Justifying the existence of professional ethics in medicine is usually connected with the traditions of a profession and with a humanistic dimension of these ethics, pointing at the same time to their culture-forming character. With such an attitude, professional ethics is treated as a part of all mankind’s output, and its teaching turns out to be an important element of preparation for taking part in culture. Taking into account the cultural meaning of professional (...) ethics, one should notice that all discussions about the character of relations of medicine and ethics exceed the very health care system. The dilemma outlined in the article deals with the problem whether the existence of medical ethics requires external regulations or is this also a creation of the very representatives of medicine and only they can formulate it. If the latter is to be assumed, ethics in medicine would have to be independent of other detailed ethics and it would not need to be included in any other more general theory. In the first solution, medical ethics is becoming a part of general ethics and, therefore, it would be justified to include it in a more general theory – bioethics. The authors indicate that professional ethics does not limit freedom of the staff but gives a special opportunity to use it. Records constituting its contents are mostly standardized by a professional group which sets criteria of recruitment on its own and general duties resting on their members. (shrink)

Economist-philosopher Amartya Sen's writings on social and political issues have attracted wide audiences. Section 2 introduces his contributions on: how people reason as agents within society; social determinants of people's (lack of) access to goods and of the effective freedoms and agency they enjoy or lack; and associated advocacy of self-specification of identity and high expectations for ‘voice’ and reasoning democracy. Section 3 considers his relation to social theory, his tools for theorizing action in society, and his limited degree of (...) attention to work by sociologists and to capitalism and power structures. Section 4 characterizes a style marked by conceptual refinement, emphases on complexity and individuality, including personal individuality, and reformist optimism. Section 5 shows the features from Sections 3 and 4 at work in his conception of personhood that advocates freedom to make a reasoned composition of personal identity. Similarly, Section 6 addresses his conception of public reasoning and neglect of the sociology of democracy. It contrasts the ideal of a reasoning polity with features in many countries. Sen's programmes for critical autonomy in personhood and for reasoned politics play, nevertheless, a normic role, while his analytical formats help investigation of obstacles to more widespread agency, voice, and democratic participation. (shrink)

Professional, Ethical, Legal, and Educational Lessons in Medicine: A Problem Based Approach provides a comprehensive review of the complex and challenging field of professional medical practice. Its problem-based format incorporates a vast pool of practical, board-exam-style multiple-choice questions for self-assessment, and is an ideal resource for exam preparation as well as ongoing clinical education among trainees and clinicians The practice of medicine is not only about clinical care of patients. Physicians must navigate ethical conundrums, legal pitfalls, (...) and quality improvement issues while maintaining scrupulous professionalism and being exemplary educators. This volume addresses common issues in the realm of professional medical practice not typically covered in other texts. Each of the 73 chapters presents a problem-based case that branches out into an oral board examination type stem questions. A discussion section with brief review articles summarizes the most recent literature. Multiple-choice questions with answers allows for comprehensive self-assessment or interactive group quizzes. This book will appeal to medical and allied health professionals in all specialties of medicine. It is an excellent and hands-on reference for the related but diverse domains associated with professional healthcare practice by students, physicians, and other healthcare providers compacted into one volume. (shrink)

Ethical questions in medicine have become common topics of discussion during the past twenty years. Bitter disputes have arisen regarding abortion, suicide, human experimentation, as well as the management of the dying patient and the severely disabled newborn. These issues are loaded with such emotion that it is sometimes difficult to look at them in a rational manner. Noted neurosurgeon and author Milton D. Heifetz has made the tough decisions in tragic, often anguishing situations. As a member of hospital (...) ethics committees for many years, Dr. Heifetz found that discussions of complex issuesmany involving urgent matters of life and deathwere all too often clouded by tradition, dogma, and gut reactions. A comprehensive moral foundation with the flexibility to respond to often rapidly changing circumstances is desperately needed if health-care professionals are to confront head-on the daily questions of medical ethics. Dr. Heifetz offers this moral grounding to help all who must make difficult medical choices: physicians, nurses, patients, families, and policy makers struggling to develop substantive rules for medical conduct. (shrink)

Hunger strikes potentially present a serious challenge for attending physicians. Though rare, in certain cases, a conflict can occur between the obligations of beneficence and autonomy. On the one hand, physicians have a duty to preserve life, which entails intervening in a hunger strike before the hunger striker loses his life. On the other hand, physicians’ duty to respect autonomy implies that attending physicians have to respect hunger strikers’ decisions to refuse nutrition. International medical guidelines state that physicians should follow (...) the strikers’ unpressured advance directives. When physicians encounter an unconscious striker, in the absence of reliable advance directives, the guidelines advise physicians to make a decision on the basis of the patient’s values, previously expressed wishes, and best interests. I argue that if there are no advance directives and the striker has already lost his competence, the physician has the responsibility to resuscitate the striker. Once the striker regains his decision-making capacity, he should be asked about his decision. If he is determined to continue fasting and refuses treatment, the physician has a moral obligation to respect this decisions and follow his advance directives. (shrink)

