Medical oaths, declarations, and codes.
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Arguments are advanced, on a pragmatic basis, for preferring a 'situational' approach to medical ethical problems, rather than an approach based on any one of the dogmatic formulations on offer. The consequences of such a preference are exemplified in relation to confidentiality; and in relation to the ethical dilemmas which surround the beginning and the end of terrestrial human life.
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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.
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Ethics committees are fairly common in healthcare institutions in the United States. Comprised of a multidisciplinary membership, including physicians, their functions within institutions are generally threefold: policy recommendation, ethics education and case consultation. The number of such committees will grow as a result of "Patient Rights" standards established by the Joint Commission on Accreditation of Healthcare Organizations (1992 Manual). The author projects and discusses five areas of development and change in the future of healthcare ethics committees. These five areas are: 1) renewed efforts to educate healthcare professionals, 2) cooperation and collaboration among ethics committees, 3) networking with community-based ethics groups, 4) clearer delineation of responsibilities and limitations, and 5) continuous quality improvement. The ability of ethics committees to address successfully these areas of change will determine their future usefulness.
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Various types of teaching and learning strategies can be effectively employed to assist students' professional development in ethical decision-making skills. To be prepared to act as a moral agent in clinical practice, a terminal goal upon completion of the baccalaureate program is the student's ability to develop and consistently use a systematic approach/framework when confronted by an ethical dilemma. Eleven skill steps not necessarily exclusive or in sequence were outlined as selected activities that can be considered for the ethical decision process. Specific ethical issues that are germane and applicable to many patient care situations were investigated and identified as frequently occurring in clinical practice. Course work about these issues prior to completion of their nursing programs may be beneficial in preparing students with basic knowledge and skill about them as they enter or return to clinical practice.
Intensive care units are challenging and technologically advanced environments. Dealing with situations that have an ethical dimension is an intrinsic part of working in such a milieu. When a moral dilemma emerges, it can cause anxiety and unease for all staff involved with it. Theoretical and abstract papers reveal that having to confront situations of ethical difficulty is a contributory factor to levels of poor morale and burnout among critical care staff. Despite this, there is a surprising dearth of published nursing research in the UK that investigates how staff deal with ethical issues in intensive care units. The purpose of this paper is to explore and discuss the development of a research framework designed to explore how staff deal with moral dilemmas in a British intensive care unit.
Ethical guidelines for conducting clinical trials have historically been based on a perceived therapeutic obligation to treat and benefit the patient-participants. The origins of this ethical framework can be traced to the Hippocratic oath originally written to guide doctors in caring for their patients, where the overriding moral obligation of doctors is strictly to do what is best for the individual patient, irrespective of other social considerations. In contrast, although medicine focuses on the health of the person, public health is concerned with the health of the entire population, and thus, public health ethics is founded on the societal responsibility to protect and promote the health of the population as a whole. From a public health perspective, research ethics should be guided by giving due consideration to the risks and benefits to society in addition to the individual research participants. On the basis of a duty to protect the population as a whole, a fiduciary obligation to realise the social value of the research and the moral responsibility to distribute the benefits and burdens of research fairly across society, how a public health perspective on research ethics results in fundamental re-assessments of the proper course of action for two salient topical issues in research ethics is shown: stopping trials early for reasons of efficacy and the conduct of research on less expensive yet less effective interventions.
When reproductive and genetic technologies spurred an extended German policy debate, the issues at stake went beyond the technologies to include the very meaning of "ethics" and the respective roles of ethicists and of the public in thinking about ethical questions.
During the 1990s medical ethics will undergo changes. Individual clinical issues, especially those related to death and dying, will continue to create conflict and preoccupy hospital staffs. But professional ethicists will focus on social concerns more frequently than they have in the past. Following are some of the most crucial ethical issues and directions they are likely to take in this decade: Clinical practice and the law will move toward less demanding standards of proof regarding the withdrawal of treatment from patients who are no longer competent. Public policy will set more lenient standards for judging whether a person would refuse artificial nutrition and hydration if he or she were able. Unless sensible people strengthen the distinction between active and passive euthanasia, more physicians and legislatures will move toward physician-assisted suicide. Those proposing a higher-brain definition of death, as opposed to whole-brain definitions, will gain ground with the general public, but not with legislators. New transplantation technologies will increase medical options but create more problems with paying for the procedures. As techniques are perfected, ethical questions will focus more on financing than on the source of transplantable material. AIDS treatment priorities will clash with other medical demands (e.g., treatment for breast cancer), and concerns about protecting both providers and patients from contracting AIDS will move policy toward routine testing. Progress in public argument will be made on the abortion issue. Members of ethics committees will have to be trained to address financing issues. Some medical schools and residency programs will add courses on the concept of character and on character development to their ethics programs.(ABSTRACT TRUNCATED AT 250 WORDS)