions concerning their health care. The right to consent to or refuse treatment is based on the ethical principle of autonomy. Respecting a patient's autonomy has emerged as one of the leading principle in medical ethics in the last years. In the United States, the Patient Self-Determination Act of 1991 stated that all patients admitted to hospital have to be informed about their right to prepare advance directives and to refuse life-prolonging treatment. Do-not-resuscitate (DNR) orders have been established to provide a mechanism for withholding specific resuscitative therapies in the event of cardiac arrest. Patients may write DNR orders to express in advance their preferences at a time when they are capable of making informed decisions. Terminally ill patients may need palliative surgical interventions to relieve pain or facilitate care. In patients with DNR orders undergoing anaesthesia and surgical procedures, the DNR status in the operating room is increasingly a matter of ethical conflict. Anaesthetic care virtually always implies the provision of resuscitative measures if necessary. Interventions like intubation, mechanical ventilation, or administration of vasoactive drugs may be regarded as a part of resuscitative efforts. There is a remarkable lack of consistency in policies and practices in hospitals regarding interpretation of DNR orders during the perioperative period. Considering policies automatically suspending DNR orders prior to anaesthetic care, the American Society of Anesthesiologists (ASA) in 1993 introduced "Ethical guidelines for the anesthesia care of patients with do not resuscitate orders or other directives that limit treatment". To address a patient's right to self-determination in a responsible and ethical way, the ASA recommends explicitly discussing with the patient all limitations of therapeutic interventions. A list of relevant items that should be considered, like defibrillation and chest compression, but also blood product transfusion or the administration of antibiotics, has been provided by the ASA. These statements can provide some order to an increasing state of the uncertainty, but guidelines might also be regarded as imposing restrictions that compromise the anaesthesiologist's autonomy. I believe that defining accepted and refused interventions in advance is not an appropriate approach to DNR orders during anaesthesia and surgery, as it will be difficult to find a definition of what constitutes resuscitation in this context. Communication with the patient and exchange of information are essential factors promoting ethical decisions. Knowing the individual patient's preferences and fears, a more suitable approach seems to be the perioperative suspension of the DNR order for a limited period of time, with the assurance that therapeutic procedures instituted during surgery will be discontinued postoperatively in reconsideration of the DNR order and if the underlying disease process turns out to be non-reversible.

Anesthesia↗
PubMed2000

[Fundamentals of scientifically based ethics in the works of Eugen Bleuler].

The name Eugen Bleuler is almost exclusively linked with matters concerning the nosology of schizophrenia, general psychopathology, and the relationship of clinical psychiatry with psychoanalysis. His bibliography lists various works dealing with contemporary themes about legislation, the fight against alcoholism, and, for the most part from later years, with themes about general psychology. In this article, material from Bleuler's texts are reviewed, including some which have been inaccessible up to now, which either allow interpretative conclusions on ethical grounds or have this explicitly as a topic. In particular, the analysis focuses on Bleuler's work "The Scientific Fundamentals of Ethics", published in 1939. Written in a time widely viewed as disorientated, the author coherently and systemically comments on the issue of a 'new' ethic. The anti-religious and anti-philosophical positions already demonstrable in some of his earlier works will be shown. According to his conception of a scientifically based ethic, the idea of social suitability is of utmost importance and also recognisable in the animal world as a general principle of nature. Bleuler perceives the ethical 'instinct' as inherent; its absence characterises the image of an 'moral idiot', which was already a theme in his earlier works. His statements about matters concerning euthanasia are presented and, furthermore, it will be attempted to construct from his texts an underlying global view. Concerning these ethical issues, it also can be shown once more that the elderly Bleuler was hardly influenced by psychoanalytical perspectives.

Ethics, Medical↗
PubMed2003

Beyond the question of placebo controls: ethical issues in psychopharmacological drug studies.

RATIONALE: There is a broad range of complex ethical issues in the conduct of psychopharmacological drug studies that go beyond the question of the ethics of placebo controls. However, our empirical knowledge with respect to these issues is very limited. This review, although not exhaustive, highlights an array of ethical issues that arose from discussions within the NIMH Human Subjects Research Council Workgroup. OBJECTIVES: To delineate issues in psychopharmacological drug studies that require debate and would benefit from research leading to the development of empirically-supported guidelines. METHODS: Information included in this report was drawn from the first author's participation as chair of the NIMH Human Subjects Research Council Workgroup, guidelines for the ethical conduct of research proposed by professional organizations to which the first and third author belong, and relevant research literature. RESULTS: We have focused on general issues relating to informed consent, research with special populations, and long-term treatment studies. Additionally, we raise issues relevant to large research-oriented institutions. CONCLUSIONS: The essential ethical challenge in psychopharmacological trials is to balance risks and benefits in the context of the needs and capacities of individual research subjects. The IRB system must become evidence-based and not rely on unproven assumptions. Specific research studies should be undertaken to address many of the issues of informed consent and research ethics postulated in this paper.

