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Maung HH. Gender Affirming Hormone Treatment for Trans Adolescents: A Four Principles Analysis. JOURNAL OF BIOETHICAL INQUIRY 2024; 21:345-363. [PMID: 38240914 PMCID: PMC11289353 DOI: 10.1007/s11673-023-10313-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/11/2023] [Indexed: 07/31/2024]
Abstract
Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender affirming hormone treatment for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong.
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Affiliation(s)
- Hane Htut Maung
- Department of Politics, Philosophy, and Religion, Lancaster University, Lancaster, LA1 4YL, United Kingdom.
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2
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Chen GY, Kuo KK, Chuang SC, Tseng KY, Wang SN, Chang WT, Cheng KI. Optimal Post-Operative Nalbuphine Dose Regimen: A Randomized Controlled Trial in Patients with Laparoscopic Cholecystectomy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:195. [PMID: 38399483 PMCID: PMC10890534 DOI: 10.3390/medicina60020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Optimal opioid analgesia is an excellent analgesia that does not present unexpected adverse effects. Nalbuphine, acting on the opioid receptor as a partial mu antagonist and kappa agonist, is considered a suitable option for patients undergoing laparoscopic surgery. Therefore, we aim to investigate the appropriate dosage of nalbuphine for post-operative pain management in patients with laparoscopic cholecystectomy. Materials and Methods: Patients were randomly categorized into low, medium, and high nalbuphine groups. In each group, a patient control device for post-operative pain control was programed with a low (0.05 mg/kg), medium (0.10 mg/kg), or high (0.20 mg/kg) nalbuphine dose as a loading dose and each bolus dose with a lockout interval of 7 min and without background infusion. Primary and secondary outcomes included the post-operative pain scale and nalbuphine consumption, and episodes of post-operative opioid-related adverse events and satisfactory scores. Results: The low-dosage group presented a higher initial self-reported pain score in comparison to the other two groups for the two hours post-op (p = 0.039) but presented lower nalbuphine consumption than the other two groups for four hours post-op (p = 0.047). There was no significant difference in the analysis of the satisfactory score and adverse events. Conclusions: An appropriate administration of nalbuphine could be 0.1 to 0.2 mg/kg at the initial four hours; this formula could be modified to a lower dosage (0.05 mg/kg) in the post-operative management of laparoscopic cholecystectomy.
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Affiliation(s)
- Guan-Yu Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (G.-Y.C.); (K.-Y.T.)
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Kung-Kai Kuo
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (K.-K.K.); (S.-C.C.); (S.-N.W.); (W.-T.C.)
| | - Shih-Chang Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (K.-K.K.); (S.-C.C.); (S.-N.W.); (W.-T.C.)
| | - Kuang-Yi Tseng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (G.-Y.C.); (K.-Y.T.)
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Shen-Nien Wang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (K.-K.K.); (S.-C.C.); (S.-N.W.); (W.-T.C.)
| | - Wen-Tsan Chang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (K.-K.K.); (S.-C.C.); (S.-N.W.); (W.-T.C.)
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (G.-Y.C.); (K.-Y.T.)
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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3
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Hardman D, Hutchinson P. Rules, practices and principles: Putting bioethical principles in their place. J Eval Clin Pract 2023; 29:1095-1099. [PMID: 37455328 DOI: 10.1111/jep.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Bioethics seems preoccupied with establishing, debating, promoting and sometimes debunking principles. While these tasks trade on the status of the word 'principle' in our ordinary language, scant attention is paid to the way principles operate in language. In this paper, we explore how principles relate to rules and practices so as to better understand their logic. We argue that principles gain their sense and power from the practices which give them sense. While general principles can be, and are, establishable in abstraction from specific practices, as they are in principlist bioethics, such principles are impotent as moral guides to action. We show that the purchase any principle has as a moral guide to action emerges from its indexical properties as a principle which has sense in a specific practice. The meaning of any principle is internal to the practice and context in which it is invoked and, therefore, principles are not kinds of master rule which dictate moral judgement in new contexts but rather chameleon-like rules which change with the contexture in which they are invoked.