The term “industrial action” includes any noncooperation with management, such as strict “working to rule,” refusal of certain duties, going slow, and ultimately withdrawal of labor. The latter form of action, striking, has posed particular problems for professional ethics, especially in those professions that provide healthcare, because of the potential impact on patients' well-being. Examination of the issues, however, displays a difference in response between the healthcare professions, in particular between doctors and nurses. In considering the ethics (...) of industrial (especially strike) action there are various aspects of professional ethics to consider: (1) whether there is a tension between industrial action and the very notion of professional ethics; (2) what specific issues arise in the case of healthcare professions; (3) what, if anything, can explain and/or justify different responses from the medical and nursing professions? (shrink)

The article explores the communist ideology that has guided the formation of professional ethics of medicine in China. It first explores the constitutions of the People’s Republic of China and the Chinese Communist Party and codes of practice for medicine enforced since 1949, showing that the core of the ideology in relation to health provision and doctor–patient relationship has always been ‘serving the people wholeheartedly’. The ideological undertaking, however, has never been successfully exercised. In the pre-reform (...) era, the bureaucratisation of health professionals led to the emergence of ‘bureaucratic medicine’ featuring negligence of patients’ interests. In the reform era, the prevailing commercialisation of health care is in fundamental conflict with the ideological commitment to serving the people. As a result, the socialist professional ethics of medicine has not been satisfactorily practiced in reality. (shrink)

Professionalism and Ethics in Medicine: A Study Guide for Physicians and Physicians-in-Training is a unique self-study guide for practitioners and trainees covering the core competency areas of professionalism, ethics, and cultural sensitivity. This novel title presents real-world dilemmas encountered across the specialties of medicine, offering guidance and relevant information to assist physicians, residents, and medical students in their decision-making. The text is divided into two parts: Foundations and Questions with Answers. The first part provides a substantive (...) foundation of knowledge in the principles, scholarship, policy guidelines, and decision-making strategies of the modern health professions. The second part assists practitioners and trainees in preparing for the complex issues that arise each day in the settings where health professionals work and train – clinics, research centers, educational contexts, and communities. Developed by renowned leaders in a broad range of clinical fields, Professionalism and Ethics in Medicine: A Study Guide for Physicians and Physicians-in-Training is a major, invaluable contribution to the literature and an indispensable reference for clinicians at all levels. (shrink)

The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the (...) American Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

This volume moves beyond ethics as problem-solving or ethics as etiquette to offer a look at ethics in primary care—as opposed to life-or-death—medical care. Professional Ethics and Primary Care Medicine deals with the ethics of routine, day-to-day encounters between doctors and patients. It probes beneath the hard decisions to look at the moral frameworks, habits of thought, and customs of practice that underlie choices. Harmon Smith and Larry Churchill argue that primary care, far (...) from being merely a setting for the rendering of care, provides a new understanding of both physician and patient, and thereby offers a fresh basis for medical ethics. (shrink)

Psychiatry presents a unique array of difficult ethical questions. However, a major challenge is to approach psychiatry in a way that does justice to the real ethical issues. Recently there has been a growing body of research in empirical psychiatric ethics, and an increased interest in how empirical and philosophical methods can be combined. Empirical Ethics in Psychiatry demonstrates how ethics can engage more closely with the reality of psychiatric practice and shows how empirical methodologies from the (...) social sciences can help foster this link. -/- The book is divided into two sections. In the first section there are discussions of the possibility of empirical ethics from a theoretical standpoint and an overview of the history of empirical medical ethics in general. The second, larger section is made up of chapters, discussing specific research projects in empirical psychiatric ethics. The contributors reflect on their choice of method: how and why they combine empirical and philosophical work, and how the two approaches relate to each other. The chapters in the second part thus have two purposes. The first is to present examples of empirical ethics in psychiatry; the second is to reflect on the way in which empirical research can support ethical analysis. -/- Empirical Ethics in Psychiatry is a unique contribution to bioethics and will be fascinating reading for all those working within the field, as well as mental health care professionals. (shrink)

