Academic literature on the topic 'Cancer Treatment Moral and ethical aspects'

The scientific importance of our recently acquired ability to test for heredity predisposition to breast and ovarian cancers is paralleled only by its social and ethical relevance. Dilemmas are common in all genetic testing, but they assume particular nuances in the setting of breast cancer. Due to its devastating nature and to its increasing incidence, breast cancer is a central issue in women’s health. Breast cancer patients and women in general are often deeply involved in understanding the disease process and the treatment options, as they are in discussing the psychological, social and moral ramifications. This paper is a reflection upon some qualitative aspects of the debate that surrounds genetic testing for breast and ovarian cancer, as they have emerged in my encounters with breast cancer patients prior to their decision to consider genetic testing. The five recurrent themes identified in those conversations may or may not be representative of other practice situations, but they illustrate some fundamental philosophical, ethical and moral questions which exist at the core of our human essence and of our moral agency, and which point to the unavoidable intertwinement of medicine, culture, normativity and philosophy, vis-à-vis the many questions raised by genetics. The Author has intentionally refrained from questionnaires, which could betray the complexity of our thinking process, and from the vignettes, as they could betray confidentiality. The paper concludes that the correct answers to the dilemmas posed by genetic testing for breast cancer predisposition can only arise from a blend of medical, social and philosophical analysis.

Over the past decade, there has been a growing development of innovative technologies to treat cancer. Many of these technologies are expensive and not funded by health funds. The present study examined physicians’ perceptions of the ethical and clinical aspects of the recommendation and use of unfunded technologies for cancer treatment. This mixed-methods study surveyed 127 oncologists regarding their perceptions toward using unfunded innovative cancer treatment technologies, followed by in-depth interviews with 16 oncologists. Most respondents believed that patients should be offered all treatment alternatives, regardless of their financial situation. However, 59% indicated that they often face dilemmas regarding recommending new unfunded treatments to patients with financial difficulties and without private health insurance. Over a third (38%) stated that they felt uncomfortable discussing the cost of treatment with patients. A predictive model found that physicians facing patients whose medical condition worsened due to an inability to access new treatments, and who expressed the opinion that physicians can assist in locating funding for patients who cannot afford treatments, were more likely to recommend unfunded innovative therapies to patients (F = 5.22, R2 = 0.15, p < 0.001). Subsequent in-depth interviews revealed four key themes: economic considerations in choosing therapy, patient–physician communication, the public healthcare fund, and discussion of treatment costs. Physicians feel a professional commitment to offer patients the best medical care and a moral duty to discuss costs and minimize patients’ financial difficulty. There is a need for careful and balanced use of innovative life-prolonging technologies while putting patients at the center of discourse on this complex and controversial issue. It is essential to develop a psychosocial support program for physicians and patients dealing with ethical and psychosocial dilemmas and to set guidelines for oncologists to conduct a comprehensive and collaborative physician–patient discourse regarding all aspects of treatment.

Abstract BACKGROUND: Professional care for children with a brain tumor can bring considerable ethical questions in clinical practice. These questions can be burdensome and cause distress among professionals, parents and patients. Awareness and skills to bring these aspects into a respectful discussion among colleagues can be meaningful and alleviate the distress. Our objective is to give overview of the ethical case deliberations which took place during a monthly multidisciplinary meeting on the pediatric neuro-oncology department. METHOD: To describe the type of ethical case deliberations as spontaneously proposed and selected by the team members for discussion. To identify main values in the care process for professionals via the dilemma method in monthly meetings led by a trained facilitator. RESULTS: The monthly meetings were visited regularly by 9-14 diverse professionals (median 10) of the team: nurses, oncologists, social worker, psychologist, educational specialist. The selected moral questions concerned children with a brain tumor between 4-13 year old (median 9) with following ten subjects: 3 not sharing the infaust prognosis with a child, 2 avoiding medical care in follow up /treatment, 2 cultural different approach for food and drink intake, 2 crossing professional boundaries and 1 time worries about emotional safety of a child. The main values that were recognized to play crucial role in the care process were honesty, respect, autonomy, quality of life, health, tolerance, courage and safety. The participants felt supported in their professional skills by sharing reflections on personal moral considerations and by openly discussing different views and experiences of other participants. CONCLUSION: The monthly ethical case discussions disclose high lights in the burden of professional care in pediatric neuro-oncology. These meetings about moral questions are supportive in the competence of the professionals to recognize and communicate about these important dilemmas.

Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional Review Board of the Kaohsiung Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses.

There is a paucity of research examining children’s experiences with cancer in India. Childhood ethics is an emerging field, focusing on the moral dimension of children’s experiences, to promote children’s participation in their health care. A focused ethnography, using a moral experience framework, was conducted to better understand children’s participation in decisions, discussions, and actions in three oncology settings in New Delhi, India. We interviewed key informants, retrieved key documents, and conducted semi-structured interviews and participant observations with children. All 22 children demonstrated interest in varying aspects of their cancer care. Certain factors facilitated or impeded their participation. Some children became distressed when they lacked information about their treatment or were not given opportunities to enhance their understanding. The results advance our understanding of the moral experiences of children with cancer in India for healthcare professionals, policy makers, families, and interested others.

10507 Background: Oncologists and fellows in Hematology/Oncology (HO) training programs report high levels of burnout. The ACGME requires accredited programs to have a mechanism to foster “well-being” and “ethical behavior” among fellows. A loss of solidarity among oncology professionals may contribute to known causes of burnout, such as heavy workload and severity of patient illness, that may in turn negatively impact patient outcomes. Methods: Through a multidisciplinary process involving fellows and faculty from psychiatry, palliative care, and hematology/oncology, a 3-year longitudinal “Art of Oncology” (AOO) curriculum was created for HO fellows at our institution to foster solidarity and mitigate burnout. The curriculum principally involved monthly hour-long sessions intended to promote reflection on oncologists’ shared experiences and the humanistic aspects of caring for patients with cancer. Facilitated by topic experts utilizing personal and published narratives, sessions foster group discussion. Fellows are also invited to write a personal narrative reflecting on their role as an oncologist. Topics include death and dying, caring for patients after treatment failure, cultivating resilience, religion/spirituality, the moral responsibility of oncologists, and oncology as a calling. Cancer patients and spouses were invited to facilitate a session to emphasize the patient experience. Burnout and preparedness for covered topic areas were measured prior to curriculum initiation and will be re-assessed annually. Results: The curriculum began in 2018. Of current fellows, 94.7% (18/19) completed the initial survey. A greater proportion of HO fellows participated in the AOO sessions than non-AOO didactic lectures (mean attendance, 59.2% v. 42.7%, p = 0.037). At curriculum initiation, most fellows reported burnout a few times or more a month (all fellows = 75%, 1st year = 85.7%, 2nd year = 80%, and higher = 62.5%). Conclusions: The implementation of a dedicated curriculum to foster solidarity among HO fellows through narrative medicine and group discussion of the humanistic aspects of oncology is feasible. A substantial degree of burnout exists among HO fellows, even incoming fellows. Further research to assess whether this curriculum mitigates burnout is needed. Because burnout is already a problem for incoming fellows, further work should investigate interventions aimed at ameliorating burnout among both residents and fellows.

This article explores refusal of medical treatment by adult patients from ethical and legal perspectives. Initially, consequentialist and deontological ethical theory are outlined. The concepts of autonomy, paternalism and competence are described and an overview of Beauchamp and Childress’s principle-based approach to moral reasoning is given. Relevant common law is discussed and the provisions of the Mental Capacity Act 2005 in assessing competence is evaluated. In order to demonstrate the consideration of moral issues in clinical practice, ethical theory is applied to two well-known incidents: the case of Re MB, where doubt over decision-making capacity led to a paternalistic act to override a patient’s choice; and the death of Emma Gough, a situation where respect for autonomy prevailed when healthcare staff acted lawfully in following a patient’s refusal of life-saving treatment. Finally, guidance from regulatory bodies on the roles and responsibilities of health professionals in relation to this topic are considered.

Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.

