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PubMed1994

Ethical issues in sexual misconduct by clinicians.

Sexual misconduct by clinicians in the form of sexual relations with patients has long been recognized as an ethics violation and an activity suitable for assessment by the ethics committees of institutions and local and national professional organizations. The issue can be examined from the vantage point of several types of duties which bear ethical implications; these ethical duties proceed from the following four notions in this area: Sexual misconduct represents a violation of professional ethics as a fiduciary breach, abuse of a power asymmetry, exploitation of vulnerability and use of undue influence. While objections to these criteria may be raised in terms of freedom of association and consent, the violation of ethical principles by sexual misconduct remains clear.

Ethics, Medical↗
PubMed2004

The search for the good in nursing? The burden of ethical expertise.

This paper examines the increasing trend by nursing scholars such as Patricia Benner to conceptualize ethics as a contextual and embodied 'way of knowing', embedded in nursing expertise. The intellectual origins of this development and its debt to neo-Aristotelian thinkers such as philosopher Charles Taylor are discussed. It will be argued that rather than revealing a truth about ethical expertise, the emergence of the 'expert' nurse as a moral and ethical category is the result of the elaboration of neo-Thomist discourses in the educational and professional shaping of nurses. These discourses act on and are enacted by the individual nurse through his or her participation in specific ethical exercises that result in the constitution of the desired subjectivity - or 'expertise'. Central to this shaping are particular notions of 'the good' and its relationship to knowledge, skill and practice. Critiques of these neo-Aristotelian perspectives are discussed and applied to the notion of moral expertise in nursing, and the claims made by its proponents concerning the 'ethical' distinction between experienced and expert nurses. Finally, a call is made for a more pluralistic approach to ethics.

Ethics, Nursing↗
PubMed1999

Ethical, legal and health economic aspects of neonatal screening.

The spectrum of the title of this work is wide, but necessarily so, because of the increasing interaction of the three key components--ethics, law and health economy--in all parts of health systems. Although by nature the key components are different, they are still interdependent. Ethics, as the overall term for values, norms and attitudes of democratic societies, is the basic reference for our controlling of our personal lives, our lives with each other, and our lives with society institutions in the broadest sense. Ethics is the cambrium for control with our general behaviour, but is at the same time the cambrium for the control mechanisms of societies, as expressed in national laws. Health economics is often considered a necessary but value-free part of the spectrum, in accordance with money's very material nature. And yet economics and other resource elements (as organs for transplantation or numbers of special experts) have a strong link to ethics via so-called distributional ethics ("we are able to do more than we can afford"). The main theme for this introduction is ethics. In neonatal screening it relates to two different aspects: one linked to the neonate as an individual who can benefit from early diagnosis of treatable diseases, the other to the neonate as a member of a family line, enabling geneticists later to use the results for genetic mapping of a whole family or of large societal groups.

Denmark↗
PubMed2005

Ethical aspects of sexual medicine.

INTRODUCTION: Ethics describe the ways in which moral life is understood. Morality comprises norms for human conduct, and addresses what is right and what is wrong. AIM: To provide a consensus-based summary of the ethical aspects of sexual medicine. METHODS: Over 200 multidisciplinary specialists from 60 countries were divided into 17 consultation committees as part of a process organized by an international consultation on sexual medicine held in Paris, June 28-July 1, 2003 in close alliance with several sexual medicine organizations. Embarking on a study on ethics in sexual medicine, 10 experts from eight countries assembled over a two-year period to develop this consensus-based summary. MAIN OUTCOME MEASURE: Although ethics are recognized as subjective, expert opinion was based on grading of evidence-based medical literature, in addition to cultural and ethical considerations. The process also involved extensive internal committee discussion, public presentation, and debate. RESULTS: Contemporary medical practitioners provide health care for patients from many different cultures from all around the world. Thus, it is recommended that all health professionals working in sexual medicine should above all be able to demonstrate respect, understanding, and tolerance toward the differing moral worldviews of their patients and colleagues, and the societies they represent. In sexual medicine, health professionals have an obligation to respect the autonomy of any individual that they treat, regardless of that individual's religious or socio-cultural tradition, race, gender, or sexual orientation. Sexual rights are a necessary condition for sexual health. Sexual health requires a positive and respectful approach to sexuality and sexual relationships as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled. CONCLUSIONS: Additional discussion and research on ethics in sexual medicine is needed.