Food production, water management, land use, and animal and public health are all topics of extensive public debate. These themes are linked to the core activities of the agricultural sector, and more specifically to the work of farmers. Nonetheless, the ethical discussions are mostly initiated by interest groups in society rather than by farmers. At least in Europe, consumer organizations and animal welfare and environmental organizations are more present in the public debate than farmers. This is not how it should (...) be. First, because consumers often cannot but rely on agriculture. Second, because recent research shows that farmers have moral beliefs and convictions that appear to be broader than economic considerations and that are—to a certain extent—specific to their profession. This raises the question how to make input from farmers operational in the public debates on the future of farming. We discuss one option: entrusting farmers with professional autonomy concerning moral matters related to farming. We sketch the historical background of the current situation in which farmers are relatively silent on moral matters and we present some clear indications that farmers have values and moral beliefs that are relevant for the public debate. Next the concepts of professionalism and professional autonomy are discussed and applied to the practice of farming. Finally, we discuss the relevance and limits of professional moral autonomy for the agricultural profession. We close with an overview of what this moral autonomy implies for and requires from farmers in practice. We conclude that if some preconditions are met by farmers, then this type of moral autonomy can be relevant for farmers and for society, and contributes to the quality of the public debate on the future of farming. (shrink)

The use of case-based reasoning in teaching professional ethics has come of age. The fields of medicine, engineering, and business all have incorporated ethics case studies into leading textbooks and journal articles, as well as undergraduate and graduate professional ethics courses. The most recent guidelines from the National Institutes of Health recognize case studies and face-to-face discussion as best practices to be included in training programs for the Responsible Conduct of Research. While there is (...) a general consensus that case studies play a central role in the teaching of professional ethics, there is still much to be learned regarding how professionals learn ethics using case-based reasoning. Cases take many forms, and there are a variety of ways to write them and use them in teaching. This paper reports the results of a study designed to investigate one of the issues in teaching case-based ethics: the role of one’s professional knowledge in learning methods of moral reasoning. Using a novel assessment instrument, we compared case studies written and analyzed by three groups of students whom we classified as: Experts in a research domain in bioengineering. Novices in a research domain in bioengineering. The non-research group—students using an engineering domain in which they were interested but had no in-depth knowledge. This study demonstrates that a student’s level of understanding of a professional knowledge domain plays a significant role in learning moral reasoning skills. (shrink)

Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started (...) searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be more robust, resistant to change and that general practitioner (GP) ethics would change more readily in response to a changing society, because surgeons perform technical work in operating theatres in hospitals whereas GPs have their offices in the midst of society. The journals of Dutch surgeons and GPs from the 1950s onwards were studied so as to detect traces of change in medical professional ethics in The Netherlands. GP ethics turned out to be malleable compared with surgery ethics. In fact, GP medicine proved to be an agent of change rather than merely responding to it, both with regard to the changing role of patients and with regard to the changing work life balance. (shrink)

Some health-care professionals refuse to perform certain services because doing so would violate their conscientiously held beliefs. Arguments for and against their accommodation claims continue both in the public square and in the courts, as well as in bioethics. This chapter introduces this debate by discussing jurisdictions in which accommodation is granted. We offer evidence of the detrimental effects it has on access to health-care services. An overview of influential ethical arguments for and against conscientious objection accommodation, including but not (...) limited to the incompatibility thesis and the moral integrity defense, is presented. We conclude with a discussion of arguments based on the values of diversity and equality of opportunity. (shrink)

The opinion of the American Medical Association (AMA) Council on Ethical and Judicial Affairs (CEJA) on the accommodation of conscientious objectors among medical doctors aims to balance fairly patients’ rights of access to care and accommodating doctors’ deeply held personal beliefs. Like similar documents, it fails. Patients will not find it persuasive, and neither should they. The lines drawn aim at a reasonable compromise between positions that are not amenable to compromise. They are also largely arbitrary. This article explains why (...) that is the case. The view that conscientious objection accommodation has no place in modern medicine is defended. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as (...) law and medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

The Professional Ethics Toolkit is an engaging and accessible guide to the study of moral issues in professional life through the analysis of ethical dilemmas faced by people working in medicine, law, social work, business, and other industries where conflicting interests and ideas complicate professional practice and decision-making. Written by a seasoned ethicist and professional consultant, the volume uses philosophical ideas, theories, and principles to develop and articulate a definitive methodology for ethical decision-making in (...) professional environments. Meyers offers the benefit of his expertise with clear and practical advice at every turn, guiding readers through numerous real-world examples and case studies to illustrate key concepts including role-engendered duties, conflicts of interest, competency, and the principles that underpin and define professionalism itself. Following the format of The Philosopher’s Toolkit, The Professional Ethics Toolkit is an essential companion to the study of professional ethics for use in both the classroom and the working world, encouraging students and general readers alike to think critically and engage intelligently with ethics in their professional lives. (shrink)

