Journal articles on the topic 'Cancer Treatment Moral and ethical aspects'
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Surbone, Antonella. "The ethical challenge of genetic testing for breast cancer." Medicina e Morale 48, no. 3 (June 30, 1999): 469–84. http://dx.doi.org/10.4081/mem.1999.799.
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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.
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Bashkin, Osnat, Keren Dopelt, Noam Asna, and Nadav Davidovitch. "Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System—A Mixed-Methods Study." Current Oncology 28, no. 4 (August 2, 2021): 2902–13. http://dx.doi.org/10.3390/curroncol28040254.
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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.
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van Meeteren, Antoinette Schouten, Simone Lenting, Mirjam Sulkers, and Marianne van de Wetering. "OTHR-21. Ethical reflections via the dilemma method in a pediatric neuro-oncology department." Neuro-Oncology 24, Supplement_1 (June 1, 2022): i151. http://dx.doi.org/10.1093/neuonc/noac079.560.
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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.
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Ko, Hsun-Kuei, Chi-Chun Chin, Min-Tao Hsu, and Shu-Li Lee. "Phenomenon of moral distress through the aspect of interpretive interactionism." Nursing Ethics 26, no. 5 (April 15, 2018): 1484–93. http://dx.doi.org/10.1177/0969733018766579.
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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.
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Behan, Justine M., Ramandeep Singh Arora, Franco A. Carnevale, Sameer Bakhshi, Bani Bhattacharjee, and Argerie Tsimicalis. "An Ethnographic Study of the Moral Experiences of Children with Cancer in New Delhi, India." Global Qualitative Nursing Research 8 (January 2021): 233339362199581. http://dx.doi.org/10.1177/2333393621995814.
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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.
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Richardson, Daniel R., Gary Winzelberg, Donald Lee Rosenstein, and Frances A. Collichio. "Development of an “Art of Oncology” curriculum to mitigate burnout and foster solidarity among hematology/oncology fellows." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 10507. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.10507.
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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.
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Shamsi Gooshki, Ehsan. "Ethical Aspects of Breast Cancer Treatment." Multidisciplinary Cancer Investigation 1, no. 1 (August 10, 2016): 29–30. http://dx.doi.org/10.21859/mci-01016.
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Bingham, Sarah-Louise. "Refusal of treatment and decision-making capacity." Nursing Ethics 19, no. 1 (January 2012): 167–72. http://dx.doi.org/10.1177/0969733011431925.
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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.
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Ventovaara, Päivi, Margareta af Sandeberg, Janne Räsänen, and Pernilla Pergert. "Ethical climate and moral distress in paediatric oncology nursing." Nursing Ethics 28, no. 6 (March 11, 2021): 1061–72. http://dx.doi.org/10.1177/0969733021994169.
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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.
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Norvoll, Reidun, and Reidar Pedersen. "Patients’ moral views on coercion in mental healthcare." Nursing Ethics 25, no. 6 (October 27, 2016): 796–807. http://dx.doi.org/10.1177/0969733016674768.
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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.
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Denisov, A. V., V. A. Cheprakova, A. V. Anisin, and S. I. Bezrukov. "Ethical aspects of modern use of animals in experimental studies." Bulletin of the Russian Military Medical Academy 20, no. 3 (December 15, 2018): 238–42. http://dx.doi.org/10.17816/brmma12383.
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Laboratory animals have been widely used in biomedical research for centuries, and there is as much debate about the validity and acceptability of it. Since ancient times there are rules and moral practices, the law fixes the responsibility for the cruel treatment of animals. Currently, developed countries have accepted laws to protect animals, which are implemented through sophisticated mechanisms. Worldwide there is a growing recognition that attention to the observance of animal rights is one of the indicators of the civilization of society. Unfortunately, in Russia, the question of legislative regulation of moral concepts of animal treatment is highly relevant. Currently, in our country, there is no an effective system of control and punishment for violations of the rules of treatment of animals, so that the government cannot effectively influence the institutions in which do not apply ethical and legal norms of work with experimental animals. In addition, in the schools of biomedical and veterinary science, not enough attention is paid to the teaching of bioethics and the ethics of experiment on animals, which makes the level of training of graduates not corresponding to the modern requirements of the civilized countries of the world. It is necessary to develop a new modern documentary base in accordance with the spiritual, scientific and legal guidelines adopted throughout the world, which will determine not only the world recognition of domestic scientific research but also will be a clear indicator of the level of development of morality and civilization of Russia.
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Epanomeritakis, Ilias Ektor. "Moral ambivalence towards the Cancer Drugs Fund." Journal of Medical Ethics 45, no. 9 (July 16, 2019): 623–26. http://dx.doi.org/10.1136/medethics-2019-105416.
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The UK’s Cancer Drugs Fund (CDF) was introduced in 2010 following the Conservative Party’s promise to address the fact that numerous efficacious cancer drugs were not available because of their cost ineffectiveness, as deduced by the National Institute of Health and Care Excellence. While, at face value, this policy appears only to promote the UK’s public welfare, a deeper analysis reveals the ethically unjustifiable inconsistencies that the CDF introduces; where is the analogous fund for other equally severe diseases? Have the patients without cancer been neglected simply due to the fear-inducing advertising and particularly ferocious speech which surrounds cancer? The CDF is unjustifiable when challenged by such questions. However, it is troubling to think that the CDF might be repealed in order to abolish these ethical concerns. Intuitively, one feels uncomfortable stripping the cancer patient of their benefits just so that they might be on an equally pessimistic footing with others. In the present essay, I argue that, although there are no ethically justifiable grounds for the CDF’s introduction, its removal would be inappropriate. Following this realisation, I investigate whether the procedural steps of the CDF itself—theoretically removed from the context of resource distribution for all disease types—represent an ethically justifiable system. I believe that the answer is yes, given the CDF’s conformity to accountability for reasonableness, a robust framework of procedural justice, which continuously improves the ethical and epistemological standards of the policies to which it is applied.
