Medical Ethics and Context

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Medical Ethics: Context Is the Key Word

Medical Ethics: Context Is the Key Word

Medical Ethics is no different to Ethics, but relates specifically to the doctor-patient relationship. This relationship is based on mutual trust—trust in the doctor’s expertise and knowledge and trust that the patient is consulting the doctor, for his/her/their own health, wellbeing and welfare, without agenda or bias. In other words, the basis of the doctor-patient relationship is one of mu- tual trust and confidence. Thus, what is imparted between them is held in the strictest confidence. The doctor must act within the law. No third party influence can be brought to bear on this rela- tionship without the patient’s consent. In the case of minors the relationship is between the child’s guardians as well as the doctor who must act within the law. In the category of “elderly” or adult guardianship or advocacy, those appointed and in positions of trust must take the person’s wishes into account if the patient has capacity to make decisions or has indicated their wish prior to any such appointment. Capacity is defined as consistent belief or wish, awareness of what one does not wish for, satisfaction when wishes are respected and fulfilled and the opposite when they are not. Ethical practice is determined by taking context into account in decision-making and ensuring the sanctity of the patient’s rights and wishes. Abuse is just the opposite, where actions taken or not taken are against a person’s wishes. Personal wish determines best interest. Best interest may also be defined in terms of social functioning and psychological wellbeing. Discussion of ethics in terms of General Systems Theory is also addressed, and affects an action on the environment or others, i.e. ethics in the wider medical context may pertain if the person has a contagious disease and a period of quarantine or “isolation” or barrier” nursing is required, and where precedent is given to society’s best interest over the person’s wishes, as part of an educational process and as required for strategic disease management.

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Cultural context in medical ethics: lessons from Japan

Cultural context in medical ethics: lessons from Japan

Many factors contribute to the shift in disclosure practices in Japan. A widely reported medical malpractice case drew national attention to the potential for increased risk to patients because of nondisclosure. The case involved a nurse who was evaluated for abdominal pain in 1983 [4]. Her doctor diagnosed bladder cancer, but told the patient that she had gallstones and recommended surgery. The patient did not follow up with treatment for six months, by which time the cancer was no longer operable; the patient died several months later. A malpractice case ensued, unusual in Japan at that time [6]. The Japanese Supreme Court concurred with the physicians' choice to conceal the cancer diagnosis. The Court did urge physi- cians to select false diagnoses of equivalent urgency to true ones, so that patients will not unduly delay treatment [4]. Japanese society has devoted significant resources to the debate on disclosure practices. Two important official groups were convened and developed contrasting sets of recommendations in 1989 and 1990. The Government Task Force on Terminal Care was an appointed group including both physicians and non-physicians. It recom- mended that disclosure of cancer diagnoses be increased, though not without assessing four patient-related factors: psychological stability; decisional capacity; positive rela- tionships between providers, family and patient; and available supports for the patient [7]. In contrast, the Bioethics Council of the Japan Medical Association, com- posed only of physicians, recommended against disclo- sure of cancer diagnoses, except in rare circumstances, i.e. when the patient excelled in all four factors listed above. Weakness in any single factor should preclude disclosure [7]. These two reports suggest that not only was Japan focused on the issue of disclosure, but that in the late 80's there was no general consensus on the ethically correct stance.

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The development of a brief and objective method for evaluating moral sensitivity and reasoning in medical students

The development of a brief and objective method for evaluating moral sensitivity and reasoning in medical students

Several researchers have criticized Kohlberg's notions in that their justice-laden framework is inapt to the Japanese cultural background where interpersonal relationships are highly valued [8]. Accordingly, an environment where interpersonal relationships and consideration of periph- eral circumstances are prioritized over reasons of justice weighs Kohlberg's 3rd and 4th stages of moral develop- ment with greater significance than the 5th and 6th stages. In light of the above, we surmise that DIT results regarding decision-making carry more significance than those results pertaining to simple moral development stage and DP values. While the original DIT may be able to assess moral reasoning in the context of medical ethics to some degree, we contend that changes in subjects' moral thoughts (decision-making) can be evaluated by using the two most relevant vignettes.

