From posts to protection: Ethical considerations regarding forensic psychiatrists and a duty to warn based on social media

Increasing use of social media in forensic mental health evaluations will lead to new challenges that must be resolved by forensic practitioners and the legal system. One such dilemma is the discovery of information that would typically trigger a legal duty and professional ethics obligation for mental health professionals to breach doctor-patient confidentiality to promote public safety and prevent harm to vulnerable third parties. Although the law and professional organizations offer clear guidance for practitioners in the treatment role, there is currently no clarity from the law or instruction from professional organizations on what mental health professionals should do if they discover such information during a confidential forensic evaluation. For example, a forensic evaluator may find evidence on social media of an evaluee’s threats to seriously harm others, abuse of children and the elderly, or severely impaired driving. There are no clear guidelines for how a forensic psychiatrist should respond in these complicated situations. We review the legal concepts and historical evolution of confidentiality, privilege, and mandated reporter duties that forensic practitioners should consider in these legally ambiguous situations. Finally, we discuss ethics frameworks practitioners can implement to determine their most ethical course of action when faced with such dilemmas.     

Medical Ethics Education: A Survey of Opinion of Medical Students in a Nigerian University

In Nigeria, medical education remains focused on the traditional clinical and basic medical science components, leaving students to develop moral attitudes passively through observation and intuition. In order to ascertain the adequacy of this method of moral formations, we studied the opinions of medical students in a Nigerian university towards medical ethics training. Self administered semi-structured questionnaires were completed by final year medical students of the College of Medicine, University of Ibadan, Nigeria. There were 82 (64.1%) male and 44 (34.4%) female respondents. The median age was 26 years. Most students (80.5%) responded that they did not receive enough training in medical ethics. The ethics instructions they received did not sufficiently prepare them for the ethical challenges they came across as medical students. Though inadequate, the few hours of lecture and discussion on human values and professional etiquette which they received positively influenced their moral reasoning. They identified end-of-life issues, dealing with financial issues and handling socio-cultural beliefs of patients and relations as some challenges that medical doctors are ill-prepared for by their current training. Most, 85.9% believed that formal medical ethics education would be worthwhile as it would enhance the making of complete and better doctors. They recommended incorporating bioethics as a course in the medical school curriculum. Nigerian medical students encounter ethical challenges for which they have not been adequately trained to resolve. They recommended formal medical ethics training in their curriculum and a uniform bioethics programme in the country.     

Teaching Medical Law in Medical Education

Although the teaching of medical ethics and law in medical education is an old story that has been told many times in medical literature, recent studies show that medical students and physicians lack confidence when faced with ethical dilemmas and medico-legal issues. The adverse events rates and medical lawsuits are on the rise whereas many medical errors are mostly due to negligence or malpractices which are preventable. While it is true that many medical schools teach their students medical law and ethics, there are wide variations in what is being taught because there is no universally agreed syllabus. Yet the knowledge of medical law and ethics is closely relevant to the medical profession and that failure in abiding the law may result in serious civil or even criminal consequences. While this paper does not propose to lay detailed analysis of the relevant areas of law or ethics, it proposes to cover some legal areas so as to highlight and bring to attention the need for a medical law and ethics course. This article also considers the problems faced and recommendation as to future directions to be taken with respect to teaching medical law and ethics. It concludes with a suggested course outline for the teaching of medical law and ethics.     

Ethics Remediation,Rehabilitation, and Recommitment to Medical Professionalism: A Programmatic Approach

This article recounts the development of the Professional/Problem-Based Ethics (ProBE) Program, the original physicians’ professional ethics remediation course. Since 1992, more than 1,200 healthcare professionals of many disciplines have been mandated to attend ProBE by licensing boards and other oversight entities. Using a small-group, interprofessional setting, the ProBE Program assists participants to discover and articulate ethical underpinnings violated by their misconduct; appreciate professional responsibilities that are societal, regulatory, and ethical; and recommit to professional ideals. The authors describe the rationale for developing ProBE, its curriculum, participant demographics, and infractions and reconsider medical professionalism in light of two decades of ProBE.     

Professional Education and Professional Ethics Right to Die or Duty to Live?

Despite the undeniable ethical dimensions of paid occupations — trades and services — other than the traditional professions, it is still natural to associate courses of professional ethics with medicine, law, nursing or teaching, rather than auto-repair, supermarket assistance or window-cleaning. Indeed, it seems plausible to hold that if there is anything more to the traditional distinction of professions from trades or other services than considerations of social and economic status, it might well reside in the distinctive ethical or moral character and implications of such occupations as medicine, law and education. This paper undertakes to explore, via examination of some of the commonly suggested criteria of professionalism, the nature of such implications and the extent to which they justify continued deployment of a distinctive occupational category of 'profession'. On the assumption that they do, however, the paper is also concerned to examine critically the consequences for education in professional ethics of any such distinctive ethics of profession.     