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Zorin, Konstantin V. "Professional competences of a doctor: Ethical and Deontological aspects." Alma mater. Vestnik Vysshey Shkoly, no. 4 (April 2022): 73–76. http://dx.doi.org/10.20339/am.04-22.073.
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The article formulates a number of ethical and deontological aspects of the training and work of a doctor. It has been revealed that there is a need for medical students and practicing doctors to form some important professional competencies, based on spiritual and moral culture, personal maturity, conscientiousness, mercy, as well as the ability to avoid and overcome conflict situations using the basic principles of biomedical ethics. Group discussion and solution of controversial ethical and deontological cases using the method of analysis of the presented situation prepares a medical student for communication, treatment, diagnostic and educational and preventive work with a patient who is faced with a difficult choice and must make an important decision.
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Falcó-Pegueroles, Anna, Teresa Lluch-Canut, Juan Roldan-Merino, Josefina Goberna-Tricas, and Joan Guàrdia-Olmos. "Ethical conflict in critical care nursing." Nursing Ethics 22, no. 5 (October 20, 2014): 594–607. http://dx.doi.org/10.1177/0969733014549883.
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Background: Ethical conflicts in nursing have generally been studied in terms of temporal frequency and the degree of conflict. This study presents a new perspective for examining ethical conflict in terms of the degree of exposure to conflict and its typology. Objectives: The aim was to examine the level of exposure to ethical conflict for professional nurses in critical care units and to analyze the relation between this level and the types of ethical conflict and moral states. Research design: This was a descriptive correlational study. Central and dispersion, normality tests, and analysis of variance were carried out. Participants and research context: A total of 203 nurses were from two third-level teaching hospitals in Spain. Both centers are part of the University of Barcelona Health Network. Participants filled out the Ethical Conflict in Nursing Questionnaire–Critical Care Version. Ethical considerations: This investigation received the approval of the ethical committees for clinical investigation of the two participating hospitals. Participants were informed of the authorship and aims of the study. Findings: The index of exposure to ethical conflict was [Formula: see text]. The situations involving analgesic treatment and end-of-life care were shown to be frequent sources of conflict. The types of ethical conflict and moral states generally arranged themselves from lesser to greater levels of index of exposure to ethical conflict. Discussion: The moderate level of exposure to ethical conflict was consistent with other international studies. However, the situations related with family are infrequent, and this presents differences with previous research. The results suggest that there is a logical relationship between types of conflict and levels of exposure to ethical conflict. Conclusion: The types of ethical conflict and moral states were related with the levels of exposure to ethical conflict. The new perspective was shown to be useful for analyzing the phenomenon of ethical conflict in the nurse.
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Jansen, Trine-Lise, Marit Helene Hem, Lars Johan Dambolt, and Ingrid Hanssen. "Moral distress in acute psychiatric nursing: Multifaceted dilemmas and demands." Nursing Ethics 27, no. 5 (October 20, 2019): 1315–26. http://dx.doi.org/10.1177/0969733019877526.
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Background In this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored. Research design A qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used. Ethical considerations Approval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary. Findings Based on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness. Conclusion Moral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves.
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Bagherian, Samaneh, Farkhondeh Sharif, Ladan Zarshenas, Camellia Torabizadeh, Abbas Abbaszadeh, and Payam Izadpanahi. "Cancer patients’ perspectives on dignity in care." Nursing Ethics 27, no. 1 (May 16, 2019): 127–40. http://dx.doi.org/10.1177/0969733019845126.
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Background: Since “dignity” is one of the fundamental rights of every patient, consideration for patients’ dignity is essential. Unfortunately, in many cases, especially in cancer patients, dignity is not fully respected. Dignity is an abstract concept, and there are only a few comprehensive studies on the dignity of cancer patients in Iran. Research objective: This study aimed to evaluate the perception of Iranian cancer patients on human dignity. Research design: A qualitative research approach was used as the study design. The data were collected through individual semi-structured interviews and analyzed using the qualitative content analysis method. Participants and research context: This study was conducted on cancer patients in internal medicine wards in Iran. The data were gathered through semi-structured interviews from May 2017 to February 2018. Ethical considerations: The study protocol was approved by the Research Ethics Committee of medical universities located in Southwest of Iran. The ethical principles were carefully followed throughout the study. Findings: Based on the results of the interviews, 3 main themes and 11 categories were determined. The main themes were identified as the “personal space and privacy,” “respect for human values,” and “moral support.” Discussion: The results of the present study showed the necessity of care for cancer patients in a respectful manner. The key elements in such care were the preservation of their personal space and privacy, respect for their values, and the provision of adequate moral support. These measures will have a positive effect on the perception of such patients on human dignity. Conclusion: Considering the special care required by cancer patients, the Iranian healthcare and hygiene managers should design and implement a care plan that includes the ethical principles related to human dignity.
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Enskär, Karin. "Ethical Aspects of Judging the Alternative Treatment of Children With Cancer." Nursing Ethics 2, no. 1 (March 1995): 51–62. http://dx.doi.org/10.1177/096973309500200107.