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Affiliation(s)
- Doug Hardman
- Department of Psychology, Faculty of Science and Technology, University of Bournemouth, Poole, UK
| | - Phil Hutchinson
- Department of Psychology, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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Konzeptionen von Simulationen mit Simulationspersonen für die Medizinethik-Lehre. Ethik Med 2022. [DOI: 10.1007/s00481-022-00714-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
ZusammenfassungSimulationen mit Simulationspersonen (Schauspieler*innen) gehören in der medizinischen Lehre zum Ausbildungs-Standard. In der medizinethischen Lehre ist dies bisher nicht in gleichem Umfang der Fall. Für ihren Einsatz, insbesondere in der klinischen Ethik, können gute Gründe angeführt werden, wie beispielsweise die Möglichkeit konkreter Erfahrungen als Lehrelement und die situationsspezifische Verbindung von Wissen, Können und Haltungen in einem Lernprozess. Die Konzeption von Simulationen mit Simulationspersonen in der medizinethischen Lehre ist jedoch voraussetzungsreich. Es müssen die mehrdimensionalen Lernziele und die Anforderungen an die medizinethische Lehre berücksichtigt werden. Der Beitrag möchte anhand eines konkreten Beispiels einen Überblick über die Entwicklung und Konzeption von Drehbüchern bzw. Rollen-Skripten für Simulationen mit Simulationspersonen für die Lehre in der klinischen Ethik als wichtigem Teilbereich der Medizinethik geben. Dabei wird auf die besonderen Voraussetzungen und Spezifika dieser Simulationen eingegangen. Abschließend wird kritisch diskutiert, welchen Stellenwert das Training von kommunikativen Fertigkeiten in der medizinethischen Theorie und klinisch-ethischen Praxis haben kann und soll. Der Beitrag schließt mit der Überlegung, ob nicht auch in der Fortbildung von klinischen Ethiker*innen Simulationspersonen zum Einsatz kommen sollten.
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Hardman D, Hutchinson P. Where the ethical action is. JOURNAL OF MEDICAL ETHICS 2021; 49:medethics-2021-107925. [PMID: 34952893 DOI: 10.1136/medethics-2021-107925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
It is common to think of medical and ethical modes of thought as different in kind. In such terms, some clinical situations are made more complicated by an additional ethical component. Against this picture, we propose that medical and ethical modes of thought are not different in kind, but merely different aspects of what it means to be human. We further propose that clinicians are uniquely positioned to synthesise these two aspects without prior knowledge of philosophical ethics.
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Affiliation(s)
| | - Phil Hutchinson
- Department of Psychology, Manchester Metropolitan University, Manchester, Greater Manchester, UK
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Hammami MM, Hammami MB, Aboushaar R. Modeling Lay People's Ethical Attitudes to Organ Donation: A Q-Methodology Study. Patient Prefer Adherence 2020; 14:173-189. [PMID: 32099336 PMCID: PMC6996217 DOI: 10.2147/ppa.s230286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Organ donation is commonly evaluated by biomedical ethicists based largely on principlism with autonomy at the top of the "moral mountain." Lay people may differ in the way they invoke and balance the various ethical interests. We explored lay people's ethical attitudes to organ donation. METHODS Respondents (n=196) ranked 42 opinion-statements on organ donation according to a 9-category symmetrical distribution. Statements' scores were analyzed by averaging-analysis and Q-methodology. RESULTS Respondents' mean (SD) age was 34.5 (10.6) years, 53% were women, 69% Muslims (30% Christians), 29% Saudis (26% Filipinos), and 38% healthcare-related. The most-agreeable statements were "Acceptable if benefit to recipient large," "Explicit donor consent and family approval for live donation," "Acceptable if directed to family member," and "Explicit donor consent and family approval for postmortem donation." The most-disagreeable statements were "Donor consent and family approval not required for postmortem donation," "Acceptable with purely materialistic motivation," and "Only donor no-known objection for postmortem donation." Women, Christians, and healthcare respondents gave higher rank to "Explicit donor consent and family approval for live donation," "Only donor family consent required for postmortem donation," and "Acceptable if organ distribution equitable," respectively, and Muslims gave more weight to donor/family harm (p ≤0.001). Q-methodology identified various ethical resolution models that were associated with religious affiliation and included relatively "motives-concerned," "family-benefit-concerned," "familism-oriented," and "religious or non-religious altruism-concerned" models. Of 23 neutral statements on averaging-analysis, 48% and 65% received extreme ranks in ≥1 women and men Q-methodology models, respectively. CONCLUSION 1) On average, recipient benefit, requirement of both explicit donor consent and family approval, donor-recipient relationship, and motives were predominant considerations; 2) ranking of some statements was associated with respondents' demographics; 3) Q-methodology identified various ethical resolution models that were partially masked by averaging-analysis; and 4) strong virtue and familism approaches in our respondents provide some empirical evidence against principlism adequacy.
