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Ethics and science: educating the public.

This article looks at the public debate which took place in the first half of the twentieth century and has repercussions to the present day. It was about the ethical stance of scientists, and how science should be organized. In particular, it examines the positions taken by Professor F. Soddy, F.R.S. and Nobel Laureate, who stressed the responsibility of scientists for the uses made of their research, Professor Michael Polanyi, F.R.S., who emphasised the obligation of scientists to the truth and the essential role of morality in the organization of science, and Professor J.D. Bernal, F.R.S., who insisted that science was practiced for utilitarian reasons and should be consciously developed for the good of society.

Ethics↗

Critical care: why there is no global bioethics.

PURPOSE OF REVIEW: The possibility of content-full, universal, bioethical norms is assessed. The literature brings into question a global bioethics. A salient moral and bioethical pluralism undermines the plausibility of imposing of uniform bioethical norms on critical care. Addressing the tension between the aspiration to a global bioethics and the presence of moral pluralism is timely, given the United Nations Educational, Scientific and Cultural Organization's development of universal, bioethical norms. The practice of critical care in the 21st century will be influenced by the tension between bioethical pluralism and counter-assertions on behalf of a global bioethics. RECENT FINDINGS: A growing literature reflects a bioethical pluralism with significant implications for critical care. Much of the literature supporting pluralism is rooted in a reaction in the Pacific Rim against North American and Western European moral and philosophical commitments. These voices of moral dissent join an already salient moral diversity in the West regarding issues ranging from abortion to end-of-life decision-making, physician-assisted suicide, and euthanasia, as well as conflicting understandings of the bioethics of appropriate approaches to the allocation of scarce medical resources. This literature acknowledging bioethical diversity contrasts with announcements of universal bioethical norms. SUMMARY: Clinicians need to appreciate the sources of moral controversy that divide them from their patients and from their colleagues and to recognize that moral and economic differences may lead to different standards of care. Taking bioethical diversity seriously supports focusing on procedural moral approaches that allow peaceable collaboration in the face of substantive moral disagreement.

Bioethics↗

[Challenges to nursing personnel and their education].

Challenges for developing nurses as persons and personalities during their education are being described in the article. The major thesis is that thorough understanding of the mission of nursing is the ground from which all educational goals derive their origin. In nursing education a reformed relationship between the teacher and the student is needed which facilitates balanced development of ethical, empirical, esthetic and personal knowledge of the student. In this way the future nurse may grow a thinker and an active risk-taking actor who bases her solutions on good knowledge base and moral reasoning. Understanding of the meaning of history, culture and international collaboration are also necessary in the development of versatile personalities.

Education, Nursing↗

[Experimentation on human embryos in the light of the personalistic principle].

One does not see a possibility for moral justification of the cloning of humans, or of any other experiments and manipulation of human embryos other than on the grounds of materialistic anthropology which reduces human spirituality to the dimensions dealt with by natural sciences. If, however, man is a person, and if "to be a person" constitutes an ontological situation and is not the result of some kind of social contract, and if the human embryo is, at least potentially a person, then the Kantian personalistic norm will demand a ban on the cloning of humans and on experimenting on human embryos, and will also exclude any attitude of ownership towards each human being. This demand seems all the more clear if we look at the personalistic norm from the point of view of what is most wonderful in being a person namely, that the person is capable of receiving, learning and giving love. The deficiency of love received at the beginning of somebody's life - even if he or she was conceived out of love - may be a cause of this person becoming closed to higher values. Thus, the idea of cloning human beings means to structurally remove love from the beginning of human life and to introduce technology instead. One cannot really do more harm to another person than by depriving him or her of love at the very beginning of his or her life. I think that the well known stories about Golem or Frankenstein express a presentation of just this truth - and that is why they are so terrifying.

Bioethics↗

Machiavellianism in patients and their children.

The role of the family in the development of Machiavellianism was examined in this study. High- and low-Machiavellian sixth graders played a bluffing game. Their parents completed Machiavellian belief measures. The Machiavellianism of fathers and mothers was positively related to their children's success at deceiving others but not at seeing through others' attempts at deception. In addition, fathers' Machiavellianism was positively related to their children's Machiavellian beliefs. These data support a modeling hypothesis for the development of Machiavellianism. Unexpectedly, the children's own behaviors and beliefs were unrelated. This pattern of results suggests that a child's manipulative behaviors and beliefs are learned separately and only become consistent over time.

Attitude↗

A job well done.

The protective services department at Children's Hospital Medical Center in Cincinnati makes employee satisfaction a priority through ongoing recognition and professional development efforts.

Attitude of Health Personnel↗

[Consensus, hedonism: the characteristics of new family and their consequences for the development of children].

