Background Recently, palliative care is increasingly important, with an emphasis on the process of dying with dignity. However, nurses who care for such patients experience the associated ethical dilemmas. Objective To explore the meaning of nurses’ experiences in dealing with ethical dilemmas in relation to palliative sedation. Research design A qualitative research design was employed with a thematic analysis approach. Participants and research context Using purposive sampling, 15 nurses, working at palliative care units for at least 1 year, (...) were recruited as participants. Data were collected using unstructured in-depth interviews, and data collection and analysis was performed simultaneously. Ethical considerations Ethical approval was obtained from the authors’ institutional review board. All participants provided informed consent. For the face-to-face interview, the South Korean standard COVID-19 quarantine guidelines, such as mandatory masking and social distancing, were followed. Results Dilemmas raised by patients, were related to concerns about appropriate drug dose; dilemmas raised by nurses, were related to passive care, sense of guilt for failure to predict death, and colleague’s disrespectful attitudes toward patients; dilemmas from patients’ families were related to demands for palliative sedation and reversal of those demands. Care actions to deal with ethical dilemmas comprised evidence-based care, person-centered thinking, reflecting on the death situation, compassion, providing explanation and help to family members. Conclusion Nurses’ ethical dilemmas were pre-dominantly influenced by themselves, rather than by the patients or their families, especially if they felt they could not do their best for patients. The core concept of care actions to deal with the ethical dilemmas, was person-centered care and compassion. Then, how patients and their family members perceive person-centered care and compassion, should be further explored to improve palliative sedation. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used (...) and the responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

Undergraduate social work students are exposed to ethical and legal dilemmas during their fieldwork training. This article presents a study that examined these ethical dilemmas in an Israeli sample of undergraduate social work students. 117 students who participated in a course in ethics submitted 31 written presentations of ethical-dilemma analysis. Their oral presentations were recorded and transcribed. Using a qualitative analysis, three major themes emerged: 1. The tension between the duty to maintain client's confidentiality and its (...) violation under certain conditions; 2. The students’ conflict of loyalty toward the client vs. the organization; 3. The question of the clients’ right to self-determination when, in the student's view, this is against their best interests.Our findings point to the vital role of an ethics course in the social work undergraduate curriculum that can enhance students’ knowledge of specific laws relevant to the limits of confidentiality in social work and their ability to analyze ethical dilemmas as future professionals. Furthermore, it is essential to raise awareness in educators and supervisors concerning moral distress that may afflict students coping with ethical dilemmas at this early professional developmental phase. (shrink)

Ebola is a deadly disease with no cure; there is no vaccine developed yet. Many died during the 2014 outbreak in West Africa, and many healthcare professionals went to the virus infected area to treat the patients while placing their lives in danger. Not every medical professional placed in the field is a fully trained specialist, and sometimes one or two under-trained doctors are in charge of the entire clinic with some nurses and operating technicians. When unexpected outbreaks of the (...) virus occur in the places, the doctor(s) would encounter medical and ethical dilemmas. Should they leave or stay? In fact, this dilemma is not confined to the Ebola pandemic but relevant to all similar cases. In this paper, three authors, a medical resident, a clinical bioethicist, and a theoretical bioethicist respond to the dilemma. (shrink)

The ethical dilemma of whether autonomous vehicles should protect the passengers or pedestrians when harm is unavoidable has been widely researched and debated. Several behavioral scientists have sought public opinion on this issue, based on the premise that EDs are critical to resolve for AV adoption. However, many scholars and industry participants have downplayed the importance of these edge cases. Policy makers also advocate a focus on higher level ethical principles rather than on a specific solution to (...) EDs. But conspicuously absent from this debate is the view of the consumers or potential adopters, who will be instrumental to the success of AVs. The current research investigated this issue both from a theoretical standpoint and through empirical research. The literature on innovation adoption and risk perception suggests that EDs will be heavily weighted by potential adopters of AVs. Two studies conducted with a broad sample of consumers verified this assertion. The results from these studies showed that people associated EDs with the highest risk and considered EDs as the most important issue to address as compared to the other technical, legal and ethical issues facing AVs. As such, EDs need to be addressed to ensure robustness in the design of AVs and to assure consumers of the safety of this promising technology. Some preliminary evidence is provided about interventions to resolve the social dilemma in EDs and about the ethical preferences of prospective early adopters of AVs. (shrink)

This study explores how therapists deal with ethical dilemmas in psychotherapy with older adults. Semi-structured interviews were conducted with 14 therapists and analyzed using grounded theory methodology. Findings clustered around three themes: (i) respecting autonomy when interacting with family of vulnerable and dependent older patients; (ii) prioritizing respecting autonomy in risk situations and in suspected financial abuse without impaired judgment; and (iii) prioritizing protecting the patient in risk situations of patients with dementia and of suspected physical abuse or neglect. (...) These findings highlight several important issues regarding the management of ethical dilemmas in psychotherapy with vulnerable and dependent older adults. (shrink)

