As web instruction becomes more and more prevalent at universities across the country, instructors of ethics are being encouraged to develop online courses to meet the needs of a diverse array of students. Web instruction is often viewed as a cost-saving technique, where large numbers of students can be reached by distance education in an effort to conserve classroom and instructor resources. In practice, however, the reverse is often true: online courses require more of faculty time and effort than do (...) many traditional classes. Based on personal experience teaching an online course in health care ethics for students in the Allied Health Professions, it is evident that there are both benefits and challenges in teaching online courses, particularly in ethics. Examples of benefits are (1) the asynchronous nature of web instruction allows students to progress through the course at their own pace and at times that are convenient given their clinical responsibilities; (2) web courses allow for a standardization of content and quality of instruction over a diversity of programs; and (3) examples can be tailored to the differing experiences of students in the course. Some challenges to teaching online ethics courses include (1) the fact that online instruction benefits visual learners and disadvantages those lacking good reading comprehension or strong writing skills; (2) developing meaningful student-student and student-instructor interaction; and (3) teaching ethics involves teaching a process rather than a product. Allowing students to apply their knowledge to real-world cases in their disciplines and encouraging them to share experiences from clinical practice is an effective way to meet several of these challenges. Building an online community is another good way to increase the interaction of students and their engagement with the material. (shrink)

Following the widespread occurrence of birth defects from the use of thalidomide to treat nausea during pregnancy in the 1960s and 1970s, the Food and Drug Administration became particularly vigilant about the use of therapeutic agents during pregnancy and in women of childbearing potential. The FDA developed a list that categorizes an agent according to the known risks to a fetus. The drug thalidomide falls into Category X: agents that have demonstrated clear risk of fetal abnormalities and whose risks outweigh (...) the benefits of use during pregnancy.Another Category X drug is isotretinoin, commonly known by its trade name Accutane. Isotretinoin is an oral medication prescribed for severe recalcitrant, nodular acne in patients who are unresponsive to conventional therapy. Isotretinoin has been available since 1982, and it remains the only effective treatment for this condition. (shrink)

The United States Food and Drug Administration , in collaboration with pharmaceutical manufacturers, have recently implemented a heavily revised risk-management program for patients on isotretinoin , a drug with known and pronounced teratogenic effects. This revised risk management plan places significant burdens on both providers and patients in the hopes of achieving its goal of reducing fetal exposure to isotretinoin. The main focus of this paper is to discuss the burdens of various aspects of the program in relationship to potential (...) corresponding benefits. In particular, we evaluate the pregnancy rates of women on isotretinoin therapy compared with that of the general population and the rate changes based on the risk management programs. Additionally, we investigate whether the benefits of the program for women have increased as the benefits have risen. We devote special attention to the ethical implications of the intent of the program and to an analysis of the ethical justification of the restrictions placed on women of childbearing potential as it compares to the risk-benefit relationship of using isotretinoin. (shrink)

This essay refutes the charge of relativism levied against religious approaches to bioethics by using Jewish bioethics as a case study. I demonstrate how an approach to ethics that includes particular spiritualities need not be essentialist but can better respect a patient's values, goals, and priorities. Recognizing the value of listening to silenced voices and showing how the identification of a nonhomogenous group can yield important insights for ethics, feminist approaches have paved the way for a reintroduction of religious approaches (...) to mainstream ethical discourse. (shrink)

For couples for whom assisted reproduction is the only way to have genetically related offspring, the donation of gametes by others makes available enhanced reproductive options. There has been an increasing demand for such services, as evidenced by the Web site launched by fashion photographer Ron Harris in the fall of 1999. Although the sale of such gametes is not new, this Web site does speak to a different set of priorities and values than has been witnessed in the context (...) of assisted reproduction: the selection of particular traits, in effect, the creation of designer babies. With the expanding demand for such services come expanded liabilities, which are the focus of this article. The author argues that this kind of commodification of gametes reinforces dubious social attitudes, leads to potential harms for the children created by this technology, and suggests a departure from traditional paradigms in medicine: a departure in an ill-advised direction. (shrink)

The reference to the vagina as “it” or “down there” is symptomatic of two larger cultural problems: not naming the vagina when speaking about the vagina, and conflating the vagina with the external female genitalia. The euphemisms and obfuscating language have implications both for lay understandings of female bodies and for the practice of health care. Granting and using a name gives both the named and the namer power and legitimacy.

