Diagnosis by Documentary: Professional Responsibilities in Informal Encounters

Most work addressing clinical workers' professional responsibilities concerns the norms of conduct within established professional–patient relationships, but such responsibilities may extend beyond the clinical context. We explore health workers' professional responsibilities in such “informal” encounters through the example of a doctor witnessing the misdiagnosis and mistreatment of a serious long-term condition in a television documentary, arguing that neither internalist approaches to professional responsibility (such as virtue ethics or care ethics) nor externalist ones (such as the “social contract” model) provide sufficiently clear guidance in such situations. We propose that a mix of both approaches, emphasizing the noncomplacency and practical wisdom of virtue ethics, but grounding the normative authority of virtue in an external source, is able to engage with the health worker's responsibilities in such situations to the individual, the health care system, and the population at large.     

Companion Animal Ethics: A Special Area of Moral Theory and Practice?

Considerations of ethical questions regarding pets should take into account the nature of human-pet relationships, in particular the uniquely combined features of mutual companionship, quasi-family-membership, proximity, direct contact, privacy, dependence, and partiality. The approaches to ethical questions about pets should overlap with those of animal ethics and family ethics (and, for veterinary issues, with healthcare ethics), and so need not represent an isolated field of enquiry, but rather the intersection of those more established fields. This intersection, and the questions of how we treat our pets, present several unique concerns and approaches for focused examination.     

Patient and Family Descriptions of Ethical Concerns

Abstract

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants (N?=?196) described 219 unique ethical experiences that spanned many of the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting.     

All careproviders need more opportunities to share their ethical concerns with others

Attention to the ethical concerns of healthcare aides can provide important information about patients' needs to careproviders, improve the ethical environment of an institution, and benefit aides who suffer from bearing ethical concerns alone. All persons benefit from sharing their ethical concerns with others. Among other benefits, ethics consultation offers careproviders, caregivers, healthcare aides, patients, and patients' loved ones an opportunity to have their concerns heard. John Fletcher tried to follow every ethics consultation with a debriefing for all participants, including patients and family members, to increase the possibility for continued healing after the conclusion of the consultation, and there are good reasons to follow this practice.     

An analysis of ethics consultation in the clinical setting

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults.     

Ethics and HRM Education

Human resource management (HRM) education has tended to focus on specific functions and tasks within organizations, such as compensation, staffing, and evaluation. This task orientation within HRM education fails to account for the bigger questions facing human resource management and employment relationships, questions which address the roles and responsibilities of the HR function and HR practitioners. An educational focus on HRM that does not explicitly address larger ethical questions fails to equip students to address stakeholder concerns about how employees are treated or the ethical dilemmas facing employers with regard to the employment relationship, and ironically makes the HRM function less strategic to the organization. In this paper, we identify some of the key ethical issues within the employment relationship, discuss how extant HRM education often fails to address these issues or help students to become aware of them, and offer a framework for integrating ethics into HRM education.     

What’s Different,Ethically, About Nanotechnology?: Foundational Questions and Answers

Whether nanotechnology is ethically unique and “nanoethics” should be treated as a field in its own right remain important, contested issues. This essay seeks to contribute to the debates on these issues by exploring several foundational questions about the relationship of ethics and nanotechnology. Ethical issues related to nanotechnology exist and adoption of a defeasible presumption that such issues amount to old ethical wine in new technological bottles appears justified. Such issues are not engendered solely by intrinsic features of the nanotechnology field, but also by contingent features of the social contexts in which work in the field unfolds. The sets of factors that engender ethical issues related to nanotechnology are combinations of social-contextual and technical elements. While there do not appear to be any qualitatively new nanotechnology-related ethical issues, nanotechnology is different, ethically, from other fields of technical inquiry in at least two ways. To avoid diluting ethical concern about nanotechnology and revival of the noxious notions of autonomous technology and technological determinism, thinking, writing, and speaking about ‘nanoethics’ should yield to thinking, writing, and speaking about ‘ethical issues related to nanotechnology in society.’ Finally, nanotechnology practitioners should become familiar with the ethical dimension of their work.     

Clinical ethics consultations: reasons for optimism, but problems exist

[The author identifies] five problems familiar to clinical ethicists. (1) Physicians often do not recognize important ethical issues. (2) Debate exists over whether such consultations should give specific management recommendations. (3) Principles of medical ethics cannot, by themselves, resolve real ethical issues. (4) The patient's interests sometimes conflict with the interests of the family, the health professionals, and the hospital. (5) Clinical ethics consultations take a toll on the consultant....[He] discuss[es] the implications of each problem for clinical ethics consultations and offer[s] a solution to it.     

Anesthesiological ethics: can informed consent be implied?