BackgroundMidwives frequently encounter ethical dilemmas in a critical unit such as a delivery room. Determining these ethical dilemmas is very important to prevent ethical problems and develop an ethical approach.AimThis study aims to identify the ethical dilemma experiences of midwives working in delivery rooms in Turkey.Research designThis study follows a qualitative phenomenological research design.Participants and research contextThe sample comprised 13 midwives with at least two years working experience in delivery rooms, having completed the midwifery (...) program of Manisa Celal Bayar University Health Sciences Institute in the 2017–2018 academic year. Data were collected through audio-recorded semi-structured interviews to reveal their experiences. Content analysis was done using the Nvivo software package program. All interviews were digitally recorded, transcribed verbatim, and transferred into NVivo for analysis.Ethical considerationsEthical approval was granted by Manisa Celal Bayar University University Health Sciences Ethics Committee (Date: 16.12.2016 No: 372). Participation in this study was voluntary. Written and verbal consent was gained. These consents include protecting midwives’ privacy, keeping information confidential, and/or allowing the participant to remain anonymous.FindingsFour themes were identified: differences of approach to the birth process, hospital management, communication, and differences in ethical approach. Several factors explained these ethical dilemmas while the midwives adopted different approaches to ethical decision making.DiscussionThese midwives experienced various dilemmas while working in the delivery room and are aware of most of them. They also took responsibility in the decision-making process and experienced many intense emotions that they had to cope with.ConclusionThe ethical dilemmas faced by these midwives while working in delivery rooms were mainly caused by hierarchy. Future studies could investigate clarifying job descriptions of midwives, who are authorized to manage normal births under their own responsibility, within the hospital management and the health care team. (shrink)

Technological advances in veterinary medicine have produced considerable progress in the diagnosis and treatment of numerous diseases in animals. At the same time, veterinarians, veterinary technicians, and owners of animals face increasingly complex situations that raise questions about goals of care and correct or reasonable courses of action. These dilemmas are frequently controversial and can generate conflicts between clients and health care providers. In many ways they resemble the ethical challenges confronted by human medicine and that spawned the creation (...) of clinical ethics committees as a mechanism to analyze, discuss, and resolve disagreements. The staff of the North Carolina State University Veterinary Hospital, a specialty academic teaching institution, wanted to investigate whether similar success could be achieved in the tertiary care veterinary setting. We discuss the background and rationale for this method, as well as the approach that was taken to create a clinical ethics committee. (shrink)

This article examines the ethical dilemmas faced by professional and academic researchers in the health field who undertake nonclinical or social research among patients or staff. The experiences of health researchers and health professionals in the UK are directly relevant to those undertaking similar health-related research in other parts of the world at a time when nonclinical research in health care is becoming widespread in all countries and cultures. This article addresses ethical dilemmas as they relate to researchers’ (...) ability to maintain confidentiality, their commitment to the welfare of respondents, and the tensions that arise from undertaking research for an employer. In addition, the danger of conducting covert research inadvertently may present unexpected ethical problems, which are discussed. Although it is impossible to provide a policy document to address all ethical dilemmas, this article does attempt to address the question of how best to approach health-related research in order to minimize the possibility of running into ethical problems at a later stage. (shrink)

The objective of this survey was to assess the extent to which nurses encounter and identify dilemma-generating situations in the light of the publication and circulation of the Israeli code of ethics for nurses in 1994. The results are being used as a basis for a programme aimed at promoting nurses' decision-making skills in coping with ethical dilemmas. In this era of major advances in medicine, the nurse's role as the protector of patient rights may bring about conflicts (...) with physicians' orders, with institutional policies, or with patients' families. Nurses will then become confronted with ethical and moral dilemmas. A nationwide survey was carried out to identify and describe the ethical conflicts with which nurses in Israel are confronted in the course of their work. A third of the enumerated dilemmas were encountered by more than 50% of the nurses. The major determinant influencing encounters with dilemmas, as perceived by the participating nurses, was their work setting, namely, the hospital versus the community. It was shown that nurses seek support mainly among their peers, they are barely familiar with the Israeli Code, and they consider their own families as the predominant factor in shaping their ethical attitudes. (shrink)

There is a tension between our need for associative control and our need for social connections. This tension creates ethical dilemmas that we can call each-we dilemmas of sociability. To resolve these dilemmas, we must prioritize either negative moral rights to dissociate or positive moral rights to social inclusion. This article shows that we must prioritize positive social rights. This has implications both for personal morality and for political theory. As persons, we must attend to each other's basic social (...) needs. As a society, we must adopt a sufficientarian approach to the regulation of social resources. (shrink)