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In recent decades the improved treatment of childhood cancer has increased the proportion of children being cured. However, the intensive treatment required also implies a heavy burden for the children and their families. The purpose of this article is to judge the ethical aspects of different treatment regimens used for children with cancer by means of a case study. The analysis is based on the ethical model by Beauchamp and Childress. The assessment is based on every person, or group of persons, involved and is on the principles of autonomy, nonmaleficence, beneficence and justice. The analysis shows that intensification of treatment of children with cancer is ethically justified from a deontological point of view. The consequences are more difficult to anticipate from a utilitarian perspective. Au cours de plusiurs décennies les traitements plus efficaces des cancers des enfants ont augmentés la proportion des enfants guéris. Pourtant, le traitement intensif pose aussi un lourd fardeau aux enfants et leurs familles. Le but de cet article est d'évaluer les implications éthiques des différents traitements utilisés pour enfants souffrants de cancer, à l'aide d'une étude particulière. L'analyse éthique est basée sur le modèle de Beauchamp et Childress. L'évaluation est basée sur chaque personne ou sur les groupes de personnes impliqués, et sur les principes d'autonomie, nonmaléficence, bénéficence et justice. L'analyse montre que l'intensification du traitement des enfants souffrant de cancer est justifié éthiquement du point de vue déontologique. Les conséquences de ces actions sont plus difficiles à prévoir vue d'une perspective utilitaire. Die verbesserte Behandlung von Kinderkrebs in den vergangenen Jahrzehnten hat die Proportion der geheilten Kinder ansteigen lassen. Die intensive Behandlung bedeutet aber auch eine schwere Belastung für die Kinder und ihre Familien. Der Zweck dieses Artikels ist es, die ethischen Aspekte der verschiedenen Behandlungsmethoden bei Kinderkrebs durch eine Fallstudie abzuwägen. Die ethische Analyse basiert auf dem ethischen Modell von Beauchamp und Childress. Die Beurteilung berücksichtigt jede betroffene Person oder Personengruppe und beruht auf den Prinzipien der Selbstbestimmung, Schädlichkeit bzw. Unschädlichkeit, Nutzen und Verträglichkeit und Gerechtigkeit. Diese Analyse zeigt, dass die Intensivierung der Behandlung von krebskranken Kindem von einem deontologischen Standpunkt aus ethisch vertretbar ist. Die Folgen der Behandlung sind jedoch vom Nützlichkeitsgesichtspunkt her schwieriger vorauszusehen.
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Bremer, Anders, María Jiménez Herrera, Christer Axelsson, Dolors Burjalés Martí, Lars Sandman, and Gian Luca Casali. "Ethical values in emergency medical services." Nursing Ethics 22, no. 8 (October 28, 2014): 928–42. http://dx.doi.org/10.1177/0969733014551597.
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Background: Ambulance professionals often address conflicts between ethical values. As individuals’ values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. Objectives: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles in Spain and Sweden. Methods: The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. Ethical considerations: This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. Findings: Spanish professionals favoured justice and Swedish professionals’ rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. Discussion: Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals’ moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. Conclusion: A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally – especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.
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Bartholdson, Cecilia, Margareta af Sandeberg, Kim Lützén, Klas Blomgren, and Pernilla Pergert. "Healthcare professionals’ perceptions of the ethical climate in paediatric cancer care." Nursing Ethics 23, no. 8 (August 3, 2016): 877–88. http://dx.doi.org/10.1177/0969733015587778.
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Background: How well ethical concerns are handled in healthcare is influenced by the ethical climate of the workplace, which in this study is described as workplace factors that contribute to healthcare professionals’ ability to identify and deal with ethical issues in order to provide the patient with ethically good care. Objectives: The overall aim of the study was to describe perceptions of the paediatric hospital ethical climate among healthcare professionals who treat/care for children with cancer. Research design: Data were collected using the Hospital Ethical Climate Survey developed by Olsson as a separate section in a questionnaire. Descriptive statistics were used to analyse perceptions of the ethical climate. Participants and research context: Physicians, nurses and nurse-aides (n = 89) from three paediatric units participated in this study: haematology/oncology, chronic diseases and neurology. Ethical considerations: The study was approved by the regional ethical review board. Findings: Different perceptions of the ethical climate were rated as positive or negative/neutral. Nurses’ ratings were less positive than physicians on all items. One-third of the participants perceived that they were able to practice ethically good care as they believed it should be practised. Discussion: Differences in professional roles, involving more or less power and influence, might explain why physicians and nurses rated items differently. A positive perception of the possibility to practice ethically good care seems to be related to inter-professional trust and listening to guardians/parents. A negative/neutral perception of the possibility to practice ethically good care appears to be influenced by experiences of ethical conflicts as well as a lack of ethical support, for example, time for reflection and discussion. Conclusion: The two-thirds of participants who had a negative/neutral perception of the possibility to practice ethically good care are at risk of developing moral stress. Clinical ethics support needs to be implemented in care where important values are at stake.
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Macpherson, Ignacio, María Victoria Roqué, and Ignacio Segarra. "Moral dilemmas involving anthropological and ethical dimensions in healthcare curriculum." Nursing Ethics 27, no. 5 (April 29, 2020): 1238–49. http://dx.doi.org/10.1177/0969733020914382.
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Background Currently a variety of novel scenarios have appeared within nursing practice such as confidentiality of a patient victim of abuse, justice in insolvent patients, poorly informed consent delivery, non-satisfactory medicine outputs, or the possibility to reject a recommended treatment. These scenarios presuppose skills that are not usually acquired during the degree. Thus, the implementation of teaching approaches that promote the acquisition of these skills in the nursing curriculum is increasingly relevant. Objective The article analyzes an academic model which integrates in the curriculum a series of specific theoretical concepts together with practical skills to acquire the basic ethic assessment competency. Research design The project includes designing two subjects, General Anthropology and Ethics-Bioethics, with an applied approach in the nursing curriculum. The sequential structure of the curriculum in both subjects is constituted by three learning domains (theoretical, practical, and communicative) with different educational strategies. Ethical considerations No significant ethical considerations as this is a discussion paper. Findings The model was structured from the anthropology’s concepts and decision-making process, applied to real situations. The structure of the three domains theoretical–practical–communicative is present in each session. Discussion It is observed that theoretical domain fosters the capacity for critical analysis and subsequent ability to judge diverse situations. The practical domain reflected two significant difficulties: students’ resistance to internalizing moral problems and the tendency to superficial criticism. The communicative domain has frequently shown that the conflicting points are in the principles to be applied. Conclusion We conclude that this design achieves its objectives and may provide future nursing professionals with ethical competences especially useful in healthcare practice. The three domains of the presented scheme are associated with the same process used in decision making at individual levels, where the exercise of clinical prudence acquires particular relevance.
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Barlow, Nichola Ann, Janet Hargreaves, and Warren P. Gillibrand. "Nurses’ contributions to the resolution of ethical dilemmas in practice." Nursing Ethics 25, no. 2 (May 3, 2017): 230–42. http://dx.doi.org/10.1177/0969733017703700.