Cultural Diversity↗
PubMed2000

Some recent developments in the international guidelines on the ethics of research involving human subjects.

We are in a period of reconsideration and revision of international ethical guidelines for the conduct of biomedical research involving human subjects. The proximate cause of much of this activity is the recent controversy over the ethics of the use of a placebo control in the clinical trials of the short-duration regimen of zidovudine for prevention of perinatal transmission of HIV infection, trials that were carried out in several so-called technologically developing countries. Critics of these trials claimed that they were in violation of Article II.3 of the Declaration of Helsinki, which states: "In any medical study, every patient--including those of a control group, if any--should be assured of the best proven diagnostic and therapeutic method. This does not exclude the use of inert placebo in studies where no proven diagnostic or therapeutic method exists." The critics claimed that since the "best proven ... method" is the 076 regimen, this is what must be provided to members of the control groups. Failure to do so, they asserted, was a serious breach of ethics. In response to this allegation, several major international and national agencies convened multidisciplinary groups to consider the ethics of multinational clinical research. The first thing they realized was that Article II.3 was in error in that it did not reflect contemporary ethical thinking. Moreover, it was routinely violated in research conducted in developed as well as in developing countries. What replaces this standard? The 1993 CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects include several criteria for justification of research carried out in developing countries. Most importantly, the research must be responsive to the health needs and priorities of the host country. They also require that any therapeutic products developed in such research must be made "reasonably available" to residents of the host country. A new standard is emerging for selecting therapies to be administered to participants in multinational clinical trials and for use as the control "treatment" in such trials. It is called the "highest attainable and sustainable" therapeutic method. Application of this standard differs from application of the "best proven method" standard in that it permits the evaluation of new therapies that are responsive to the health needs and priorities of resource-poor countries. It has long been recognized that the Declaration of Helsinki is a flawed document in that it relies on the illogical distinction between therapeutic and nontherapeutic research. This distinction has been removed from the most recent draft revisions of the Helsinki and the CIOMS documents.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Patients' ethical obligation for their health.

In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine because it fails to appreciate that medicine's basis as a moral enterprise is oriented towards health values. A naturalistic model for medical ethics is proposed which builds upon biological and medical values. This perspective clarifies ethical obligations to ourselves and to others for life and health. It provides a normative framework for the doctor-patient relationship within which to formulate medical advice and by which to evaluate patient choice.

Attitude to Health↗
PubMed2004

Coordinating the norms and values of medical research, medical practice and patient worlds-the ethics of evidence based medicine in orphaned fields of medicine.

Evidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients.

Allied Health Occupations↗
PubMed1981

Ethical aspects of clinical decision-making.

The aim of the present investigation was to describe and to classify significant ethical problems encountered by the members of the staff during the daily clinical work at a hospital medical department. A set of definitions was prepared for the purpose, including the definition of a 'significant ethical problem'. During a three month period 426 inpatients and 173 outpatients were admitted. Significant ethical problems were encountered during the management of 106 in-patients (25 per cent) and 9 out-patients (5 per cent). No significant difference was found between the frequency of ethical problems in female and male patients, but a positive correlation was noted between the number of problems and the patients' age. The problem types were classified according to a problem list. The results of this investigation suggest that greater attention must be paid to discussions about ethical problems among doctors and other categories of health personnel and that, among others, medical students ought to be taught the analysis of ethical problems.

Adolescent↗
PubMed2006

Dismembering the ethical physician.