Formal training in clinical ethics must become a central part of residency curricula to prepare practitioners to manage the ethical dimensions of patient care. Residency educators must ground their teaching in an understanding of the conceptual, biomedical, and psychosocial aspects of the important ethical issues that arise in that field of practice. Four aspects of professional competence in clinical ethics provide a useful framework for curricular planning. The physician should learn to: (1) recognize ethical issues as they (...) arise in clinical care and identify hidden values and unacknowledged conflicts; (2) think clearly and critically about these issues in ways that lead to ethically justifiable courses of action; (3) apply those practical skills needed to implement an ethically justifiably course of action; and (4) judge when the management of a clinical situation requires consultation with individuals or institutional bodies with additional expertise or authority. We argue that these practical goals can be accomplished with a relatively modest emphasis on the theoretical aspects of medical ethics. (shrink)

Se realiza una revisión bibliográfica con el objetivo de analizar los diferentes códigos éticos y deontológicos internacionales, regionales y nacionales de los que se nutre la especialidad de psiquiatría. Se concluye que el comportamiento ético se basa en el sentido de la responsabilidad individual de cada psiquiatra hacia cada paciente y en la capacidad de ambos para determinar cuál es la conducta correcta y más apropiada. Las normas externas y las directrices, tales como los códigos de conducta profesional, las aportaciones (...) de la ética y de las normas legales, no garantizan por sí solas la práctica ética de la medicina, pero constituyen un importante marco referencial. A literature review was performed with the objective of analyzing the various international, regional and national ethical and deontological codes that the psychiatry specialty feeds on. It is concluded that ethical behavior is based on the sense of individual responsibility of each psychiatrist to each patient and the ability of both to determine what the correct and appropriate behavior is. External standards and guidelines, such as professional codes of conduct, the study of ethics and legal standards alone do not guarantee the ethical practice of medicine but are an important framework. (shrink)

In recent years the literature on bioethics has begun to pose the sociological challenge of how to explore organisational processes that facilitate a systemic response to ethical concerns. The present discussion seeks to make a contribution to this important new direction in ethical research by presenting findings from an Australian pilot study. The research was initiated by the Clinical Ethics Committee of Redland Hospital at Bayside Health Service District in Queensland, Australia, and explores health professionals’ understanding of the nature (...) of ethics and their experience with ethical decision-making within an acute medical ward. This study focuses on the actual experience, understanding and attitudes of clinical professionals in a general medical ward. In particular, the discussion explores the specific findings from the study concerned with how a multi-disciplinary team of health professionals define and operationalise the notion of ethics in an acute ward hospital setting. The key issue reported is that health professionals are not only able to clearly articulate notions of ethics, but that the notions expressed by a multi-disciplinary diversity of participants share a common definitional concept of ethics as patient-centred care. The central finding is that all professional groups indicated that there is a guiding principle to address their ethical sense of the ‘good’ or the ‘ought’ and that is to act in a way that furthered the interests of patients and their families. The findings affirm the importance of a sociological perspective as a productive new direction in bioethical research. (shrink)

Burns, C. R. Introduction.--Antiquity: Margalith, D. The ideal doctor as depicted in ancient Hebrew writings. Edelstein, L. The Hippocratic oath. Edelstein, L. The professional ethics of the Greek physician. Michler, M. Medical ethics in Hippocratic bone surgery. Maas, P. L., Oliver, J. H. An ancient poem on the duties of a physician.--The medieval era: Levey, M. Medical deontology in ninth century Islam. Bar-Sela, A., Hoff, H. E. Isaac Israeli's fifty admonitions of the physicians. Rosner, F. The physician's (...) prayer attributed to Moses Maimonides. MacKinney, L. C. Medical ethics and etiquette in the early middle ages, the persistence of Hippocratic ideals. Welborn, M. C. The long tradition, a study in fourteenth-century medical deontology.--The modern period: Larkey, S. V. The Hippocratic oath in Elizabethan England. Pleadwell, F. L. Samuel Sorbiere and his Advice to a young physician. Clark, G. Bernard Mandeville, M.D., and eighteenth-century ethics. Burns, C. R. Thomas Percival, medical ethics or medical jurisprudence? Burns, C. R. Reciprocity in the development of Anglo-American medical ethics, 1765-1865. Williams, T. F. Cabot, Peabody, and the care of the patient. (shrink)

In this paper, we discuss the largely neglected topic of semantics in medicine and the associated ethical issues. We analyse several key medical terms from the informed perspective of the healthcare professional, the lay perspective of the patient and the patient’s family, and the descriptive perspective of what the term actually signifies objectively. The choice of a particular medical term may deliver different meanings when viewed from these differing perspectives. Consequently, several ethical issues may arise. Technical terms that (...) are not commonly understood by lay people may be used by physicians, consciously or not, and may obscure the understanding of the situation by lay people. The choice of particular medical terms may be accidental use of jargon, an attempt to ease the communication of psychologically difficult information, or an attempt to justify a preferred course of action and/or to manipulate the decision-making process. (shrink)