A New Experience: The Course of Ethics in Engineering in the Department of Civil Engineering,University of Granada

A course in professional ethics for civil engineers was taught for the first time in Spain during the academic year 2007/08. In this paper a survey on the satisfaction and expectation of the course is presented. Surprisingly the students sought moral and ethical principles for their own ordinary lives as well as for their profession. Students were concerned about the law, but in their actions they were more concerned with their conscience, aware that it can be separate from the law.     

完善医学生职业道德培养教育途径

为了提高我国医学生职业道德教育的有效性和实效性,需不断完善和健全现有职业道德培养渠道,并拓展新渠道。在探讨研究国外医学生道德培养途径基础上,博采众家之长,形成以职业道德教育贯穿于专业教育全过程为特征,以职业道德教育与临床医疗实践相结合,以提高医学生自我道德教育能力为目的,适合我国特点的医学生职业道德培养途径。     

当代美国行政伦理的理论与实践

当代美国行政伦理的基本价值理念在个人价值上重视诚实和正义;在职业价值上重视专业和敬业;在组织价值上重视效率和规则;在合法价值上重视依法和守法;在公共利益价值上重视为公共利益服务。美国行政伦理规范经历了一个制定、修订和演进过程,并始终重视其管理和实践。美国行政伦理50年的建设经验,对我国社会主义行政伦理建设具有重要启示意义。     

An Experiential, Game-Theoretic Pedagogy for Sustainability Ethics

The wicked problems that constitute sustainability require students to learn a different set of ethical skills than is ordinarily required by professional ethics. The focus for sustainability ethics must be redirected towards: (1) reasoning rather than rules, and (2) groups rather than individuals. This need for a different skill set presents several pedagogical challenges to traditional programs of ethics education that emphasize abstraction and reflection at the expense of experimentation and experience. This paper describes a novel pedagogy of sustainability ethics that is based on noncooperative, game-theoretic problems that cause students to confront two salient questions: “What are my obligations to others?” and “What am I willing to risk in my own well-being to meet those obligations?” In comparison to traditional professional ethics education, the game-based pedagogy moves the learning experience from: passive to active, apathetic to emotionally invested, narratively closed to experimentally open, and from predictable to surprising. In the context of game play, where players must make decisions that can adversely impact classmates, students typically discover a significant gap between their moral aspirations and their moral actions. When the games are delivered sequentially as part of a full course in Sustainability Ethics, students may experience a moral identity crisis as they reflect upon the incongruity of their self-understanding and their behavior. Repeated play allows students to reconcile this discrepancy through group deliberation that coordinates individual decisions to achieve collective outcomes. It is our experience that students gradually progress through increased levels of group tacit knowledge as they encounter increasingly complex game situations.     

There is no such thing as environmental ethics

Engineers and scientists, whose professional responsibilities often influence the natural environment, have sought to develop an environmental ethic that will be in tune with their attitudes toward the non-human environment, and that will assist them in decision making regarding questions of environmental quality. In this paper the classical traditions in normative ethics are explored in an attempt to formulate such an environmental ethic. I conclude, however, that because the discipline of ethics is directed at person-person interactions, ethics as a scholarly discipline does not help us understand how we ought to treat non-human nature. We therefore cannot look to ethics as a source for understanding our attitudes and for providing guidance to our actions with regard to the environment. To do so is to ask too much of ethics. If we are to find an acceptable environmental morality, it must come from a new paradigm. One approach might be to understand our attitudes on the basis of spirituality, modeled after animistic religions.     

Ethical issues in biomedical research: Perceptions and practices of postdoctoral research fellows responding to a survey

We surveyed 1005 postdoctoral fellows by questionnaire about ethical matters related to biomedical research and publishing; 33% responded. About 18% of respondents said they had taken a course in research ethics, and about 31% said they had had a course that devoted some time to research ethics. A substantial majority stated willingness to grant other investigators, except competitors, access to their data before publication and to share research materials. Respondents’ opinions about contributions justifying authorship of research papers were mainly consistent but at variance with those of many biomedical journal editors. More than half said they had observed what they considered unethical research practices. To increase the chances of getting a grant funded, 27% said they were willing to select or omit data to improve their results; to make publication of their work more likely or to benefit their career, 15% would select or omit data and 32% would list an undeserving author. Of respondents who thought they had been unfairly denied authorship on a paper, or been listed with or asked to list an undeserving author, 75% said they would be willing to list an undeserving author (P<0.001). Having taken a course dealing with research ethics had no effect on stated willingness to select or omit data or to fabricate data in the future, but was positively associated with willingness to grant undeserved authorship (P<0.04). Although these results do not controvert research demonstrating the effectiveness of ethics courses during professional education, they indicate that the research environment is a powerful component of a trainee’s experience and ethical development. Preliminary results of this work were presented in part as a poster at the forumEthics, Values, and the Promise of Science, presented by Sigma Xi, The Scientific Research Society, 25–26 February 1993 in San Francisco, California, USA.     

