How to "Do Ethics" in Pediatrics Practice: A Framework for Addressing Everyday Ethics Issues

Pediatricians have a fiduciary responsibility to advocate for the best interests of their patients. They accomplish this through the therapeutic alliance with the patient and their parent. In everyday clinical medicine, the pediatrician may be faced with challenging situations. When a case raises concerns, the pediatrician needs to determine if the issues relate to ethical obligations and whether they are in conflict. To resolve the concerns, a systematic process for gathering, organizing, and analyzing the facts of a case is needed to discern morally permissible options. This article presents a framework for performing an ethics case analysis.

The role of epistemological beliefs in STEM faculty's decisions to use culturally relevant pedagogy at Hispanic-Serving Institutions

BACKGROUND

The growing understanding of the oppressive inequities that exist in postsecondary education has led to an increasing need for culturally relevant pedagogy. Researchers have found evidence that beliefs about the nature of knowledge predict pedagogical practices. Culturally relevant pedagogy supports students in ways that leverage students' own cultures through three tenets: academic success, cultural competence, and sociopolitical consciousness. If STEM practitioners believe that their disciplines are culture-free, they may not enact culturally relevant pedagogy in their courses. We investigated how and in what forms 40 faculty from mathematics, physics, chemistry, and biology departments at Hispanic-Serving Institutions enacted culturally relevant pedagogy. We used the framework of practical rationality to understand how epistemological beliefs about the nature of their discipline combined with their institutional context impacted instructors' decision to enact practices aligning with the three tenets of culturally relevant pedagogy.

RESULTS

In total, 35 instructors reported using practices that aligned with the academic success tenet, nine instructors with the cultural competence tenet, and one instructor with the sociopolitical consciousness tenet. Instructors expressed and even lauded their disciplines' separation from culture while simultaneously expressing instructional decisions that aligned with culturally relevant pedagogy. Though never asked directly, six instructors made statements reflecting a "culture-free" belief about knowledge in their discipline such as "To me, mathematics has no color." Five of those instructors also described altering their teaching in ways that aligned with the academic success tenet. The framework of practical rationality helped explain how the instructors' individual obligation (to the needs of individual students) and interpersonal obligation (to the social environment of the classroom) played a role in those decisions.

CONCLUSIONS

Instructors' ability to express two contradictory views may indicate that professional development does not have to change an instructor's epistemological beliefs about their discipline to convince them of the value of enacting culturally relevant pedagogy. We propose departmental changes that could enable instructors to decide to cultivate students' cultural competence and sociopolitical consciousness. Our findings highlight the need for future research investigating the impacts of culturally relevant pedagogical content knowledge on students' experiences.

Preventing conscientious objection in medicine from running amok: a defense of reasonable accommodation

A US Department of Health and Human Services Final Rule, Protecting Statutory Conscience Rights in Health Care (2019), and a proposed bill in the British House of Lords, the Conscientious Objection (Medical Activities) Bill (2017), may well warrant a concern that-to borrow a phrase Daniel Callahan applied to self-determination-conscientious objection in health care has "run amok." Insofar as there are no significant constraints or limitations on accommodation, both rules endorse an approach that is aptly designated "conscience absolutism." There are two common strategies to counter conscience absolutism and prevent conscientious objection in medicine from running amok. One, non-toleration, is to decline to accommodate physicians who refuse to provide legal, professionally accepted, clinically appropriate medical services within the scope of their clinical competence. The other, compromise or reasonable accommodation, is to impose constraints on accommodation. Several arguments for non-toleration are critically analyzed, and I argue that none warrants its acceptance. I maintain that non-toleration is an excessively blunt instrument to prevent conscientious objection in medicine from running amok. Instead, I defend a more nuanced contextual approach that includes constraints on accommodation.

The ethics of caring for hospital-dependent patients

Background

Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis. It is hard to reliably identify these patients on admission and more research is needed to better understand the unique medical needs of this population. But the inability to safely discharge these patients to their home or to a skilled nursing facility without rapid readmissions also creates ethical implications for the physicians who care for them. The aim of this paper is to clarify some of the ethical considerations involved in caring for hospital-dependent patients.

Main body

Among physicians, the care of hospital-dependent patients is likely to disproportionately affect hospitalists and intensivists, whose care is often evaluated in terms of reducing patient length of stay and readmissions. Because hospital-dependent patients’ medical needs thwart the traditional goal of safe discharge, both clinical ethics and physicians’ professional obligations are implicated by their care. The inability to reliably identify these patients early can complicate discussions about treatment goals and informed consent. Similarly, the tremendous dedication of limited resources to these patients without safe discharge back to the community may raise concerns about the just allocation of healthcare resources.

Conclusion

Our current acute care hospitals are not designed to provide long-term care for hospital-dependent patients. Unfortunately, safe discharge options remain elusive for these patients. Further research and support of this population is needed to more reliably identify hospital-dependent patients on admission, better inform the discussions of short- and long-term treatment goals, and more wisely allocate resources both within our acute care hospitals and larger healthcare system.

Attitude of Dental Practitioners Towards their Colleagues: A Justifiable Criticism

AIM

A cross-sectional, questionnaire based study was conducted in Moradabad, U.P., India to assess the attitude of dental practitioners towards their colleagues. Materials and Methods : Eleven-item, close-ended, validated questionnaire was formulated. The responses of 60 registered dental practitioners were recorded.

RESULTS

Majority of the respondents were well versed with ethical obligations towards their colleagues but only few of them were aware of all the principles mentioned in Codes of dental ethics, DCI, India.

CONCLUSION

Dentists face ethical problems/dilemmas while dealing with their duties towards colleagues and their patients. Adopting of ethical ways in practice was independent of gender, qualification and experience of practice. It is recommended that dental ethics should be emphasized upon during the formative years of dental education.