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The Ethics of Veracity and It Is Importance in the Medical Ethics

The Ethics of Veracity and It Is Importance in the Medical Ethics

The goals of this overview is to discuss the ethics of telling the patient the truth, with some historical backgrounds and it is importance in medical prac- tice, Justifying Less than Full Disclosure in some situations in which the truth may have a terrible impact on the occasional patient, and the influence of the culture on the health care professionals attitudes towards telling the patient the truth. Conclusion: The health care professionals need more awareness, and training in ethics of veracity and also in the communication skills espe- cially in the context of breaking bad news in telling the patient the truth about diagnosis, treatment outcomes, and prognosis of any serious illness.

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Students’ medical ethics rounds: a combinatorial program for medical ethics education

Students’ medical ethics rounds: a combinatorial program for medical ethics education

The project of Students’ Medical Ethics Rounds (SMER) was conducted in the Students’ Scientific Research Center (SSRC) of Tehran University of Medical Sciences, Iran, from October 2012 to February 2014 as an extra-curricular program of medical ethics education. All students of medical sciences including medicine, dentistry, nursing, pharmacy, and etc. were eligible and allowed to voluntarily participate in round sessions. The program was designed based on a combination of Medical ethics is an important part of the medical curriculum today (1). Presently, all medical schools increasingly require that students be well educated in ethical issues, so as to be equipped with the ills for better management of ethical 3). It is well recognized that there is no single, best model for medical ethics education; therefore, there was a trend toward developing high quality undergraduate curricula in the past decades e aims of medical ethics education is well portrayed in literature. However, the effective methods of teaching ethics to students have not yet been investigated comprehensively and there is still significant debate on learning and teaching methods is clear that the current curricular educational methods cannot provide a suitable context for ethical issues to form students’ professional attitudes, because of the different perspectives of medical ethics to the other components of medical dical ethics educators believe the current single, separate course of medical ethics presented during the medical curriculum is insufficient to meet the goals of medical ethics Evidence shows medical students and residents have nterest in diverse ethics topics and learning practical skills of preparation for ethical decision- making in clinical situations (5, 8, 9). Moreover, recent recommendations for medical ethics education centered education in medical icula (1, 10). The active involvement of students in the process of medical ethics education is advocated (11). In this regard, small group based learning (3, 13, based discussion (5, 15, 16), ethics grand ward rounds with ethicists, simulated 19), and some other educational methods have been introduced in However, there is a lack of information regarding the efficacy of combinatorial programs using the diverse oposed medical education methods. Thus, we curricular program of medical ethics teaching, and investigated its impact on the students’ attitude and knowledge

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Neuroethics: the pursuit of transforming medical ethics in scientific ethics

Neuroethics: the pursuit of transforming medical ethics in scientific ethics

Despite the coincidence in time, the situation was very different from the ethical problems resulting from the biotechnological revolution: uncertainty, risk and danger. In the early 1970s, the revolutionary cellular and animal virus research began to show its misty and ominous face: the growing threat to which researchers were exposing the entirety of humanity. Alarms went off vividly, recall- ing the words of Oppenheimer after the fateful nuclear tests, “physicists have known sin and this is a knowl- edge which they cannot lose” [20]. It was in June 1973 and again from February 24–27 in 1975 at the Asilomar conferences on the risks of recombinant DNA that, after heated discussion, safety guidelines were approved with two types of protective barriers, biological and physical, and four levels of risk. With what was termed the “pre- cautionary principle” and the certain awareness that the manipulation of genetic material is always done in the context of uncertainty, GenEthics was born. Its main con- clusion, unprecedented as it had never been expressed before so unequivocally, was that humanity had to be considered as a limiting end to scientific and techni- cal interventions, for example, to positive and negative genetic engineering [21]. But at the same time the biolog- ical sciences passionately took up again the doctrine that

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Students’ medical ethics rounds: a combinatorial program for medical ethics education

Students’ medical ethics rounds: a combinatorial program for medical ethics education

Medical ethics is an important part of the medical curriculum today (1). Presently, all medical schools increasingly require that students be well educated in ethical issues, so as to be equipped with the necessary skills for better management of ethical dilemmas (1-3). It is well recognized that there is no single, best model for medical ethics education; therefore, there was a trend toward developing high quality undergraduate curricula in the past decades (4, 5). The aims of medical ethics education is well portrayed in literature. However, the effective methods of teaching ethics to students have not yet been investigated comprehensively and there is still significant debate on learning and teaching methods (1). It is clear that the current curricular educational methods cannot provide a suitable context for ethical issues to form students’ professional attitudes, because of the different perspectives of medical ethics to the other components of medical knowledge. Medical ethics educators believe the current single, separate course of medical ethics presented during the medical curriculum is insufficient to meet the goals of medical ethics education (1, 6, 7).

