1
|
Allinson M, White S, Black P. Pharmacy graduates' perceived impact of long-term undergraduate use of an ethical decision-support tool on their early practice. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:760-769. [PMID: 34074504 DOI: 10.1016/j.cptl.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 12/06/2020] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Values-based practice is an important concept within healthcare decision-making that sits alongside evidence-based practice. Values Exchange (Vx) (http://www.vxcommunity.com) is an online tool that supports the development of ethical and professional decision-making skills through values transparency. The aim of this research was to explore the perceived impact of long-term use of the tool during undergraduate study on pharmacy graduates' early practice. METHODS Alumni in their pre-registration year or up to two years qualified were invited to participate via a question at the end of a survey, with additional students invited prospectively during an undergraduate lecture. All had completed three cases per year on Vx during the four-year master of pharmacy course. Semi-structured interviews were audio-recorded and transcribed verbatim, and framework analysis was applied. Ethical approval was obtained. RESULTS A total of 18 interviews (nine pharmacists and nine pre-registration tutees) were conducted between May 2015 and March 2016. Thirteen participants were female, 13 were based in community pharmacy, and 10 were Caucasian. Interviews ranged from 50 min to 2 hours. Three themes emerged from the data: (1) the Vx learning environment, (2) learning and reflection, and (3) potential enhancements for learning. Participants perceived Vx to be an effective teaching tool supporting the development of skills necessary to exercise professional judgement in pharmacy practice. CONCLUSIONS Vx appears to be a worthy addition to the armoury of teaching methods necessary to support future pharmacists in their preparedness to deal with ethical and professional dilemmas in practice.
Collapse
Affiliation(s)
- Maria Allinson
- School of Pharmacy, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | - Simon White
- School of Pharmacy, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | - Patricia Black
- School of Pharmacy, Keele University, Keele, Staffordshire ST5 5BG, UK.
| |
Collapse
|
2
|
Onarheim KH, Wickramage K, Ingleby D, Subramani S, Miljeteig I. Adopting an ethical approach to migration health policy, practice and research. BMJ Glob Health 2021; 6:e006425. [PMID: 34321236 PMCID: PMC8319989 DOI: 10.1136/bmjgh-2021-006425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/02/2021] [Indexed: 11/05/2022] Open
Abstract
Migration health is affected by decision making at levels ranging from global to local, both within and beyond the health sector. These decisions impact seeking, entitlements, service delivery, policy making and knowledge production on migration health. It is key that ethical challenges faced by decision makers are recognised and addressed in research and data, clinical practice and policy making on migration health. An ethical approach can provide methods to identify ethical issues, frameworks for systematising information and suggesting ethically acceptable solutions, and guidance on procedural concerns and legitimate decision making processes. By unpacking dilemmas, conflicts of interests and values at stake, an ethical approach is relevant for all who make decisions about migration health policy and practice. Adopting an ethical approach to migration health benefits governments, organisations, policy makers, health workers, data managers, researchers and migrants themselves. First, it highlights the inherent normative questions and trade-offs at stake in migration health. Second, it assists decision makers in deciding what is the ethically justifiable thing to do through an 'all things considered' approach. Third, ethical frameworks and technical guidance set normative and practical standards for decision makers facing ethical questions - from 'bedside rationing' to collection of big data or in policy making - that can ensure that migrants' interests are considered. Fourth, there is a need for greater transparency and accountability in decision making, as well as meaningful participation of migrant groups. An ethical approach connects to public health, economic and human rights arguments and highlights the urgent need to mainstream concerns for migrants in global and national health responses.
Collapse
Affiliation(s)
| | - Kolitha Wickramage
- Migration Health Division, International Organization of Migration, Manila, Philippines
| | - David Ingleby
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, Netherlands
| | - Supriya Subramani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Ingrid Miljeteig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Research and Development, Haukeland Universitetssjukehus, Bergen, Norway
| |
Collapse
|
3
|
Campbell MLH. An Ethical Framework for the Use of Horses in Competitive Sport: Theory and Function. Animals (Basel) 2021; 11:1725. [PMID: 34207809 PMCID: PMC8230307 DOI: 10.3390/ani11061725] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/23/2022] Open
Abstract
Growing ethical concern about equestrian sport is reflected in publications by regulatory authorities, animal charities, and the lay press; and in government debate and social media. However, attempts by regulators and stakeholders to address ethical issues in equine sport have been discipline specific and ad hoc. Ethical frameworks can help stakeholders to make contextual decisions about what should or should not be done in a particular situation. However, when existing animal welfare frameworks and existing sports ethics frameworks are reviewed in this paper, it becomes clear that none provide us with a suitable or sufficient tool for considering ethical issues which can arise in situations where the athlete is a non-human, non-consenting participant. This paper presents the theoretical development of a novel ethical framework, with the aim of providing stakeholders with a tool which they might apply to the consideration of the ethical questions which inevitably arise in relation to (equestrian) sport. The derivation and limitations of the ethical framework are explained. The use of the framework will serve both to underwrite the continuation of the social license to use horses in sport and also to enable those within equestrian sport to critically assess existing and proposed practices and to make welfare-improving adjustments to practice if/where necessary. The theoretical framework as presented here is currently being practically tested and refined in consultation with industry stakeholders, and that research will be submitted for publication in due course.
