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Mahadevan A, Azizi A, Dastur C, Stern-Nezer S, Nahmias J, Dayyani F. Characterization of patients requiring inpatient hospital ethics consults- A single center study. PLoS One 2024; 19:e0296763. [PMID: 38564582 PMCID: PMC10986956 DOI: 10.1371/journal.pone.0296763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/18/2023] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Ethics consultations are often needed at difficult junctures of medical care. However, data on the nature of how patient characteristics, including race/ethnicity, language, and diagnosis, affect ethics consult outcomes are lacking. METHODS We performed a retrospective cohort study of all patients who were seen by the Ethics Consult Service between 2017 and 2021 at a large tertiary academic center with the aim of determining whether patient demographic and clinical factors were associated with the timing of ethics consult requests and recommendations of the ethics team. RESULTS We found that patients admitted for COVID-19 had significantly longer median times to consult from admission compared with other primary diagnoses (19 vs 8 days respectively, p = 0.015). Spanish-speaking patients had longer median times to consult from admission compared to English speaking patients (20 vs 7 days respectively, p = 0.008), indicating that language barriers may play a role in the timing of ethics consultation. CONCLUSIONS This study demonstrates the need to consider clinical and demographic features when planning and prioritizing ethics consultations at large institutions to enhance consult efficiency, resource utilization, and patient experience and autonomy.
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Affiliation(s)
- Aditya Mahadevan
- University of California Irvine School of Medicine, Irvine, Irvine, CA, United States of America
| | - Armon Azizi
- University of California Irvine School of Medicine, Irvine, Irvine, CA, United States of America
| | - Cyrus Dastur
- Department of Neurology, Division of Neurocritical Care, University of California, Irvine, Irvine, CA, United States of America
| | - Sara Stern-Nezer
- Department of Neurology, Division of Neurocritical Care, University of California, Irvine, Irvine, CA, United States of America
| | - Jeffry Nahmias
- Department of Surgery, Division of Trauma, Burns, Critical Care & Acute Care Surgery, University of California, Irvine, Irvine, CA, United States of America
| | - Farshid Dayyani
- Department of Medicine, Division of Hematology and Oncology, University of California, Irvine, Irvine, CA, United States of America
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Manuel J, Pitama S, Clark M, Crowe M, Crengle S, Cunningham R, Gibb S, Petrović-van der Deen FS, Porter RJ, Lacey C. Racism, early psychosis, and institutional contact: A qualitative study of Indigenous experiences. Int J Soc Psychiatry 2023; 69:2121-2127. [PMID: 37665228 PMCID: PMC10685688 DOI: 10.1177/00207640231195297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. Racism has been implicated as having an important role. AIM To use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis outcomes. METHODS Critical Race Theory informed the methodology used. Twenty-three Indigenous participants participated in four family focus group interviews and thirteen individual interviews, comprising of 9 Māori youth with early psychosis, 10 family members and 4 Māori mental health professionals. An analysis of the data was undertaken using deductive structural coding to identify descriptions of racism, followed by inductive descriptive and pattern coding. RESULTS Participant experiences revealed how racism operates as a socio-cultural phenomenon that interacts with institutional policy and culture across systems pertaining to social responsiveness, risk discourse, and mental health service structures. This is described across three major themes: 1) selective responses based on racial stereotypes, 2) race related risk assessment bias and 3) institutional racism in the mental health workforce. The impacts of racism were reported as inaction in the face of social need, increased use of coercive practices and an under resourced Indigenous mental health workforce. CONCLUSION The study illustrated the inter-related nature of interpersonal, institutional and structural racism with examples of interpersonal racism in the form of negative stereotypes interacting with organizational, socio-cultural and political priorities. These findings indicate that organizational cultures may differentially impact Indigenous and minority people and that social responsiveness, risk discourse and the distribution of workforce expenditure are important targets for anti-racism efforts.
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Affiliation(s)
- Jenni Manuel
- Māori/Indigenous Health Innovation, University of Otago Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Innovation, University of Otago Christchurch, New Zealand
| | | | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Newtown, Wellington, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, Newtown, Wellington, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
- Te Whatu Ora Waitaha, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Innovation, University of Otago Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
- Te Whatu Ora Waitaha, New Zealand
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Le Fort M, Demeure Dit Latte D, Perrouin-Verbe B, Ville I. Organizational ethics in urgent transfers of severely disabled people to intensive care units - a qualitative study. Disabil Rehabil 2023; 45:3852-3860. [PMID: 36369957 DOI: 10.1080/09638288.2022.2140847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Urgent transfers of severely impaired patients with chronic neurological disability (PwND) from a neurological physical and rehabilitation medicine (nPRM) to an intensive care unit (ICU) or an emergency room (ER) served as the basis for this study. We hypothesized that human and structural factors interfered with but were not directly related to the acute context. METHODS We decided to use a qualitative methodology, based on in-depth interviews with 16 ICU/ER physicians. We used mixed bottom-up and top-down methods. We interpreted our data using a thematic approach based on the key principles of grounded theory, which were modified with consideration of the literature. RESULTS Three main domains emerged. The impact of the clinical setting notably implied the patient's clinical typology between the acute event and the chronic background, but also bed availability. Key elements of the telephone negotiation were confidence and perceived usefulness of the transfer. Finally, the otherness of some categories of patients, transferred with more difficulty, involved those with cognitive impairment. CONCLUSIONS The existence of healthcare pathways for many years has created an organizational culture between departments of nPRM and ICUs. But urgent transfers also imply organizational ethics, as a balance should be struck between utility and equity. IMPLICATIONS FOR REHABILITATIONStructural and human factors interfere in urgent transfers, involving the settings within health pathways, the key elements of negotiation to get confidence and a perceived utility of transfer, and certain categories of people, especially those with cognitive impairment.Transfers that imply negotiation between practitioners from physical and rehabilitation medicine and intensive care unit departments, lead to a need of organizational ethics, as a balance should be struck between the principles of utility and equity.The development of facilitating tools such as a commitment charter is of paramount importance as it can support ethical decision-making.