Background: Coercion in mental healthcare has led to ethical debate on its nature and use. However, few studies have explicitly explored patients’ moral evaluations of coercion. Aim: The purpose of this study is to increase understanding of patients’ moral views and considerations regarding coercion. Research design: Semi-structured focus-group and individual interviews were conducted and data were analysed through a thematic content analysis. Participants and research context: A total of 24 adult participants with various mental health problems and experiences with coercion were interviewed in 2012–2013 in three regions of Norway. Ethical considerations: Ethical approval and permissions were obtained according to required procedures. Informed consent and confidentiality were also secured. Findings: Ethical considerations regarding coercion included seven main themes: the need for alternative perspectives and solutions, the existence of a danger or harm to oneself or others, the problem of paternalism, the problem of discrimination and stigma, the need for proportionality, the importance of the content and consequences of coercion and concerns about way that coercion is carried out in practice. Discussion: The participants’ views and considerations are in line with previous research and reflect the range of normative arguments commonly encountered in ethical and legal debates. The study accentuates the significance of institutional factors and alternative voluntary treatment opportunities, as well as the legal and ethical principles of proportionality and purposefulness, in moral evaluations of coercion. Conclusion: Broader perspectives on coercion are required to comprehend its ethical challenges and derive possible solutions to these from a patient perspective.

The dramatic improvement of neonatal intensive care has produced vexing ethical and legal questions. One of the most striking issues is to determine whether the most defective neonates should be provided with intensive care and to what extent they should be treated. This thesis demonstrates that an attempt to answer this question and an analysis of the demands and limitations of a duty to treat defective neonates cannot properly occur without first considering the legal concerns and ethical issues surrounding the notion of "person". The author examines germane ethical theories and North-American jurisprudence to see what approaches and standards commentators and courts have adopted in this respect. This thesis demonstrates that in the context of the cessation or non-initiation of intensive care, the legal and moral status of very defective neonates remain ambiguous. In particular, the author suggests that a legal best interests analysis that includes quality of life considerations may actually involve the use of criteria similar to those supported by the authors of the controversial moral theories that negate the personhood of seriously handicapped newborns. The author ultimately concludes that a clear divide between the legal definition of the "person" and the moral and social perceptions of that term is misleading.