Neonatal professionals encounter many ethical challenges especially when it comes to interventions at the limit of viability (weeks 22–25 of gestation). At times, these challenges make the moral dilemmas in neonatology tragic and they require a particular set of intellectual and moral virtues. Intellectual virtues of episteme and phronesis, together with moral virtues of courage, compassion, keeping fidelity to trust, and integrity were highlighted as key virtues of the neonatal professional. Recognition of the role of ethics requires a (...) recognition that answering the obvious question (what shall we do?) does not always suffice. Acknowledging the tragic question (is any of the alternatives open to us free from serious moral wrongdoing) and recognizing the ethical dilemmas, where the lines between right and wrong are blurred, leads to actions taken towards establishing ethics frameworks to support decision-making. In neonatology units, such organizational support can help in allowing the team members to recognize the ethical dilemmas, avoid moral distress, and improve team cohesion and the quality of care provided. Only when the organizational structure allows ethical dilemmas to be recognized, adequate decisions can be made. (shrink)

The current legal framework within the Lithuanian health system is described including a review of the physician’s autonomy, rights and duties, and patients’ rights including the right to reimbursement. The role of ethical codes and the law are discussed.

Machine generated contents note: CHAPTER 1 HEALTH CARE PROFESSIONALS AND HIV: The Duty To WarnI -- CHAPTER 2 EMERGENCY CARE AND HIV: Treatment Policy and -- Pracice17 -- CHAPTER 3 A REVOLUTIONARY POLICY? Mandatory Disclosure of HIV -- Serostaus29 -- CHAPTER 4 MINORS AND HEALTH CARE: The Limits of Consent and -- Confidentiality39 -- CHAPTER 5 THE RIGHTS TO REFUSE AND DEMAND MEDICAL -- TREATMENT: The Bounds ofAutonomy andFutli{y47 -- CHAPTER 6 RELIGIOUS FREEDOM AND THE RIGHT TO REFUSE CARE: -- (...) What Are The Limits?65 -- CHAPTER 7 ASSISTED REPRODUCTIVE TECHNOLOGY: The Business of -- Making Babies 89 -- CHAPTER 8 TWINS AND TRANSPLANTS: Choosing Who Lives 113 -- CHAPTER 9 FREE ABORTION SERVICES AND FETAL TISSUE RESEARCH: -- Freedom of Choice and Coercion123 -- CHAPTER 10 PROPERTY RIGHTS, BODY PARTS, AND REPRODUCTION: -- Who Owns the Human Body? - 139 -- CHAPTER 11 OUTBREAK IN AMERICA: The Policy of Public Verses Private -- Interests 153 -- APPENDIX A CONFIDENTIALITY OF HIV TEST RESULTS: California Health -- and Safety Code Sections 120975 Through 121020169 -- APPENDIX B HEALTH CARE PROFESSIONALS AND HIV: Texas Health and -- Safety Code Section 58.204 175 -- APPENDIX C TARASOFF v, THE REGENTS OF THE UNIVERSITY OF -- CALIFORNIA: Supreme Court of California177 -- APPENDIX D THE RIGHTS OF MINORS TO CONSENT TO HEALTH CARE: -- California Family Code Sections 6903 Through 6929183 -- APPENDIX E FEDERAL DRUG AND ALCOHOL ABUSE CONFIDENTIALITY -- REGULATIONS: Title 42 Code of Federal Regulations Part 2 187 -- APPENDIX F CHILD ABUSE REPORTING LAWS: Caitfornia Penal Code -- Sections 11164 Through 11166 193. (shrink)

Values in dialogue offers a practical and theoretical model for ethics in care, that has grown from experience and research. The foundation of this ethical model is laid in the care relationship and in relational personalism. It consists of three pillars: values, dialogue, and attitudes. On this basis, a practical model for ethical reflection is developed. The aim is to empower professionals in their own ethical reflection and responsibility in concrete care situations. The model is applied on several topics, (...) such as collaboration between professionals, collaboration with clients and significant others, restriction of freedom and use of coercion, and exchange of information and confidentiality. 'Values in dialogue' is written for care professionals in their daily practice and in ethics commitees, but also for teachers and students in ethics courses. It focuses in particular on mental healthcare, support for people with mental disabilities, and care for elderly persons. (shrink)

The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each other. The authors explore how medicine, through its new reproductive technologies, is altering the stucture of families, how families can participate more fully in medical decision-making, and how to understand the impact on families of medical advances to extend life but not vitality.

This books examines the fundamental values and principles of conduct in the professions, focusing specifically on four areas: law, politics, medicine and business. One central question unifies its inquiry into the different professions: should the principles for judging the actions of professionals be the same as those used to judge private individuals, or do these professions require special moral principles to guide their conduct. The author considers arguments deriving from the underlying institutional goals of each profession in turn.