Over the last three decades, the marital family model described by Durkheim at the end of the nineteenth century has undergone numerous changes, e.g. questioning about the principle of authority, women emancipation, occurrence of the "new fathers", the growing influence of the media on the daily life of families, the less frequent and most precious child (due to the reduced number of children per family),... Through clinical, psychoanalytical and developmental models we, here, analyze these changes together with their impact on child. Historical and sociological approaches also allowed us to examine some of the effects induced by consensus and hedonism, the new familial parameters, on the child's life and development. The modern family being classically founded upon duty (central value) and the principle of authority to settle relationships between individuals, its main features are opposed to those of the contemporary family. The latter, which started to emerge over the sixties, is characterized by both the prevalence of parent-child relationships symmetrization and the emergence of the search for immediate pleasure. The change from parental authority to consensus as a principle ruling the relationships within families leads to many consequences later noticed through changes in the construction of the child's psyche along his development and in the relationships dynamics. Authority imposes on child to submit to the parents-mediatized requirements of the society and implies a change in impulses through the setting of Superego agencies and Ego Ideal, which (both ?) represent taboos and social ideals in the psyche. When consensus is at the center of the family, and according to concrete meetings with the other offered by the thousand and one situations met in the daily life, the aims and satisfaction modalities of the child's impulses will evolve into a relation often based on either strength or seduction. As a result, the settlement of classical instances will be affected. It will result in. Considering hedonism as the central value in child education leads one to support the pleasure principle and contributes to making more difficult the switching to the reality principle. The couple " I want, I don't want" is at the origin of most behaviors, and then further leads to the development of the assertive agency, "I do what I want, and thus I am". The libidinal excitation is, therefore, little restricted and reinforced by the media-based environment. The child's Superego is built on the concrete practices of his parents, but not on their Superego, whereas the Ideal of Ego is poorly socialized and driven towards the ideal Ego, early narcissist formation with the signs of child megalomania. Due to these early years of life throughout which the pleasure principle has been favored by their environment, the children are not prepared for life with its restrictions and unavoidable frustrations possibly experienced as persecutions. In the same way, when they have to meet the requirements of life in community, eg the discipline imposed within a college, these rules are more and more often felt by a pupil as unfair, arbitrary persecutions sometimes related to his own personality, "the teacher doesn't like me" of course, it is all the more legitimate to rebel against them as the charter of the pupils' rights, posted up in the school, has been read through very quickly by the teenagers. This mechanism takes one back to the archaically perception of environment by the very young child and to the projection developed by S. Freud in his description of the building "Ego-pure pleasure", (moi-plaisir purifie) (The Ego and the id, 1920). The opposed mechanism is expressed through an experience of shame felt by the subject when he is unable to satisfy, not the requests of his own impulses, but the social group's requirements. From the libidinal point of view, advertisements stimulate one's desires, incite one to consume and are at the origin of consumer needs. As a consequence, there is a resonance between the individual pleasure principle and the promotion of hedonism suggested by the society. The modern children have their mastery of impulse motions hampered by this phenomenon. The temporality of , new children " in new families sounds centered on the present, which is made of moments of eternity, always restarted (cyclic time of the first ages of life) ; it overrides historical time with a start, an end and references to intergeneration difference and filiations. This prevalence of present offers few support to neurotic defenses, with predictable problems in social interactions due to an inability to manage the tensions issued from the time discrepancies between one and his alter ego. Tran cultural studies have shown that to any social and cultural organization corresponds one or several basic personalities; among them, modem society has exuded the standard neurotic personality characterized by an ample mental space, a strict modulation of behaviors governed by the representations play and spreading out in Le théâtre du Je (The I theatre, Mac Dougall, 1982), a conflict between desire and internalized taboo, and the problematic of transgression and guilt. The modern family produces different personality structures. This led us to assume new basic personalities as follows, and to envision some psychopathological consequences: The passive dependent personality with an extreme narcissist fragility and at high risks of depressive disorders; The perverse-anarchistic personality characterized by subjects unable to feel guilty, taking at the best advantage of others to achieve his own ends thanks to his grasping of social situations and to his own seduction, lacking of true empathy; The slightly-psychopathic personality: these subjects can integrate well, but for a short time, in a social structure. They need to frequently find a new job, move in another place or country. Their relationships with others are always disrupted and changing for they can be involved in only short commitments. They are very susceptible to immediate gratifications.

Adult↗

A defense of unqualified medical confidentiality.

It is broadly held that confidentiality may be breached when doing so can avert grave harm to a third party. This essay challenges the conventional wisdom. Neither legal duties, personal morality nor personal values are sufficient to ground professional obligations. A methodology is developed drawing on core professional values, the nature of professions, and the justification for distinct professional obligations. Though doctors have a professional obligation to prevent public peril, they do not honor it by breaching confidentiality. It is shown how the protective purpose to be furthered by reporting is defeated by the practice of reporting. Hence there is no conflict between confidentiality and the professional responsibility to protect endangered third parties.