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Principles of medical ethics: implications for the disclosure of medical errors

Principles of medical ethics: implications for the disclosure of medical errors

It is important to note that ethical disclosure standards come with certain limitations. First, the literature suggests that patients prefer a sincere apology. Thus, providers may face an ethical conflict if their apology is not genuine. Future research is needed to elaborate this tension. Second, a causal link between the apology element and positive error disclosure outcomes has not been empirically established. In light of the legal controversy on this disclosure element, future studies need to provide causal data on this association and also test for potential mediators, such as nonverbal involvement. Third, the operationalized communicative elements assume that the error disclosure is initiated by the provider. Most of the existing literature approaches error disclosures from this standpoint. However, future research needs to evaluate to what extent a patient-elicited disclosure may be different. Fourth, multi- disciplinary approaches to error disclosure that include all protagonists in the system are needed, including all patients and professionals involved. Such a systemic approach can promote partnership in this relationally challenging context and facilitate more reliable patient safety.

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Childhood, genetics, ethics and the social context

Childhood, genetics, ethics and the social context

One typical example of its time, is a Medical Research Council (MRC) Report from 1932. The premise of the Report is that crime `indicates a congenital fault of mental organisation... a failure of the brain to function properly'. Menstruation is posited as a cause of insanity and crime `attributable to irritation of the ovaries or uterus, a disease by which the chaste and modest woman is transformed into a raging fury of lust'. Facial and other anomalies of the `criminal type' were thought to resemble `the Mongoloid or sometimes the Negroid', being morally and physically `peculiar'. Psychologists quoted in the Report had examined numerous women prisoners, noting their abnormal genitalia, menstrual changes and `orgies' which included attempts to escape from prison. Many case studies of working class adolescents noted ugly and `fierce' features, the `marks of a hopeless moral reprobate'. These `very dangerous' girls, the MRC Report recommended, must be sterilised and permanently confined in colonies `under the guardianship' of psychologists who should be allocated `hunting grounds' in working class areas from which to select their cases. i

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Medical ethics and the trolley problem

Medical ethics and the trolley problem

This principle has applications in two very delicate subjects in medical ethics: abortion and euthanasia. Consider the case of a pregnant woman who has been diagnosed with uterine cancer, and the only way to treat her is by removing the uterus (16). This will end the fetus’ life. Yet, even those religious traditions (especially Catholicism) that are staunchly opposed to abortion, would allow such a procedure, on the basis of the doctrine of double effect. Although the surgeon may foresee that by removing the uterus, the fetus will die, he does not intend it. However, performing an abortion just because the mother’s life is in danger, but directly targeting the fetus, would not be allowed according to Catholic standards. Again, this would not receive moral approval, because the harm would be intended, and not merely foreseen.

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On classifying the field of medical ethics

On classifying the field of medical ethics

To summarise, in order to be perceived as justified, a classification strategy must expose the purpose of the classification, identify and make explicit the premises and assumption behind the classification, and explore trade-offs and explicit viewpoints taken towards these premises. As we see it, any approach to classifying the field of medical ethics for some strategic purpose should also be accompanied with self-reflective aware- ness of the three inherent threats described above: power abuse, inadequate coverage of the field, and nega- tive unintended impact on practice. From this, substan- tive constraints on how to shape and determine a classification are derived. In the following, we will at- tempt to demonstrate how to do exactly that. We start by declaring the purpose of our classification, followed by laying out our initial reflections on a variety of premises for a purposive classification of medical ethics before deriving sections that are intended to adequately cover the whole field of medical ethics. We will then re- turn to consider the threats described above and assess our suggested classification of medical ethics accord- ingly. Finally, we discuss the pros and cons of this the- oretical approach compared to the practical deliberative approach used by the journal.

