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At least 19 recordsLinked to original sources
PubMed1984

Extraordinary nutritional support: a case study and ethical analysis.

Ethical issues surrounding decisions to limit treatment often focus on dramatic and highly technical interventions, such as mechanical ventilation. Many less dramatic forms of therapy are considered routine, and ethical aspects of their use may be less closely examined. Nutritional support can be crucially important in elderly patients, especially the very frail. Yet, appropriate use of nutritional therapy must consider the circumstances of an individual patient. Where severe underlying illness cannot be reversed, technical means of providing nutrition can represent extraordinary rather than ordinary means of prolonging life. The following case examines the ethical issues in respecting the apparent refusal of nutritional support by a severely debilitated geriatric patient.

Aged↗
PubMed1991

Nursing diagnosis: an ethical analysis.

The ethical consequences of nursing diagnosis in light of the principle "to do no harm" have not been adequately explored. It is proposed that human suffering is created through nursing actions that objectively judge and reduce human beings and their complex relationships with the world. The ethical dimensions for nurses required to participate in the diagnostic process are clarified and three levels of potential harm for individuals with parallel ethical conflicts for nurses are described. National nursing associations and accrediting agencies are challenged to consider the paternalistic underpinnings of the diagnostic process and the ethical outcomes of mandating only one approach in practice. Parse's humanistic theory of nursing is presented as one scientific approach which upholds the duty "to do no harm."

Beneficence↗
PubMed1988

Teaching ethical analysis in occupational therapy.

Ethical decision making is a cognitive skill requiring education in ethical principles and an understanding of specific ethical issues. It is also a psychodynamic process involving personalities, values, opinions, and perceptions. This article proposes the use of case studies and role-playing techniques in teaching ethics in occupational therapy to supplement conventional methods of presenting ethical theories and principles. These two approaches invite students to discuss and analyze crucial issues in occupational therapy from a variety of viewpoints. Methodology of developing case studies and role-playing exercises are discussed. The techniques are evaluated and their application to the teaching of ethics is examined.

Behavior Control↗
PubMed2005

[Independence, consciously accepted dependency, self-responsibility and shared responsibility as key categories of an ethical analysis of old age].

This contribution begins with a brief introduction into some seminal problems of ethics: the search for the essential being of things, the attitude of value consciousness in the context of ethical reflections, and the reflection on models of a 'good life' and on decisions as well as actions in significant moral situations. These introductory statements are illustrated by the example of stoic philosophy. In a second step, independence, consciously accepted dependency, self-responsibility and shared responsibility are discussed as highly significant categories for an ethical analysis of all ages. However these categories must be specified with reference to specific ages. In this contribution, such a specification is carried out for old age focussing on the particular relevance of the four categories for ethical analysis. In a third step, each of the four categories is discussed in detail in the context of basic ethical approaches. In this context, ethical analysis proceeds from the perspectives of the individual, the environment, and the society. Concerning the perspective of the society special interest is offered to societal models of good life in old age which might have an impact on the potential development of a pro-aging culture and shared responsibility in older people. Moreover, these models contribute to older people's ability to use the necessary means of support in cases of dependency and to consciously accept dependency.

Activities of Daily Living↗
PubMed2004

The European Union Directive and the protection of incapacitated subjects in research: an ethical analysis.

OBJECTIVE: We perform an ethical analysis of European Union Directive 2001/20/EC on the simplification and harmonization of guidelines regarding good clinical practice in the conduct of clinical trials involving drugs. BACKGROUND: The Directive provides guidance on protecting incapacitated subjects who participate in drug clinical trials. Such guidance promotes society's obligations of beneficence because the participation of incapacitated subjects in research is crucial in advancing the understanding and treatment of serious diseases. The Directive requires proxy consent for incapacitated subjects which adheres to the principle of respect for persons. The Directive also recommends additional safeguards to further protect subjects against exploitation and harm. These include respect for the assent and dissent of incapacitated subjects and the "necessity" and "subject-condition" requirements. RESULTS: While these essential protection mechanisms are commendable, the Directive fails to endorse other safeguards that have been recommended by other research ethics guidelines, especially for riskier research. The Directive's silence regarding research in the emergency setting frustrates the principle of beneficence because the lack of guidance might prove to be a barrier for the conduct of such potentially beneficial research. CONCLUSIONS: We conclude that the European Directive fails in many respects to promote several important ethical principles in research involving incapacitated subjects.

Critical Care↗
PubMed1995

A comparison of principle-based and case-based approaches to ethical analysis.

Illness is not just something that persons have or get--it is something that they experience. They live this experience fully with their entire being--emotionally, psychologically, spiritually, and physiologically. Any method of ethical analysis must take care to not simplify the process of dealing with morally troubling cases. The multidimensional nature of human life is so complex that the decisions made in these situations are seldom if ever strictly medical decisions--they are also social, emotional, religious, and moral ones. Ethical dilemmas present in today's health care settings compel members of HECs to engage in and contribute toward meaningful dialogue in ethics that is collaborative, multidisciplinary, and mutually respectful. The inevitability of change in the way in which the health needs of people are going to be handled in the future demands this proactive approach. Individuals who accept this responsibility must equip themselves for ethical analysis that deals effectively with the inevitably complex questions that will arise.