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Background: Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas. Aims: To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice. Design: An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from the local National Research Ethics Committee. Findings: Four major themes emerged: ‘best for the patient’, ‘accountability’, ‘collaboration and conflict’ and ‘concern for others’. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas. Discussion: Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making. Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas.
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Ping Fen Tang, Camilla Johansson, Barbro Wadensten, Stig Wenneberg, and Gerd Ahlström. "Chinese Nurses' Ethical Concerns in a Neurological Ward." Nursing Ethics 14, no. 6 (November 2007): 810–24. http://dx.doi.org/10.1177/0969733007082140.
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Our aim was to describe Chinese nurses' experiences of workplace distress and ethical dilemmas on a neurological ward. Qualitative interviews were performed with 20 nurses. On using latent content analysis, themes emerged in four content areas: ethical dilemmas, workplace distress, quality of nursing and managing distress. The ethical dilemmas were: (1) conflicting views on optimal treatment and nursing; (2) treatment choice meeting with financial constraints; and (3) misalignment of nursing responsibilities, competence and available resources. The patients' relatives lacked respect for the nurses' skills. Other dilemmas could be traced to the transition from a planned to a market economy, resulting in an excessive workload and treatment withdrawal for financial reasons. Lack of resources was perceived as an obstacle to proper patient care in addition to hospital organization, decreasing the quality of nursing, and increasing moral and workplace distress. The nurses managed mainly by striving for competence, which gave them hope for the future.
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Brodtkorb, Kari, Anne Valen-Sendstad Skisland, Åshild Slettebø, and Ragnhild Skaar. "Ethical challenges in care for older patients who resist help." Nursing Ethics 22, no. 6 (August 21, 2014): 631–41. http://dx.doi.org/10.1177/0969733014542672.
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Background: Situations where patients resist necessary help can be professionally and ethically challenging for health professionals, and the risk of paternalism, abuse and coercion are present. Research question: The purpose of this study was to examine ethical challenges in situations where the patient resists healthcare. Research design: The method used was clinical application research. Academic staff and clinical co-researchers collaborated in a hermeneutical process to shed light on situations and create a basis for new action. Participants and research context: Four research groups were established. Each group consisted of six to eight clinical co-researchers, all employees with different health profession backgrounds and from different parts of the municipal healthcare services, and two scientific researchers. Ethical considerations: The study was conducted in compliance with ethical guidelines and principles. Participants were informed that participation was voluntary and that confidentiality would be maintained. They signed a consent form. Findings: The findings showed that the situations where patients opposed help related to personal hygiene, detention in an institution and medication associated with dental treatment. The situations were perceived as demanding and emotionally stressful for the clinicians. Discussion: The situations can be described as everyday ethics and are more characterised by moral uncertainty and moral distress than by being classic ethical dilemmas. Conclusion: Norwegian legislation governing the use of force seems to provide decision guidance with the potential to reduce uncertainty and moral stress if the clinicians’ legal competence had been greater.
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Freeland, Cynthia. "Ethical Engagement with Movies." Projections 13, no. 3 (December 1, 2019): 105–11. http://dx.doi.org/10.3167/proj.2019.130308.
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In Screen Stories, Carl Plantinga concedes that films have considerable power to manipulate our emotions, attitudes, and even action tendencies. Still, he believes that film viewers do consciously engage in various types of cognition and judgment, and thus he argues that they can resist films’ manipulations. The “engaged critic” he calls for can assist in assessing how films create and convey their moral messages. I raise some questions about the account Plantinga gives of how both character engagement and narrative structures contribute to filmic manipulation. First, I note that there is an unresolved active/passive tension in his picture of film viewers. Second, I suggest that his treatment of narrative paradigm scenarios does not offer a strong enough account of the specifically filmic aspects of screen stories and how they differ from literary stories. And finally, I raise some questions about his ideal of the ethically engaged film critic and the social role to be played by such a critic.
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LOVELESS, SHERRY E., and JAMES GIORDANO. "Neuroethics, Painience, and Neurocentric Criteria for the Moral Treatment of Animals." Cambridge Quarterly of Healthcare Ethics 23, no. 2 (February 4, 2014): 163–72. http://dx.doi.org/10.1017/s0963180113000698.
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Abstract:Neuroscience affords knowledge that can be leveraged in the ontological valuation of individuals, groups, and species. Sociocultural sentiments, norms, and mores may impede embracing such knowledge to revise moral attitudes, ethics, and policies. We argue that the practices of neuroethics will be valuable in that they ground ethico-legal discourse in (1) naturalistic philosophy; (2) the current epistemological capital of neuroscience; (3) the issues, problems, and solutions arising in and from neuroscientific research and its applications; and 4) the use of neurocentric criteria—such as painience—to define and resolve ethical decisions regarding attitudes toward and treatment of nonhuman animals.
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McDonnell, Melissa, and Robert T. M. Phillips. "Physicians Should Treat Mentally Ill Death Row Inmates, Even if Treatment is Refused." Journal of Law, Medicine & Ethics 38, no. 4 (2010): 774–88. http://dx.doi.org/10.1111/j.1748-720x.2010.00531.x.
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The history of physician involvement in capital proceedings is longstanding and ripe with controversy and conflicts of ethical concerns. Previously one of us (Phillips) has written that the controversy is more appropriately characterized as a conflict of moral position rather than one of ethical dilemma.In hindsight, we believe that analysis, while true, does not capture the depth or complexity of the issue.Forensic psychiatric evaluations, including competency to be executed evaluations, are done with a clear understanding that no physician-patient relationship exists. Treatment, however, is not so neatly re-categorized in large measure because it involves the physician’s active provision of the healing arts.
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Hem, Marit Helene, Elisabeth Gjerberg, Tonje Lossius Husum, and Reidar Pedersen. "Ethical challenges when using coercion in mental healthcare: A systematic literature review." Nursing Ethics 25, no. 1 (March 1, 2016): 92–110. http://dx.doi.org/10.1177/0969733016629770.