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The Ethics of National and International Organ Markets

The Ethics of National and International Organ Markets

of policy requires a practical, verifiable, and sincere approach to informing patients (both recipient/buyers and donor/sellers) and limiting undue influence. There is always room for improvement, but to help assure informed consent in living organ donation, at a minimum one must: 1) verify basic personal information such as age, personal and family medical history, 2) conduct a thorough medical assessment, including physical examination, proper laboratory tests, sonogram, and study of the donor kidney vessels by either standard selective angiography or CT angiography, 3) maintain accurate record keeping that assures continuity of identity, and most importantly, 4) ensure that at least one healthcare professional, for whom assuring informed and voluntary decision making is a priority, is involved early in the donation processes.

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Must we remain blind to undergraduate medical ethics education in Africa? A cross-sectional study of Nigerian medical students

Must we remain blind to undergraduate medical ethics education in Africa? A cross-sectional study of Nigerian medical students

The range of their responses to the perception state- ments on doctor-patient relationship is indicative of the variation in the students’ ethical sensitivity, depending on their knowledge, beliefs,values, experiences and interac- tions with their patients/attending doctors. The tension existing between the principles of respect for autonomy and beneficence (non-maleficence) and the tendency towards being paternalistic in the course of clinical decision-making is highlighted by the pattern of responses on the items addressing refusal of treatment on religious grounds, euthanasia/physician-assisted suicide and wilful termination of pregnancies; with socio-cultural and religious perspectives probably exerting their influences on these choices (Table 3).This could also be indicative of the lack of ethics training on the part of these students, who can only learn from the prevailing attitudes and prac- tices of their medical teachers, most of whom apparently belong to the paternalistic traditions. In ethical dilemmas where conflicting values, preferences, principles, risks and benefits play out, a more structured analytical approach is imperative in achieving justifiable resolution. Without adequate ethics education, a vicious cycle of paternalism will invariably continue to dominate in the doctor-patient relationships in our settings.

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Christian Ethics and Islamic Ethics: A Critical Comparative Study in the Ghanaian Context

Christian Ethics and Islamic Ethics: A Critical Comparative Study in the Ghanaian Context

Thecommandments of the Qur„an and the Prophet, read together, accorded full protection to human life, neither an individual would be allowed to take away the life of another individual, nor shall the state destroy any human life except in either case, when the law so requires or permits. All forms of abortion, man slaughter, homicide, infanticide, etc, are therefore, regarded in Islam ethics as heinous crime. 73 Allah denounces murder and says in the Holy Qur‟an: “kill not your children for fear of want: We shall provide sustenance for them as well as for you. Verily the killing of them is a great sin.” 74

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Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice

Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice

Applied ethics is a branch of ethics that involves the application of ethics in the private and public lives of people and tries to solve common tangible problems in a variety of communities and professions. Applied ethics does not aim at developing the understanding of ethical concepts, but at making suggestions that have beneficial practical results and assists in ethical decision-making (3). Medical ethics is considered to be one of the branches of applied ethics. Its orientation is towards tangible medical issues and it intends to explain the principles and basic concepts of this science and introduces ethics into the field of practice and important ethical decisions (4). In this vein, medical ethics focuses on putting ethics into practice in real-life situations. It is very clear that this branch will succeed if it puts the findings of theoretical research into practice and accomplishes its practical aims. This objective raises the issue of the relationship between knowledge and practice. People’s voluntary behavior (that is, the topic of ethics) is shaped on the basis of their willingness and determination. It is evident that voluntary behavior is preceded by a sort of science and cognition, but not every science and theory necessarily leads to practice. We are always dealing with behavior patterns that are in contrast with the beliefs and ideas of their owners (2). Many people who have dangerous behavior, like people who smoke or diabetics who do not follow their diets, believe that their behavior is hazardous and inappropriate. Furthermore, regarding ethical behavior, it can be stated that many physicians who do not respect patient’s rights confess that their behavior is wrong or at least are aware of their false behavior from the viewpoint of medical ethics.