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Affiliation(s)
- Marc Le Fort
- Nantes Université, Centre Hospitalier Universitaire de Nantes, Service universitaire de Médecine Physique et de Réadaptation neurologique, Hôpital Saint-Jacques, Nantes, France
- Institut national de la santé et de la recherche médicale (INSERM-CERMES3), Ecole des hautes études en sciences sociales (EHESS-PHS), Paris, France
| | - Dominique Demeure Dit Latte
- Nantes Université, Centre Hospitalier Universitaire de Nantes, Service de Réanimation chirurgicale, Hôtel-Dieu, Nantes, France
| | - Brigitte Perrouin-Verbe
- Nantes Université, Centre Hospitalier Universitaire de Nantes, Service universitaire de Médecine Physique et de Réadaptation neurologique, Hôpital Saint-Jacques, Nantes, France
| | - Isabelle Ville
- Institut national de la santé et de la recherche médicale (INSERM-CERMES3), Ecole des hautes études en sciences sociales (EHESS-PHS), Paris, France
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Stringer Smith C. History of Racism in Healthcare: From Medical Mistrust to Black African-American Dentists as Moral Exemplar and Organizational Ethics-a Bioethical Synergy Awaits. Am J Bioeth 2022; 22:7-9. [PMID: 35905330 DOI: 10.1080/15265161.2022.2105588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Carlos Stringer Smith
- VCU School of Dentistry, VCU Dental Care and VCU Institute for Inclusion, Inquiry and Innovation
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Frolic A, Miller P. Implementation of Medical Assistance in Dying as Organizational Ethics Challenge: A Method of Engagement for Building Trust, Keeping Peace and Transforming Practice. HEC Forum 2022; 34:371-390. [PMID: 36001242 DOI: 10.1007/s10730-022-09485-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
This paper focuses on the ethics of how to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the ethics of why MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that drew inspiration from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option.
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Affiliation(s)
- Andrea Frolic
- Program for Ethics and Care Ecologies (PEaCE), Hamilton Health Sciences, McMaster University Medical Center, 1F9-1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
- Medical Assistance in Dying Program, Hamilton Health Sciences, Hamilton, ON, Canada.
- Department of Family Medicine, McMaster University, Hamilton, Canada.
| | - Paul Miller
- Medical Assistance in Dying Program, Hamilton Health Sciences, Hamilton, ON, Canada
- Division of Emergency Medicine, McMaster University, Hamilton, Canada
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Berkman E, Clark J, Diekema D, Jecker NS. A world away and here at home: a prioritisation framework for US international patient programmes. J Med Ethics 2022; 48:557-565. [PMID: 33753472 DOI: 10.1136/medethics-2020-106772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
Programmes serving international patients are increasingly common throughout the USA. These programmes aim to expand access to resources and clinical expertise not readily available in the requesting patients' home country. However, they exist within the US healthcare system where domestic healthcare needs are unmet for many children. Focusing our analysis on US children's hospitals that have a societal mandate to provide medical care to a defined geographic population while simultaneously offering highly specialised healthcare services for the general population, we assume that, given their mandate, priority will be given to patients within their catchment area over other patients. We argue that beyond prioritising patients within their region and addressing inequities within US healthcare, US institutions should also provide care to children from countries where access to vital medical services is unavailable or deficient. In the paper, we raise and attempt to answer the following: (1) Do paediatric healthcare institutions have a duty to care for all children in need irrespective of their place of residence, including international patients? (2) If there is such a duty, how should this general duty be balanced against the special duty to serve children within a defined geographical area to which an institution is committed, when resources are strained? (3) Finally, how are institutional obligations manifest in paradigm cases involving international patients? We start with cases, evaluating clinical and contextual features as they inform the strength of ethical claim and priority for access. We then proceed to develop a general prioritisation framework based on them.
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Affiliation(s)
- Emily Berkman
- Division of Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jonna Clark
- Division of Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas Diekema
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
- Division of Pediatric Emergency Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nancy S Jecker
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
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Mohindra R. 'Value, values and valued': a tripod for organisational ethics. J Med Ethics 2022; 48:154-159. [PMID: 33741679 DOI: 10.1136/medethics-2020-106837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
Public benefit corporations are National Health Service, that is, state, entities whose function to provide healthcare in discharge of public duties. If we regard value as the output of such organisations, it seems logical to connect the values of the organisation to the value produced by such organisations. But, on closer examination there are competing underlying logics in play: (1) those based on promoting organisational efficiency and efficacy; and (2) those based on the idea of building service provision around the clinician-patient relationship. Underlying these logics are differing value sets. These clash. Because of the clashing of underlying moral frameworks the connection between values and value becomes hard, if not impossible. This paper argues that (1) the clash in these moral frameworks must be addressed by the organisation rather than between individuals or groups of individuals within the organisation; (2) alloying duties within hybrid professionals submerges but does not resolve these conflicts; (3) one approach could be to impose on the organisation itself an ethical imperative to promote, enhance and protect from deterioration the welfare of the patients; (4) a board ethics committee is a possible organisational structure that could transparently and fairly balance clashes within the competing moral frameworks in a way that could reconcile the competing logics and (5) if such conflicts can be better resolved at the organisational level what the organisation must do to achieve its objectives will become clearer because what needs to be valued would naturally emerge connecting values, value and what is valued.
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8
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Culbertson R. Grateful Patient Philanthropy: A Challenge to Organizational Ethics. Narrat Inq Bioeth 2022; 12:47-52. [PMID: 35912608 DOI: 10.1353/nib.2022.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
An examination of organization development in health care reveals a pattern of increasing reliance of academic medical centers toward new sources of revenue in support of operations. This trend is partly in response to the reduction of traditional funding sources such as public appropriations and tuition. Clinical income from faculty earnings and hospital transfer payments have supplanted heritage funding sources and are now predominantly institutional transactions rather than physician-patient interactions. Grateful patient philanthropy can be viewed as moving toward transactional status, with challenging ethical questions for the involved physician and patient as institutional control increases.