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Affiliation(s)
- Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University College of Medicine, Riyadh, Saudi Arabia
- Correspondence: Muhammad M Hammami Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh11211, Saudi ArabiaTel +966-11-442-4527Fax +966-11-442-7894 Email
| | - Muhammad B Hammami
- Division of Gastroenterology, Department of Medicine, John Hopkins University, Baltimore, MD, USA
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Levin K, Carson J. The hidden health care costs of power of attorney legislation in Scotland: what needs to be done? J Health Serv Res Policy 2018; 24:266-269. [PMID: 30501528 DOI: 10.1177/1355819618814055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Current power of attorney legislation in many European countries seeks to protect the rights of adult patients who lack capacity by ensuring that discharge from hospital to an alternative care setting only occurs when there is legal authority to do so, via a named guardian or power of attorney. In Scotland, a clause introduced in 2007 allows some patients who lack capacity to be transferred from hospital to a community care service provided all relevant parties are agreed that this is in keeping with the legislation (the ‘least restrictive option’) and the patient does not resist the move. However, there is variation in the understanding and use of this clause by local authorities across Scotland, often resulting in avoidable hospital delays, which are costly and cause ‘bed blocking’. This essay illustrates the costs of hospital delays due to current power of attorney legislation in Scotland and highlights the need for the systematic monitoring of power of attorney data and related hospital delays, and for alternative legislation to be considered in the future.
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Affiliation(s)
- Kate Levin
- Senior Researcher, NHS Greater Glasgow & Clyde, Gartnavel Hospital, UK
| | - Jill Carson
- Adult Health Services Manager, NHS Greater Glasgow & Clyde, Gartnavel Hospital, UK
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Magalhães-Sant'Ana M. A theoretical framework for human and veterinary medical ethics education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:1123-1136. [PMID: 26671254 DOI: 10.1007/s10459-015-9658-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/05/2015] [Indexed: 06/05/2023]
Abstract
In their practice, physicians and veterinarians need to resort to an array of ethical competences. As a teaching topic, however, there is no accepted gold standard for human medical ethics, and veterinary medical ethics is not yet well established. This paper provides a reflection on the underlying aims of human and veterinary medical ethics education. Drawing from published literature on ethics education in the health professions a theoretical framework common to the teaching of human and veterinary medical ethics is proposed, based on three concepts: professional rules, moral virtues and ethical skills. The rules approach relies on the transmission of professional and social values by means of regulatory documents and depends intimately on the knowledge that students have of those documents. The virtues approach involves the inculcation of moral values and virtues that will stimulate students to develop desirable behaviours. The main focus of this approach to ethics is to develop students' attitudinal competences. Finally, the skills approach is focused on equipping the students with the necessary moral reasoning abilities to recognise and respect the plurality of ethical views that make part of contemporary society. This framework can inform future curriculum development in human and veterinary medical ethics as well as in other health care professions.