Thesis (MPhil)--Stellenbosch University, 2000.
ENGLISH ABSTRACT: The community of the Western Cape carries the burden of the serious consequences of alcohol addiction. Alcohol abuse is very common and the consequences range from severe to devastating, not just for the individual but also for the family and the community as a whole. If answers are sought within the community, the problem deepens, and it becomes apparent why the problem of alcohol abuse is not being successfully addressed. The addict refuses treatment, the community respects the autonomy of the individual, and the problem drags on. The community also has many misperceptions concerning the causes and perpetuation of the pathological drinking behaviour of the addict, and are thus not equipped with the knowledge necessary to suggest the correct interventions for this physical and psychological illness. There is also concern that a person's autonomy and human rights are so highly regarded in the community that the appropriate treatment necessary for this serious disorder of addiction does not receive the attention it deserves. This paper investigates the causes of alcoholism and the factors which reinforce a person's drinking behaviour. The autonomy of the alcoholic is challenged and examined in depth. The importance currently assigned to autonomy and individual rights is questioned, and balanced against other important moral and ethical principles of our time. Alcohol is a drug which causes physical and psychological addiction. Addiction literally means "under the control" of something. Alcohol use is a socially acceptable habit. The psychotropic (calming) effect of alcohol serves as an effective support in or escape from stress in the life of the individual. There are also "vulnerable" individuals in the community in whom a genetic predisposition increases the chance of the development of alcohol dependence. In spite of the fact that alcohol dependence is an acquired physical condition, nobody intentionally becomes addicted to alcohol. With the knowledge of the power that addiction exercises over the life of the individual, attention is now given to the autonomy of the addict, and his/her capacity for rational decision making. The significance of the decision to request treatment for the individual, his/her family and the community is balanced against competency to take the decision. Argument is developed towards the conclusion that the alcoholic is indeed not autonomous, and does not have the competency to make decisions concerning treatment. If the autonomy of the addict is thus questioned, the way in which the person is then treated by the community becomes a difficult moral dilemma. The community's responsibility of care towards the individual and the wider community are jeopardized. The ethical principles of deontology (rules), utilitarianism (the best result for the greatest number), autonomy versus beneficence, solicitude, virtue, human rights and other principles are discussed in depth. A solution is sought that will eventually be "good" for the addict and the community. The conclusion is reached that it is "good" to intervene in the life of the addict at a certain stage of addiction. Involuntary treatment is suggested as one possible way of attacking the problem of serious alcohol abuse that is threatening to overwhelm the community. Practical suggestions are offered for the renewed application of existing treatment structures and legislation to the benefit of the addict and the community.
AFRIKAANSE OPSOMMING: Die gemeenskap in die Wes-Kaap gaan gebuk onder die ernstige gevolge wat alkoholverslaafdheid meebring. Alkoholmisbruik is baie algemeen en het ernstige tot vernietigende gevolge, nie net vir die induvidu nie, maar ook vir die gesin en die gemeenskap as geheel. As daar na antwoorde vir hierdie probleem in die gemeenskap gesoek word, verdiep die probleem en kom dit duidelik aan die lig waarom die probleem van alkoholmisbruik nie suksesvol aangespreek kan word nie. Die verslaafde persoon weier behandeling, die gemeenskap respekteer die indivdu sy · outonomiteit en die proble~m sleep voort. Die gemeenskap het ook baie wanopvattings omtrent die oorsake en instandhouding van die verslaafde se patologiese drinkgedrag en is dus nie met die nodige kennis toegerus om die korrekte ingrepe vir hierdie fisiese en psigiese siektetoestand voor te stel nie. Daar is ook kommer dat die gemeenskap 'n persoon se outonomiteit menseregte s6 hoog aanslaan dat 1 die toepaslike hantering van die ernstige verslawing nie tot sy reg kom nie. Hierdie werkstuk ondersoek die oorsake van alkoholisme en die faktore wat die persoon se drinkgedrag versterk. Die alkoholverslaafde se outonomiteit word uitgedaag en in diepte ondersoek. Die gewig wat 'n persoon se outonomiteit en 'regte' in die gemeenskap dra, word bevraagteken en met ander belangrike moreel etiese beginsels van die dag gebalanseer. Alkohol is 'n dwelm wat fisiese en psigiese verslaafdheid veroorsaak. Verslaafdheid beteken letterlik 'onder die beheer' van daardie substans. Alkohol gebruik is sosiaal 'n aanvaarbare gewoonte. Alkohol se psigotrope effek (kalmerend) dien as 'n effektiewe stut of ontvlugting vir stres in die lewe van die individu. Daar is ook 'kwesbare' individue in die gemeenskap waar 'n genetiese predisposisie die persoon meer 'vatbaar maak vir die ontwikkeling van alkohol afhanklikheid. Ten spyte van die feit dat alkohol-afhanklikheid 'n verworwe fisiese toestand is, raak niemand 'moedswillig' aan alkohol verslaaf nie. Met die kennis van die krag wat verslawing op die individua se lewe uitoefen as agtergrond word daar voorts gekyk na die outonomie en die verslaafde se vermoe tot rasionele besluitname. Die gewigtigheid van die besluit tot behandeling vir die individu, sy gesin en die gemeenskap word met kompetensie tot besluitname gebalanseer. Arguemente word gebou wat tot die gevolgtrekking lei dat die alkohol-afhanklike inderdaad nie outonoom is en nie die kapasiteit vir die neem van behandelingsbesluite besit nie. Indien die verslaafde se outonomiteit dan bevraagteken word, word die gemeenskap se verdere hantering van die persoon 'n groot morele dilemma. Die gemeenskap se verantwoordelikheid van sorg teenoor die individu en die groter gemeenskap kom in gedrang. Die etiese beginsels van deontologie (reels), konsekwensialisme (die beste vir die meeste), outonomiteit versus goedwilligheid, sorgsaamheid, deug, menseregte en ander beginsels word in diepte bespreek. Daar word voorgestel dat die gemeenskap se plig tot so~g, in die geval van endstadium alkoholisme, moreel sterker is as bloot die respek vir outonomie. Daar word tot die gevolgtrekking gekom dat dit 'goed' is om op 'n sekere stadium van verslawing in die lewe van 'n persoon in te gryp.· Nie-vrywillige behandeling word voorgestel as bloot een van die aanslae vanuit die gemeenskap om die ernstige probleem van alkoholmisbruik wat besig is om die gemeenskap te oorweldig aan te pak. Praktiese voorstelle word gemaak om huidige behandelingsstrukture en wetgewing opnuut tot voordeel van die verslaafde en die gemeenskap aan te wend.