Physicians may experience ethical distress when they are caught in difficult clinical situations that demand ethical decision making, particularly when their preferred action may contravene the expectations of patients and established authorities. When principled and competent doctors succumb to patient wishes or establishment guidelines and participate in actions they perceive to be ethically inappropriate, or agree to refrain from interventions they believe to be in the best interests of patients, individual professional integrity may be diminished, and ethical reliability is potentially compromised. In a climate of ever-proliferating ethical quandaries, it is essential for the medical community, health institutions, and governing bodies to pursue a judicious tension between the indispensable regulation of physicians necessary to maintain professional standards and preserve public safety, and the support for "freedom of conscience" that principled physicians require to practise medicine in keeping with their personal ethical orientation.

Attitude of Health Personnel↗
PubMed2006

[Ethical attitudes in Spanish pediatric critical care units].

OBJECTIVES: To assess physicians' awareness and experience of ethical problems that arise when dealing with critically ill children in pediatric intensive care units (PICUs). MATERIAL AND METHODS: Questionnaires containing 20 questions about ethical dilemmas and attitudes related to the care of children admitted to PICUs were mailed to 43 PICUs in Spain. RESULTS: Ninety-five responses corresponding to 24 residents and 71 attending physicians were received from 21 PICUs. The occurrence of ethical dilemmas in the PICU was recognized by 96.8 % of the respondents. The most frequent method of solving these problems was through medical consensus (80 %), while family participation in the decision making process was highly variable. A total of 95.8 % of respondents stated that decisions to limit therapy were made in their PICU, although only one third of these decisions were written in the medical record. The most frequent form of therapeutic limitation was the do not resuscitate order. One third (32.6 %) of participants considered there were ethical differences between withdrawal and withholding of treatment. Attending physicians had greater experience of therapeutic limitation than did residents, but their opinions on the subject were similar. CONCLUSIONS: Ethical dilemmas are common in the PICU. In this setting, decisions about limitation of therapy are frequent, although many physicians admit to not being clear on this issue or on other aspects of clinical ethics. Family members' participation in the decision making process is insufficient in Spanish PICUs.

Attitude of Health Personnel↗
PubMed2005

Ethical issues faced by nursing editors.

This study reports on ethical issues faced by editors of nursing journals, a topic which has not appeared in the nursing literature. A survey of nursing editors (n = 88)was conducted via e-mail; this article is the content analysis of survey questions about ethics. Eight categories of ethical issues emerged: problems with society/association/publisher; decisions about inflammatory submissions; informed consent or IRB issues; conflicts of interest; advertising pressures; duplicate publications and/or plagiarism; difficult interactions with authors; and authorship. Some issues were similar to those published about medical editors; however, others were unique. This study can assist authors to better understand some of the ethical issues in publishing, can help editors to view their issues in the context of what others experience, and can assist societies and publishers to work toward avoiding these ethical issues in the future. Professional discussions about ethics in nursing publications should be the subject of ongoing research and scientific inquiry.

Adult↗
PubMed1997

Ethical issues experienced by HIV-infected African-American women.

The epidemic of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has led to many ethical problems. Most studies have focused on the ethical issues faced by nurses who provide care to persons with AIDS (PWA), rather than the ethical issues faced by PWAs themselves. The purpose of this study, therefore, was to explore the ethical issues faced by five HIV/AIDS-infected African-American women. An analysis of interview data revealed that these women deal with four broad categories of ethical issues: diagnosis; disclosure; treatment by, and of, others; and future pregnancies. The results of this study provide an initial description of the ethical issues faced by HIV/AIDS-infected African-American women, and begin to lay the foundation necessary for nurses appropriately to facilitate and support their decisions.

Adult↗
PubMed1999

A study of the ethics of induced abortion in Korea.