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Falcó-Pegueroles A, Zuriguel-Pérez E, Via-Clavero G, Bosch-Alcaraz A, Bonetti L. Ethical conflict during COVID-19 pandemic: the case of Spanish and Italian intensive care units. Int Nurs Rev 2021. [PMID: 33615479 DOI: 10.1111/inr.v68.210.1111/inr.12645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AIM To identify factors underlying ethical conflict occurring during the current COVID-19 pandemic in the critical care setting. BACKGROUND During the first wave of the COVID-19 outbreak, Spanish and Italian intensive care units were overwhelmed by the demand for admissions. This fact revealed a crucial problem of shortage of health resources and rendered that decision-making was highly complex. SOURCES OF EVIDENCE Applying a nominal group technique this manuscript identifies a series of factors that may have played a role in the emergence of the ethical conflicts in critical care units during the COVID-19 pandemic, considering ethical principles and responsibilities included in the International Council of Nurses Code of Ethics. The five factors identified were the availability of resources; the protection of healthcare workers; the circumstances surrounding decision-making, end-of-life care, and communication. DISCUSSION The impact of COVID-19 on health care will be long-lasting and nurses are playing a central role in overcoming this crisis. Identifying these five factors and the conflicts that have arisen during the COVID-19 pandemic can help to guide future policies and research. CONCLUSIONS Understanding these five factors and recognizing the conflicts, they may create can help to focus our efforts on minimizing the impact of the ethical consequences of a crisis of this magnitude and on developing new plans and guidelines for future pandemics. IMPLICATIONS FOR NURSING PRACTICE AND POLICY Learning more about these factors can help nurses, other health professionals, and policymakers to focus their efforts on minimizing the impact of the ethical consequences of a crisis of this scale. This will enable changes in organizational policies, improvement in clinical competencies, and development of the scope of practice.
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Affiliation(s)
- Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences. Quantitative Psychology Research Group (SGR 269), University of Barcelona, Barcelona, Spain
| | | | - Gemma Via-Clavero
- Critical Care Unit, Hospital Universitari de Bellvitge, Nursing Research Group (GRIN-IDIBELL), Barcelona, Spain
- Pediatric Critical Care Unit, Sant Joan de Deu Hospital, Barcelona, Spain
| | - Alejandro Bosch-Alcaraz
- Pediatric Critical Care Unit, Sant Joan de Deu Hospital, Barcelona, Spain
- School of Nursing, Faculty of Medicine and Health Sciences, University de Barcelona, Barcelona, Spain
| | - Loris Bonetti
- Clinical Expert in Nursing Research, Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Etzioni A. Commentary on "Pandemics and Beyond: Considerations When Personal Risk and Professional Obligations Converge". J Clin Ethics 2021; 32:35-37. [PMID: 33656455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The excellent article by Daniel J. Benedetti, Mithya Lewis-Newby, Joan S. Roberts, and Douglas S. Diekema draws strength by dealing both with micro ethical (personal) and macro ethical (institutional policies and structures) considerations. One should further note that often, the macro factors are even stronger than the article implies, although individuals can affect the macro context. A particularly important macro factor for all matters concerning healthcare, indeed all human services, is the tension between the profit motive and ethical decisions.
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Affiliation(s)
- Amitai Etzioni
- University Professor and Professor of International Relations at George Washington University in Washington, District of Columbia USA.
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Appel J, Michels-Gaultieri M. The Resident and the Spouse and the Lover and the Ethicist: Considerations and Challenges in Nursing Home Romance. J Clin Ethics 2021; 32:77-82. [PMID: 33656460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The level of impairment shown by the 1.3 million residents of nursing homes in the United States varies significantly, and this raises considerable challenges for how to address the sexual and romantic interests and needs of these diverse individuals. Unfortunately, bright-line rules and a one-size-fits-all approach are often taken when addressing these challenges. This article proposes a novel taxonomy for classifying the potential sexual and romantic relationships of cognitively impaired nursing home residents that includes relationships between unmarried residents, relationships between residents and their own spouses, and adulterous relationships. We explore the ethical and logistical challenges distinctive to each category of relationship.
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Affiliation(s)
- Jacob Appel
- Associate Professor of Psychiatry and Medical Education and Director of Ethics Education in Psychiatry at the Icahn School of Medicine at Mount Sinai and is an Attending Physician at Mount Sinai Hospital in New York, New York USA.
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Barach P, Ahmed R, Nadel ES, Hafferty F, Philibert I. COVID-19 and Medical Education: A Four-Part Model to Assess Risks, Benefits, and Institutional Obligations During a Global Pandemic. Mayo Clin Proc 2021; 96:20-28. [PMID: 33413818 PMCID: PMC7584423 DOI: 10.1016/j.mayocp.2020.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Paul Barach
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI; Jefferson College of Population Health, Philadelphia, PA; The University of Queensland, Australia, St Lucia, Australia.
| | - Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Emergency Medicine, Indianapolis
| | - Eric S Nadel
- Department of Emergency Medicine, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Frederic Hafferty
- Division of General Internal Medicine and Program in Professionalism and Values, Mayo Clinic, Rochester, MN
| | - Ingrid Philibert
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT
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Lind MN, Adams-Clark AA, Freyd JJ. Isn't high school bad enough already? Rates of gender harassment and institutional betrayal in high school and their association with trauma-related symptoms. PLoS One 2020; 15:e0237713. [PMID: 32813685 PMCID: PMC7444512 DOI: 10.1371/journal.pone.0237713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/01/2020] [Indexed: 12/01/2022] Open
Abstract
Germinal studies have described the prevalence of sex-based harassment in high schools and its associations with adverse outcomes in adolescents. Studies have focused on students, with little attention given to the actions of high schools themselves. Though journalists responded to the #MeToo movement by reporting on schools’ betrayal of students who report misconduct, this topic remains understudied by researchers. Gender harassment is characterized by sexist remarks, sexually crude or offensive behavior, gender policing, work-family policing, and infantilization. Institutional betrayal is characterized by the failure of an institution, such as a school, to protect individuals dependent on the institution. We investigated high school gender harassment and institutional betrayal reported retrospectively by 535 current undergraduates. Our primary aim was to investigate whether institutional betrayal moderates the relationship between high school gender harassment and current trauma symptoms. In our pre-registered hypotheses (https://osf.io/3ds8k), we predicted that (1) high school gender harassment would be associated with more current trauma symptoms and (2) institutional betrayal would moderate this relationship such that high levels of institutional betrayal would be associated with a stronger association between high school gender harassment and current trauma symptoms. Consistent with our first hypothesis, high school gender harassment significantly predicted college trauma-related symptoms. An equation that included participant gender, race, age, high school gender harassment, institutional betrayal, and the interaction of gender harassment and institutional betrayal also significantly predicted trauma-related symptoms. Contrary to our second hypothesis, the interaction term was non-significant. However, institutional betrayal predicted unique variance in current trauma symptoms above and beyond the other variables. These findings indicate that both high school gender harassment and high school institutional betrayal are independently associated with trauma symptoms, suggesting that intervention should target both phenomena.