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Affiliation(s)
- Manuel Magalhães-Sant'Ana
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal.
- Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal.
- School of Veterinary Medicine, 248 Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
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Sokol DK. William Osler and the jubjub of ethics; or how to teach medical ethics in the 21st century. J R Soc Med 2016; 100:544-6. [DOI: 10.1177/0141076807100012010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Daniel K Sokol
- Lecturer in Medical Ethics and Law, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Honorary Research Fellow, Imperial College, London
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Newson AJ, McDougall R. Do We Need Ethical Theory to Achieve Quality Critical Engagement in Clinical Ethics? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:43-45. [PMID: 27471941 DOI: 10.1080/15265161.2016.1196259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Henning MA, Malpas P, Ram S, Rajput V, Krstić V, Boyd M, Hawken SJ. Students' responses to scenarios depicting ethical dilemmas: a study of pharmacy and medical students in New Zealand. JOURNAL OF MEDICAL ETHICS 2016; 42:466-473. [PMID: 27154898 DOI: 10.1136/medethics-2015-103253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) completed a questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the 'four principles' determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded using the framework. The subsequent subgroup analysis revealed different response patterns depending on the case being reviewed. The findings showed that when students are faced with challenging ethical dilemmas their responses can be aligned with the Beauchamp and Childress framework, although more contentious dilemmas involving issues of law are less easily categorised. The differences between year and discipline groups show students are developing ethical frames of reference that may be linked with their teaching environments and their levels of understanding. Analysis of these response patterns provides insight into the way students will likely respond in 'real' settings and this information may help educators prepare students for these clinical ethical dilemmas.
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Affiliation(s)
- Marcus A Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Phillipa Malpas
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sanya Ram
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Vijay Rajput
- Ross University School of Medicine, Miramar, Florida, USA
| | - Vladimir Krstić
- Department of Philosophy, University of Auckland, Auckland, New Zealand
| | - Matt Boyd
- Independent researcher, formerly University of Auckland, Auckland, New Zealand
| | - Susan J Hawken
- Department of General Practice and Primary Healthcare, Faculty of Medical and Health Sciences, University of Auckland, Auckland New Zealand
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12
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Ethics Cases: Do they Elicit Different Levels of Ethical Reasoning? JOURNAL OF ACADEMIC ETHICS 2015. [DOI: 10.1007/s10805-015-9234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Godbold R, Lees A. Ethics education for health professionals: A values based approach. Nurse Educ Pract 2013; 13:553-60. [DOI: 10.1016/j.nepr.2013.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/13/2013] [Accepted: 02/19/2013] [Indexed: 10/27/2022]
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Hamilton R. The frustrations of virtue: the myth of moral neutrality in psychotherapy. J Eval Clin Pract 2013; 19:485-92. [PMID: 23692232 DOI: 10.1111/jep.12044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 11/27/2022]
Abstract
This article questions a number of widely held views of the role of values in psychotherapy. It begins with a discussion of the now largely discredited view that psychotherapy can be value free. It also broadens this challenge to question the popular idea that values form an inescapable part of the therapeutic encounter. While this view is correct in outline, it is necessary to reject the underlying conception of values as largely arbitrary preferences that the client and the therapist bring to the encounter, as this fails to do justice to the inherently ethical nature of psychotherapy. It argues that we should recover the Greek notion of therapy as essentially concerned with the character of a person. In other words, the goal of therapy is virtue.