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Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according to the Vancouver Protocol. Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress.
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Pikuza, O. I., A. M. Zakirova, and N. K. Shoshina. "Actual aspects of medical ethics in training of the pediatrician." Kazan medical journal 95, no. 3 (June 15, 2014): 469–71. http://dx.doi.org/10.17816/kmj1538.
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Nowadays the problems of medical ethics are gaining the special significance as a result of changes in social and economic relations, healthcare modernization due to appearance of new effective methods for instrumental and laboratory examinations, treatment approaches, development of market relations in medicine. The aim of the presented paper is to cover the actual aspects of medical ethics in pediatrics. The paper reviews the ethical aspects of the work of a in detail. Differentiated approach in choosing pediatrician interns, which is based not only on academic progress, but also on professional and moral qualities of the medical university alumni and continuity in their upbringing starting form the first years of the medical school until the end of post-graduate education, seems rationale. It is during the student years when the cognitive and moral values of a forthcoming specialist are formed, which may be a criterion of a suitability of working with children. The roles of the competition, including the modular approach to knowledge evaluation, professional competencies and rating system are stressed. Considering the modern requirements to a young professional, the accent is made on the role of the leading tutor in a forthcoming specialist formation. The requirements to a higher education teacher and the importance of the moral atmosphere in hospitals and faculties for forming the ethical features of a forthcoming pediatrician and improving his/her professional level according to the medical progress are outlined. Thus, teaching pediatrics has a lot of particularities, including teaching the basics of medical ethics, having an extremely important role in professional education of pediatricians for proper forming of the young professional according to contemporary life requirements.
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Settle, Peggy Doyle. "Nurse Activism in the newborn intensive care unit." Nursing Ethics 21, no. 2 (March 1, 2013): 198–209. http://dx.doi.org/10.1177/0969733012475254.
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Nurses working in a newborn intensive care unit report that treatment decision disagreements for infants in their care may lead to ethical dilemmas involving all health-care providers. Applying Rest’s Four-Component Model of Moral Action as the theoretical framework, this study examined the responses of 224 newborn intensive care unit nurses to the Nurses Ethical Involvement Survey. The three most frequent actions selected were as follows: talking with other nurses, talking with doctors, and requesting a team meeting. The multiple regression analysis indicates that newborn intensive care unit nurses with greater concern for the ethical aspects of clinical practice (p = .001) and an increased perception of their ability to influence ethical decision making (p = .018) were more likely to display Nurse Activism. Future research is necessary to identify other factors leading to and inhibiting Nurse Activism as these findings explained just 8.5% of the variance.
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Schenck, David P. "Ethical Considerations in the Treatment of Head and Neck Cancer." Cancer Control 9, no. 5 (September 2002): 410–19. http://dx.doi.org/10.1177/107327480200900506.
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Background The second half of the 20th century saw not only important developments in medical science and technology, but also a rapid growth in the application of biomedical ethics in medical decision making. Withdrawal of treatment, allowing to die, informed consent, and patient autonomy are concerns that now comprise a part of the overall medical treatment, particularly in patients with head and neck cancers. Methods The author discusses ethical issues relating to disfigurement/dysfunction in head and neck cancer patients and examines the aspects of “principlism” — autonomy, nonmaleficence, beneficence, and justice. Two case reports are presented to illustrate the ethical challenges that may confront physicians who treat head and neck cancer patients. Results Head and neck oncology generates unique problems relating to disfigurement and dysfunction. An algorithm that considers the patient's medical good and greater good, as well as the goods of others, can assist in arriving at appropriate ethical decisions. Conclusions Bioethical decision making requires the integration of virtues with principles, followed by the application of these standards to each patient.
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Denburg, Avram. "Social values and cancer funding priorities: Empirical evidence for cancer policy." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18352-e18352. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18352.
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e18352 Background: Achieving value in health care requires knowledge of public values and priorities. To better understand public values for resource allocation on cancer care, we conducted a population-based stated preference survey with a nested randomized controlled moral reasoning intervention. Our objective was to generate evidence to inform economic evaluation and policymaking on cancer care priority-setting and payment reform in developed health systems. Methods: We conducted a population-based stated preference survey of societal views on the prioritization of health resources between children and adults, administered to a nationally representative sample (n = 1,556) of Canadian adults. Allocative preferences were elicited across a range of hypothetical treatment scenarios and scored on a visual analogue scale. Participants were randomized to a moral reasoning intervention (n = 773) or a control group (n = 783). Those randomized to the intervention group were exposed to a moral reasoning exercise prior to each choice task. The exercise presented participants with a list of ethical principles relevant to health care resource allocation and tasked them to select the top principles guiding their choice. The main outcomes were the difference in mean preference scores by group, scenario, and participant demographics. Results: Multiple regression analyses demonstrated a consistent aggregate preference by participants to allocate scarce health system resources to children. Exposure to the moral reasoning exercise weakened but did not eliminate allocative preference for children, as compared to control (difference 0.72, SE 0.14, p < 0.0001). Younger respondent age (-0.71, SE 0.14, p < 0.0001) and parenthood (-0.40, SE 0.11, p < 0.0002) were associated with greater preference for children. The top three principles guiding participants’ allocative decisions were treat equally (54.3-63.9%), relieve suffering (39.6-66.1%), and rescue those at risk of dying (37-40.8%). Conclusions: Our results demonstrate a significant preference by participants to allocate health care resources to children, but one attenuated by exposure to a range of ethical principles to guide decision-making. It also evinced strong support for humanitarian principles to guide health care resource allocation. Definitions of value in health care based primarily on the magnitude of clinical benefit and cost-effectiveness may exclude moral considerations that the public values.
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Baxter, Rosario, Ann Long, and David Sines. "The Legal and Ethical Status of Children in Health Care in the UK." Nursing Ethics 5, no. 3 (May 1998): 189–99. http://dx.doi.org/10.1177/096973309800500302.