Although online education is becoming increasingly commonplace in health professional education, methods to evaluate student progress and knowledge base adequately remain uncertain. This paper describes a project that attempted to assess whether or not an online course was an effective way to teach applied ethics to students preparing for the health professions by qualitatively analyzing responses to a pre-test and post-test administered to students in the course. While previous studies have reported various findings regarding the success of online ethics courses, (...) our study failed to demonstrate that students gained a greater understanding of key concepts in ethics—respect for autonomy, decisional capacity, informed consent, and role of the provider. Our findings demonstrate the need for better subjective methods of evaluation and raise questions regarding the efficacy of current models of online ethics courses for health professional students. (shrink)

Subpart B of 45 Code of Federal Regulations Part 46 (CFR) identifies the criteria according to which research involving pregnant women, human fetuses, and neonates can be conducted ethically in the United States. As such, pregnant women and fetuses fall into a category requiring “additional protections,” often referred to as “vulnerable populations.” The CFR does not define vulnerability, but merely gives examples of vulnerable groups by pointing to different categories of potential research subjects needing additional protections. In this paper, I (...) assess critically the role of this categorization of pregnant women involved in research as “vulnerable,” both as separate entities and in combination with the fetuses they carry. In particular, I do three things: (1) demonstrate that pregnant women qua pregnancy are either not “vulnerable” according to any meaningful definition of that term or that such vulnerability is irrelevant to her status as a research participant; (2) argue that while a fetus may be vulnerable in terms of dependency, this categorization does not equate to the vulnerability of the pregnant woman; and (3) suggest that any vulnerability that appends to women is precisely the result of federal regulations and dubious public perceptions about pregnant women. I conclude by demonstrating how this erroneous characterization of pregnant women as “vulnerable” and its associated protections have not only impeded vital research for pregnant women and their fetuses, but have also negatively affected the inclusion of all women in clinical research. (shrink)

“What is a poet? An unhappy person who conceals profound anguish in his heart but whose lips are so formed that as sighs and cries pass over them they sound like beautiful music.” These opening lines from Kierkegaard's Either/Or signify a tragic state of affairs because the poet brings joy to others and yet experiences no joy himself. In a similar vein, consider the child prodigy—Bobby Fischer, Shirley Temple, Mozart. Although there is no question that these children were gifted, there (...) is some debate about how happy their childhoods were. There are benefits to just “being a kid,” and it is not clear that these individuals had that opportunity. (shrink)

Assessing mastery of bioethics in a graduate program requires careful attention not simply to the content knowledge and skill development of students but also to the principles of sound assessment processes. In this article, we describe the rationale, development process, and features of the comprehensive exam we created as a culminating experience of a master’s program in bioethics. The exam became the students’ opportunity to demonstrate the way they were able to integrate course, textual, and practical knowledge gained throughout the (...) experience of the program. Additionally, the exam assessed students’ proficiency in the field of bioethics and their ability to critically and constructively analyze bioethical issues. In this article, we offer tips to other exam creators regarding our experiences with question and answer development, scoring of the exam, and relationships between coursework and exam preparation and completion. We also include a sample rubric for others to see how we determined which student answers were satisfactory. (shrink)

Volume 19, Issue 9, September 2019, Page 44-45.

The American Journal of Bioethics, Volume 12, Issue 1, Page W1-W2, January 2012.

The American Journal of Bioethics, Volume 11, Issue 11, Page 31-38, November 2011.

The American Journal of Bioethics, Volume 12, Issue 9, Page 6-7, September 2012.

Pharmaceutical companies can dramatically improve their understanding of how certain drugs work by having access to data from prospective research participants and those enrolled in clinical trials. Yet can data legitimately be used in ways that these individuals have not specifically authorized? In some cases it is ethically acceptable to share data with pharmaceutical companies even if there was no specific consent to do so by appealing to the principles of beneficence and respect for persons. These principles require us to (...) look not just at how well the process and documentation of consent conform to regulatory requirements, but also at how well they minimize harm and maximize benefit for research participants and future beneficiaries of the research. (shrink)

Volume 20, Issue 7, July 2020, Page 145-147.