This article describes the nature of ethical dilemmas in perioperative nursing practice. Using the Critical Incident Technique, common ethical dilemmas experienced by periop erative nurses are explored. The aim of the study was to elicit the ethical dilemmas that arise in perioperative nurses' practice. The study has a descriptive design and the data are critical incidents described by 48 anaesthetic nurses and 76 operating theatre nurses. An analysis of the critical incidents gave four domains of ethical (...) dilemmas: those arising as value conflicts in the intraoperative phase of surgery; those emanating from the patient's right of self- determination ; those arising in caring for patients; and those resulting from the alloca tion of scarce resources and the demands of increased effectiveness. (shrink)

The accidents at Three Mile Island and Chemobyl have slowed the development of commercial nuclear fission in most industrialized countries, although nuclear proponents are trying to develop smaller, allegedly “fail-safe” reactors. Regardless of whether or not they succeed, we will face the problem of radioactive wastes for the next million years. After a brief, “revisionist” history of the radwaste problem, Isurvey some of the major epistemological and ethical difficulties with storing nuclear wastes and outline four ethical dilemmas common (...) to many technological and environmental controversies. I suggest two solutions to these ethical dilemmas and show why they are also economical and realistic proposals. (shrink)

Background: In 2019, an outbreak of COVID-19 broke out in Hubei, China. Medical workers from all over the country rushed to Hubei and participated in the treatment and care of COVID-19 patients. These nurses, dedicated to their professional practice, volunteered to provide compassion and expert clinical care during the pandemic. As with other acts of heroism, the ethical dilemmas associated with working on the front line must be considered for future practice. Purpose: To explore the ethical dilemmas of (...) frontline nurses of Jiangsu Province in China during deployment to Wuhan to fight the novel coronavirus pneumonia, and to provide a basis for developing strategies to help nursing staff address personal and practice concerns in order to work more effectively during this pandemic and other disasters in the future. Research design and method: Using the phenomenological research method and the purpose sampling method, semi-structured interviews were conducted with 10 nurses, post-deployment to Wuhan, who had worked on the front line to fight the novel coronavirus. Ethical considerations: The research proposal was approved by the Research Ethic Committee of Yangzhou University, China. Findings: From the analysis of the interviews of the 10 participants, three main themes were identified: ethical dilemmas in clinical nursing, ethical dilemmas in interpersonal relationships, and ethical dilemmas in nursing management. Conclusion: During a quick response to public health emergencies, where nurses are deployed immediately as a call to action, the issues surrounding ethical dilemmas from several perspectives must be considered. This research suggests that a team approach to proactive planning and open communication during the emergency is an efficient and productive strategy to improve the nurses’ experience and sense of well-being. (shrink)

Gaining ethical approval for qualitative health research and implementing all the planned research processes in a proposed study are not straightforward endeavours. The situation becomes more complex when qualitative research is conducted in a cross-national healthcare and academic context. Also, it is even exhausting when the study is student-based, as student researchers may be considered novices and inexperienced researchers, especially for field-based research. Our aim in this reflective paper is to present, reflect, and discuss the experiences of a doctoral (...) researcher in dealing with two independent institutional review boards in Canada and Ghana during an interdisciplinary Ph.D. project and the ethical dilemmas encountered while collecting data in Ghana. Based on the researcher’s experiences, it became apparent that consent and its documentation can have cultural implications in different settings; hence, institutional review boards must exercise reflexivity in their protocol review practice. Also, sharing research data with participants and institutional leaders while maintaining participant confidentiality and privacy in institutional ethnographic research requires sensitivity to bi-lateral ethical values. With the experiences shared in this paper, we advocate for a dialogic ethical review process in qualitative research where researchers and research ethics boards engage in ongoing dialogue rather than the usual prescriptive format research ethics reviews often assume. (shrink)

Ethical dilemmas in community mental health care is the focus of this article. The dilemmas are derived from a discussion of the results of a qualitative research project that took place in five countries of the European Union. The different stakeholders are confronted with the following dilemmas: community care versus hospital care ; a life with care versus a life without care ; stimulation of the client toward greater responsibility versus protection against such responsibility ; budgetary control versus financial (...) incentives , and respect for the client versus particular private needs . These dilemmas are interpreted against the background of a value based ethical model. This model offers an integral approach to the dilemmas and can be used to determine policy. The dilemmas are discussed here as the result of conflicting values—namely autonomy and privacy, support and safety, justice and participation, and trust and solidarity. (shrink)

This paper discusses ethical dilemmas related to social work practice with young adults with autism. It does so via the use of a case study taken from real life practice. The different viewpoints and ethical frameworks of the young person, the young person's parents and the Local Authority (or the Local Authority social worker) are considered and discussed. The competing rights of the 2006 United Nations Convention on the Rights of Persons with Disabilities (and the Optional Protocol) are (...) also considered. (shrink)