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Ethical issues about children’s rights in respect of matters concerning resource allocation or treatment opportunities are now a matter for public consumption and concern. Alongside this exists a long-frustrated desire by children’s nurses to promote children’s health. Long-held assumptions about the legal and moral status of children within the health care system in this country are now rightly scrutinized and challenged. Those of us who claim to represent children now possess an opportunity to exploit public attention for the benefit of these children. This article will explore selected major relevant legal and moral concepts that relate to children with the aim of making transparent some of the important and often confusing information available. It is anticipated that debates about the legal and ethical status of children may be stimulated and fuelled from the following discussion. It is strongly recommended that entering into dialogue with families and children about their perceived needs will go a long way towards advancing thoughtful nursing care of individual children, their families and the general population.
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Iglesias, Marta Elena Losa, Ricardo Becerro de Bengoa Vallejo, Paloma Salvadores Fuentes, and Michael J. Trepal. "Comparative Analysis of Moral Distress and Values of the Work Organization Between American and Spanish Podiatric Physicians." Journal of the American Podiatric Medical Association 102, no. 1 (January 1, 2012): 57–63. http://dx.doi.org/10.7547/1020057.
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Background: Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress. Methods: A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N = 186) presented statements about different ethical dilemmas, values, and goals in the workplace. Results: Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients’ treatment and economic constraints, overload of paperwork, and acting against one’s conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results. Conclusions: The results underline the significance of moral distress for both samples, mainly related to time constraints and organizational aspects concerning patients and lack of resources. (J Am Podiatr Med Assoc 102(1): 57–63, 2012)
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Melis, Paola, Maura Galletta, Cesar Ivan Aviles Gonzalez, Paolo Contu, and Maria Francisca Jimenez Herrera. "Ethical perspectives in communication in cancer care: An interpretative phenomenological study." Nursing Ethics 27, no. 6 (May 14, 2020): 1418–35. http://dx.doi.org/10.1177/0969733020916771.
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Background: In cancer care, many clinical contexts still lack a good-quality patient–health professional communication about diagnosis and prognosis. Information transmission enables patients to make informed choices about their own healthcare. Nevertheless, disclosure is still an ethically challenging clinical problem in cancer care. High-quality care can be achieved by understanding the perspectives of others. The perspective of patients, their caregivers, physicians and nurses have seldom been simultaneously studied. Objective: To investigate the phenomenon of diagnosis and prognosis-related communication as experienced by patients, their caregivers, and both their attending nurses and physicians, to enlighten meanings attached to communication by the four parties. Methods: A qualitative study using interpretative phenomenological analysis was performed. Participants and research context: Purposive sampling of six patients, six caregivers, seven nurses and five physicians was performed in two oncological hospitals in Italy. Ethical considerations: Local Ethics Committee approved the study. It was guided by the ethical principles of voluntary enrolment, anonymity, privacy and confidentiality. Results: Three main themes were identified: (a) the infinite range of possibilities in knowing and willing to know, (b) communication with the patient as a conflicting situation and (c) the bind of implicit and explicit meaning of communication. Conclusion: The interplay of meanings attached by patients, their caregivers, and their attending oncologist and nurse to communication about diagnosis and prognosis revealed complexities and ambiguities not yet settled. Physicians still need to solve the ethical tensions in their caring relationship with patients to really allow them ‘to choose with dignity and being aware of it’. Nurses need to develop awareness about their role in diagnosis and prognosis-related communication. This cognizance is essential not just to assure consistency of communication within the multi-disciplinary team but mostly because it allows and enables the moral agent to take its own responsibilities and be accountable for them.
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Litton, Paul, and Franklin G. Miller. "A Normative Justification for Distinguishing the Ethics of Clinical Research from the Ethics of Medical Care." Journal of Law, Medicine & Ethics 33, no. 3 (2005): 566–74. http://dx.doi.org/10.1111/j.1748-720x.2005.tb00519.x.
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In the research ethics literature, there is strong disagreement about the ethical acceptability of placebo-controlled trials, particularly when a tested therapy aims to alleviate a condition for which standard treatment exists. Recently, this disagreement has given rise to debate over the moral appropriateness of the principle of clinical equipoise for medical research. Underlying these debates are two fundamentally different visions of the moral obligations that investigators owe their subjects.Some commentators and ethics documents claim that physicians, whether acting as care givers or researchers, have the same duty of beneficence towards their patients and subjects: namely, that they must provide optimal medical care. In discussing placebo surgery in research on refractory Parkinson's disease, Peter Clark succinctly states this view: “The researcher has an ethical responsibility to act in the best interest of subjects.”
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Kuuppelomäki, Merja, and Sirkka Lauri. "Ethical Dilemmas in the Care of Patients with Incurable Cancer." Nursing Ethics 5, no. 4 (July 1998): 283–93. http://dx.doi.org/10.1177/096973309800500402.
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This article aims to identify and describe the ethical dilemmas that are involved in the care of patients with incurable cancer. The data were collected in semistructured focused interviews with 32 patients, 13 nurses and 13 doctors from two central hospitals and four community health centres. The interviews were tape-recorded and transcribed verbatim. Interpretation was based on the method of content analysis. Ethical dilemmas occurred at the time of diagnosis, in connection with telling the truth, in providing information, in the treatment of pain, and in decision-making situations concerning active treatment. Dilemmas of active treatment concerned chemotherapy, intravenous infusions, blood transfusions and antibiotics. There were also problems in relationships between nursing staff and next of kin, as well as a lack of co-operation between nurses and doctors.
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Georges, Jean-Jacques, and Mieke Grypdonck. "Moral Problems Experienced by Nurses when Caring for Terminally Ill People: a literature review." Nursing Ethics 9, no. 2 (March 2002): 155–78. http://dx.doi.org/10.1191/0969733002ne495oa.