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Affiliation(s)
- Monika N. Lind
- Department of Psychology, University of Oregon, Eugene, Oregon, United States of America
- * E-mail:
| | - Alexis A. Adams-Clark
- Department of Psychology, University of Oregon, Eugene, Oregon, United States of America
| | - Jennifer J. Freyd
- Department of Psychology, University of Oregon, Eugene, Oregon, United States of America
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Giwa A, Milsten A, Vieira D, Ogedegbe C, Kelly K, Schwab A. Should I Stay or Should I Go? A Bioethical Analysis of Healthcare Professionals' and Healthcare Institutions' Moral Obligations During Active Shooter Incidents in Hospitals - A Narrative Review of the Literature. J Law Med Ethics 2020; 48:340-351. [PMID: 32631184 DOI: 10.1177/1073110520935348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Active shooter incidents (ASI) have unfortunately become a common occurrence the world over. There is no country, city, or venue that is safe from these tragedies, and healthcare institutions are no exception. Healthcare facilities have been the targets of active shooters over the last several decades, with increasing incidents occurring over the last decade. People who work in healthcare have a professional and moral obligation to help patients. As concerns about the possibility of such incidents increase, how should healthcare institutions and healthcare professionals understand their responsibilities in preparation for and during ASI?
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Affiliation(s)
- Al Giwa
- Al O. Giwa, L.L.B., M.D., M.B.A., M.B.E. (anticipated), F.A.C.E.P., F.A.A.E.M., is an Associate Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Andrew Milsten, M.D., M.S., F.A.C.E.P., is an Associate Professor, Department of Emergency Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center. Dorice L. Vieira, M.L.S., M.A., M.P.H., is an Associate Curator, NYU Health Sciences Library, NYU School of Medicine. Chinwe Ogedegbe, M.D., M.P.H., F.A.C.E.P., is an Associate Professor of Emergency Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack University Medical Center, Emergency and Trauma Center. Kristen M. Kelly, M.D., is a Resident-in-Training, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Abraham P. Schwab, Ph.D., is a Professor of Philosophy, Purdue University Fort Wayne
| | - Andrew Milsten
- Al O. Giwa, L.L.B., M.D., M.B.A., M.B.E. (anticipated), F.A.C.E.P., F.A.A.E.M., is an Associate Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Andrew Milsten, M.D., M.S., F.A.C.E.P., is an Associate Professor, Department of Emergency Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center. Dorice L. Vieira, M.L.S., M.A., M.P.H., is an Associate Curator, NYU Health Sciences Library, NYU School of Medicine. Chinwe Ogedegbe, M.D., M.P.H., F.A.C.E.P., is an Associate Professor of Emergency Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack University Medical Center, Emergency and Trauma Center. Kristen M. Kelly, M.D., is a Resident-in-Training, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Abraham P. Schwab, Ph.D., is a Professor of Philosophy, Purdue University Fort Wayne
| | - Dorice Vieira
- Al O. Giwa, L.L.B., M.D., M.B.A., M.B.E. (anticipated), F.A.C.E.P., F.A.A.E.M., is an Associate Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Andrew Milsten, M.D., M.S., F.A.C.E.P., is an Associate Professor, Department of Emergency Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center. Dorice L. Vieira, M.L.S., M.A., M.P.H., is an Associate Curator, NYU Health Sciences Library, NYU School of Medicine. Chinwe Ogedegbe, M.D., M.P.H., F.A.C.E.P., is an Associate Professor of Emergency Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack University Medical Center, Emergency and Trauma Center. Kristen M. Kelly, M.D., is a Resident-in-Training, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Abraham P. Schwab, Ph.D., is a Professor of Philosophy, Purdue University Fort Wayne
| | - Chinwe Ogedegbe
- Al O. Giwa, L.L.B., M.D., M.B.A., M.B.E. (anticipated), F.A.C.E.P., F.A.A.E.M., is an Associate Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Andrew Milsten, M.D., M.S., F.A.C.E.P., is an Associate Professor, Department of Emergency Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center. Dorice L. Vieira, M.L.S., M.A., M.P.H., is an Associate Curator, NYU Health Sciences Library, NYU School of Medicine. Chinwe Ogedegbe, M.D., M.P.H., F.A.C.E.P., is an Associate Professor of Emergency Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack University Medical Center, Emergency and Trauma Center. Kristen M. Kelly, M.D., is a Resident-in-Training, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Abraham P. Schwab, Ph.D., is a Professor of Philosophy, Purdue University Fort Wayne
| | - Kristen Kelly
- Al O. Giwa, L.L.B., M.D., M.B.A., M.B.E. (anticipated), F.A.C.E.P., F.A.A.E.M., is an Associate Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Andrew Milsten, M.D., M.S., F.A.C.E.P., is an Associate Professor, Department of Emergency Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center. Dorice L. Vieira, M.L.S., M.A., M.P.H., is an Associate Curator, NYU Health Sciences Library, NYU School of Medicine. Chinwe Ogedegbe, M.D., M.P.H., F.A.C.E.P., is an Associate Professor of Emergency Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack University Medical Center, Emergency and Trauma Center. Kristen M. Kelly, M.D., is a Resident-in-Training, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Abraham P. Schwab, Ph.D., is a Professor of Philosophy, Purdue University Fort Wayne
| | - Abraham Schwab
- Al O. Giwa, L.L.B., M.D., M.B.A., M.B.E. (anticipated), F.A.C.E.P., F.A.A.E.M., is an Associate Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Andrew Milsten, M.D., M.S., F.A.C.E.P., is an Associate Professor, Department of Emergency Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center. Dorice L. Vieira, M.L.S., M.A., M.P.H., is an Associate Curator, NYU Health Sciences Library, NYU School of Medicine. Chinwe Ogedegbe, M.D., M.P.H., F.A.C.E.P., is an Associate Professor of Emergency Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack University Medical Center, Emergency and Trauma Center. Kristen M. Kelly, M.D., is a Resident-in-Training, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai. Abraham P. Schwab, Ph.D., is a Professor of Philosophy, Purdue University Fort Wayne
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Ma L, Cao Y, Jiang D, Gao Y, Du X. Does ethics really matter to the sustainability of new ventures? The relationship between entrepreneurial ethics, firm visibility and entrepreneurial performance. PLoS One 2020; 15:e0226920. [PMID: 31990925 PMCID: PMC6986731 DOI: 10.1371/journal.pone.0226920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/06/2019] [Indexed: 12/03/2022] Open
Abstract
This paper aims to explore whether entrepreneurial ethics can improve entrepreneurial performance in new ventures. The dynamic impact of entrepreneurial ethics on entrepreneurial performance (survival and sustainable growth) is investigated from an institutional perspective, and the moderating role of firm visibility between them is explored. From different regions of China, 296 valid questionnaires are obtained and analyzed. We find that entrepreneurial ethics is adverse to the survival of new ventures but conducive to their sustainable growth of new ventures. We also find that high firm visibility can help entrepreneurial ethics be more effective in improving entrepreneurial performance. This study provides a new insight to explain the theoretical controversy of entrepreneurial ethics and provides guidance for the establishment of the internal ethical structures of new ventures. Suggestions for government and industry regulators on the management of entrepreneurial ethics are also provided.