Thesis (M.Phil.)--Stellenbosch University, 2000.
ENGLISH ABSTRACT: AIDS is the most important threat to world health. Recent years have seen a dramatic spread of HIVand AIDS in South Africa. Health education directed at modifying risk behaviour appears to be the only way in which the disease can be contained. Controlling AIDS is not only by controlling the virus, but also involves tackling social, economic and political issues and putting AIDS into the broader context of sexuality and gender roles. This requires a broader understanding of this aspect of HIV-AIDS ranging from population dynamics, through to research on individual behaviour and its socio-economic impact; so that we can dispel the myths and rumours that surround AIDS and answer searching questions that will be asked by the community. In South Africa, HIV-AIDS remains a stigmatized disease. There have been calls from courageous and influential people for those who are living with HIV-AIDS to be open about their status and to destigmatise the disease. Institutions too have been drawn into the controversy about whether to remain silent or speak out. Southern African Anglican bishops, as well as some politicians declared their intention to undergo testing for HIV status in order to sensitise the public to the seriousness of the epidemic. Were AIDS not regarded as intolerable, the entire issue of confidentiality would fall away. Calls to destigmatise the disease through openness cannot stand alone. Government must put effective treatment programmes in place. In the absence of treatment, AIDS may represent only frustration and hopelessness to those who test positive; and fear, danger and resultant animosity to those who are HIV negative. The text is in four chapters. Chapter 1 focuses on confidentiality as an important principle in the management of disease. In HIV -AIDS, confidentiality is a more sensitive issue as AIDS is particularly viewed as a social stigma, accompanied by discrimination and harassment. The chapter also addresses HIV infection, transmission, counseling and screemng. Chapter 2 deals with the principles of biomedical ethics namely, autonomy, to enable the patient to determine his/her course of treatment; informed consent, designed to protect the interests of patients from exploitation and harm, and encourage health professionals to act responsibly; beneficence and nonmaleficence, to protect the welfare of others; and justice, to ensure access to health care for all. It also highlights the aspects of and limitations to confidentiality. Chapter 3 discusses broadly the ethical dilemmas pertammg to professional-patient relationships, women and HIV-AIDS, religion, prisoners and employer-employee relationships. When the AIDS epidemic started, very few people suffered from the disease, and the disease was treated with great caution and confidentiality. Today, AIDS is a pandemic and emphasis should shift from the ethic of autonomy and confidentiality, to a social ethic, which emphasizes the responsibility of minimizing the risk of spread of infection. The chapter also examines the role of the Department of Health, the participation of health professional bodies and the legal aspects relating to confidentiality in HIV-AIDS. Chapter 4 attempts to construct an argument to destigmatise HIV-AIDS by arguing the responsibility of the government to make sufficient resources available for the treatment and control of the pandemic. Health professionals are challenged to engage their expertise and skills in the service of the sick with dignity and respect. The community is encouraged to support the drive towards controlling the spread of HIV infection and enable people living with AIDS to disclose their status without fear of harassment.
AFRIKAANSE OPSOMMING: Vigs is die gevaarlikste bedreiging van wéreldgesondheid. Die afgelope paar jaar het 'n dramatiese verspreiding van mv en VIGS in Suid-Afrika plaasgevind. Gesondheidsopvoeding wat gemik is op die verandering van risiko-gedrag is skynbaar die enigste metode wat die siekte kan beheer. Die kontrolering van VIGS is nie net die kontrolering van die virus nie, maar dit betref ook herbesinning oor sosiale, ekonomiese en politiese en geslagsrolle. Dit vereis 'n omvattender verstaan van hierdie aspek van HIV-VIGS, wat strek vanaf van bevolkingspatrone tot by die navorsing oor individuele gedrag en die sosio-ekonomiese impak van 19. So kan ons hopelik help om die mites rondom VIGS te besweer. In Suid-Afrika bly mV-VIGS 'n gestigmatiseerde siekte. Daar rus 'n veranbtwoordelikheid op invloedryke mense wat met mV-VIGS leef en wat as rolmodelle sou kon dien, om hul mv -status te openbaar en sodoeonde te help om die siekte te destigmatiseer. Instansies is ook by hierdie twispunt betrek om vas te stelof die mense moet praat of swyg. Suider-Afrikaanse Anglikaanse Biskoppe, asook somige politici het hulle intensies aangekondig om die mv -toets te ondergaan om sodoende die publiek te help opvoed oor die gevaar van hierdie epidemie. Oproepe om die siekte te destigmatiseer deur openbaarheid kan nie in isolasie funksioneer nie. Die staat moet effektiewe kuratiewe en voorkomingsprogramme hier rondom loods en kontinueer. In die afwesigheid van 'n geneesmiddel, sal VIGS slegs frustrasie, hopeloosheid, en vrees skep by diegene wat positief getoets is, sowel as vyandigheid onder diegene wat nie mv positief is nie. Die teks het vier hoofstukke. Hoofstuk 1 fokus op vertroulikheid as 'n belangrike beginsel in die bestuur van die siekte. In mV-VIGS is vertroulikheid 'n meer sensitiewe beginsel aangesien VIGS in die besonder as 'n sosiale skandvlek, aangevreet deur diskriminasie, gesien word. Die hoofstuk bespreek ook mv -infeksie, transmissie, raadgewing en toetsing. Hoofstuk 2 gaan oor die beginsels van die biomediese etiek, naamlik, outonomie, waaronder ingeligte toetstemming, ontwerp om die belange van die pasiente te beskerm teen eksploitasie en gevaar: om gesondheids professionele aan te moedig om hulle op 'n verantwoordelike manier te gedra. Ander beginsels is goedwilligheid en niekwaadwiligheid om die welsyn van ander te beskerm, asook geregtigheid, om toegang tot gesondheidshulp vir almal te verseker. Dit beklemtoon ook die aspekte verwant aan beperkinge tot vertroulikheid. Hoofstuk 3 bespreek breedweg die etiese dilemmas met betrekking tot die verhouding tussen pasiënye en professionele gesondheidswerkers, vrouens en mV-VIGS, godsdiens, gevangenes en werkgewer-werker verhoudings. Toe die VIGS-epidemie begin het, het min mense aan die siekte gely, en die siekte is met groot sorg en vertroulikheid behandel. Vandag is VIGS 'n pandemie en die klem moet geskuif word vanaf outonomie en vetrouilikheid na 'n sosiale etos wat verantwoordlikheid en die vermindering van die risiko van die verspreiding van die infeksie beklemtoon. Die hoofstuk kyk ook na die rolle van gesondheidsdepartmente, deelname van gesondheids professionele organisasies en die juridiese aspekte met betrekking tot vertroulikheid van HIV-VIGS. Hoofstuk 4 poog om 'n argument te ontwikkel wat daartoe sou kon bydra dat HIV-VIGS gedestigmatiseer sal word. Klem word gelê op die verabtwoordelikheid van die staat om soveel moontlike bronne beskikbaar te stel vir die behandeling van en beheer oor hierdie pandemie. Gesondheids professionele word uitgedaag om hulle deskundigheid en bekwaamheid in die diens van die siekes met waardigheid en respek te gebruik. Die gemeenskap word aangemoedig om die poging tot die beheer van die verspreiding van die HIV -infeksie te ondersteun en om die mense wat met VIGS leef in staat te stelom hul status sonder die dreigement van stigmatisering bekend te maak.