Surgical ethics is a well-recognized field in clinical ethics, distinct from medical ethics. It includes at least a dozen important issues common to surgery that do not exist in internal medicine simply because of the differences in their practices. But until now there has been a tendency to include ethical issues of anesthesiology as a part of surgical ethics. This may mask the importance of ethical issues in anesthesiology, and even help perpetuate an unfortunate view that surgeons are "captain of the ship" in the operating theater (leaving anesthesiologists in a subservient role). We will have a better ethical understanding if we see surgery and anesthesia as two equal partners, ethically as well as in terms of patient care. Informed consent is one such issue, but it is not limited to that. Even on the topic of what type of anesthesia to use, anesthesiologists have often felt subsumed to the surgeon's preferences. This commentary takes the case study and uses it as a exemplar for this very claim: it is time to give due recognition for a new field in clinical ethics, ethics in anesthesia.     

Morality in group and family therapies: multiperson therapies and the 1992 ethics code

Although virtually every psychotherapeutic approach or orientation has adapted group and family therapy to its conceptions of psychological dysfunctions and how to treat them, levels of training of practitioners in all of these approaches are often insufficient to meet the requirements of ethically as well as technically responsible conduct of treatment for persons in groups and families. The new ethics code (American Psychological Association [APA], 1992) does include a few issues specific to multiperson therapies, but other issues critical to the competent practice of group and family therapy remain unaddressed. The result can be confusing to those applying standards for individual therapy to multiperson therapies. It is argued that the classical ethical concerns of psychotherapists, informed consent, confidentiality, countertransference reactions, aand intrusions of therapist values, require special sensitivity to how they are expressed in mulitperson therapies. Practitioners of group and family therapies must be better sensitized to the technical distinctions and the associated ethical vulnerabilities of the modalities they use. Future planning for revision of the APA ethics code should take these factors into account.     

Ethics in the Humanities: Findings from Focus Groups

This project examined the ethical issues faced by academics and professionals in the Humanities. We conducted focus groups to gather information about the ethical concerns in these fields and used the qualitative data arising from the discussions to create a taxonomy that represents the structure of ethical issues in the Humanities. A key implication of our findings is that while the focus of ethics research and interventions has been primarily on the sciences and engineering, academics and professionals in other fields also encounter some unique critical ethical dilemmas that require further research and methods of intervention.     

A Survey of Expectations About the Role of Robots in Robot-Assisted Therapy for Children with ASD: Ethical Acceptability,Trust, Sociability,Appearance, and Attachment

The use of robots in therapy for children with autism spectrum disorder (ASD) raises issues concerning the ethical and social acceptability of this technology and, more generally, about human–robot interaction. However, usually philosophical papers on the ethics of human–robot-interaction do not take into account stakeholders’ views; yet it is important to involve stakeholders in order to render the research responsive to concerns within the autism and autism therapy community. To support responsible research and innovation in this field, this paper identifies a range of ethical, social and therapeutic concerns, and presents and discusses the results of an exploratory survey that investigated these issues and explored stakeholders’ expectations about this kind of therapy. We conclude that although in general stakeholders approve of using robots in therapy for children with ASD, it is wise to avoid replacing therapists by robots and to develop and use robots that have what we call supervised autonomy. This is likely to create more trust among stakeholders and improve the quality of the therapy. Moreover, our research suggests that issues concerning the appearance of the robot need to be adequately dealt with by the researchers and therapists. For instance, our survey suggests that zoomorphic robots may be less problematic than robots that look too much like humans.     

The hazards of writing or disclosing information in psychiatry

The health care professional must be aware of the potential hazards in writing or disclosing information about a patient or a non-patient. Two important interests are pitted against each other: dissemination of scientific information versus confidentiality. Presented is a discussion of the legal and ethical issues involved in (1) writing an article or book about a patient, (2) writing about a research subject, (3) writing about a subject of a forensic examination on behalf of the court or attorney, and (4) writing in a medical record.     

Manufacturing Mistrust: Issues in the Controversy Regarding Foster Children in the Pediatric HIV/AIDS Clinical Trials

The use of foster children as subjects in the pediatric HIV/AIDS clinical trials has been the subject of media controversy, raising a range of ethical and social dimensions. Several unsettled issues and debates in research ethics underlie the controversy and the lack of consensus among professional researchers on these issues was neither adequately appreciated nor presented in media reports. These issues include (1) the tension between protecting subjects from research risk while allowing them access to the possible benefits of research; (2) the blurring of the potentially conflicting roles of investigator and physician and the boundaries between research and therapy; (3) the adequacy of Institutional Review Board oversight; and (4) trust and the relationships among physicians, investigators and industry. The media controversy about the pediatric HIV/AIDS clinical trials can be seen as a means of “manufacturing mistrust” in health care, research and social services that have not always met the needs and expectations of the public. In an era of emerging infections, it is critical to the public’s health that people understand the role of rigorous and ethical research in the development of safe and effective care. Investigators, journalists and the public need to become knowledgeable about major ethical issues in the conduct of research in order to engage in dialogue about balancing research risks and benefits and to be able to distinguish fact from distortion in an era of multiple and rapid transmission of information.     