Beneficence↗
PubMed1996

Choosing a framework for ethical analysis in advanced practice settings: the case for casuistry.

The need for advanced practice nurses to incorporate ethical analysis into case management is becoming more apparent -- particularly for the increasingly independent practice settings of psychiatric and mental health nursing. The nursing literature contains many articles dealing with the more abstract treatment of clinical ethics, but for the practitioner there is unfortunately little information available that uses ethical principles in a practical framework, which addresses the concrete reality of daily, difficult clinical decision making. This article applies a model of reasoned analysis to an actual case study using the concepts of casuistry or case-based reasoning. This method offers an alternative to the more popular paradigm of principilism. Complicated by the existence of violence and abuse, the case examines several ethical issues including patient privacy and legitimate breaches of patient confidentiality.

Adolescent↗
PubMedDate not supplied

Rural woman abuse and sexually transmitted disease: an ethical analysis of clinical dilemmas.

Women who have experienced abuse are often offered individual and group psychotherapeutic interventions to help them overcome psychological aftereffects of abuse and avoid future abusive relationships. Clinical cases that are complicated by the existence of abuse and sexually transmitted diseases (STDs) often involve ethical issues concerning patient privacy and legitimate breaches of confidentiality that can potentially harm the individual. There is little known about the experiences of abused rural women with STDs, underscoring the need for modification of existing interventions for this patient population. This paper presents the application of an ethical framework to an actual case involving an abused rural woman with an STD that utilizes the concepts of casuiStry, or case-based reasoning. A methodological tool for ethical analysis of the clinical dilemmas involving evidence-based psychotherapeutic interventions for abused rural women with STDs is used to apply the concepts of casuistry to the development of the taxonomy of cases for clinical practice.

Adult↗
PubMed2002

Ethical analysis in public health.

Public-health regularly encounters serious ethical dilemmas, such as rationing scarce resources, influencing individuals to change their behaviour, and limiting freedom to diminish disease transmission. Yet unlike medical ethics, there is no agreed-upon framework for analysing these difficulties. We offer such a framework. It distinguishes three philosophical views, often invoked in public-health discourse: positions based on outcomes (utilitarianism), positions focused on rights and opportunities (liberalism), and views that emphasise character and virtue (communitarianism). We explore critical variations within each approach, and identify practical problems that arise in addressing the ethical dimensions of health policy. We conclude by examining challenges posed by the feminist argument of ethics-of-care and by postmodern views about the nature of ethics. Health professionals need enhanced skills in applied philosophy to improve the coherence, transparency, and quality of public deliberations over ethical issues inherent in health policy.

Ethical Analysis↗
PubMed2004

The ethical analysis of risk in intensive care unit research.

Research in the intensive care unit (ICU) is commonly thought to pose 'serious risk' to study participants. This perception may be at the root of a variety of impediments to the conduct of clinical trials in the ICU setting. Component analysis offers a promising approach to the ethical analysis of ICU research. Because clinical trials commonly involve a mixture of study interventions, therapeutic and nontherapeutic procedures must be analyzed separately. Therapeutic procedures must meet the requirement of clinical equipoise. Risks associated with nontherapeutic procedures must be minimized consistent with sound scientific design, and be deemed reasonable in relation to the knowledge to be gained. When research involves a vulnerable population, such as adults incapable of providing informed consent, nontherapeutic risks are limited to a minor increase over minimal risk. Understood in this way, the incremental risk posed by participation in ICU research may be minimal. This realization has important implications for review by institutional review boards of such research and for the informed consent process.

Biomedical Research↗
PubMed2003

Sham surgery: an ethical analysis.

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.

Arthroscopy↗
PubMed1989

Abandonment of patients by home health nursing agencies: an ethical analysis of the dilemma.

Home health care nurses are facing the ethical dilemma of discontinuing care to nonpaying needy patients or facing agency economic demise. Nurses perceive discontinuing care under such circumstances as patient abandonment. Ethical analysis of the dilemma yields two conclusions: (1) discontinuing care under non-life-threatening circumstances is not abandonment and does not violate the duty of beneficence, and (2) nurses do have an obligation to inform society of such instances so that public policy decision makers can be armed with that information when making allocation decisions.

Ethics, Nursing↗
PubMed1995

[Open questions in neurotransplantation. Attempted at an unbiased ethical analysis].

Neurotransplantation utilizing fetal (embryonic) tissue for treating Morbus Parkinson is a matter of ethical debate, among professionals as well as the public at large. Here, we take a systematic approach to the questions raised to facilitate an unbiased ethical analysis and to attempt adequate answers. Possible functions of ethics in medicine, principles of ethical reflexion in medicine and perspectives of ethical reflexion are differentiated resp. combined. Relevant areas of ethical conflict may thus be identified separating at the same time the context of explantation from that of implantation. Taking as our starting point a systematic discussion of the various open questions, we put forward 5 conclusions. These should help clarify under which conditions the therapy model of neurotransplantation will be admissible.

Attitude of Health Personnel↗