This thesis is concerned with the correctional treatment process for sex offenders, and the problems that criminal justice system authority poses for treatment settings. A particular focus is whether inmate participation in treatment programs is voluntary or coerced, given the link between programs and prospects of release. In examining this question, the author considers the results of an empirical project in which a group of inmates were interviewed about their perceptions of the correctional treatment process. Background to this project includes discussion of the doctrine of informed consent and respect for autonomy as its underlying rationale; discussion of the concepts of coercion and voluntariness; and examination of the development of rehabilitative ideals. A conclusion drawn from the discussion is that the presence of coercive authority may impact adversely upon correctional treatment efforts. Coercive authority creates difficulties in relation to the voluntariness of inmates' consent, the confidentiality of the treatment relationship, and the professional autonomy of the clinician. These problems in turn raise questions as to whether correctional programs retain the character of treatment, or are more properly considered as part of punishment, or as tools of social control. However, coercive authority is a necessary presence if correctional services are to work towards the goal of protection of society. The central question to be addressed therefore is whether the prospects of release can be used to motivate inmates for treatment in a way that is consistent with the requirement of voluntary consent to treatment. The results of the empirical project suggest that for the majority of inmates, the link between treatment and release is not coercive. However, a number of inmates did indicate they felt coerced into treatment programs. Reforms may thus be necessary to avoid coercive authority resulting in coerced treatment. In discussing these results, the author considers a number of directions for reform, including the introduction of an operational presumption of coerced referrals to treatment, which would place greater emphasis on clinicians' obligations to secure voluntary consent.