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Infant With Trisomy 18 and Hypoplastic Left Heart Syndrome

Infant With Trisomy 18 and Hypoplastic Left Heart Syndrome

improbable or impossible, outcomes such as having more time with their living child, avoiding suffering, having an opportunity to hold, staying hopeful or faithful, or being a good parent may determine their choices. The same event, such as a child dying on the operating table during surgery, may be perceived by parents as better than having their child die while receiving comfort care. Surgeons might perceive that same outcome as the worst possible one. Many professionals have negative attitudes toward infants anticipated to have severe impairment. Medical literature has been focused on the high morbidity and mortality of these conditions and the degree of

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Social Justice as a Moral Imperative

Social Justice as a Moral Imperative

It is of utmost importance to note that this debate about Principle 4 is about ethics; it is not a political debate. Political ideology has no place in a discussion about the human distribution of health care to the orphaned, widow, foreigner, and the poor. It also is important to note that official documents of the association provide guidance and direction to the entire profession of occupational therapy and, as such, represent the views of the association, not the views of a few individuals.

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Effectiveness of the Course of Medical Ethics for Undergraduate Medical Students

Effectiveness of the Course of Medical Ethics for Undergraduate Medical Students

Comparing the end of the course data between group A and B: Mean score of group B students at the end of the term (6.12 ± 1.3) was significantly more than the mean score of group A students (3.63 ± 1.7) (P=0.001). Students' knowledge about informed consent (P<0.001), decision making capacity (P<0.001), confidentiality (P<0.0001) and conflict of interest (P=0.001) was significantly higher in group B (Table 3), while knowledge of the two groups were not significantly different on other issues such as medical error, ethical theories, abortion and euthanasia.

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Ethics in Context: The Thessalonians and their neighbours

Ethics in Context: The Thessalonians and their neighbours

K.-W. Niebuhr suggested that Jewish and Christian identity was not found in the content of their moral teaching, but in their claim that it was the will of God (Niebuhr 1987:70−72), to which W. Ameling objected that that idea would have meant little to pagans, who would have been astonished by the similarity to the ethics they had been taught by popular philosophy or religion (Ameling 2011:246). They are both correct with respect to 1 Thessalonians 4:3−8. The content of the teaching is not unique, and the notion of the will of God, in which the readers had been instructed, was not clear to them, hence the need for Paul to provide the clarification. Ἁγιασμὸς here is a noun describing action (cf. 2 Th 2:13), not a condition (ctst. ἁγιωσύνη, 3:13). The action is that of Paul’s readers (cf. v. 7 for God’s action), which is specified in a series of infinitives marking a progression in thought. The first is a general prohibition against sexual immorality (ἀπέχεσθαι ὑμᾶς ἀπὸ τῆς πορνείας [4:3]), which, to the Jewish mind, is a vice characteristic of pagans, and was frequently associated with idolatry (Wisdom 14:13; cf. Rm 1:24, 26). It is natural that Paul would begin in this way in writing to readers who not too long beforehand had turned from idols to serve the living and true God (1:9). He would have had to make the connection between morality and religion very early in his instruction.

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An update on the “empirical turn” in bioethics: analysis of empirical research in nine bioethics journals

An update on the “empirical turn” in bioethics: analysis of empirical research in nine bioethics journals

In the last decade, a few publications have sought to present evidence that bioethics is becoming in- creasingly empirical, resulting in the use of the term ‘empirical turn in bioethics’ [5, 6]. Sugarman, Faden, and Boyce’s [7] seminal study laid the foundation of empirical research in this field. Their PubMed search for the period ranging from 1980 to 2005 concluded that 13% of all ethics publications in PubMed were related to empirical biomedical ethics. They defined such works as the application of social science re- search methods to the direct examination of issues of biomedical ethics (p. 21). Their study reported that empirical biomedical ethics publications had increased from 8% in the period of 1980–1984 to 16% in 2000– 2005; and during this 25-year period, 11,776 pub- lished papers were deemed empirical. The limitation of this study was that the results were based on out- puts obtained from the use of specific MESH terms and manuscripts were not individually evaluated.

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