Board oversight of community benefit: an ethical imperative

Board oversight of community benefit responsibility in tax-exempt organizations in the nonprofit health care sector is attracting considerable attention. Scrutiny by the IRS and other official bodies has led to stricter measures of compliance with the community benefit standard. But stricter compliance does not sufficiently engage the underlying ethical imperative for boards to provide effective oversight--an imperative that recent research suggests has not been sufficiently honored. This analysis considers why there is a distinctively ethical imperative for board oversight, the organizational nature of the imperative involved, and practical ways to fulfill its obligations. We adopt an organizational ethics paradigm to illuminate the constituent components of the ethical imperative and to clarify emerging benchmarks as flexible guidelines. As these emerging benchmarks enhance board oversight of community benefit they also can shed light on what it means to be a virtuous organization.     

Disabilities and aging

Both older persons and those who havedisabilities can encounter discrimination whenthey seek medical care. Just as ageism andstereotypes about older persons mayinappropriately limit medical care for theelderly, limits may be placed on medical carefor those who are disabled simply because ofthe presence of a disability. At the sametime death is the natural end of the lifespanfor all individuals and there are situationswhen aggressive medical care is not indicated. It is not right to always insist on ``doingeverything' for a person even if that personmay be at risk otherwise for discrimination. Using the example of the elderly, this paperexamines the risks of discrimination and thedangers of overtreatment in caring for olderpersons and suggests parallels in theappropriate care of those who havedisabilities. This revised version was published online in June 2006 with corrections to the Cover Date.     

Caring about patients and caring about money: the American Psychiatric Association code of ethics meets managed care

Although the medical profession's codes of ethics have rightly been criticized for having claimed authority to decide questions of medical ethics for society, codes continue to provide crucial guidance to the individual clinician in matters of ethics. Examination of the code of the American Psychiatric Association (APA) shows that while it emphasizes the psychiatrist's fiduciary responsibility to individual patients, it ignores the crucial dimension of stewardship responsibilities to society. As a result, the ethical pronouncements of the APA have thus far been of little use to clinicians with regard to the major issues posed by managed care. In contrast, the code of the National Association of Social Workers considers the ethics of social institutions as well as those of individual practitioners, and advises clinicians on how to manage the inevitable and legitimate tensions between fiduciary and stewardship commitments. Until the APA extends the scope of its ethical vision, it will not be able to help clinicians struggle constructively with the question of how it is possible to "care about patients" and "care about money."     

An analysis of the structure of justification of ethical decisions in medical intervention

The most important distinction in value theory is the subjective-objective distinction which determines the epistemological status of value judgments about medical intervention. Ethical decisions in medical intervention presuppose one of three structures of justification — namely, an inductive approach, a deductive approach which can be either consequentialist or non-consequentialist, and a uniquely ethical approach. Inductivism and deductivism have been discussed extensively in the literature and are only briefly described here. The uniquely ethical approach which presupposes value objectivism is analyzed in detail. This method involves a purely ethical inference which moves from facts to values directly with an emphasis on reason which involves a non-logical justification (as opposed to illogical). It involves the use of natural practical arguments which have an imperative conclusion but no imperative premise and exhibit a value-requiredness between two states of affairs.     

Jewish medical ethics in the care of the cancer patient

The care of the patient with cancer requires the development not only of a medical plan, but an ethical plan as well. This plan should integrate the physician's and the patient's perceptions of medical and ethical propriety. Jewish biomedical ethical principles are based on the teaching of the Old Testament and its various interpretations. In this paper, I discuss how these principles can be used to help guide the physician caring for the patient with cancer. Other ethical systems could be applied in a similar fashion.     

Two Dimensions of the Ethical Problems Related to Nanotechnology

The current literature on nanoethics focuses on a wide array of topics such as equity, privacy, military, environment, human enhancement, intellectual property, and security. The identification of those topics leads to the adoption of an ethical stance, which we call the in itself dimension. In this article we argue that even though it is correct to identify the areas where ethical problems are imperative to deal with (in itself dimension), it is a partial approach. This is because the in itself dimension pays no attention to another ethical stance; one that does not have anything to do with individual or collective responsibilities, but rather with the socio-economic system into which those responsibilities are embedded. We call this second issue the contextual dimension.     