D.Ed.
The practice regarding the diagnosing and therapeuterising, with Ritalin, of children with ADHD (Attention Deficit Hyperactivity Disorder) is inadequate. There is in general practice little, if any, signs of holistic interactive co-operation amongst practitioners regarding diagnosing and therapeuterising, with Ritalin, exceptions excluded. The practice situation reflects a rather fragmented image, unscientific practises regarding diagnostic and therapeutic instruments and procedures, ignorance and incompleteness. The rational why this study was undertaken is because of the researcher's experience of the overwhelming inadequacy of this practice. The aim of this research was to develop, validate and describe standards for the holistic interactive management of the practice of diagnosing of the child \Vith ADHD and his/her therapy, with Ritalin. These standards can contribute towards improvement of the total practice, that is improvement of aid rendering to this child in order to optimise his/her functioning accordingly. In order to reach this aim, a research method was followed whereby an intensive literature study, multiple case studies and a questionnaire survey regarding a variety of professional practitioners and parents, was introduced in order to obtain data from the practice situation. Data was continuously qualitatively analised within the parameters of a theoretically grounded conceptual framework. These analyses eventually culminated in the description of concept standards and revised concept standards which were submitted to five domain experts for validation. The final standards which were determined through a process of a reasonable high level of consensus amongst these experts, is described in two official languages, namely Afrikaans and English. The final standards reflect the need from practice, namely holistic interactive management of the procedures of diagnosis and therapy, with Ritalin, of the child with ADHD.

The South African Department of Correctional Services has a legislative mandate of detaining offenders in safe custody whilst ensuring their human dignity amongst others. This stems from section 2 of the Correctional Services Act 111 of 1998 as amended. In addition to that, chapter 3 of this Act makes provision for conditions under which offenders should be treated, conditions of human dignity. This piece of legislation is effectively giving effect to the Bill of Rights as articulated in chapter two of the Constitution of the Republic of South Africa of 1996. It is expected of the department to treat offenders according to the provisions of not only this Constitution and Correctional Services Act 111 of 1998 as amended but also to comply with the international conventions and treaties. Extensive empirical and non-empirical studies on the treatment of offenders have been conducted by various scholars in the field of penology but not much has been done to bring to the fore knowledge with regard to the developmental trend of the treatment of offenders. It is against this backdrop that a qualitative study through systematic review of literature was conducted to bring together and examine available literature. In other words, a systematic literature review was conducted to determine if there is a developmental trend towards the treatment of offenders in South Africa as required by the prescripts of the law. Furthermore, this study was conducted to also demonstrate the researcher’s knowledge in the field of penology. The focus was on the central theories identified as offenders’ rights. The Department of Correctional Services identified eight offenders’ rights and sees them as its Constitutional mandate (Department of Correctional Services, 2013:8). This study has found a violation of the offenders’ right to equality to be diminishing over time. Apart from that, this study reveals a substantial violation of offenders’ rights because out of seven offenders’ rights, only one [freedom of religion] appears be successfully protected and promoted by the department. This study further present the recommendations and suggested areas of further research.
Penology
D. Litt. et Phil. (Penology)

Introduction and overview of ethical guidance 170 End of life issues 172 Withdrawing and withholding treatment 176 Ethical and moral values affect all aspects of cancer care, including treatment, management of symptoms, end of life care and participation in research. With advancing medical technology and developing evidence-based practice, ethical issues in cancer care are increasingly complex....

This section analyzes the early years of the Revolution, including the ethics of the war and Americans’ attention to maintaining moral superiority. It shows that the patriots wanted to win, but win well. They wanted the new country to succeed, but not at the cost of honor or virtue. Thus, this chapter shows attempts to discourage the old European notions of honor that still existed in favor of the democratized version. It shows how ethical ideals played a role in all aspects of military establishment from battlefield tactics, to the treatment of prisoners, to the recruitment of soldiers. It also presents an expansion of honor and a broadening of ethics as part of a wider social revolution that included those of different genders, races, and classes as equal participants and claimants to honor. It looks at martial and civil policies that enforced conduct and recognized women’s and African Americans’ contributions. All people could claim their share of honor and virtue through proper conduct, duty to the nation, and, above all, ethical behavior.

This chapter discusses ethical and legal aspects of the global distribution of medical resources; the allocation of national resources; and medical treatment of the individual. It argues that so long as decisions are made taking into account fundamental moral values and principles of equity, impartiality, and fairness, and provided the bases for decision making are flexible in relation to the times, then the underlying system is just and is likely to yield just results.