In spite of the growing interest in nursing ethics, few studies have focused on ethical dilemmas experienced by nurses working with clinical studies as ‘research nurses’. The aim of the present study was to describe and explore ethical dilemmas that Swedish research nurses experience in their day-to-day work. In a qualitative study a purposeful sample of six research nurses from five wards of differing disciplines in four Swedish hospitals was interviewed. The analysis displayed several examples of ethical (...) dilemmas, primarily tensions between the nurses’ obligations to the study and to the patients involved. A guiding moral principle for the nurses was patient-centeredness, where the interest of research must not override the interest of the patient. In situations where tensions between research and patient interests occurred, and doctors and nurses disagreed upon the judgement, the nurses sometimes chose to follow the doctors’ advice, and thus acted against their own moral judgment. Such situations seemed to create feelings of moral distress among the nurses. They described their profession as being ‘invisible’ and as lacking opportunities for ethical competence building. The conclusion is that research nurses frequently experience severe and difficult ethical dilemmas in their daily work. They need to be acknowledged as a particular profession in the health care organisation and encouraged to develop their specific ethical competence. (shrink)

Purpose This article aims to describe the personal experience and ethical dilemmas that the author encountered when conducting qualitative research on a highly sensitive topic, i.e. interviews with offenders convicted of child pornography. Design/methodology/approach This study uses an autoethnographic approach to describe and reflect on my personal experience, emotions and ethical dilemmas when undertaking sensitive research that examines illegal acts. Findings Ethical dilemmas and emotional challenges highlighted refer to the issue of access to useful empirical material, conducting (...) interviews with convicted offenders in prison environments, the complexity surrounding confidentiality when interviewing offenders about their criminal activities, vulnerability and insecurity for the researcher and emotional challenges for the researcher when listening to the offenders’ stories describing serious crimes against children. Originality/value This article contributes with insights and reflections on conducting qualitative research with a marginalized and stigmatized group in prison environments. (shrink)

People frequently make ethical choices they later regret. Causal Loop Archetypes offer a basic systems framework for analyzing the unintended consequences of personal and professional ethical decisions. Pressure or enticement or defensiveness can stymie individuals’ rational sensemaking. Causal Loop Thinking, and in particular the “Fixes That Fail” Archetype, draw on the familiar decision model of identifying the problem, specifying the alternative courses of action andtheir consequences, to guide our final choice. As students grapple with their own conflicts and (...) business school faculty look for tools to anticipate professional ethical dilemmas, Causal Loop Thinking can expand our awareness of the context of choices and actions, thus leading to a more fully assessed decision. (shrink)

This article presents the complicated ethical dilemmas that arise in the procedures and proceedings of the Nursing Disciplinary Committee, which deals with matters of life and death (e.g. patients' rights to quality. and safe care, professional integrity and account ability, and the nurse's future). The article also describes the composition and function of the Committee, the type of case it deliberates, its limitations, and the dilemmas its members may encounter.

Background Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence. Research aim This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic. Research design This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews (...) were conducted and analysed thematically. Participants and research context Healthcare teachers ( n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated. Ethical considerations This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research. Findings Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students’ ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone’s needs, and who gets my time? Conclusions This study highlights the importance of healthcare teachers’ continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible consequences for students and healthcare teachers. (shrink)

Médecins Sans Frontières (MSF) is an independent medical humanitarian organisation working in over 70 countries. It has provided medical assistance for over 35 years to populations vulnerable through conflict, disease and inadequate health systems. Medical ethics define the starting point of the relationship between medical staff and patients. The ethics of humanitarian interventions and of research in conflict settings are much debated. However, less is known about the ethical dilemmas faced by medical humanitarian staff in their daily work. (...) class='Hi'>Ethical dilemmas can be intensified in humanitarian contexts by insecure environments, lack of optimum care, language barriers, potentially heightened power discrepancies between care providers and patients, differing cultural values and perceptions of patients, communities and medical staff. Time constraints, stressful conditions and lack of familiarity with ethical frameworks can prevent reflection on these dilemmas, as can frustration that such reflection does not necessarily provide instant solutions. Lack of reflection, however, can be distressing for medical practitioners and can reduce the quality of care. Ethical reflection has a central role in MSF, and the organisation uses ethical frameworks to help with clinical and programmatic decisions as well as in deliberations over operational research. We illustrate and discuss some real ethical dilemmas facing MSF teams. Only by sharing and seeking guidance can MSF and similar actors make more thoughtful and appropriate decisions. Our aim in sharing these cases is to invite discussion and dialogue in the wider medical community working in crisis, conflict or with severe resource limitations. (shrink)

The aim of this study was to describe specialist ambulance nurse students’ experiences of ethical conflicts and dilemmas in prehospital emergency care. In the autumn of 2015, after participating in a mandatory lecture on ethics, 24 specialist ambulance nurse students reported experiences and interpretations concerning conflicts and ethical dilemmas from prehospital emergency care. The text consisted of 24 written critical incidents which were interpreted using hermeneutic text interpretation. The text revealed three themes: Not safeguarding a patient’s body and (...) identity; Not agreeing on the care actions; and Not treating the patient with dignity. The SANs experiences ethical dilemmas and conflict of values when they witness how others violate a patient’s dignity. Discussion and reflection is based on ethical conflicts and dilemmas experienced when students see how caregivers do not safeguard the patient’s body or identity. When caregivers have a conflicting will, it results in patients not being treated in an ethical manner. Also, seeing how caregivers put themselves in a power position over patients is described as an ethical dilemma that students experience when they choose not to intervene. (shrink)