The purposes of this study were to investigate the ethical aspects of induced abortion from the viewpoint of Korean women, and to compare and contrast their ethical considerations and values with the views of western ethical scholars. The two extremes of ethical arguments about induced abortion are pro-life and pro-choice. However, the Korean women who participated in this study showed that conflicting ethical values were raised between the principle of caring and the sanctity of life or the principle of respect for the person, not between the right of self-determination and the sanctity of life. The results of the study suggest that it would be better to include the viewpoints of women in any ethical discussion on abortion in order for ethicists and health professionals to understand more fully the dimensions of moral clinical problems and be in a better position to discuss them in a practical manner.

Abortion, Induced↗
PubMed2002

Ethical decision making in international nursing research.

Researchers in international settings must continually examine cross-cultural ethical issues to ensure that their work is ethically sound. In this article, the authors discuss the process of ethical decision making in international nursing research. They draw on research in Ghana during 1999 involving HIV seropositive women to document this process. Referring to this experience, they argue that international research involving human beings must meet two related but distinct ethical tests: It must meet international ethical standards for the protection of human participants but, at the same time, acknowledge the ethical standards related to the institutional setting and cultural environment in which the research takes place.

Cultural Diversity↗
PubMed2004

Ethical dilemmas in research on Internet communities.

There has been a rapid growth in the number of articles using Internet data sources to illuminate health behavior. However, little has been written about the ethical considerations of online research, especially studies involving data from Internet discussion boards. Guidelines are needed to ensure ethical conduct. In this article, the authors examine how a youth-focused research program negotiated ethical practices in the creation of its comprehensive health site and online message board. They address three situations in which ethical predicaments arose: (a) enrolling research participants, (b) protecting participants from risk or harm, and (c) linking public and private data. Drawing on the ethical principles of autonomy, nonmaleficence, justice, and beneficence, the authors present practical guidelines for resolving ethical dilemmas in research on Internet communities.

Beneficence↗
PubMed1999

An ethical dilemma in school nursing.

School nurses must consider the ethical principles that guide everyday practice. Autonomy, beneficence, justice, and nonmaleficence are the ethical principles most often confronted in the school setting. When beneficent care-giving begins to conflict with the family's decision-making autonomy, paternalism, a form of beneficence, affects the family's autonomy. This creates an ethical dilemma for the school nurse who guides his or her practice by ethical principles but who also must decide when it is appropriate to refer a child or family to a medical provider for further evaluation. A case study is presented to illustrate a specific ethical dilemma. The ethical dilemma is described using a model that examines external factors, professional responsibilities, and possible courses of action. The discussion includes cultural considerations and barriers pertinent to the case example.

Arm Injuries↗
PubMed1995

Research on hospital administrators' ethics: an agenda.

This discussion argues that whereas ethically questionable practices have been identified in many industries, the moral consequences of many hospital management decisions make this industry particularly worthy of ethics studies. Because health care, the hospital's product, typically represents more immediate, intimate, and possibly irreversible benefit or harm to its customer, the patient, than does the typical product of general industry, hospital executives should be held to higher ethical standards in their decision making. Yet little is known about the ethical thinking of hospital managers. Kohlberg's moral reasoning development theory and Rest's Defining Issues Test offer the theoretical base and the means to compare the ethical reasoning of hospital executives to that of their nonhospital counterparts in general industry. This research agenda can offer important clues regarding the need to emphasize ethics in health care industry educational programs.

Decision Making, Organizational↗
PubMed2002

Older persons' ethical problems involving their health.

Although older persons (aged 65 years and older) experience stressful ethical problems involving their health, research is lacking about this phenomenon. The purpose of this study was to describe and examine the content and basic nature of older persons' ethical problems concerning their health. The conceptual framework and method combined ethical enquiry and phenomenology. The participants were 18 older persons and 12 of their children or grandchildren (for contextual understanding). The 19 women and 11 men, 73% of whom were Caucasian, described 184 ethical problems, from which emerged 10 content categories. The basic nature of the ethical problems consisted of conflict, resolution and rationale. The results could assist health professionals to promote older persons' ethical decision making, quality of life, and good death.

Adult↗