Who is Authorized to Do Applied Ethics? Inherently Political Dimensions of Applied Ethics

A standard view in ethics is that ethical issues concern a different range of human concerns than does politics. This essay goes beyond the long-standing dispute about the extent to which applied ethics needs a commitment to ethical theory. It argues that regardless of the outcome of that dispute, applied ethics, because it presumes something about the nature of authority, rests upon and is implicated in political theory. After internalist and externalist accounts of applied ethics are described, “mixed” approaches are considered that contain inevitable political dimensions. A feminist alternative, Walker’s metaethic of responsibility, shows that authority is best understood as relational and that situations of unequal power are therefore often the places where applied ethics arises. Furthermore, in a democratic society, commitments to democracy should shape the account of authority, and, thus, the nature of applied ethics as well.     

Ethics of field research: Do journals set the standard?

To determine whether ethical issues concerned with field research are addressed in the peer-review process, instructions to authors and reviewers of 141 (mainly natural science) journals were examined to ascertain how often ethical issues were mentioned. Only one-third (n=41) of responding journals addressed ethical issues in their instructions to authors or reviewers. When ethical issues were considered, most of the journals limited their concerns to ethical issues associated with animal and general human experimentation. No journal mentioned ethical practices in working with indigenous peoples or on traditional lands. Only two journals addressed the ethics of research in sensitive areas in their instructions to authors, only one in its instructions to reviewers. We suggest that peer-reviewed journals respond to an emerging issue in ecological research by formally incorporating research ethics into their instructions to authors and reviewers. Furthermore, these instructions should address the ethical issues associated with field research and in working with indigenous peoples and on traditional lands.     

关于阴茎移植的伦理问题

随着医学科学的发展,器官移植日趋成熟,不仅使患者延长了生命,更大大提高了生活质量。阴茎移植是器官移植和免疫学发展的结晶,是异体器官移植领域内新的突破,为阴茎缺失的患者带来了新生,对患者心理、家庭和社会有着重大影响。但目前异体阴茎移植刚刚起步,技术尚不成熟,且阴茎是一特殊器官,涉及到的伦理道德问题很多,我们试图从受者、供者、医生和法律等方面讨论阴茎移植所面临的伦理道德问题,希望阴茎移植能真正造福于人类。     

Business Faculty Perceptions and Actions Regarding Ethics Education

This paper examines faculty perceptions regarding ethical behavior among colleagues and students, and faculty practices with regard to teaching ethics in three institutions over a 4-year period. Faculty reported an uneven pattern of unethical behavior among colleagues over the period. A majority of business courses included ethics, however as both a specific topic on the syllabus and within course discussions. The percentage of courses with ethics discussions increased in 2006, however, the time allocated to these discussions decreased. These results suggest that faculty are approaching ethics instruction less formally, raising concerns over the success of curriculum integration.     

Ways of thinking about and teaching ethical problem solving: Microethics and macroethics in engineering

Engineering ethics entails three frames of reference: individual, professional, and social. "Microethics" considers individuals and internal relations of the engineering profession; "macroethics" applies to the collective social responsibility of the profession and to societal decisions about technology. Most research and teaching in engineering ethics, including online resources, has had a "micro" focus. Mechanisms for incorporating macroethical perspectives include: integrating engineering ethics and science, technology and society (STS); closer integration of engineering ethics and computer ethics; and consideration of the influence of professional engineering societies and corporate social responsibility programs on ethical engineering practice. Integrating macroethical issues and concerns in engineering ethics involves broadening the context of ethical problem solving. This in turn implies: developing courses emphasizing both micro and macro perspectives, providing faculty development that includes training in both STS and practical ethics; and revision of curriculum materials, including online resources. Multidisciplinary collaboration is recommended 1) to create online case studies emphasizing ethical decision making in individual, professional, and societal contexts; 2) to leverage existing online computer ethics resources with relevance to engineering education and practice; and 3) to create transparent linkages between public policy positions advocated by professional societies and codes of ethics.     

How clinical trials really work rethinking research ethics

Despite prevalent concerns about the ethical conduct of clinical trials, little is known about the day-to-day work of trials and the ethical challenges arising in them. This paper reports on a study designed to fill this gap and demonstrates a need to refine the oversight system for trials to reflect an understanding of this day-to-day work. It also illuminates ethical challenges that cannot be addressed by the oversight system and so necessitate a rethinking of the ethics of clinical trials.