In the last several years, philosophical enthusiasm for applied professional ethics has spread from medicine to law, education, government, engineering, business, and to other professional and semiprofessional fields. Each involves an institutional structure within which professional practitioners provide specific services to those who seek them, and within which practitioner behavior in providing these services is regulated by both formal and informal institutional codes and conventions. Recent work in applied ethics has forced reinspection of these (...) codes and conventions and of the moral features of the professional practices they govern—from client confidentiality to the exchange of fees—and has revealed characteristic dilemmas and conflicts which are endemic to these areas of professional activity. Indeed, in some cases—for instance, in the de-paternalization of medicine—the inquiries of applied professional ethicists have begun to produce quite striking changes in professional practice itself. (shrink)

In a wide ranging paper the author, a barrister, considers medical ethics in the context of divided loyalties, particularly those of a doctor employed by the National Health Service and those of doctors in occupational medicine. He argues for more specific professional codes of medical ethics, especially in relation to the need to obtain patients' explicit consent before medical details are transmitted to third parties. On the thorny question of when, if ever, can the good of (...) society override the doctor's special duty to his patient of confidentiality, he urges medical organisations to be more explicit at least on how members can set about resolving such dilemmas - mere assertion that a problem exists and that individual doctors must resolve it according to their consciences is not good enough, he says. Extolling honesty and openness as fundamental values he ends by suggesting that part of a binding code of medical ethics might be a requirement that doctors display in their waiting rooms information about their personal moral stances concerning major dilemmas of medical ethics. The paper was given as the Lucas lecture under the aegis of the Royal College of Physicians' Faculty of Occupational Medicine, in whose journal it is also published. (shrink)

My problem is how should we approach the concrete moral problems that arise in medicine, law, management or engineering in a pluralistic society — in what follows I shall concentrate upon medicine, but my concern is basically with the whole spectrum presented by the term “professional ethics”. My thesis is that we shall not be in a position to discuss the moral problems of professionals until we get clear about “where ethics comes from” as one (...) concerned scholar put it1 — something that modern philosophy is generally confused about — and something that the very notion of ‘applied’ ethics confuses. My suggestion is that we have much to learn from the example of the Hastings Center , with respect to handling problems of professional ethics. My assumptions are, first, that philosophers — as Alasdair Maclntyre has long insisted — for the most part confuse the ethical issues they would illuminate by endeavoring to supply theoretical solutions to practical problems, and, second, that this confusion is rooted in an erroneous notion of how concepts function, namely, in the idea that concepts have meaning prior to their application. (shrink)

Despite the undeniable ethical dimensions of paid occupations — trades and services — other than the traditional professions, it is still natural to associate courses of professional ethics with medicine, law, nursing or teaching, rather than auto‐repair, supermarket assistance or window‐cleaning. Indeed, it seems plausible to hold that if there is anything more to the traditional distinction of professions from trades or other services than considerations of social and economic status, it might well reside in the distinctive (...) ethical or moral character and implications of such occupations as medicine, law and education. This paper undertakes to explore, via examination of some of the commonly suggested criteria of professionalism, the nature of such implications and the extent to which they justify continued deployment of a distinctive occupational category of ‘profession’. On the assumption that they do, however, the paper is also concerned to examine critically the consequences for education in professional ethics of any such distinctive ethics of profession. (shrink)

To help professionals in all health care disciplines grapple with ethical issues, Ahronheim (medicine, New York Medical College), Moreno (biomedical ethics, U. of Virginia) and Zuckerman (Center for Ethics in Medicine, Beth Israel Medical Center) review the history and theory of clinical ethics and present 31 case studies analyzed from medical, ethical and legal perspectives. This second edition expands the original discussions of ethical dilemmas caused by advances in medical genetics, organ transplants, HIV medicine (...) and other developments. The appendix includes Internet references, suggested readings and other resources. (shrink)

Before we can resolve or avoid an ethical dilemma, we need to understand what makes something ethical. Practical and Professional Ethics : Key Concepts introduces us to a series of real cases where the stakes can be high, the situations complex, and the ethical issues often difficult to see. Drawing on examples from medicine, law and science, it offers a practical approach to thinking critically about the ethical problems that occur in our professions, teaching us how to: (...) focus on the ethical aspects of any situation distinguish between different kinds of ethical problems tailor our response to the kind of problem we face construct arguments we can plausibly attribute to those involved identify the role of power, discretion and moral blindness By guiding us through the concepts, issues and skills at play when we face an ethical problem, we learn how to find a solution. Ideal for students or professionals, this book provides the grounding required to become a more complex moral thinker, a quality that can be applied in a number of fields and jobs. (shrink)