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Affiliation(s)
- Richard Hamilton
- School of Philosophy and Theology, School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
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Kaldjian LC, Shinkunas LA, Forman-Hoffman VL, Rosenbaum ME, Woodhead JC, Antes LM, Rowat JA. Do Medical Students Recall and Use the Language of Ethics They are Taught Preclinically Once They are in the Clinical Training Environment? An Empirical Study in Ethics Education. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21507716.2012.757258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
SummarySurvival to discharge after in-hospital cardiopulmonary resuscitation (CPR) is about 20% in those aged 65–69 years, declining with advancing age to about 10% in those aged 90 years or more. There are conflicting reports on whether or not advanced age, independent of the severity of acute and chronic illness, is a determinant of outcome. Recognition that the outcome of CPR in hospital patients is often poor has prompted extensive debate regarding the appropriate use of this procedure. In particular, there has been concern about unnecessary CPR in extended-care and hospice settings. Conversely, there has also been evidence that doctors and families may be prone to underestimate the quality of life and likelihood of benefit from CPR in older people and to make resuscitation decisions without considering the preferences of older people themselves. Recent guidelines have attempted to strike a balance between ensuring patient participation whenever possible but without offering illusory choices where CPR is very unlikely to succeed.
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Hariharan S. Ethical issues in anesthesia: the need for a more practical and contextual approach in teaching. J Anesth 2009; 23:409-12. [DOI: 10.1007/s00540-009-0776-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
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McCullough MT. A skills-based approach to teach clinical ethics. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:154. [PMID: 19174654 DOI: 10.1097/acm.0b013e31819398cd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
AIM To carry out an appropriate overview and inventory of the teaching of ethics within the European Union Schools of Medicine. METHODS A questionnaire was sent by email to 45 randomly selected medical schools from each of 23 countries in the European Union in February 2006. RESULTS 25 schools of medicine from 18 European countries were included (response rate = 56%). In 21 of 25 medical schools, there was at least one ethics module. In 11 of 25 medical schools, the teaching of ethics was transversal. Only one of the responding schools did not teach ethics. The mean time invested in ethics teaching was 44 h during the overall curriculum. CONCLUSIONS Ethics now has an established place within the medical curriculum throughout the European Union. However, there is a notable disparity in programme characteristics among schools of medicine.
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Affiliation(s)
- Frédérique Claudot
- Department of Legal and Forensic Medicine, Faculty of Medicine, Nancy University, France.
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Johnston C, Haughton P. Medical students' perceptions of their ethics teaching. JOURNAL OF MEDICAL ETHICS 2007; 33:418-22. [PMID: 17601871 PMCID: PMC2598142 DOI: 10.1136/jme.2006.018010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The teaching of ethics in UK medical schools has recently been reviewed, from the perspective of the teachers themselves. A questionnaire survey of medical undergraduates at King's College London School of Medicine provides useful insight into the students' perception of ethics education, what they consider to be the value of learning ethics and law, and how engaged they feel with the subject.
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Affiliation(s)
- Carolyn Johnston
- King's College London, Department of General Practice and Primary Care, 5 Lambeth Walk, London SE11 6SP, UK.
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Strous RD. Psychiatry during the Nazi era: ethical lessons for the modern professional. Ann Gen Psychiatry 2007; 6:8. [PMID: 17326822 PMCID: PMC1828151 DOI: 10.1186/1744-859x-6-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Accepted: 02/27/2007] [Indexed: 11/29/2022] Open
Abstract
For the first time in history, psychiatrists during the Nazi era sought to systematically exterminate their patients. However, little has been published from this dark period analyzing what may be learned for clinical and research psychiatry. At each stage in the murderous process lay a series of unethical and heinous practices, with many psychiatrists demonstrating a profound commitment to the atrocities, playing central, pivotal roles critical to the success of Nazi policy. Several misconceptions led to this misconduct, including allowing philosophical constructs to define clinical practice, focusing exclusively on preventative medicine, allowing political pressures to influence practice, blurring the roles of clinicians and researchers, and falsely believing that good science and good ethics always co-exist. Psychiatry during this period provides a most horrifying example of how science may be perverted by external forces. It thus becomes crucial to include the Nazi era psychiatry experience in ethics training as an example of proper practice gone awry.