Teaching for Transformation: Insights from Fiji,India, South Africa,and Jamaica

Abstract. How can teaching and living abroad impact our teaching in North America? This article explores how what I do teaching religion and ethics to undergraduates at Texas Christian University has been influenced by twelve years of teaching in the two‐thirds world. It is structured in terms of three insights that correlate with what I call the past, present, and future dimensions of ethics, respectively. First, we need to begin where our students are – taking their contexts seriously. Second, we should expose them to the moral and religious experience of others, so that they might be pulled by those others toward broader perspectives. Third, we should challenge them to envision new ways of living, including new self‐understandings and images of society. Drawing on examples of how I use these insights in courses at TCU, I contend that we can best promote transformation in our students by holding these three insights in creative tension.     

Is it Morally Wrong to Defend Unjust Causes as a Lawyer?

The question I address in this article is whether it is morally wrong for a lawyer to represent a client whose purpose is immoral or unjust. My answer to this question is that it is wrong, prima facie. This conclusion holds, even accepting certain traditional principles of lawyer's professional ethics, such as the right of defence and the so‐called principle of ‘adversarial’ litigation. Both the adversarial system and the right of defence are sufficient to support or justify the right of potential clients (and citizens in general) to defend their interests in the judicial system and to do so with the technical assistance of a lawyer. This right includes a right to pursue unjust or immoral purposes (within the law). However, having a right to do X does not mean that it is morally permissible to do X. We can have a right to do something morally wrong. This being so, the fundamental moral reason for a lawyer not to accept representation for a client with an immoral purpose is that it is, prima facie, morally wrong to help someone do something wrong.     

Applied Ethics in Mental Health in Cuba: Part I-Guiding Concepts and Values

As part of a project on professionals' lived experience of ethics, this article explores the guiding concepts and values concerning ethics of mental health professionals in Cuba. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans conceptualize applied ethics in terms of its central role in professional practice and its connection to the social context and subjective processes. Findings also show that Cuban professionals are guided not only by a set of professional values but by a specific set of civic values as well. The former are subdivided into other-oriented values and self-oriented values. The study of ethics in another culture such as Cuba offers a unique point of view from which to critique the social construction of our own conceptions of applied ethics in North America.     

Applied ethics in mental health in Cuba: part I--guiding concepts and values

As part of a project on professionals' lived experience of ethics, this article explores the guiding concepts and values concerning ethics of mental health professionals in Cuba. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans conceptualize applied ethics in terms of its central role in professional practice and its connection to the social context and subjective processes. Findings also show that Cuban professionals are guided not only by a set of professional values but by a set of civic values as well. The former are subdivided into other-oriented values and self-oriented values. The study of ethics in another culture such as Cuba offers a unique point of view from which to critique the social construction of our own conceptions of applied ethics in North America.     

Ethical Challenges for Military Psychologists: When Worlds Collide

Despite the mental health needs in the military and improved access to military psychologists, many in need do not seek psychological services. The military policies, culture, and environment pose considerable barriers to help seeking. In turn, military practices often conflict with the psychologist’s professional ethics, leading to a range of ethical dilemmas including multiple relationships, multiple agencies, and limited confidentiality. To address ethical concerns and encourage service members to seek mental health services, this article proposes maintaining an understanding of military rules, law, and professional ethics; identifying multiple relationships and establishing boundaries up front; and collaborating with the patient in disclosures of information.     

Disclosure of Genetic Research Results to Members of a Founder Population

There is currently extensive discussion and debate in the literature on how, when, and to whom genetic research results should be returned (see Genetics in Medicine, April 2012 issue). Here, we describe our experience in disclosing genetic information on Mendelian disorders discovered during the course of our research in the Hutterites. We first assessed attitudes toward the disclosure of carrier results, which revealed that many individuals wanted carrier information and that many intended to use the information in family planning. Based on this information, we developed a pilot study to test and disclose cystic fibrosis (CF) carrier status. Next, a larger scale project was developed in order to disclose genetic research results for 14 diseases to those interested in receiving the information. We developed brochures, offered a live interactive educational program, conducted a consent process, and disclosed results in letters mailed to the consented individuals. Overall, ~80 % of individuals who participated in the educational program signed consent forms for the release of their results for 14 diseases. We describe our experience with returning individual genetic research results to participants in a population-based research study.     