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Affiliation(s)
- Li Ma
- School of Business, Dalian University of Technology, Panjin, China
| | - Yue Cao
- School of Business, Dalian University of Technology, Panjin, China
| | - Dake Jiang
- School of Business, Dalian University of Technology, Panjin, China
| | - Yang Gao
- School of Business, Dalian University of Technology, Panjin, China
- * E-mail:
| | - Xiaomin Du
- Department of Economic Management, Yingkou Institute of Technology, Yingkou, China
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Lahey T, DeRenzo EG, Crites J, Fanning J, Huberman BJ, Slosar JP. Building an Organizational Ethics Program on a Clinical Ethics Foundation. J Clin Ethics 2020; 31:259-267. [PMID: 32960808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Organizational ethics programs often are created to address tensions in organizational values that have been identified through repeated clinical ethics consultation requests. Clinical ethicists possess some core competencies that are suitable for the leadership of high-quality organizational ethics programs, but they may need to develop new skills to build these programs, such as familiarity with healthcare delivery science, healthcare financing, and quality improvement methodology. To this end, we suggest that clinical ethicists build organizational ethics programs incrementally and via quality improvement projects undertaken in collaboration with senior clinical leaders. Organizational ethics programs often differ from clinical ethics programs in their membership and processes, and likely will require ethicists to forge new partnerships with a wide array of organizational leaders. With attention to the ways that organizational ethics programs differ from clinical ethics programs, and investment in quality improvement methodology and formal institutional needs assessments, clinical ethics leaders can position an organizational ethics program to advocate effectively for visible and compelling alignment of leadership decision making with the values of the organization.
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Affiliation(s)
- Timothy Lahey
- University of Vermont Medical Center, UVM's Larner College of Medicine, Burlington, Vermont USA.
| | - Evan G DeRenzo
- John J. Lynch, MD, Center for Ethics, Medstar Washington Hospital Center, Washington, District of Columbia USA.
| | - Joshua Crites
- Staff Ethicist, Center for Bioethics, Cleveland Clinic, Cleveland, Ohio USA.
| | - Joseph Fanning
- Clinical Ethics Consultation Service and Vanderbilt University Medical Center, Nashville, Tennessee USA.
| | - Barrie J Huberman
- Division of Medical Ethics, Weill Cornell Medical College; and Medical Ethics, New York Presbyterian Weill Cornell Medicine, New York, New York USA.
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Abstract
Multidrug resistant organisms (MDROs) are a public health threat that have reduced the effectiveness of many available antibiotics. Antimicrobial stewardship programs (ASPs) have been tasked with reducing antibiotic use and therefore the emergence of MDROs. While fecal microbiota transplant (FMT) has been proposed as therapy to reduce patient colonization of MDROs, this will require additional evidence to support an expansion of the current clinical indication for FMT. This article discusses the evidence and ethics of the expanded utilization of FMT by ASPs for reasons other than severe recurrent or refractory Clostridioides (formerly Clostridium) difficile infection.
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Affiliation(s)
- Thomas S Murray
- Thomas S. Murray, M.D., Ph.D., is affiliated with Yale School of Medicine, Department of Pediatrics Section Infectious Diseases, New Haven CT. Jennifer Herbst, J.D., M.Bioethics, LL.M., is affiliated with Quinnipiac University School of Law and Frank H. Netter, MD, School of Medicine, North Haven CT
| | - Jennifer Herbst
- Thomas S. Murray, M.D., Ph.D., is affiliated with Yale School of Medicine, Department of Pediatrics Section Infectious Diseases, New Haven CT. Jennifer Herbst, J.D., M.Bioethics, LL.M., is affiliated with Quinnipiac University School of Law and Frank H. Netter, MD, School of Medicine, North Haven CT
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Abstract
This article explores the relationship between obligation and publicly funded healthcare. Taking the National Health Service (NHS) as the focal point of discussion, the article presents a historical analysis of the shifting nature and function of obligation as it relates to this institution. Specifically, and drawing inspiration from recent literature that takes seriously the notion of the tie or bond at the core of obligation, the article explores how the forms of social relation and bonds underpinning a system like the NHS have shifted across time. This is undertaken via an analysis of Aneurin Bevan's vision of the NHS at its foundation, the importance today of the patient (and the individual generally) within publicly funded healthcare, and the role of contract as a contemporary governance mechanism within the NHS. A core feature of the article is its emphasis on the impact that a variety of economic factors-including privatisation, marketisation, and the role of debt and finance capital-are having on previously settled understandings of obligation and the forms of social relation underpinning them associated with the NHS. It is therefore argued that an adequate analysis of obligation in healthcare law and related fields must extend beyond the doctor-patient relationship and that of state-citizen of the classical welfare state in order to incorporate new forms of relation, such as that between creditor and debtor, and new actors, including private healthcare providers and financial institutions.
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Abstract
This study examines whether Catholic hospitals disclose their religious identity and health care practices based on the church’s teachings on their websites.
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Affiliation(s)
| | - Abigail Cher
- University of Colorado School of Medicine, Aurora
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
| | - Stephanie Teal
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
| | - Maryam Guiahi
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
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Stern EG. Parens Patriae and Parental Rights: When Should the State Override Parental Medical Decisions? J Law Health 2019; 33:79-106. [PMID: 31841618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Alfie Evans was a terminally ill British child whose parents, clinging to hope, were desperately trying to save his life. Hospital authorities disagreed and petitioned the court to enjoin the parents from removing him and taking him elsewhere for treatment. The court stepped in and compelled the hospital to discontinue life support and claimed that further treatment was not in the child's best interest. This note discusses the heartbreaking stories of Alfie and two other children whose parents' medical decisions on their behalf were overridden by the court. It argues that courts should never decide that death is in a child's best interest and compel parents to withdraw life support from their children. Such a decision is outside the scope of the judiciary. Furthermore, it argues that even in those instances when the court may or must intervene, a new framework is necessary because the current framework used by the court to determine the best interest of the child ignores fundamental realities of child psychology. Too often, as a result of the court's mistaken framework, the court illegitimately trespasses into the parental domain. By adopting a new framework, the court will intervene only when actual abuse or neglect is suspected. In all other cases, judicial restraint will be practiced and the court will show greater deference to the parents' wishes.