This qualitative social scientific study explores professional texts of healthcare ethics to understand the ways in which ethical professionalism in medicine and nursing are culturally constructed in Finland. Two books in ethics, published by Finnish national professional organizations—one for nurses and one for physicians—were analyzed with the method of critical discourse analysis. Codes of ethics for each profession were also scrutinized. Analysis of the texts sought to reveal what is taken for granted in the (...) texts as well as to speculate what appeared to be relegated to the margins of the texts or left entirely invisible. Physicians’ ethics was discovered to emphasize objectivity and strong group membership as a basis for ethical professionalism. The discourses identified in the physicians’ ethics guidebook were universal ethics, reductionism, non-subjectivity, and threat. Nursing ethics was discovered to highlight reflectivity as its central focus. This idea of reflectivity was echoed in the identified discourses: local ethics, enlightenment, and moral agency. The analysis exposes a cultural gap between the ethics discourses of medicine and nursing. More work is needed to bridge ethics discourses in Finland in a way that can support healthcare professionals to find common ground and to foster inclusivity in ethical dialogue. Further development of bioethical practices is suggested as a potential way forward. (shrink)

In an era of rapidly rising health care costs, physicians and policymakers are searching for new and effective ways to contain health care spending without sacrificing the quality of services provided. These proposals are increasingly articulated in terms of an ethical duty of stewardship. The duty of stewardship in medicine, however, is not at present well understood, and it is frequently conflated with other duties. This article presents a critical analysis of the notion of stewardship, which shows that it (...) has an important and distinctive place in medical ethics. It claims that stewardship in medicine concerns the responsible use of a society’s medical resources and it discusses the extent to which medical professionals are the proper stewards of these resources. The article argues that the duty of stewardship is best understood as a duty that applies in a space between the obligations of health care providers to provide beneficent care to their patients on the one hand and the obligations of citizens to bring about and support a just health care system on the other. Seen with clear eyes, stewardship in medicine is neither a consequence of beneficent medical care nor a substitute for justice. (shrink)

Colgrove challenges Doug Hardman’s account of deception in medicine. Hardman contends physicians can unintentionally deceive their patients, illustrating this by way of an acupuncturist who believes what she says despite insufficient medical evidence, falling short of what Hardman believes adequate disclosure requires. Colgrove argues deception requires intent but constructs an alternative case in which an acupuncturist does not believe what he tells the patient, but purportedly lacks an intent to deceive. Here, I argue that both acupuncturists deceive, and both (...) can be said to do so intentionally. Neither lies, but rather they seem to engage another deceptive form of speech, what Frankfurt calls bullshit. Building on Colgrove’s case, I argue cases where a physician’s disclosure includes reading a script they do not believe, this is both deceptive and contrary to professional medical ethics. (shrink)

All professional ethics are dependent on the epistemology of the profession. The possibility of following a code of ethics, whether the official one or an alternative code, is dependent on being able to obtain knowledge and understand the world. Professional knowledge has to be based on inferences from limited information. Statistics provides the optimal methods for making such inferences, and thus ethical professional conduct requires individual or collective understanding of some statistical thcory and practice. This (...) is demonstrated using the medical profession as an example. Statistical methods are essential in all areas of medicine, in routine medical practice, in screening for disease and in research. Evidence from medical journals, textbooks and research bodies shows that the statistical basis for ethical conduct is lacking. However, there are attempts to improve the situation. (shrink)

The Belgian health care system has a few features that may havecontributed to the rising costs of health care: patients' freechoice of physicians, large clinical freedom of physicians, essentiallya fee-for-service remuneration for medical specialists in which the feesare agreed between insurance funds and physicians. The increased medicalconsumption and costs have prompted the state and insurance companies totake measures that limit the professional autonomy of the physicians.Access to medical education, free until 1997, is now restricted. Themedical profession is organized in (...) the Order of Physicians that hasestablished a code of professional ethics that has moral but not legalforce. So far, there is no special legislation for thepatient–physician relationship, though laws on specific issueslike organ transplantation contain duties for physicians. In recentyears a debate is taking place on patients' rights, of which informedconsent is central and gaining importance in medico-legal publications.An analysis of (ethical and legal) regulations concerning thewithholding or withdrawal of treatment by physicians demonstrate thatthe profession still enjoys a large clinical autonomy, though duediscussion with the patient has become more explicitly required. Therespect for professional autonomy is not primarily due to any formalpower that the Order of Physicians would have, but is rather grounded inthe generally high quality of the patient–physician relationshipthat in ethical terms is considered essentially as a confidencerelationship rather than a contractual relationship. (shrink)