Adolescent↗
PubMed2003

Ethical issues in the use of animals in biomedical and psychopharmocological research.

RATIONALE: The ethical debate concerning the use of animals in biomedical and pharmacological research continues to be replete with misunderstandings about whether animals have moral standing. OBJECTIVES: This article briefly reviews the central ethical positions and their relationship to the basic parameters of research regulation from an international perspective. The issues associated with the validation of animal models will then be discussed. Finally, suggestions for empirical ethics research will be presented. METHODS: Recent literature reviews were accessed and analyzed. RESULTS: This review summarizes the pertinent ethical and research literature. CONCLUSIONS: In summary, regardless of the ethical perspective one favors, there is strong agreement that animals matter morally and that at a minimum their welfare must be considered. This position is reflected in the structure of national regulatory schemes that emphasize the three Rs (replacement, reduction, refinement). Researchers should more actively participate in the discussion by becoming more knowledgeable about the details of the ethical issues. Research with animal models has been problematic in that it has often focused on attempting to produce global models of psychiatric disorders, which suffer from inherent validity problems. Researchers must also become more sophisticated about issues of model validation and the nature of the animals they use.

Animal Experimentation↗
PubMed2003

Ethics curricula in surgery: needs and approaches.

Surgeons practice an intense form of applied ethics. The growing complexity of medical and surgical interventions combined with reduced opportunity to serve as ethical role models for trainees necessitates formal ethics curricula in surgery and the development of continued ethics education for surgeons through all stages of their careers. The Royal College of Physicians and Surgeons of Canada and the American College of Surgeons ethics curricula provide practical methods for dealing with the ethical issues that confront surgical residents each day. We can improve and expand upon curricula for surgical residents by taking into consideration the evolutionary stages of life of a surgeon: the pre-surgeon, the medical student, the beginning resident, the midlevel resident, the senior resident, the young to midlevel surgeon, and the advanced surgeon.

Curriculum↗
PubMed2004

[Genet(h)ics: the philosophical concept of the discourse ethics and consequences for the research community].

The research community is increasingly confronted with the problem of ethic responsibility. Ethic reflection might be integrated as a part of one's own research projects. This question is discussed against the background of Jürgen Habermas' discourse ethics, which considers the diverse state of being in the modern age as the basis. In this situation, the process of understanding ("Verständigungsprozess") the norms assumed to be valid receives extraordinary significance, since this process of understanding itself inheres authorizing function for the norms. Taking this philosophicial approach seriously, researchers have the specific responsibility not to perform the ethical judgement based on facts alone. Since researchers might be predestined to envisage the ethical implication of their own research at an early stage, they have the possibility to activate the process of understanding about relevant ethical norms themselves as early as possible.

Biomedical Research↗
PubMed2005

Ethical considerations in mental health research with racial and ethnic minority communities.

Mental health researchers are now expected to include racial and ethnic diversity in their study samples. These studies meet ethics requirements, but the tendency to focus on deontological ethical objectives has not been sufficient to ensure ethical or equitable outcomes for research participants. To ensure these outcomes, we need to emphasize utilitarian ethical principles that take into account the historical and contemporary processes that have promoted negative outcomes for racial and ethnic minority participants in research. Suggestions are made for how both deontological and utilitarian ethical concerns regarding respect, beneficence and justice can be addressed within a broadened research ethic.

Biomedical Research↗
PubMed2004

Student development and ownership of ethical and professional standards.

Ethics and professional conduct are vital to civil engineering undergraduate curricula. Many programs struggle to ensure that students are given an adequate exposure to and appreciation of ethical and professional conduct issues. This paper describes a two-part ethics/professionalism project used in a senior-level course taught at the University of Arkansas. Initially, students scrutinize ethical canons and standards of professional conduct published by the American Society of Civil Engineers (ASCE) and the National Society of Professional Engineers (NSPE), and prepare an essay concerning the applicability of these standards. The second part of the project builds on the first: based on the opinion(s) generated in Part 1, students are asked to develop a set of canons or standards targeted specifically to the undergraduate student, and suggest processes for implementing those standards within the department. Project objectives include: (1) exposure to nationally-recognized ethical canons and standards of professional conduct; (2) personal formulation of ethical and professional standards; (3) skill enhancement for non-technical written communications. Feedback by students prior to and after the project indicates success in meeting all objectives. The feedback also indicates that for some students, definitions and applications of ethics and professionalism are being broadened to include more than academic honesty issues.

Arkansas↗
PubMed2005

Ethics in an operations management course.

Graduates of the management major at the University of Pittsburgh at Greensburg find employment in a variety of organizations. As future managers with employees from different professions, students expressed an interest in discussing ethics cases in the operations management class. The semester starts with students familiarizing themselves with various professional and corporate codes of ethics. Throughout the semester a number of short ethics' cases in operations' areas such as inventory management, scheduling, facility location, and product design are introduced to illustrate ethical issues that a manager and his/her employees might face. Students prepare individual responses before the in-class discussions. The semester ends with a long group ethics case discussion and formal case presentations. In the end-of-semester survey, students responded very favorably to an ethics component in the operations management class.