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This article is a review of the literature on the subject of how nurses who provide palliative care are affected by ethical issues. Few publications focus directly on the moral experience of palliative care nurses, so the review was expanded to include the moral problems experienced by nurses in the care of the terminally ill patients. The concepts are first defined, and then the moral attitudes of nurses, the threats to their moral integrity, the moral problems that are perceived by nurses, and the emotional consequences of these moral problems are considered in turn. The results show that the moral behaviour of nurses, which is theoretically grounded in commitment to care and to the patient, appears to be shaped by specific processes that lead to engagement or to mental and behavioural disengagement in morally difficult situations. Nurses often appear to fail to recognize the moral dimensions of the problems they experience and also to lack the skills they need to resolve moral problems adequately. Although the findings show that several elements that are beyond the control of nurses, owing to their lack of autonomy and authority, influence their moral experience, intrinsic factors such as feelings of insecurity and powerlessness have a profound effect on nurses’ perceptions and attitudes in the face of moral problems. The moral problems perceived by these nurses are related to end-of-life issues, communication with patients, the suffering of patients, and the appropriateness of the medical treatment.
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Axelsson, Lena, Eva Benzein, Jenny Lindberg, and Carina Persson. "Processes toward the end of life and dialysis withdrawal Physicians’ and nurses’ perspectives." Nursing Ethics 27, no. 2 (June 11, 2019): 419–32. http://dx.doi.org/10.1177/0969733019848050.
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Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.
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Tsimmerman, Y. S. "Persistent delusions of modern gastroenterology." Bulletin of the Club of Pancreatologists 35, no. 1 (March 6, 2017): 46–54. http://dx.doi.org/10.33149/vkp.2017.01.09.
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The author shares his thoughts about exaggerating the role of infection with Helicobacter pylori in etiology and pathogenesis of chronic gastritis, peptic ulcer disease, gastric cancer. Arguments against the common concept of functional gastrointestinal disorders, formulation of syndromic rather than nosological diagnosis are represented. Particular attention is paid to the moral and ethical aspects of the use of placebo in clinical trials. The shortcomings and errors of the terms that are used in modern gastroenterology are analyzed in detail.
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Regan, Á., M. Henchion, and B. McIntyre. "Ethical, moral and social dimensions in farm production practices: a segmentation study to assess Irish consumers’ perceptions of meat quality." Irish Journal of Agricultural and Food Research 57, no. 1 (March 9, 2018): 9–14. http://dx.doi.org/10.1515/ijafr-2018-0002.
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AbstractGrowing consumer concerns with modern farming and food production systems indicate a significant market opportunity for meat production practices that consider ethical, moral and social value traits. In the current study, we aimed to identify and characterise distinct segments of Irish consumers based on their perceptions of the quality of meat from different farm-level production practices (organic farming, high animal welfare standards, free range farming, and “natural”, treatment-free feeding regimes). An online survey was carried out with 251 Irish meat consumers. Using cluster analysis, we identified three distinct segments: “Target consumers”, “Purist consumers” and “Disinterested consumers”. Chi-square analyses revealed differences between the segments based on gender, age and meat-purchasing motivations. The results provide insight into the opportunities that exist for exploring new viable market segments as well as for engaging Irish consumers and empowering them with information around the ethical, social and moral aspects of farm-level practices related to meat production.
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Mor, Pnina, and Kathleen Oberle. "Ethical Issues Related To BRCA Gene Testing in Orthodox Jewish Women." Nursing Ethics 15, no. 4 (July 2008): 512–22. http://dx.doi.org/10.1177/09697330080150041201.
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Persons exhibiting mutations in two tumor suppressor genes, BRCA1 and BRCA2, have a greatly increased risk of developing breast and/or ovarian cancer. The incidence of BRCA gene mutation is very high in Ashkenazi Jewish women of European descent, and many issues can arise, particularly for observant Orthodox women, because of their genetic status. Their obligations under the Jewish code of ethics, referred to as Jewish law, with respect to the acceptability of various risk-reducing strategies, may be poorly understood. In this article the moral direction that Jewish law gives to women regarding testing, confidentiality, and other issues is explored. The intent is to broaden nurses' knowledge of how a particular religious tradition could impact on decision making around genetics testing, with the aim of enhancing their understanding of culturally sensitive ethical care.
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Shrager, Jeff, Mark Shapiro, and William Hoos. "Is Cancer Solvable? Towards Efficient and Ethical Biomedical Science." Journal of Law, Medicine & Ethics 47, no. 3 (2019): 362–68. http://dx.doi.org/10.1177/1073110519876164.
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Global Cumulative Treatment Analysis (GCTA) is a novel clinical research model combining expert knowledge, and treatment coordination based upon global information-gain, to treat every patient optimally while efficiently searching the vast space that is the realm of cancer research.
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Miljeteig, Ingrid, Ingeborg Forthun, Karl Ove Hufthammer, Inger Elise Engelund, Elisabeth Schanche, Margrethe Schaufel, and Kristine Husøy Onarheim. "Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway." Nursing Ethics 28, no. 1 (January 12, 2021): 66–81. http://dx.doi.org/10.1177/0969733020981748.
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Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval granted by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms.
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Leever, Martin G. "Cultural competence: Reflections on patient autonomy and patient good." Nursing Ethics 18, no. 4 (July 2011): 560–70. http://dx.doi.org/10.1177/0969733011405936.
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Terms such as ‘cultural competence’ and ‘transcultural nursing’ have comfortably taken their place in the lexicon of health care. Their high profile is a reflection of the diversity of western societies and health care’s commitment to provide care that is responsive to the values and beliefs of all who require treatment. However, the relationship between cultural competence and familiar ethical concepts such as patient autonomy has been an uneasy one. This article explores the moral foundations of cultural competence, ultimately locating them in patient autonomy and patient good. The discussion of patient good raises questions about the moral relevance of a value’s rootedness in a particular culture. I argue that the moral justification for honoring cultural values has more to do with the fact that patients are strongly committed to them than it does with their cultural rootedness. Finally, I suggest an organizational approach to cultural competence that emphasizes overall organizational preparedness.
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Post, Stephen G. "Dementia in Our Midst: The Moral Community." Cambridge Quarterly of Healthcare Ethics 4, no. 2 (1995): 142–47. http://dx.doi.org/10.1017/s0963180100005818.