Este estudio tiene como propósito explicar la relatividad del secreto médico y la actuación del médico perito. El secreto profesional médico es un derecho a la intimidad y constituye obligación ineludible para el personal de la salud, los pacientes y peritados, de ahí que todo lo que revelen deba ser guardado para evitar daños a la vida privada de los individuos. Desde el punto de vista ético el secreto médico profesional obliga al perito a no revelar más de lo necesario (...) para el peritaje, así como a no divulgar dicho informe, limitándose a entregarlo solamente a quienes tuvieran derecho a él. This study aims at explaining the relativity of medical secrecy and the performance of the medical expert. The medical professional secrecy is a right to privacy and it is an unavoidable obligation for the health staff, and assessed patients, hence everything they reveal must be stored to prevent damage to the private life of individuals. From the ethical point of view medical confidentiality forces the expert not to disclose more than necessary for the expertise, as well as not to disclose such report, just limited to be delivered to those who had right to it. (shrink)

In our current climate of rapid technological progress, it seems counterintuitive to think that modern science can learn anything of ethical value from the dark recesses of the nineteenth century or earlier. However, this happens to be quite true, with plenty of knowledge and wisdom to be gleaned by studying our scientific predecessors. Presently, our journals are flooded with original concepts and potential breakthroughs, a continuous stream of ideas pushing the frontiers of knowledge ever forward. Some ideas flourish while others (...) flounder; but what sets the two apart? The distinguishing feature between success and failure within this context is the ability to discern the appropriate time to accept an innovation with open arms, versus when to take a more cautious approach. And the primary arbiters for whether an idea will catch on or not are the professional audience. I illustrate this concept by comparing the initial reception of two innovative ideas from Medicine’s past: sterile technique, and prefrontal lobotomy. Sterile technique was first introduced by Dr. Ignaz Semmelweis and was initially ridiculed and rejected, with Semmelweis eventually dying in exile. Conversely, lobotomy was accepted and lauded and its inventor, Dr. Egas Moniz, won the Nobel Prize for his “discovery”. This begs the question: why was a technique with the potential to save millions of lives initially rejected, whereas paradoxically, one that compromised and sometimes destroyed lives, accepted? Here I explore and analyze the potential reasons why, suggest how we can learn from these mistakes of the past and apply new insight to some current ethical dilemmas. (shrink)

Medicine and families, two venerable institutions crucial to human well-being, are in crisis. The medical profession, struggling to control and equitably distribute care, finds itself compromised by its own success; families are shattered by divorce, violence and confusion about their own nature. What has gone unnoticed is the way these two powerful and pervasive spheres contribute to each other's loss of direction. The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each (...) other. The authors explore how medicine, through its new reproductive technologies, is altering the structure of families, how families can participate more fully in medical decision-making, and how to understand the impact on families when medical advances extend life but not vitality . This book takes an unprecedented perspective on both institutions. Innovative and vivid, their stories tell the tales of families interacting with the medical establishment. (shrink)

Conflict of interests in medicine are typically taken to be financial in nature: it is often assumed that a COI occurs when a healthcare practitioner’s financial interest conflicts with patients’ interests, public health interests, or professional obligations more generally. Even when non-financial COIs are acknowledged, ethical concerns are almost exclusively reserved for financial COIs. However, the notion of “interests” cannot be reduced to its financial component. Individuals in general, and medical professionals in particular, have different types of interests, (...) many of which are non-financial in nature but can still conflict with professional obligations. The debate about healthcare delivery has largely overlooked this broader notion of interests. Here, we will focus on health practitioners’ moral or religious values as particular types of personal interests involved in healthcare delivery that can generate COIs and on conscientious objection in healthcare as the expression of a particular type of COI. We argue that, in the healthcare context, the COIs generated by interests of conscience can be as ethically problematic, and therefore should be treated in the same way, as financial COIs. (shrink)

In this article, I apply the concept of solidarity to collective knowledge practices in healthcare. Generally, solidarity acknowledges that people are dependent on each other in many respects, and it captures those support practices that people engage in out of concern for others in whom they recognise a relevant similarity. Drawing on the rich literature on solidarity in bioethics and beyond, this article specifically discusses the role that epistemic solidarity can play in healthcare. It thus focuses, in particular, on solidarity’s (...) relationship with justice and injustice. In this regard, it is argued (1) that justice and solidarity are two equally important and complementary values that should both be considered in healthcare practices and institutions and (2) that solidarity often arises in unjust situations and can be a means to bring about justice. I transfer these ‘general’ insights about solidarity to knowledge practices in healthcare and link them to the discussion about epistemic injustices in healthcare and how to overcome them. I argue that epistemic solidarity can play an important role in overcoming epistemic injustices as well as—and independently from its contribution to justice—in knowledge production in medicine more generally. To demonstrate how epistemic solidarity can add to our understanding of collective knowledge practices, I discuss two examples: patients sharing their medical data for research purposes and healthcare professionals’ engagement with patients to better understand their afflictions. (shrink)