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Lantos JD, Saleem S, Raza F, Syltern J, Khoo EJ, Iyengar A, Pais P, Chinnappa J, Lezama-Del Valle P, Kidszun A. Clinical Ethics in Pediatrics: An International Perspective. J Clin Ethics 2019; 30:35-45. [PMID: 30896442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this article, we first review the development of clinical ethics in pediatrics in the United States. We report that, over the last 40 years, most children's hospitals have ethics committees but that those committees are rarely consulted. We speculate that the reasons for the paucity of ethics consults might be because ethical dilemmas are aired in other venues. The role of the ethics consultant, then, might be to shape the institutional climate and create safe spaces for the discussion of difficult and sometimes contentious issues. Finally, we report how pediatric clinical ethics has evolved differently in a number of other countries around the world.
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Affiliation(s)
- John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri USA.
| | - Sarosh Saleem
- Bioethics Department, Shalamar Medical and Dental College, Lahore, Pakistan.
| | - Fajar Raza
- Department of Medical Education, Shalamar Medical and Dental College, Lahore, Pakistan.
| | - Janicke Syltern
- Department of Pediatrics, St. Olav's Hospital, Olav Kyrres gate 11, 7006 Trondheim, Norway.
| | - Erwin J Khoo
- \PediatricDepartment, School of Medicine, International Medical University, Kuala Lumpur, Malaysia.
| | - Arpana Iyengar
- 550, 1st Stage, 9th 'A' Main Road, Indiranagar, Bangalore 560038, India.
| | - Priya Pais
- St. John's Medical College, Department of Pediatric Nephrology, Bangalore, India
| | | | - Pablo Lezama-Del Valle
- Calle Fr Marquez 162, colonia Doctores, Delegacion Cuauhtemoc, Ciudad de Mexico, Mexico 06720.
| | - Andre Kidszun
- Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
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Villacieros M, Bermejo JC, Steegman L. [Ethical attitudes Scale in residences for the elderly. Development of a tool for social and healthcare professionals]. J Healthc Qual Res 2018; 33:352-359. [PMID: 30497971 DOI: 10.1016/j.jhqr.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/09/2018] [Accepted: 09/03/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION In Spain, there is very little institutional training in bioethics for healthcare professionals, and even less tools for measuring ethical attitudes. The objective of this study was the design and validation of a brief measure of ethical attitudes, collecting general attitudes of healthcare professionals in their daily practice with the dependent elderly. MATERIAL AND METHODS After drawing up a list of 42 items around the principles of bioethical autonomy, beneficence, confidentiality, justice, and non-maleficence, a committee of experts selected 31 items. A total of 191 health care professionals with a mean age of 43.8 years (SD=11.3), including 150 (78.5%) women and 41 (21.5%) men, and with experience in the field of dependence. responded to the online questionnaire. Model fit was studied using confirmatory factor analysis. Cronbach's alpha was used for the analysis of internal consistency. RESULTS A model of 2independent scales with adjusted goodness-of-fit index was observed. Autonomy scale (4 items related to this principle) explained 83% of the variance (P=.005), with χ2/gl=1.782; RMSEA=0.064; GFI=0.991; CFI=0.958. The beneficence, confidentiality and non-maleficence scale (9 items including these 3principles), explained 82% (P<.001) with goodness-of-fit index: χ2/gl=2.194; RMSEA=0.079; GFI=0.931; CFI=0.627. The Cronbach Alphas were 0.525 and 0.748, respectively. CONCLUSIONS An ethical attitudes scale (EAS) is presented for professionals in the field of caring for dependent adults, including 13 items related to the observance, in daily practice, of the 4 principles of bioethics, autonomy, beneficence, confidentiality and non-maleficence.
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Affiliation(s)
| | - J C Bermejo
- Centro San Camilo, Tres Cantos, Madrid, España
| | - L Steegman
- Centro San Camilo, Tres Cantos, Madrid, España
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Abstract
Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called "moral spaces," reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings.
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Abstract
Numerous studies have revealed that health care transitions for chronically ill older adults are frequently poorly managed, often with devastating human and economic consequences. And poorly managed transitions and their consequences also occur among younger, relatively healthy individuals who have adequate resources and are prepared to advocate on their own behalf. Despite the rich base of research confirming that evidence-based transitional care enhances patients' experiences, improves health and quality of life, and reduces costs, organizational, regulatory, financial, and cultural barriers have, until recently, prevented widespread adoption of these proven approaches. Provisions of the Affordable Care Act, such as reductions in Medicare payments to hospitals with very high thirty-day rehospitalization rates, have reduced barriers, but uptake of evidence-based transitional care beyond demonstration projects continues to be sporadic and far too slow. With a rich understanding about how to better anticipate and respond to the compelling problems experienced by patients, family caregivers, and health care professionals throughout episodes of acute illness, the time has come to frame transitional care as a system's ethical responsibility in an aging society. Embedding transitional care within the ethical obligations of a health care system requires the perspectives and involvement of nurses and nursing because of this profession's integral role in every aspect of care transitions.
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Abstract
Undisputedly, the United States' health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty-five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the balance of benefits and burdens associated with these advances. Every day on every shift, nurses at the bedside feel an intense array of ethical issues. At the same time, administrators, policy-makers, and regulators struggle to balance commitments to patients, families, staff members, and governing boards. Ethical responsibilities and the fiduciary, regulatory, and community service goals of health care institutions are not mutually exclusive; they must go hand in hand. If they do not, our health care system will continue to lose valued professionals to moral distress, risk breaking the public's trust, and potentially undermine patient care. At this critical juncture in health care, we must look to new models, tools, and skills to confront contemporary ethical issues that impact clinical practice. The antidote to the current reality is to create a new health care paradigm grounded in compassion and sustained by a culture of ethical practice.
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Abstract
In the past, trauma centers have almost exclusively focused on caring for patients who suffer from physical trauma resulting from violence. However, as clinicians' perspectives on violence shift, violence prevention and intervention have been increasingly recognized as integral aspects of trauma care. Hospital-based violence intervention programs are an emerging strategy for ending the cycle of violence by focusing efforts in the trauma center context. These programs, with their multipronged, community-based approach, have shown great potential in reducing trauma recidivism by leveraging the acute experience of violence as an opportunity to introduce services and assess risk of re-injury. In this article, we explore the evolving role of trauma centers and consider their institutional duty to address violence broadly, including prevention.