Ethical analysis of the new proposed mental health legislation in England and Wales

The ethical case for Open Access (OA) (free online access) to research findings is especially salient when it is public health that is being compromised by needless access restrictions. But the ethical imperative for OA is far more general: It applies to all scientific and scholarly research findings published in peer-reviewed journals. And peer-to-peer access is far more important than direct public access. Most research is funded so as to be conducted and published, by researchers, in order to be taken up, used, and built upon in further research and applications, again by researchers (pure and applied, including practitioners), for the benefit of the public that funded it – not in order to generate revenue for the peer-reviewed journal publishing industry (nor even because there is a burning public desire to read much of it). Hence OA needs to be mandated, by researchers' institutions and funders, for all research.     

Being, Doing, and Knowing: Developing Ethical Competence in Health Care

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested.     

The relationship between medicine's internal morality and religion.

In the face of managed care and market economies infringing on the practice of medicine, reducing its autonomy and determining the moral guidelines for medical practice, many physicians are calling out for a return to what is perceived as a traditional medical ethic. Many religiously motivated critics of certain modern developments in medicine have made similar appeals. These calls are best understood as an attempt to define medicine as a practice that is necessarily ethical in nature, a practice the moral basis of which is internal to that practice. This article examines and assesses this definition of medicine in reference to Aristotle's division of human undertakings into three distinct categories: theory, poieisis (i.e., production), and praxis. It is concluded that medicine can be understood as a praxis (as opposed to a theory or production, both of which are morally neutral), because the practice of medicine, and all of its constitutive acts, can only be explained and assessed in reference to health, which is itself a final good and hence of moral value. Such an understanding would immunize medicine against usurpation by the free market. However, by the same token it would also dissociate medicine from all other moralities external to it, including those grounded in faith and religion.     

Surrogate medical decision making on behalf of a never-competent, profoundly intellectually disabled patient who is acutely ill

With the improvements in medical care and resultant increase in life expectancy of the intellectually disabled, it will become more common for healthcare providers to be confronted by ethical dilemmas in the care of this patient population. Many of the dilemmas will focus on what is in the best interest of patients who have never been able to express their wishes with regard to medical and end-of-life care and who should be empowered to exercise surrogate medical decision-making authority on their behalf. A case is presented that exemplifies the ethical and legal tensions surrounding surrogate medical decision making for acutely ill, never-competent, profoundly intellectually disabled patients.     

论医务社会工作中的价值观冲突和伦理困境

医务社会工作遵循着社会工作专业的一般价值观和伦理守则,并在此基础上,发展出其特有的价值观和职业伦理。对医务社会工作实践中的价值冲突和伦理困境及解决这些难题的指导原则等问题进行探讨,以期使医务社会工作者对工作实践中可能遇到的相关问题有初步的认识,并为他们在行动决策时提供参考和借鉴。     

Ethical Challenges with Welfare Technology: A Review of the Literature

Demographical changes in high income counties will increase the need of health care services but reduce the number of people to provide them. Welfare technology is launched as an important measure to meet this challenge. As with all types of technologies we must explore its ethical challenges. A literature review reveals that welfare technology is a generic term for a heterogeneous group of technologies and there are few studies documenting their efficacy, effectiveness and efficiency. Many kinds of welfare technology break with the traditional organization of health care. It introduces technology in new areas, such as in private homes, and it provides new functions, e.g. offering social stimuli and entertainment. At the same time welfare technology is developed for groups that traditionally have not been extensive technology users. This raises a series of ethical questions with regard to the development and use of welfare technologies, which are presented in this review. The main challenges identified are: (1) Alienation when advanced technology is used at home, (2) conflicting goals, as welfare technologies have many stakeholders with several ends, (3) respecting confidentiality and privacy when third-party actors are involved, (4) guaranteeing equal access and just distribution, and (5) handling conflicts between instrumental rationality and care in terms of respecting dignity and vulnerability. Addressing these issues is important for developing and implementing welfare technologies in a morally acceptable manner.     