New and experienced psychotherapists alike can find themselves overwhelmed by an ethical quandary where there doesn't seem to be an easy solution. This book presents positive ethics as a means to overcome such ethical challenges. The positive approach focuses on not just avoiding negative consequences, but reaching the best possible outcomes for both the psychotherapist and the client. The authors outline a clear decision-making process that is based on three practical strategies: the ethics acculturation model to help therapists (...) incorporate personal ethics into their professional roles, the quality enhancement model for dealing with high-risk patients who are potentially harmful, and ethical choice-making strategies to make the most ethical decision in a situation where two ethical principles conflict. Throughout the decision-making process, psychotherapists are encouraged to follow four basic guidelines: Focus on overarching ethical principles Consider intuitive, emotional, and other nonrational factors Accept that some problems have elusive solutions Solicit input from colleagues and consultation groups Numerous vignettes illustrate how to apply positive ethics to many different ethical challenges that psychotherapists will likely encounter in practice. (shrink)

This book discusses the ethical dilemmas of migration in the era of globalization. Centered on the recent influx of large numbers of migrants and refugees to the United States and Europe and viewed through the lens of the 2016 World Humanitarian Summit and the United Nations Summit on Refugees and Migrants, this book focuses on the problems posed by globalized migration and analyzes proposed responses. Using prominent ethical theories and moral principles, such as Utilitarianism, duty, justice, and integrity, (...) the book proposes a framework for analyzing decision-making by migrants and policymakers and formulating equitable policies to address the migration crisis. Drawing attention to the ethical dilemmas that migrants and policymakers experience, this book fills a gap in the literature and enriches it, adding to the economic, political, and human rights issues that are traditionally part of the migration discussion. Appropriate for students and scholars of ethics, policy, and political science, this book is also meant to be of use to practitioners and decision-makers faced with similar decisions. (shrink)

Book reviewed in this article: Ethical Dilemmas and Social Science Research. By Paul Davidson Reynolds.

Background:Caring for a partner with primary malignant brain tumour can be a dramatic life-changing event. Primary malignant brain tumour is known to give poor life expectancy and severe neurological and cognitive symptoms, such as changed behaviour and personality, which demand greater caring responsibilities from spouses.Aim:The aim of the study is to explore ethical dilemmas spouses experience in the everyday care of a partner in treatment for primary malignant brain tumour.Research design, participants and research context:A phenomenological and hermeneutic qualitative descriptive (...) design was adopted as a method for collecting and analysing data. Ten spouses were interviewed twice using an in-depth, semi-structured interview guide. The interviews took place at the spouses’ homes or at the hospital.Ethical consideration:Ethical matters were considered throughout the research process. Permission from The National Committee on Health Research Ethics and the Danish Data Protection Agency was obtained.Findings:The analysis showed that the spouses perceived daily ethical dilemmas in caring for a partner with primary malignant brain tumour. Their life as well as their partner’s life had changed considerably. The main theme that emerged therefore was ‘oscillating in a changing relationship’. This theme was further elaborated in three subthemes that in more detail demonstrated the dilemmas: ‘doing the right thing in unpredictable daily situations’; ‘torn between patience and guilt’; and ‘living in a time of uncertainty, hope and despair’.Conclusion:Caring for a partner with changed behaviour and personality due to primary malignant brain tumour may involve exhausting ethical caring dilemmas. Spouses’ married life may change to a semi-professional asymmetrical relationship, which is challenged by the oscillation between acting responsibly for their partners’ well-being and caring dilemmas with no answer for what the right thing to do is. Mixed feelings of right and wrong, patience and guilt, hope and despair seem to be spousal companions through their partners’ progressing illness. (shrink)

The existing literature in medical ethics does not serve the practical needs of medical students and trainees very well. Medical students or junior doctors often have their own set of ethical concerns and the dilemmas that arise are generally beyond their direct control. The editors have addressed the gap in the literature by compiling a series of case studies from around the world and inviting an international team of leading ethicists and clinicians to comment on them. This volume includes (...) over 80 actual cases that cover the range of possible problems a medical trainee may encounter on the ward. (shrink)

The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel–patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up (...) an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients’ life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population. (shrink)