In their article in the September-October 2010 issue of IRB: Ethics & Human Research, Chris Kaposy and Françoise Baylis argue that the contraception policy of the University of Nebraska Medical Center’s institutional review board fails to meet an ethically ideal standard in establishing the criteria investigators should follow when including women of childbearing potential in clinical research. In this response, we argue that the UNMC IRB’s policy is evidence-based and pragmatically oriented and that it therefore better safeguards women’s autonomy than (...) an ideal policy could. We also offer some of our experiences with the policy since it was implemented six years ago. (shrink)

The Declaration of Helsinki is recognised worldwide as a cornerstone of research ethics. Working in the wake of the Nazi doctors’ trials at Nuremberg, drafters of the Declaration set out to codify the obligations of physician-researchers to research participants. Its significance cannot be overstated. Indeed, it is cited in most major guidelines on research involving humans and in the regulations of over a dozen countries.Although it has undergone five revisions,1 and most recently incorporated language aimed at addressing concerns over research (...) carried out in resource-poor countries,2–5 the Declaration could go much farther in addressing the profoundly altered landscape of research with humans. Research involving humans is now a global enterprise and often involves participants from resource-poor countries. Rather than being carried out at single institutions by veteran researchers, many studies are now conducted at many locations—including sites that are not academic medical centres—by new and relatively inexperienced investigators. A growing number of projects involve novel agents, based on innovative work in genomics and proteomics. Increasingly, research is sponsored by the for-profit sector. National governments and professional organisations around the globe provide laws, regulations and standards for the conduct of research involving humans. Considerable scholarship also critiques and guides this endeavour.In light of the current effort of the World Medical Association to revise the Declaration, we offer ideas on how to re-conceive the concept of “vulnerability” and its links with the principle of justice and, in turn, redirect the attention of researchers towards those who might be so designated.In the research context, “vulnerability” is associated with an inability partly or totally to protect one’s own interests. Typically, conceptions of vulnerability centre upon characteristics associated with particular groups that …. (shrink)

Introduction to healthcare ethics committees / D. Micah Hester and Toby Schonfeld -- Brief introduction to ethics and ethical theory / D. Micah Hester and Toby Schonfeld -- Ethics committees and the law / Stephen Latham -- Cultural and ...

Drawing on theoretical arguments from the psychology discipline, we investigate the implications of employee entitlement in organizational settings. Specifically, we utilize workplace engagement theory to suggest that due to their skewed sense of deservingness, employees high in entitlement are less likely to experience workplace engagement. Furthermore, the negative relationship between employee entitlement and workplace engagement is strengthened when ethical leadership is low, yet mitigated when ethical leadership is high. Finally, we predict that under conditions of low ethical leadership, reductions in (...) engagement explain why employee entitlement results in hindered job performance. This mediated effect does not hold when ethical leadership is high. We tested our theoretical model utilizing field data from employees and their direct supervisors in the financial services industry. Our results support our theoretical model. Theoretical and practical implications are discussed. (shrink)

Healthcare ethics has become part of the standard curriculum of students in the health professions. The goals of healthcare ethics education are to give students the skills they need to identify, assess, and address ethical issues in clinical practice and to develop virtuous practitioners. Incorporating the medical humanities into medical school, for example, is intended to foster empathy and professionalism among students and to provide mechanisms for enhanced physician well-being. Yet, despite the long-standing inclusion of the humanities in nursing curricula, (...) increases in the amount and kinds of scientific knowledge essential for clinical practice has resulted in the erosion of the “humanistic arts” from nursing education. One potential solution to this challenge comes with the increase in interprofessional education, where students in a variety of healthcare professions programs come together to learn about issues common to all healthcare fields. (shrink)

McCarthy, Homan, and Rozier’s presentation of theological anthropology and its contribution to secular bioethics suffers from three primary limitations. First, the article re...

A hub and spoke model offers an effective and efficient approach to providing informed guidance to those who need it. The National Center for Ethics in Health Care (NCEHC) at the Veterans Health Administration, Department of Veterans Affairs, is the largest known hub and spoke healthcare ethics delivery model. In this article, we describe ways NCEHC’s hub and spoke configuration succeeded during the COVID- 19 pandemic, as well as limitations of the model and possible improvements to inform adoption at other (...) healthcare systems. (shrink)