Why physicians should not do ethics consults

Increasing complexities facing physicians negotiating the bedside decision continue to fuel the debate over who is the appropriate party to offer ethics consults, should one be needed, during the decision-making process. Some very good arguments have been put forth on behalf of clinical ethicists as being the proper and best party to engage in ethics consultations. However, serious questions remain about the role of the clinical ethicist and his ability to provide the necessary level of objectivity called for in an ethics consult. I argue that the clinician's professional psyche, or mode of thinking as a professional, leaves him little room to maneuver as an objective and detached third party ethics consultant. Several factors are cited and discussed that greatly influence the analyses applied to a case problem by physicians. The most formidable of these factors are habits and the practice of defensive medicine. I conclude that clinical ethicists are less suited for the overall tasks required of an objective consultant in medical cases that appear to involve insurmountable ethical issues.     

器官移植的临床决策难题——医务人员面临的伦理尴尬

器官移植技术在临床的推广应用,在有效救治病人同时,也面临着复杂的伦理问题,医务人员身处诸多两难的尴尬境地,已成为临床决策过程中亟待解决的难题。     

器官移植的临床决策难题--医务人员面临的伦理尴尬

器官移植技术在临床的推广应用,在有效救治病人同时,也面临着复杂的伦理问题,医务人员身处诸多两难的尴尬境地,已成为临床决策过程中亟待解决的难题.     

The ethics of complexity and the complexity of ethics

Abstract

In this paper, we investigate the implications that a general view of complexity - i.e. the view that complex phenomena are irreducible - hold for our understanding of ethics. In this view, ethics should be conceived of as constitutive of knowledge and identity, rather than as a normative system that dictates right action. Using this understanding, we elaborate on the ethics of complexity and the complexity of ethics. Whilst the former concerns the nature and the status of our modelling choices, the latter denotes a contingent and recursive understanding of ethics. Although the complexity of ethics cannot be captured in a substantive normative model, we argue that this view of ethics nevertheless commits one to, what we term, ‘the provisional imperative’. Like Kant’s categorical imperative, the provisional imperative is sub-stantively-empty; however, unlike Kant’s imperative, our imperative cannot be used to generate universal ethical principles. As such, the provisional imperative simultaneously demands that we must be guided by it, whilst drawing attention to the exclusionary nature of all imperatives. We further argue that the provisional imperative urges us to adopt a certain attitude with regard to ethical decision-making, and that this attitude is supported and nurtured by provisionality, transgressivity, irony, and imagination.     

The development of computer ethics: Contributions from business ethics and medical ethics

In this essay, we demonstrate that the field of computer ethics shares many core similarities with two other areas of applied ethics, Academicians writing and teaching in the area of computer ethics, along with practitioners, must address ethical issues that are qualitatively similar in nature to those raised in medicine and business. In addition, as academic disciplines, these three fields also share some similar concerns. For example, all face the difficult challenge of maintaining a credible dialogue with diverse constituents such as academicians of various disciplines, professionals, policymakers, and the general public, Given these similarities, the fields of bioethics and business ethics can serve as useful models for the development of computer ethics. A version of this paper was presented at ETHICOMP98, the Fourth International Conference on Ethical Issues of Information Technology, March 25–27, 1998, Erasmus University, the Netherlands. Kenman Wong, Ph.D., is an Associate Professor of Business Ethics; Gerhard Steinke, Ph.D., is Professor of Management and Information Systems. Both authors are at Seattle Pacific University's School of Business and Economics.     

Professional ethics of psychologists and physicians: morality, confidentiality, and sexuality in Israel

Clinical psychologists' and nonpsychiatric physicians' attitudes and behaviors in sexual and confidentiality boundary violations were examined. The 171 participants' responses were analyzed by profession, sex, and status (student, resident, professional) on semantic differential, boundary violation vignettes, and a version of Pope, Tabachnick, and Keith-Spiegel's (1987) ethical scale. Psychologists rated sexual boundary violation as more unethical than did physicians (p less than .001). Rationale (p less than .01) and timing (p less than .0001) influenced ratings. Psychologists reported fewer sexualized behaviors than physicians (p less than .05). Professional experience (p less than .01) and sex (p less than .05) were associated with confidence-violating behavior. Overall, 78% of the sample reported attitudes or behaviors associated with boundary violations. The behavior violations were correlated (r = .49). Actual violators rated vignette violators more leniently than did nonviolators (p less than .01).     

Emotional interactions and an ethics of care: Caring relations in families affected by HIV and AIDS

In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers' ability to provide the ‘good care’ that integrates the key ethical phases in Tronto's (1993) ideal of the caring process.     

The ethics of morphing

Here’s one piece of practical reasoning: “If I do this then a person will reap some benefits and suffer some costs. On balance, the benefits outweigh the costs. So I ought to do it.” Here’s another: “If I do this then one person will reap some benefits and another will suffer some costs. On balance, the benefits to the one person outweigh the costs to the other. So I ought to do it.” Many influential philosophers say that there is something dubious about the second piece of reasoning. They say that it makes sense to trade-off costs and benefits within lives, but not across lives. In this paper I make a case for the second piece of reasoning. My case turns on the existence of morphing sequences—sequences of possible states of affairs across which people transform smoothly into other people.

The ethics of poverty

Conclusions The conclusions set forth in this paper are of a highly tentative and even exploratory nature. I am willing to be demonstrated to be wrong at any point and excited by the realization that some of my hunches have been sufficiently far out to prompt confirmatory or invalidating research of a more precise variety. Yet I am willing to stand by my observations as to the relationship between the ethical perspective of the poor to the following seemingly unrelated events: (1) the implosion of these ethical perspectives into the middle classes, (2) through contemporary political uses of the poor by the upper classes, (3) professional interaction with the poverty community, (4) the unconscious moral identification of the middle classes with the ethics of the poor, (5) the transformation of thekinds of emotional disorder from one level of affluence to another by reason of the criterion of work as an indication of mental health, and (6) the ethical issue involved in economic determination of the use of medical and ministerial time in the care of the emotionally disturbed.     

Ante-natal HIV testing: An observational study of HIV test discussion in maternity care

There has been a vociferous call for ante-natal HIV testing but low uptake persists in the UK despite DOH guidelines. The reasons for this are complex, with many studies examining intention, offer and uptake of HIV test but few observing the process to understand the nature of HIV discussion with pregnant women. A field observational study was undertaken where researchers attended 154 ante-natal consultations. These were selected in rotation during ante-natal visits by women at four London hospital based ante-natal clinics. A standardized checklist was utilized to monitor information on HIV. A mean of 1.73 minutes was spent discussing HIV infection and testing during ante-natal consultations which lasted for a mean of 33.1 minutes. Risk factors for HIV were mentioned infrequently. When mentioned they concentrated on sexual behaviour which was raised in 11.7% of the consultations. Potential interventions to reduce vertical transmission were discussed with no more than one in five women and possible adverse implications of HIV testing with fewer than one in ten, the only exception being the implications of a positive diagnosis for the baby. Discussion of interventions was associated with HIV test uptake, but risk discussion was not. The short time spent on discussing HIV testing, combined with paucity of mention of information relevant to pregnancy are issues for concern and probably help to explain the level of uptake in the UK.