Various U.S. laws, such as the Clean Air Act and the Food Quality Protection Act, require additional protections for susceptible subpopulations who face greater environmental health risks. The main ethical rationale for providing these protections is to ensure that environmental health risks are distributed fairly. In this article, we (1) consider how several influential theories of justice deal with issues related to the distribution of environmental health risks; (2) show that these theories often fail to provide specific guidance concerning (...) policy choices; and (3) argue that an approach to public decision making known as accountability for reasonableness can complement theories of justice in establishing acceptable environmental health risks for the general population and susceptible subpopulations. Since accountability for reasonableness focuses on the fairness of the decision-making process, not the outcome, it does not guarantee that susceptible subpopulations will receive a maximum level of protection, regardless of costs or other morally relevant considerations. (shrink)

El aborto voluntario del embarazo es un tema de salud global y constituye uno de los más complejos de la bioética, pues tiene connotaciones psicológicas, éticas y jurídicas no solo para la persona que lo practica, sino también para la sociedad donde se desarrolla y para el lugar que en esta ocupa la mujer. Para profundizar en la temática se realizó una revisión bibliográfica para exponer algunos de los dilemas éticos en cuanto a la interrupción del embarazo por malformaciones congénitas. (...) En Cuba en el 2013, se aprobaron las normas para la terminación voluntaria del embarazo, por razones médicas o de salud o por el diagnóstico prenatal de malformaciones congénitas incompatibles con la vida. La conducta ética del asesor genético debe basarse en los principios éticos y bioéticos que se reflejan en los principios de la ética médica, que aplicados al quehacer profesional aseguran y amparan su práctica legal. Abortion is a world health issue and one of bioethics most complex subjects, since it has psychological, ethical and legal connotations not only for the person who experiences it but also for the society where it is carried out and for the role women play in this society. In order to set forth some of the ethical dilemmas regarding abortion due to congenital abnormalities, a bibliographic review meant to deepen on the subject was conducted. Laws for abortion due to medical, health or life incompatible congenital abnormalities prenatal diagnosis were passed in Cuba in 2013. A genetic counselor's ethical behavior must be based on the ethical and bioethical principles reflected on medical ethics principles which, applied to professional work, ensure and protect its legal practice. (shrink)

Ethics and business -- Culture, business and ethics in a globalising world -- Moral development, moral positioning and decision-making -- Ethical dilemmas and decision-making (models) -- Professional ethics -- Organisational ethics -- Corporate social responsibility -- Sustainability and business -- Business and human rights -- Responsible entrepreneurship and innovation -- Information technology and business.

It has been argued that humans can face an ethical/epistemic dilemma over the automatic stereotyping involved in implicit bias: ethical demands require that we consistently treat people equally, as equally likely to possess certain traits, but if our aim is knowledge or understanding our responses should reflect social inequalities meaning that members of certain social groups are statistically more likely than others to possess particular features. I use psychological research to argue that often the best choice from (...) the epistemic perspective is the same as the best choice from the ethical perspective: to avoid automatic stereotyping even when this involves failing to reflect social realities in our judgements. This argument has an important implication: it shows that it is not possible to successfully defend an act of automatic stereotyping simply on the basis that the stereotype reflects an aspect of social reality. An act of automatic stereotyping can be poor from an epistemic perspective even if the stereotype that is activated reflects reality. (shrink)

The aim of the present article is to contribute empirically derived knowledge about Swedish researchers’ experience of ethical problems, conflicts and dilemmas in their research practice in relation to the ethical vetting legislation and procedure. The study has been carried out using the critical incident technique, with researchers from various disciplines providing examples from their own research practice of problems relating to research ethics. The analysis of the researchers’ responses indicates three phenomena, partly in line with similar studies (...) in other countries: the law of ethical vetting puts limits on the relevant research ethical questions; it is not possible to anticipate all questions of research ethics; and there are consequences to the fact that the boards for ethical vetting ignore problems that fall outside the law. (shrink)

This article aims to identify and describe the ethical dilemmas that are involved in the care of patients with incurable cancer. The data were collected in semistructured focused interviews with 32 patients, 13 nurses and 13 doctors from two central hospitals and four community health centres. The interviews were tape-recorded and transcribed verbatim. Interpretation was based on the method of content analysis. Ethical dilemmas occurred at the time of diagnosis, in connection with telling the truth, in providing information, (...) in the treatment of pain, and in decision-making situations concerning active treatment. Dilemmas of active treatment concerned chemotherapy, intravenous infusions, blood transfusions and antibiotics. There were also problems in relationships between nursing staff and next of kin, as well as a lack of co-operation between nurses and doctors. (shrink)

Truth-telling is often regarded as a challenge in Chinese medical practices given the amount of clinical and ethical controversies it may raise. This study sets to collect and synthesize relevant ethical evidence of the current situation in mainland China, thereby providing corresponding guidance for medical practices. This study looks into the ethical issues on the basis of the philosophy of deontology and utilitarianism and the ethical principles of veracity, autonomy, beneficence, and nonmaleficence. Chinese philosophy, context and (...) culture are also discussed to provide some suggestions for decision-making about disclosure in a medical setting. This study holds that, in order to respect the basic rights to which critically ill patients are entitled, decisions regarding truth-telling and their implementation should be carried out with thorough consideration, which can be achieved by critical thinking, well-developed and effective communication skills, the consideration of cultural context, an understanding of individual differences, and compliance with relevant laws and regulations. (shrink)

BackgroundRadiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.MethodsSemi-structured (...) interviews were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.ResultsParticipants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.ConclusionsMultiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views. (shrink)

Background: There are intriguing and challenging ethical dilemmas in the practice of palliative care in a traditional developing society.Objective: To review the different ethical issues involved in cancer and palliative care in developing countries, with special reference to India.Methods: Published literature on pain relief and palliative care in the developing countries was reviewed to identify ethical issues and dilemmas related to these, and ways in which ethical principles could be observed in delivery of palliative care in (...) such countries are discussed.Results: The literature review revealed a number of ethical dilemmas and challenges that professionals, cancer patients and their families encountered during palliative care. It was noted that patients’ preferences and decisions are influenced by family members. Dilemmas leave the professionals and families confused about how ethical their actions have been. Specific ethical issues were noted in relation to the availability and use of oral morphine for pain relief, spiritual care, lack of adequate palliative care services, and palliative care education.Conclusions: The four principles of ethics posed difficulties in understanding the complex ethical issues in a developing country with a traditional background. Ethical issues need to be handled delicately and sensitively in palliative care settings, within the framework of the traditions and culture of the society and financial constraints. The possible role of ethics committees in palliative care settings to help decision-making needs to be studied and discussed. (shrink)

This article examines the ethical dilemmas that can occur due to university and industry cooperative arrangements. The values that Conant (1952) and Merton (1942) ascribed to university science are used as a measure of the evolving university-industry relations in the 1980s. Examples of the types of relations being forged are discussed and possible conflicts of interest are explored. The author argues that the goals of the university are and must remain different from those of industry for the good of (...) the entire society. The transformation of the university into a research institution for industry could result in the university not adequately training the scientists of tomorrow, and simultaneously, not discharging its duty to do basic research as it focuses on the more applied research that industry desires and funds. (shrink)

The 'wall' that differentiates two different kinds of attitudes of the same person at different points of time denotes, as the author envisages, Conscious Attitudinal Infringement Area (CAIA), where moral dilemmas take birth to bridge the two different kinds of attitudes to give way to attitudinal interrelatedness. In order to 'reinforce' CAIA to narrow the gap between personal behaviour and public behaviour, lead a moral life and behave ethically in public, there has to be harmony between the inner life of (...) thoughts, feelings and emotions, and the circumstances and events in the person's outer environment. After discussing the corporate scenario in India in brief, the author has put forward a model called Action By Objectives (ABO) as the basis of the harmonization approach. Drawing inspiration from the ethical aspects of Buddhism, Sufism, Sikhism and Vedanta in this context, he suggests an abhyasa yoga (perfection through disciplined practice) menu for refining samskaras (inner predispositions) and reaching the ultimate level of positive, inspiring leadership. (shrink)

Are there any business decisions that do not have an ethical dimension? Who decides that a decision is unethical? What impact does ethics have in today’s business environment? The case focuses on the development of Hawaii’s first public-private venture capital fund by three very different entities: the State of Hawaii economic development corporation; a US mainland-based private equity investment firm; and a partnership of two serial entrepreneurs. The case uses a progressive disclosure format so students only read and analyze (...) the actions and ethical issues that occur at a specific point in time: creation of the venture capital fund; selection of startups to be included in the fund’s investment portfolio; and public reaction to decisions and actions by the fund. The case frames the issues confronted at each point as ethical dilemmas. Analysis includes answering questions and formulating recommendations or solutions to each dilemma. (shrink)

A two-part survey was conducted, where respondents reported ethically challenging incidents encountered in the previous two years and actions taken to address them. 132 certified counseling psychologists participated and reported 136 ethical dilemmas. The top categories of dilemmas pertained to breaking confidentiality between respondents and clients, including mandatory reporting, collaborating with education associates, and interjecting by the authority. 82% of the respondents took actions to address the dilemmas. These actions ranged from steering a middle course, upholding professional ethical (...) standards, seeking consultation to taking no actions. Potential environmental contributors to the dilemmas and actions taken to address them were explored. (shrink)

How ethical have recent banking practices been? We answer this question via an economic analysis. We assess the two dominant practices of the modern banking system – fractional reserves and maturity transformation – by gauging the respective rights of the relevant parties. By distinguishing the legal and economic differences between deposit and loan contracts, we determine that the practice of maturity transformation (in its various guises) is not only ethical but also serves a positive social function. The foundation (...) of the modern banking system – the holding of fractional reserves against deposits – is, however, problematic from economic, legal and ethical perspectives. Starting from a microanalysis of money's function, a reassessment of the current laws concerning the practice is encouraged, with the aim not only to rectify economic irregularities but also to realign depositors' rights with the obligations of the banking sector. (shrink)