Ethics, Professional↗
PubMed2006

Teaching ethics in engineering education through historical analysis.

The goal of this paper is to stress the significance of ethics for engineering education and to illustrate how it can be brought into the mainstream of higher education in a natural way that is integrated with the teaching objectives of enriching the core meaning of engineering. Everyone will agree that the practicing engineer should be virtuous, should be a good colleague, and should use professional understanding for the common good. But these injunctions to virtue do not reach closely enough the ethic of the engineer as engineer, as someone acting in a uniquely engineering situation, and it is to such conditions that I wish to speak through a set of specific examples from recent history. I shall briefly refer to four controversies between engineers. Then, in some detail I shall narrate three historical cases that directly involve the actions of one engineer, and finally I would like to address some common contemporary issues. The first section, Engineering Ethics and the History of Innovation, includes four cases involving professional controversy. Each controversy sets two people against each other in disputes over who invented the telegraph, the radio, the automobile, and the airplane. In each dispute, it is possible to identify ethical and unethical behavior or ambiguous ethical behavior that serves as a basis for educational discussion. The first two historical cases described in "Crises and the Engineer" involve the primary closure dam systems in The Netherlands, each one the result of the actions of one engineer. The third tells of an American engineer who took his political boss, a big city mayor, to court over the illegal use of a watershed. The challenges these engineers faced required, in the deepest sense, a commitment to ethical behavior that is unique to engineering and instructive to our students. Finally, the cases in "Professors and Comparative Critical Analysis" illuminate the behavior of engineers in the design of structures and also how professors can make public criticisms of designs that seem wasteful.

Engineering↗
PubMed2006

A team-taught interdisciplinary approach to engineering ethics.

This paper outlines the development and implementation of a new course in Engineering Ethics at the University of Tennessee. This is a three-semester-hour course and is jointly taught by an engineering professor and a philosophy professor. While traditional pedagogical techniques such as case studies, position papers, and classroom discussions are used, additional activities such as developing a code of ethics and student-developed scenarios are employed to encourage critical thinking. Among the topics addressed in the course are engineering as a profession and its role in society; ethical successes and failures; risk, safety, and the environment; professional responsibilities; credit and intellectual property; and international concerns. The most significant aspect of the course is that it brings both engineering and non-engineering points of view to the topics at hand. This is accomplished in two ways. First, as mentioned previously, it is team-taught by engineering faculty with an interest in ethical and societal issues, and by philosophy faculty with expertise in the field of professional ethics and an interest in science and technology. Second, the course is offered to both engineers and non-engineers. This mix of students requires that all students must be able to explain their technical and ethical decisions in a non-technical manner. Work teams are structured to maximize interdisciplinary interaction and to foster insights by each student into the professional commitments and attitudes of others.

Curriculum↗
PubMed2006

Integrating ethics into technical courses: micro-insertion.

Perhaps the most common reason science and engineering faculty give for not including 'ethics' (that is, research ethics, engineering ethics, or some discussion of professional responsibility) in their technical classes is that 'there is no room'. This article 1) describes a technique ('micro-insertion') that introduces ethics (and related topics) into technical courses in small enough units not to push out technical material, 2) explains where this technique might fit into the larger undertaking of integrating ethics into the technical (scientific or engineering) curriculum, and 3) concludes with some quantified evidence (collected over more than a decade) suggesting success. Integrating ethics into science and engineering courses is largely a matter of providing context for what is already being taught, context that also makes the material already being taught seem 'more relevant'.

Engineering↗
PubMed2004

Sources of ethical conflict in medical housestaff training: a qualitative study.

PURPOSE: Despite increased emphasis on medical ethics and professionalism in medical education, concern about unethical and unprofessional behavior by physicians is widespread. This study sought to identify and classify the range of work-related ethical conflicts experienced by medical house officers. METHODS: We performed a qualitative study using data from in-depth interviews conducted in 2001 with 31 internal medicine residents in one traditional and one primary care residency. Using the constant comparative method, we explored work-related experiences during housestaff training that involved ethical conflict with patients or colleagues. RESULTS: The interviews revealed five categories of ethical conflict: concern over telling the truth, respecting patients' wishes, preventing harm, managing the limits of one's competence, and addressing performance of others that is perceived to be inappropriate. Conflicts occurred between residents and attending physicians, patients or families, and other residents. Many of the conflicts were exacerbated by the function of the hierarchical structure in residency training. CONCLUSIONS: This study provides a classification of work-related ethical conflicts that houseofficers experience, which may be used to improve the working environment for residents and support their professional development. By attending to the challenges that residents face, particularly previously underemphasized conflicts concerning competence and performance, this framework can be used to enhance education in ethics and professionalism.

Adult↗