A myriad of ethical problems pervade clinical practice and research in psychiatry. Yet with few exceptions, psychiatric ethics has generally been regarded as an addendum to mainstream bioethics. An assumption has been made that ‘tools’ developed to deal with issues like assisted reproduction or transplant surgery can be used essentially unmodified in psychiatry. These tools certainly help the psychiatrist but the hand-me-down approach has meant that salient features of psychiatric ethics have been prone to misunderstanding. Psychiatric ethics is concerned with the application of moral rules to situations and relationships specific to the field of mental health practice. We will focus on ethical aspects of diagnosis and treatment that challenge psychiatrists, and on codes of ethics. Resolution of ethical dilemmas requires deliberation grounded in a moral theoretical framework that serves clinical decision-making, and we conclude with our preferred theoretical perspective.

Although cancer is considered a treatable disease today, as a result of scientific and technological advances, attitudes toward the disease and its management in each country are influenced by the cultural and religious situations and beliefs of the society, in addition to its economic, political, and health status. The historical background of this disease in Iran dates back to more than a thousand years ago and has been treated by traditional Iranian physicians ever since. Therefore, this disease is still seen as a stigma, taboo, a divine test, and predestination, and its management is not possible without considering cultural and social aspects. Cancer should be investigated from individual, family and social perspectives in Iran. On the other hand, ethical and legal issues associated with cancer care, such as hiding the truth and end-of-life care, are also among challenging factors for health care professionals. In this chapter, while studying the cultural variables affecting the different stages of the disease, including diagnosis, treatment, death, and mourning, a review of the traditional Iranian medicine is done along with its cancer-related principles that are rooted in this medicine. The impact of spirituality and religion on different aspects of the disease is also examined. It is hoped that health care professionals will be able to provide transcultural care effectively by having knowledge regarding these variables.

Is Socrates in the Protagoras a sincere hedonist? The decipherment of the latter question is fundamental to the unraveling of key aspects of Plato’s ethical thought. It has been suggested that Socrates in the Protagoras finds hedonism philosophically attractive for it functions as a necessary anti-akrasia premise and, therefore, it fits his moral psychology. At the same time quantitative hedonism provides for commensurability of moral value and, in turn, for a more straightforward, quantifiable, and action-guiding Platonic ethical theory. Although initially appealing, the latter hypothesis is deeply problematic. On the one hand, hedonism is not a necessary theoretical tool either for commensurability of value or for a quantifiable eudemonistic ethical theory. On the other hand a hedonistic interpretation of the Protagoras would result in a plethora of blatant anomalies for Platonic ethical theory as it is exhibited in the early and middle period dialogues. In particular, the endorsement of quantitative hedonism comes tied with an apotheosis of sophistic education and also with a purely instrumental conception of virtue which contradicts cardinal components of Socrates’ and Plato’s virtue theory. Therefore, a prohedonistic approach of the Protagoras is untenable and has to be rejected. As a result, a sufficiently plausible defense of the Socratic doctrine “no one does wrong willingly” needs to be constructed on non-hedonistic grounds. My suggestion is that we should recast Plato’s treatment of akrasia in terms of two –commonly defended by early Plato- descriptive theses of human psychology; that is, psychological eudemonism and motivational intellectualism. This move will lead us to the conclusion that the traditional conceptualization of akrasia as a single and unified phenomenon is incomplete as it does not pay justice to the richness of Plato’s moral psychology. Rather, as I will maintain, there are two types of akrasia implicit in Plato’s treatment of the phenomenon: synchronic akrasia and diachronic akrasia. On this revisionary theoretical basis, the differences between early Plato and later Plato on akrasia can be understood as variations in the adherence or not to psychological eudemonism and motivational intellectualism.

This chapter aims to provide a physician with the foundation and principles of philosophy in medicine for freer and independent thinking. In previous chapters, a sub-branch of the philosophy of medicine related to epistemological concepts and metaphysical implications was highlighted, including ethical and even moral principles. The philosophy of medicine is a blend of medical education and training with philosophical aspects to achieve improvements and innovative findings for public health services. The philosophy of medicine includes the contra-active interactions of diseases, health and the search for effective reciprocity. By asking questions about how medical and health professionals know what to do, and detailed information is given in terms of practical medical wisdom. How should they make the right and wise decisions in morally complex and uncertain situations? And what is the patient’s role in this decision-making process? In medical practice and research, it is recommended to start problem-solving with philosophical thinking and then logical evaluations in order to reveal a better diagnosis, treatment and healing qualities for patient care.