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Affiliation(s)
- Rael D Strous
- Department of Psychiatry, Beer Yaakov Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Sutton AG. Reasoned and reasonable approaches to ethics in undergraduate medical courses. JOURNAL OF MEDICAL ETHICS 2006; 32:682. [PMID: 17074829 PMCID: PMC2563296 DOI: 10.1136/jme.2006.016097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Brassington I. Teaching to the converted: religious belief in the seminar room. JOURNAL OF MEDICAL ETHICS 2006; 32:678-81. [PMID: 17074828 PMCID: PMC2563295 DOI: 10.1136/jme.2005.015818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
It is not unknown for participants in discussions of ethics to prefix their claims with a profession of their religious faith - to say, for instance, "Well, I'm a Christian/Muslim/whatever, so I think that ...". Other participants in the debate may well worry about how to respond without the risk of giving offence or appearing ad hominem. Within a teaching environment, the worry may be even more acute. Nevertheless, it is suggested in this paper that such worries should not be allowed to impede debate; moreover, a teacher who let such prefixes pass without critique would be considered a poor teacher. In fact, a kind of duty for a teacher of ethics is to be contrary and to play the apostate.
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Affiliation(s)
- I Brassington
- School of Law, University of Manchester, Manchester, UK.
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Hariharan S, Jonnalagadda R, Walrond E, Moseley H. Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados. BMC Med Ethics 2006; 7:E7. [PMID: 16764719 PMCID: PMC1524795 DOI: 10.1186/1472-6939-7-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Accepted: 06/09/2006] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study is to assess the knowledge, attitudes and practices among healthcare professionals in Barbados in relation to healthcare ethics and law in an attempt to assist in guiding their professional conduct and aid in curriculum development. Methods A self-administered structured questionnaire about knowledge of healthcare ethics, law and the role of an Ethics Committee in the healthcare system was devised, tested and distributed to all levels of staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) during April and May 2003. Results The paper analyses 159 responses from doctors and nurses comprising junior doctors, consultants, staff nurses and sisters-in-charge. The frequency with which the respondents encountered ethical or legal problems varied widely from 'daily' to 'yearly'. 52% of senior medical staff and 20% of senior nursing staff knew little of the law pertinent to their work. 11% of the doctors did not know the contents of the Hippocratic Oath whilst a quarter of nurses did not know the Nurses Code. Nuremberg Code and Helsinki Code were known only to a few individuals. 29% of doctors and 37% of nurses had no knowledge of an existing hospital ethics committee. Physicians had a stronger opinion than nurses regarding practice of ethics such as adherence to patients' wishes, confidentiality, paternalism, consent for procedures and treating violent/non-compliant patients (p = 0.01) Conclusion The study highlights the need to identify professionals in the workforce who appear to be indifferent to ethical and legal issues, to devise means to sensitize them to these issues and appropriately training them.
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MESH Headings
- Barbados
- Codes of Ethics
- Ethics Committees, Clinical
- Ethics, Clinical
- Ethics, Medical
- Ethics, Nursing
- Health Knowledge, Attitudes, Practice
- Helsinki Declaration
- Hippocratic Oath
- Humans
- Jurisprudence
- Medical Staff, Hospital/ethics
- Medical Staff, Hospital/psychology
- Medical Staff, Hospital/statistics & numerical data
- Nursing Staff, Hospital/ethics
- Nursing Staff, Hospital/psychology
- Nursing Staff, Hospital/statistics & numerical data
- Patient Rights
- Referral and Consultation
- Surveys and Questionnaires
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Affiliation(s)
- Seetharaman Hariharan
- School of Clinical Medicine & Research, The University of the West Indies, Queen Elizabeth Hospital, Barbados, West Indies
| | - Ramesh Jonnalagadda
- School of Clinical Medicine & Research, The University of the West Indies, Queen Elizabeth Hospital, Barbados, West Indies
| | - Errol Walrond
- School of Clinical Medicine & Research, The University of the West Indies, Queen Elizabeth Hospital, Barbados, West Indies
| | - Harley Moseley
- School of Clinical Medicine & Research, The University of the West Indies, Queen Elizabeth Hospital, Barbados, West Indies
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