Voices from the Front Lines: An Analysis of Physicians’ Reflective Narratives about Flaws with the ‘System’

Physicians often express frustration with the ‘system’ in which they work. Over time, this frustration may put them at risk of burnout and disengagement, which may impact patient care. In this study, we aimed to understand the nature of the system flaws that physicians identified in their published narratives and to explore their self-representation as agents of change. We reviewed all reflective narratives published in four medical journals (NEJM, JAMA, CMAJ, Annals IM) between January 2015 and December 2017 (n?=?282). By consensus, we identified those that addressed system flaws (n?=?87). Using content and narrative analysis, we analyzed the types of flaws and the physicians’ orientation to the flawed system. We identified seven recurring system flaws—five related to medical culture: failures of communication, erosive impact of the hidden curriculum, inadequate health advocacy, frenzied pace of work, and experience of stigma. Less frequently, physicians’ narratives also exposed limited and disparate healthcare resources and restrictive institutional practices as impeding patient-centered care. Physicians expressed agency to create change foremost when writing about flaws related to medical culture. While physicians are challenged by system flaws, they strive to practice in ways that do not succumb to them. We saw tension between the elements outside the physician’s control and those within it. This tension becomes a source of distress when the compromises that emerge from system flaws move physicians away from the values that define their professional identity.

     

Human Participants in Engineering Research: Notes from a Fledgling Ethics Committee

For the past half-century, issues relating to the ethical conduct of human research have focused largely on the domain of medical, and more recently social–psychological research. The modern regime of applied ethics, emerging as it has from the Nuremberg trials and certain other historical antecedents, applies the key principles of: autonomy, respect for persons, beneficence, non-maleficence, and justice to human beings who enter trials of experimental drugs and devices (Martensen in J Hist Med Allied Sci 56(2):168–175, 2001). Institutions such as Institutional Review Boards (in the U.S.) and Ethics Committees (in Europe and elsewhere) oversee most governmentally-funded medical research around the world, in more than a hundred nations that are signers of the Declaration of Helsinki (World Medical Association 2008). Increasingly, research outside of medicine has been recognized to pose potential risks to human subjects of experiments. Ethics committees now operate in the US, Canada, the U.K. and Australia to oversee all governmental-funded research, and in other jurisdictions, the range of research covered by such committees is expanding. Social science, anthropology, and other fields are falling under more clear directives to conduct a formal ethical review for basic research involving human participants (Federman et al. in Responsible research: a systems approach to protecting research participants. National Academies Press, Washington, 2003, p. 36). The legal and institutional response for protecting human subjects in the course of developing non-medical technologies, engineering, and design is currently vague, but some universities are establishing ethics committees to oversee their human subjects research even where the experiments involved are non-medical and not technically covered by the Declaration of Helsinki. In The Netherlands, as in most of Europe, Asia, Latin America, or Africa, no laws mandate an ethical review of non-medical research. Yet, nearly 2 years ago we launched a pilot ethics committee at our technical university and began soliciting our colleagues to submit their studies for review. In the past year, we have become officially recognized as a human subjects ethics committee for our university and we are beginning the process of requiring all studies using human subjects to apply for our approval. In this article, we consider some of the special problems relating to protecting human participants in a technology context, and discuss some of our experiences and insights about reviewing human subjects research at a technical university, concluding: that not less than in medical studies, human participants used in technology research benefit from ethical committees’ reviews, practical requirements for publications, grants, and avoiding legal liability are also served by such committees, and ethics committees in such contexts have many similarities to, but certain other special foci than medical ethics committees. We believe that this experience, and these observations, are helpful for those seeking to establish such committees in technology research contexts, and for framing the particular issues that may arise in such contexts for the benefit of researchers, and nascent committees seeking to establish their own procedures.     

Feminist and medical ethics: two different approaches to contextual ethics

Feminist ethics and medical ethics are critical of contemporary moral theory in several similar respects. There is a shared sense of frustration with, the level of abstraction and generality that characterizes traditional philosophic work in ethics and a common commitment to including contextual details and allowing room for the personal aspects of relationships in ethical analysis. This paper explores the ways in which context is appealed to in feminist and medical ethics, the sort of details that should be included in the recommended narrative approaches to ethical problems, and the difference it makes to our ethical deliberations if we add an explicitly feminist political analysis to our discussion of context. It is claimed that an analysis of gender is needed for feminist medical ethics and that this requires a certain degree of gener-ality, i. e. a political understanding of context.