Collapse
Affiliation(s)
- Madeleine L H Campbell
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, Herts AL9 7TA, UK
| |
Collapse
|
4
|
Machin LL, Proctor RD. Engaging Tomorrow's Doctors in Clinical Ethics: Implications for Healthcare Organisations. HEALTH CARE ANALYSIS 2020; 29:319-342. [PMID: 32895863 PMCID: PMC8560662 DOI: 10.1007/s10728-020-00403-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinical ethics can be viewed as a practical discipline that provides a structured approach to assist healthcare practitioners in identifying, analysing and resolving ethical issues that arise in practice. Clinical ethics can therefore promote ethically sound clinical and organisational practices and decision-making, thereby contributing to health organisation and system quality improvement. In order to develop students’ decision-making skills, as well as prepare them for practice, we decided to introduce a clinical ethics strand within an undergraduate medical curriculum. We designed a programme of clinical ethics activities for teaching and assessment purposes that involved using ethical frameworks to analyse hypothetical and real-life cases in uni- and inter- professional groups. In this paper, we draw on medical student feedback collected over 6 years to illustrate the appeal to students of learning clinical ethics. We also outline the range of benefits for students, healthcare organisations, and the field of clinical ethics arising from tomorrow’s doctors experiencing clinical ethics early in their training. We conclude by briefly reflecting on how including clinical ethics within tomorrow’s doctors curricular can secure and continue future engagement in clinical ethics support services in the UK, alongside the dangers of preparing students for organisational cultures that might not (yet) exist. We anticipate the findings presented in the paper will contribute to wider debates examining the impact of ethics teaching, and its ability to inform future doctors’ practice.
Collapse
Affiliation(s)
- Laura L Machin
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Robin D Proctor
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| |
Collapse
|
5
|
Kuziemsky CE, Hunter I, Gogia SB, Lyenger S, Kulatunga G, Rajput V, Subbian V, John O, Kleber A, Mandirola HF, Florez-Arango J, Al-Shorbaji N, Meher S, Udayasankaran JG, Basu A. Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems. Yearb Med Inform 2020; 29:44-50. [PMID: 32303097 PMCID: PMC7442533 DOI: 10.1055/s-0040-1701976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives. METHODS We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth. RESULTS Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts. CONCLUSIONS Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.
Collapse
Affiliation(s)
- Craig E Kuziemsky
- Office of Research Services and School of Business, MacEwan University, Edmonton, Alberta, Canada
| | - Inga Hunter
- School of Management, Massey University, New Zealand
| | - Shashi B Gogia
- Society for Administration of Telemedicine and Healthcare Informatics (SATHI), New Delhi, India
| | | | - Gumindu Kulatunga
- Postgraduate Institute of Medicine, University of Colombo, Sri Lanka
| | - Vije Rajput
- General Practitioner, Stonydelph Health Centre, Tamworth, UK
| | | | - Oommen John
- George Institute for Global Health, University of New South Wales, New Delhi, India
| | | | | | | | | | | | | | - Arindam Basu
- School of Health Sciences, University of Canterbury, New Zealand
| |
Collapse
|
6
|
Malik A, Conroy M, Turner C. Phronesis in Medical Ethics: Courage and Motivation to Keep on the Track of Rightness in Decision-Making. HEALTH CARE ANALYSIS 2020; 28:158-175. [PMID: 32356112 PMCID: PMC7319403 DOI: 10.1007/s10728-020-00398-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ethical decision making in medicine has recently seen calls to move towards less prescriptive- based approaches that consider the particularities of each case. The main alternative call from the literature is for better understanding of phronesis (practical wisdom) concepts applied to decision making. A well-cited phronesis-based approach is Kaldjian's five-stage theoretical framework: goals, concrete circumstances, virtues, deliberation and motivation to act. We build on Kaldjian's theory after using his framework to analyse data collected from a three-year empirical study of phronesis and the medical community. The data are a set of narratives collected in response to asking a medical community (131 doctors at various stages of their careers) what making ethically wise decisions means to them. We found that Kaldjian's five concepts are present in the accounts to some extent but that one of the elements, motivation, is constructed as playing a different, though still crucial role. Rather than being an end-stage of the process as Kaldjian's framework suggests, motivation was constructed as initiating the process and maintaining the momentum of taking a phronesis-based approach. The implications for medical ethics decision-making education are significant as motivation itself is a highly complex concept. We therefore theorise that motivation is required for leading in, continuing and completing the actions of the ethical decision taken. Appreciating the central importance of motivation through the whole of Kaldjian's framework has implications for cultivating the virtues of phronesis and courage to take the right course of action.
Collapse
Affiliation(s)
- Aisha Malik
- Health Services Management Centre, University of Birmingham, Birmingham, UK.
| | - Mervyn Conroy
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Chris Turner
- Emergency Medicine, University Hospital Coventry and Warwickshire, Coventry, UK
| |
Collapse
|
7
|
Megregian M. Ethics and Professionalism: The Whole Is More Than the Sum of Its Parts. J Midwifery Womens Health 2019; 64:526-528. [DOI: 10.1111/jmwh.13016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/20/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Michele Megregian
- School of NursingOregon Health and Science University Portland Oregon
| |
Collapse
|
8
|
Davies J, Black S, Bentley N, Nagi C. Forensic case formulation: theoretical, ethical and practical issues. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2013; 23:304-14. [PMID: 24101410 DOI: 10.1002/cbm.1882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/17/2013] [Accepted: 07/23/2013] [Indexed: 05/22/2023]
Abstract
ARGUMENT Forensic case formulation, of increasing interest to practitioners and researchers raises many ethical, theoretical and practical issues for them. CONCLUSION Systemic, contextual and individual factors which need to be considered include the multitude of staff often involved with any one individual, the pressure to 'get it right' because of the range of risk implications that are associated with individuals within forensic mental health settings, and individual parameters, for example reluctance to be engaged with services.
Collapse
Affiliation(s)
- Jason Davies
- Abertawe Bro Morgannwg University Health Board, Cefn Coed Hospital, Cockett, Swansea, UK; School of Medicine, Swansea University, Swansea, UK
| | | | | | | |
Collapse
|