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Affiliation(s)
- Sara Scarlet
- A fifth-year general surgery resident and member of the hospital ethics committee at the University of North Carolina at Chapel Hill
| | - Selwyn O Rogers
- The chief of trauma and acute care surgery at the University of Chicago, where he is also the director of the new trauma center
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Colaco KA, Courtright A, Andreychuk S, Frolic A, Cheng J, Kam AJ. Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs. J Med Ethics 2018; 44:13-20. [PMID: 28751469 DOI: 10.1136/medethics-2016-103531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 12/24/2016] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments (EDs) in order to build ethics capacity and provide a foundation for the development of an ethics education programme. METHODS This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. RESULTS Of the 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress (16%), conflict management with patients or families (16%) and resource issues (15%). Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams (42%) was the most desired method. CONCLUSIONS Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists.
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Affiliation(s)
- Keith A Colaco
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Alanna Courtright
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Andreychuk
- Office of Clinical and Organizational Ethics, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Andrea Frolic
- Office of Clinical and Organizational Ethics, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ji Cheng
- Biostatistics Unit, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - April Jacqueline Kam
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Harrison KL, Taylor HA, Merritt MW. Action Guide for Addressing Ethical Challenges of Resource Allocation Within Community-Based Healthcare Organizations. J Clin Ethics 2018; 29:124-138. [PMID: 29916829 PMCID: PMC6070378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article proposes an action guide to making decisions regarding the ethical allocation of resources that affect access to healthcare services offered by community-based healthcare organizations. Using the filter of empirical data from a study of decision making in two community-based healthcare organizations, we identify potentially relevant conceptual guidance from a review of frameworks and action guides in the public health, health policy, and organizational ethics literature. We describe the development of this action guide. We used data from a prior empirical study of the values that influence decision making about the allocation of resources in particular types of community-based healthcare organizations. We evaluated, organized, and specified the conceptual guidance we found in 14 frameworks for ethical decision making. The result is an action guide that includes four domains that are relevant to the context of the decision to be made, eight domains that are relevant to the process of the decision to be made, and 15 domains that are relevant to the criteria of the decision to be made. We demonstrate the potential use of this action guide by walking through an illustrative resource allocation decision. The action guide provides community-based healthcare organizations with a conceptually grounded, empirically informed framework for ethical decision making.
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Affiliation(s)
- Krista L Harrison
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.
| | - Holly A Taylor
- Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health; and the Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland USA.
| | - Maria W Merritt
- Department of International Health, the Johns Hopkins Bloomberg School of Public Health; and the Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland USA.
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Paris JJ, Ahluwalia J, Cummings BM, Moreland MP, Wilkinson DJ. The Charlie Gard case: British and American approaches to court resolution of disputes over medical decisions. J Perinatol 2017; 37:1268-1271. [PMID: 29048408 PMCID: PMC5712473 DOI: 10.1038/jp.2017.138] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/29/2017] [Indexed: 02/03/2023]
Affiliation(s)
- J J Paris
- Department of Bioethics, Boston College, Chestnut Hill, MA, USA
- Campion Hall, Oxford University, Oxford, UK
| | | | - B M Cummings
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - M P Moreland
- Villanova University School of Law, Villanova, PA, USA
| | - D J Wilkinson
- John Radcliffe Hospital, Oxford, UK
- Oxford Uehiro Center for Practical Ethics, University of Oxford, Oxford, UK
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Kiefer B. [Not Available]. Rev Med Suisse 2017; 13:128. [PMID: 28703558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Editorial. Healthc Q 2017; 20:1-2. [PMID: 28550690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Breslin J. A Survey of Hospital Ethics Structures in Ontario. Healthc Q 2017; 20:27-30. [PMID: 28837011 DOI: 10.12927/hcq.2017.25224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In response to the growing recognition of the prevalence of ethical issues in clinical care, hospitals in Canada began forming ethics committees in the 1980s. Studies showed significant growth in the prevalence of ethics committees over the ensuing decade. Although the limited studies available suggest that ethics committees have become very prevalent in Canadian hospitals, hospital ethics services have evolved in recent years to include a wider range of structures. In some cases, these structures may work in conjunction with an ethics committee, but in other cases they may replace ethics committees. They include on-staff ethicists, external ethics consultants, "hub-and-spokes" structures and regional ethics programs. What is not known, however, is how prevalent these other structures are and whether ethics committees continue to function as the main delivery mechanism for ethics services in Canadian hospitals. This paper reports on the results of a survey of hospitals in Ontario to answer those questions.
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Affiliation(s)
- Jonathan Breslin
- practicing healthcare ethicist with 12 years of experience providing ethics services to healthcare organizations in Ontario. He is currently shared between Southlake Regional Health Centre and Mackenzie Health
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Abstract
This study examined polarization of perceptions of Procedural Justice. Two polarization mechanisms are examined, Persuasive Arguments and Social Comparisons. Participants were students enrolled in a first-year introductory business class. There were 216 participants in the Persuasive Arguments study, 429 in the Social Comparisons study. The average age of all participants was 22.3 yr. ( SD = 2.1); 56% were women. Fields of study represented were business, engineering, information technology, and sports. Analysis showed under conditions of low Procedural Justice, polarization effects were only found with the Persuasive Arguments mechanism. Under conditions of high Procedural Justice, polarization effects were only found with Social Comparisons. Implications for group polarization and Procedural Justice theories are considered.
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Affiliation(s)
- Douglas H Flint
- Faculty of Administration, University of New Brunswick, P.O. Box 4400, Fredericton, NB E3B 5A3.
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Pandya S, Nagral S, Nundy S. World Medical Association's tainted president, Ketan Desai. BMJ 2016; 355:i5867. [PMID: 27834266 DOI: 10.1136/bmj.i5867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Participation in patient safety is one concrete expression of a foundational principle of medical ethics: do no harm. Being an ethical professional requires taking action to prevent harm to patients in health care environments. Checklists and time-outs have become common patient safety tools in the US and other nations. While their use can support ethical practice, recent research has revealed their limitations and has underscored the importance of interpersonal collaboration in developing and using these patient safety tools. This article summarizes key research and discusses the professional and organizational ethics of patient safety, using the surgical time-out as a case study.