The purpose of this study was to examine the nature and extent to which cultural differences bear on perceptions of ethical Organizational Development consulting behaviors. U.S. (n=118) and Taiwanese (n=267) business students evaluated eleven vignettes depicting potential ethical dilemmas. Respondents judged the ethicality of each vignette, the likelihood of the event's occurrence and the party responsible for the event's occurrence. Multivariate Analyses of Variance revealed significant cultural differences in perceptions of ethicality, and group differences in perceptions of the (...) events' likelihood of occurrence. U.S. subjects provided higher ethicality ratings than the Taiwanese, and lower ratings on the likelihood of occurrence. Response distributions resulting from the identification of the responsible party were similar for six of the eleven vignettes. When differences did occur, it appeared that the Taiwanese were more inclined than the U.S. subjects to view responsibility as shared by the client and the consultant. The results suggest the need for the incorporation of cultural differences in a code of ethics for the profession and the need for cross-cultural ethics training for partitioners. (shrink)

Multinational corporations' international staffing policies have been evaluated in terms of cost and efficiency arguments. Research has not addressed, however, the ethical impact of these policies on diverse stakeholder groups. This paper presents a conceptual framework by which ethnocentric, polycentric and geocentric staffing policies are theoretically linked to underlying decision-making modes of instrumentality, bounded rationality and economic rationality, respectively. It goes on to describe the ethical rationales associated with each policy type, namely, distributive justice, moral rights of man, (...) and utilitarianism. An investigation of resulting ethical dilemmas affecting relevant MNC stakeholder groups is incorporated and offered as a tool for analyzing the true and full costs of trade-offs when choosing one policy over another. The paper concludes with a discussion of the implications of the conceptual framework for theory and practice and directions for future research. (shrink)

Background: Nursing documentation is an essential aspect of ethical nursing care. Lack of awareness of ethical dilemmas in nursing documentation may increase the risk of patient harm. Considering this, ethical dilemmas within nursing documentation need to be explored. Aim: To explore ethical dilemmas in nurses’ conversations about nursing documentation. Research design, participants and context: The study used a qualitative design. Participants were registered nurses from a Patient Hotel at a Danish University Hospital. Data were collected in (...) three focus groups with a total of 12 participants. Data analysis consisted of qualitative content analysis inspired by Graneheim and Lundman. Ethical consideration: This study was conducted in accordance with the ethical principles of research and regulations in terms of confidentiality, anonymity and provision of informed consent. Findings: Ethical dilemmas were strongly present in nurses’ conversations about nursing documentation. These dilemmas were demonstrated in two themes: a dilemma between respecting patients’ autonomy and not causing harm, which was visible in nurses’ navigation between written documentation and oral tradition, and a dilemma concerning justice and fair distribution of goods, which was visible in nurses’ balancing between documenting deviations and proof of nursing practice. Discussion: Ethical dilemmas in nursing documentation regarding respecting patients’ autonomy and not causing harm accentuated discussions on professional responsibility and patient participation in clinical decisions. Dilemmas in justice and fair distribution of goods emphasised discussions on trust in relationships versus trust in electronic health records. Conclusion: Actual tendencies in the healthcare system may increase ethical dilemmas in nursing documentation. Sharing otherwise invisible and individual experiences of ethical dilemmas in nursing documentation among nurses, nurse leaders and decision-makers will enable addressing these in reflections and discussions as well as in considering adjustments of conditions for nursing documentation. (shrink)

I write this article as a postgraduate researcher undertaking a doctorate in Education, with an interest in research as a transformative process, and fascinated by the debate as to whether reality is objective or subjective. In reflecting on this, I recalled a significant incident that occurred when I was Professional Education Lead in an NHS hospital. I had been asked to work with a nurse, who had been disciplined as a consequence of talking about her Christian faith with a patient. (...) The nurse was assuming that, in sharing experiences that were transformative for her, she might also transform the patient’s perception of her own illness and its meaning. As a Christian myself, I was caught in a situation where I could understand the conflicting perspectives of all key players, including the patient, her family, the nurse, and the NHS managers. I explore how I mediated my way through this situation, aiming to do justice to all perspectives, and the ethical dilemmas I faced when having to choose between personal and professional values. As a consequence of this incident, I have learned that, not only is transformation a deeply personal experience, but because it is either influenced by, or leads to, a specific world view, it supports the idea of reality being subjective rather than objective. (shrink)

Does feedback of abnormal results affect validity during a longitudinal study?A fundamental requirement of research is that no harm should come to the participants; however, being granted ethical approval for research does not imply that individuals will necessarily benefit from participation.Certain ethical dilemmas become apparent only during the course of a longitudinal cohort study, such as the EarlyBird diabetes study in Plymouth, Devon.1 In this non-intervention study, the aim is to observe children for 12 years, monitoring for early (...) signs of insulin resistance. A substantial volume of data is gathered every 6 months on the children and their parents, relating to lifestyle and indices of metabolic health. …. (shrink)