Governing Humanity

In the United Kingdom, clinical governance has become a master narrative for health care over the last decade. While many see this political imperative as embodying both enlightening and humanistic goals, I argue that it has also become an apparatus for resuscitating a hypermodernist worldview which further conceals the political drivers of health care delivery. While resistance to clinical governance seems futile, insistence on the inclusion of historical analysis in understanding modern health care delivery may be profitable. Drawing from selected dramatic texts by Henrik Ibsen, an historical moment of clinical governance may be analysed showing the complex interplay of the personal, social, empirical and ethical dimensions of health care delivery.     

Gain-of-Function Research: Ethical Analysis

Gain-of-function (GOF) research involves experimentation that aims or is expected to (and/or, perhaps, actually does) increase the transmissibility and/or virulence of pathogens. Such research, when conducted by responsible scientists, usually aims to improve understanding of disease causing agents, their interaction with human hosts, and/or their potential to cause pandemics. The ultimate objective of such research is to better inform public health and preparedness efforts and/or development of medical countermeasures. Despite these important potential benefits, GOF research (GOFR) can pose risks regarding biosecurity and biosafety. In 2014 the administration of US President Barack Obama called for a “pause” on funding (and relevant research with existing US Government funding) of GOF experiments involving influenza, SARS, and MERS viruses in particular. With announcement of this pause, the US Government launched a “deliberative process” regarding risks and benefits of GOFR to inform future funding decisions—and the US National Science Advisory Board for Biosecurity (NSABB) was tasked with making recommendations to the US Government on this matter. As part of this deliberative process the National Institutes of Health commissioned this Ethical Analysis White Paper, requesting that it provide (1) review and summary of ethical literature on GOFR, (2) identification and analysis of existing ethical and decision-making frameworks relevant to (i) the evaluation of risks and benefits of GOFR, (ii) decision-making about the conduct of GOF studies, and (iii) the development of US policy regarding GOFR (especially with respect to funding of GOFR), and (3) development of an ethical and decision-making framework that may be considered by NSABB when analyzing information provided by GOFR risk-benefit assessment, and when crafting its final recommendations (especially regarding policy decisions about funding of GOFR in particular). The ethical and decision-making framework ultimately developed is based on the idea that there are numerous ethically relevant dimensions upon which any given case of GOFR can fare better or worse (as opposed to there being necessary conditions that are either satisfied or not satisfied, where all must be satisfied in order for a given case of GOFR to be considered ethically acceptable): research imperative, proportionality, minimization of risks, manageability of risks, justice, good governance (i.e., democracy), evidence, and international outlook and engagement. Rather than drawing a sharp bright line between GOFR studies that are ethically acceptable and those that are ethically unacceptable, this framework is designed to indicate where any given study would fall on an ethical spectrum—where imaginable cases of GOFR might range from those that are most ethically acceptable (perhaps even ethically praiseworthy or ethically obligatory), at one end of the spectrum, to those that are most ethically problematic or unacceptable (and thus should not be funded, or conducted), at the other. The aim should be that any GOFR pursued (and/or funded) should be as far as possible towards the former end of the spectrum.     

关于麻醉后监测治疗室的伦理思考

麻醉后监测治疗室(post-anesthesia care unit,PACU)中医学高新技术设备对确保手术后患者的安全发挥极其重大的作用,然而PACU中也产生许多危机与伦理冲突。为了PACU的良性发展,我们认为如下伦理准则必须遵循:科学认定准则、最佳选择准则、精益求精准则、无伤准则、患者自主准则。     

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.     

Fostering Collective Ethical Capacity within the Teaching Profession

A depth of ethical knowledge and understanding are essential for the enactment of ethical decisions and actions. Ethics is the foundational core for democratic teaching, learning and educational leadership. It is imperative that the development of ethical insight and the formation of an ethical stance become fundamental elements of both initial and continuing teacher education. Educators must be adept at cultivating ethical cultures within schools and districts. They need to know how to effectively foster the collective ethical capacity of all those with whom they are called to serve. To ensure the highest level of ethical professional practice and action, the collective ethical knowledge, sensitivity, awareness, and efficacy of the teaching profession must continue to evolve. The ongoing ethical formation of the teaching profession is essential for the public’s continued trust and confidence in the ethical actions and practices of the educational community. Educative processes designed to enhance the collective ethical capacity of the teaching profession are explored in this inquiry. Critical reflection and various dialogic processes focusing on the lived ethical experiences encountered within teaching were used for fostering the ethical leadership and decision making of educators.