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Affiliation(s)
- Nancy Berlinger
- Research scholar at the Hastings Center in Garrison, New York
| | - Elizabeth Dietz
- Research assistant and project manager at the Hastings Center in Garrison, New York
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Abstract
De-adoption refers to the discontinuance of a medical practice or health service found to be ineffective or harmful following a previous period of adoption. As growing healthcare budgets threaten to cripple the societies that fund them, facilitating de-adoption may be integral to sustainable healthcare systems that provide high-quality care. This article explores ethical issues pertinent to de-adoption including the underpinnings of beneficence, non-maleficence, justice, and autonomy.
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Affiliation(s)
- Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Research Priorities & Implementation, Alberta Health Services, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Stulberg DB, Jackson RA, Freedman LR. Referrals for Services Prohibited In Catholic Health Care Facilities. Perspect Sex Reprod Health 2016; 48:111-117. [PMID: 27467888 DOI: 10.1363/48e10216] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT Catholic hospitals control a growing share of health care in the United States and prohibit many common reproductive services, including ones related to sterilization, contraception, abortion and fertility. Professional ethics guidelines recommend that clinicians who deny patients reproductive services for moral or religious reasons provide a timely referral to prevent patient harm. Referral practices in Catholic hospitals, however, have not been explored. METHODS Twenty-seven obstetrician-gynecologists who were currently working or had worked in Catholic facilities participated in semistructured interviews in 2011-2012. Interviews explored their experiences with and perspectives on referral practices at Catholic hospitals. The sample was religiously and geographically diverse. Referral-related themes were identified in interview transcripts using qualitative analysis. RESULTS Obstetrician-gynecologists reported a range of practices and attitudes in regard to referrals for prohibited services. In some Catholic hospitals, physicians reported that administrators and ethicists encouraged or tolerated the provision of referrals. In others, hospital authorities actively discouraged referrals, or physicians kept referrals hidden. Patients in need of referrals for abortion were given less support than those seeking referrals for other prohibited services. Physicians received mixed messages when hospital leaders wished to retain services for financial reasons, rather than have staff refer patients elsewhere. Respondents felt referrals were not always sufficient to meet the needs of low-income patients or those with urgent medical conditions. CONCLUSIONS Some Catholic hospitals make it difficult for obstetrician-gynecologists to provide referrals for comprehensive reproductive services.
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Affiliation(s)
| | - Rebecca A Jackson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco
| | - Lori R Freedman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco
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Aşcigil SF, Magner NR, Sonmez Y. Are Employees' Ratings of Coworkers' Organizational Citizenship Behavior Influenced by Their Own Perceptions of Organizational Justice? Psychol Rep 2016; 97:98-100. [PMID: 16279309 DOI: 10.2466/pr0.97.1.98-100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Partial correlation analysis of questionnaire data from 62 of 65 employees of a Turkish company indicated that employees' own perceptions of organizational justice in terms of distributive, procedural, and interactional justice were related to how they rated their coworkers' organizational citizenship behavior. Specifically, all three two-way interactions between the justice variables were related to organizational citizenship behavior.
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Abstract
The purpose of this article is to discuss an external whistleblowing event that occurred after all internal whistleblowing through the hierarchy of the organization had failed. It is argued that an organization that does not support those that whistle blow because of violation of professional standards is indicative of a failure of organizational ethics. Several ways to build an ethics infrastructure that could reduce the need to resort to external whistleblowing are discussed. A relational ethics approach is presented as a way to eliminate the negative consequences of whistleblowing by fostering an interdependent moral community to address ethical concerns.
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Affiliation(s)
- Susan L Ray
- University of Western Ontario, London, Canada.
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Abstract
Studies of workers in health care and the care of older people disclose tensions that emerge partly from their conflicting obligations. They incur some obligations from the personal relationships they have with clients, but these can be at odds with organizational demands and resource constraints. One implication is the need for policies to recognize the importance of allowing workers some discretion in decison making. Another implication may be that sometimes care workers can meet their obligations to clients only by taking collective action.
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Affiliation(s)
- Chris Provis
- School of International Business, University of South Australia, North Terrace, Adelaide, South Australia 5000.
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Abstract
The study presented in this article is based on field observations over one year on a critical care unit in Norway. Data were analysed according to Glaser’s grounded theory and generated a theory of hidden and emerging drama in the context of ambiguity while the nurses routinized the handling of complex technology. To the untrained eye the unit presented a picture of calm competence, while under the surface one finds hidden drama full of difficult interacting clinical and ethical problems. The nurses identified six ethical dilemmas: (1) end of life issues; (2) whether there should be an age limit for coronary surgery; (3) distributing limited resources; (4) resource allocation in terms of better staffing; (5) situations in which is it more harmful than beneficial to continue treatment; and (6) transferring patients to other facilities. The six problems overlap and have clinical as well as ethical components, but it was the ethical dimensions that the nurses identified and discussed. The significance for nursing is the importance of well-educated and well-qualified nurses and how they find viable solutions to complex ethical and clinical problems.
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Affiliation(s)
- E H Bunch
- Institute of Nursing Science, Medical Faculty, University of Oslo, POB 1126, Blinderen, 0317 Oslo, Norway
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Abstract
This article discusses some of the most recent developments in US mental health services that follow on the heels of the for-profit hospital scandal that was brought to public attention less than a decade ago. As individuals and as a profession, nurses have a responsibility to uncover, openly discuss and condemn malfeasance when it occurs, yet there has been a collective silence about these developments. The authors explore the reasons for this and make recommendations for regaining nursing’s moral voice and integrity.
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Affiliation(s)
- W K Mohr
- Indiana University, Indianapolis, USA
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Abstract
Practitioners’ ethical orientation and responses vary between practice settings. Yet, currently, the ethics for midwifery practice that is explicit in the literature and which provides the ideals of socialization into practice, is that of bio(medical)ethics. Traditional bioethics, developed because of World War II atrocities and increased scientific research, is based on moral philosophy, normative theory, abstract universal principles and objective problem solving, all of which focus on right and wrong ‘action’ for resolving dilemmas. They exclude context and relationship. Personal narratives of mothers and midwives contest the appropriateness of these accepted values and systems for childbirth because they induce conflict between work-place/service provider ethics and personal/professional midwifery ethics. In contrast to the disembedded and disembodied approach of biomedical ethics, an ethically adequate response in midwifery practice resonates more with the ethics of intimates, such as feminist virtue ethics.
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