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This article focuses on the elderly patient with a progressive and irreversible dementia, most often of the Alzheimer type. However dementia, the decline in mental function from a previous state, can occur in all ages. For example, if Alzheimer's disease (AD) is the dementia of the elderly, increasingly AIDS is the dementia of many who are relatively young. I will not present the major ethical issues relating to dementia care following the progression of disease from the mild to the severe stages, for I have done this elsewhere. Among the issues included are: presymptomatic testing, both psychological and genetic; responsible diag- nostic disclosure and use of support groups; restrictions on driving and other activities; preemptive assisted suicide; advance directives for research and treatment; quality of life in relation to the use of life-extending technologies; and euthanasia.
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Hultman, C. M., A. C. Lindgren, M. G. Hansson, J. Carlstedt-Duke, M. Ritzen, I. Persson, and H. Kieler. "Ethical Issues in Cancer Register Follow-Up of Hormone Treatment in Adolescence." Public Health Ethics 2, no. 1 (April 1, 2009): 30–36. http://dx.doi.org/10.1093/phe/php003.
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Bayefsky, Michelle J. "The Ethical Case for Mandating HPV Vaccination." Journal of Law, Medicine & Ethics 46, no. 2 (2018): 501–10. http://dx.doi.org/10.1177/1073110518782957.
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When the HPV vaccine was released over a decade ago, there was intense opposition to mandating the vaccine, including among bioethics and legal scholars. Some of the original concerns are now obsolete, while other objections continue to present an obstacle to mandating the vaccine. This essay responds to earlier critiques of mandatory HPV vaccination and offers a series of arguments in support of a vaccine mandate. The first section briefly addresses initial concerns that are no longer relevant. The second section makes the ethical case for mandating HPV vaccination, based on three principles: 1) the best interests of children, 2) solidarity, and 3) health equity. The final section addresses concerns related to implementation of the vaccine, including the validity of linking vaccination to school entry. The essay concludes that we have a moral imperative to protect children from the leading cause of cervical cancer, and that mandating HPV vaccination is the best way to ensure that children of all backgrounds receive the vaccine before they have been exposed to the virus.
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Delong, Marek. "Moral and ethical aspects of the Polish transition from communism in the enunciations of the Polish Episcopate." Annales. Etyka w Życiu Gospodarczym 20, no. 7 (February 25, 2017): 117–29. http://dx.doi.org/10.18778/1899-2226.20.7.09.
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The Polish Episcopate critically assessed the social and economic situation in Poland in the period of the transition from communism to democracy and a freemarket economy. Privatisation led to production being stopped and to an increase in unemployment. Profit and not human dignity became the measure of labour. The economic and social reality was dominated by the treatment of economics and financial success as of the highest values and the dissemination of the opinion that in politics and economics there are no values. The political elites showed an inability to develop long-term strategies for getting out of the crisis. The disappearance of the morality of many representatives of public life, which was manifested in universal corruption and the aspiration to improve social status as soon as possible, contributed to this state of affairs. As a result, there was a crisis of the idea of the common wealth and an increase in crime. The social crisis was particularly visible in moral attitudes, social behaviour, and in the economic sphere, public finance, on the labour market, and in the quickly progressing social stratification.
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Gamoneda Lanza, Amelia. "La chute dans la conscience. Animalité, philosophie et cognition dans l’oeuvre de Camus." Çédille, no. 18 (2020): 415–43. http://dx.doi.org/10.25145/j.cedille.2020.18.17.
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Camus’s work contains «blind and instinctive» aspects that the author himself pointed out as insufficiently considered by the critics. The questioning of conscience from a cognitive and moral point of view runs through his entire production, often trying to situate itself in the uncertain division that separates and brings together the animal and man. This epistemic critical axis –which straddles philosophy and the cognitive sciences– will serve in this article to analyze the articulation between L'Étranger and La Chute that makes Clamence into Meursault’s reverse. The nostalgia for an innocent paradise, the ethical and moral problem of violence and the consideration of death receive in Camus’ thought a cognitive treatment that links the phenomenological phylosophie of his time with the current biology of consciousness or evolutionary anthropology.
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Haghighinezhad, Ghazaleh, Foroozan Atashzadeh-Shoorideh, Tahereh Ashktorab, Jamileh Mohtashami, and Maasoumeh Barkhordari-Sharifabad. "Relationship between perceived organizational justice and moral distress in intensive care unit nurses." Nursing Ethics 26, no. 2 (July 28, 2017): 460–70. http://dx.doi.org/10.1177/0969733017712082.
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Background: The nature of the nursing profession pays more attention to ethics of healthcare than its therapeutic dimension. One of the prevalent moral issues in this profession is moral distress. Moral distress appears more in intensive care units due to the widespread need for moral decision-making regarding treatment and care in emergency situations. In this connection, organizational justice is of high importance and, as a significant motivational tool, leaves important impacts upon attitude and behavior of personnel. Aim/objective: This study aimed at investigation of the relationship between perceived organizational justice and moral distress in intensive care unit nurses. Research design: This is a descriptive-correlational research which examined the relationship between perceived organizational justice and moral distress in intensive care unit nurses. Participants and research context: A total of 284 intensive care unit nurses were selected via census sampling. The data were collected through questionnaires and then were analyzed via SPSS-20 using Pearson and Spearman correlation tests. Ethical considerations: This study was approved by the Committee of Ethics in Medical Research. Completion of informed consent form, guarantee of the confidentiality of information, explanation on purposes of the research, and voluntary participation in the study were moral considerations observed in this study. Findings: There was a statistically significant negative correlation between the total perceived organizational justice and the total moral distress (p = 0.024, r = −0.137) and also between “procedural and interactional justice and errors” and “not respecting the ethics principles.” Meanwhile, no relationship was found by the findings between distributive justice and dimensions of moral distress. Conclusion: According to the results of the study, there was a reverse significant relationship between moral distress and perceived organizational justice; therefore, the head nurses are expected to contribute to reduce moral distress and to increase perceived organizational justice in nurses.