Confidentiality↗

Development and initial validation of the Stress of Conscience Questionnaire.

Stress in health care is affected by moral factors. When people are prevented from doing 'good' they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach's alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: 'internal demands' and 'external demands and restrictions'. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts.

Adult↗

Principled thinking: a comparison of nursing students and experienced nurses.

BACKGROUND: A descriptive study was used to compare ethical reasoning abilities in senior baccalaureate nursing students and experienced registered nurses. The effects of environmental factors and previous experience with ethical dilemmas in regard to nursing principled thinking were also examined. RESULTS: Findings on the Nursing Dilemma Test indicated a significant difference in the level of nursing principled thinking in the two groups, with nursing students scoring higher than experienced nurses. There was a significant negative correlation between years of experience and level of nursing principled thinking. The level of nursing education (e.g., associate degree of nursing, diploma, bachelor of science in nursing, masters degree, or doctorate) did not appear to have an effect on nursing principled thinking. In addition, subjects who were most affected by practical considerations demonstrated less use of higher level moral reasoning. The effect of previous experience with ethical dilemmas on nursing principled thinking was found to be nonsignificant. CONCLUSION: Ethical dilemmas continue to create much confusion and uncertainty for practicing nurses. Suggestions are made regarding individual analysis of personal and professional values in nurses. In addition, recommendations include ongoing educational offerings and nursing administration support to assist nurses during times of moral distress.

Adult↗

Patient decision-making: medical ethics and mediation.

A review of medical ethics literature relating to the importance of the participation of patients in decision-making introduces the role of rights-based mediation as a voluntary process now being developed innovatively in America. This is discussed in relation to the theory of communicative ethics and moral personhood. References are then made to the work of medical ethics committees and the role of mediation within these. Finally it is suggested that mediation is part of an eirenic ethic already being used informally in good patient care, and that there is a case for developing it further.

Bioethical Issues↗

Balancing access to pharmaceuticals with patent rights.

It is generally recognised that public health problems in the developing world are dire and that the rest of the world has a moral commitment to provide assistance. Yet many of the world's poor are unable to access essential pharmaceuticals simply because products that are under patent are too expensive and cheaper generics are not available. One of the proposed solutions to this problem is to allow domestic manufacture of generic products in response to health crises. However, this solution will provide no assistance in countries that lack the capacity to manufacture pharmaceuticals. This article discusses the extensive international negotiations occurring during the last couple of years that seek to provide an appropriate balance between access rights and patent rights.

Developing Countries↗

Intra-abdominal infection in patients with abdominal trauma.

HYPOTHESIS: Identifying patients with risk factors associated with the development of intra-abdominal infections makes possible early interventions to minimize morbidity and mortality. We sought to determine the incidence of intra-abdominal infection (organ/space surgical site infection) in patients undergoing operation because of abdominal trauma, to identify the risk factors associated with the development of this complication, and to estimate the respective magnitudes of the risk factors. DESIGN: We performed a prospective cohort study in patients older than 12 years who were treated surgically for penetrating or blunt abdominal trauma, with or without other associated lesions. SETTING: Hospital Universitario San Vicente de Paul in Medellin, Colombia (HUSVP), a level I trauma center for referral and the general community. PATIENTS: From November 1, 2000, through August 31, 2002, 916 patients with abdominal trauma were admitted to the HUSVP trauma unit. Of these, we excluded 2 who underwent operation at different institutions; 97 (10.6%) who died within 48 hours after admission; and 55 (6.0%) in whom complete follow-up (until the 30th postoperative day) was not feasible. The final study sample consisted of 762 patients. MAIN OUTCOME MEASURE: We performed univariate analysis to explore in an isolated way the behavior of the dependent and independent variables. Bivariate analysis was carried out with each of the independent variables and the main outcome to establish the association between individual risk factors and intra-abdominal infection. Finally, a logistic regression model was developed using the SPSS 10.0 program and the forward method. RESULTS: Intra-abdominal infection developed in 81 patients (10.6%). Variables independently associated with this complication were an Abdominal Trauma Index greater than 24, abdominal contamination, and admission to the intensive care unit. CONCLUSIONS: The development of intra-abdominal infection in patients undergoing operation because of abdominal trauma is a complex phenomenon resulting from the multiple risk factors during the preoperative, intraoperative, and postoperative periods. Multivariate logistic regression analysis allowed us to identify an Abdominal Trauma Index greater than 24, contamination of the abdominal cavity, and admission to the intensive care unit as independent risk factors for the development of organ/space surgical site infection.

Abdominal Abscess↗