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1
Jayawardena, Hemamal. "AIDS and Professional Secrecy in the United States." Medicine, Science and the Law 36, no. 1 (January 1996): 37–42. http://dx.doi.org/10.1177/002580249603600108.
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Objective: To create a legal awareness of AIDS patients' right to privacy among the medical profession. Discussion and recommendations: Doctors should recognize confidentiality as a patient's right, since in most countries the AIDS patient is practically considered a person who is going through a punishment, having no legal rights, rather than a patient suffering from a grave illness. Originally the common law did not recognize the concept of professional secrecy as a right of the patient. It was only regarded as an ethical duty not actionable in court. But with the eruption of diseases such as AIDS, statutes requiring written authorization for the release of confidential information were enacted. A problem with our hospital records is that they are freely available to almost all the staff in the hospitals and sometimes even to outsiders. In the case of AIDS at least, strict measures should be taken to enforce secrecy in relation to all disease-related information such as sexual history, HIV status and CD4 cell counts. The duty to keep medical information confidential is not absolute. An overriding duty towards society, occurs when the benefits of disclosure outweigh its harm. This Utopian argument is even more convincing when an HIV-positive person is acting irresponsibly, engaging in risky behaviour without warning the partner. All persons who have a compelling interest, such as sexual partners, needle sharers, medical and nursing personnel, should be provided with this information. It should also extend to mortuary attendants when the patient dies. A person having a STD has a legal duty to take precautions against transmission. In Berner v. Caldwell (543 So. 2d. 686), the US court held that one who knows or should reasonably know that he has genital herpes is under a duty to abstain from sex or warn others before risky contact. As doctors we should familiarize ourselves now with the concepts and laws regarding patients' rights, without waiting until a malpractice crisis develops to correct ourselves.
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Rottman, Steven J., Kimberley I. Shoaf, Jennifer Schlesinger, Eva Klein Selski, Joey Perman, Kerry Lamb, and Janet Cheng. "Pandemic Influenza Triage in the Clinical Setting." Prehospital and Disaster Medicine 25, no. 2 (April 2010): 99–104. http://dx.doi.org/10.1017/s1049023x00007792.
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AbstractIntroduction:There has been much federal and local health planning for an influenza pandemic in the United States, but little is known about the ability of the clinical community to deal quickly and effectively with a potentially overwhelming surge of pandemic influenza patients.Problem:The attitudes and expectations of emergency physicians, emergency nurses, hospital nursing supervisors, hospital administrators, and infection control personnel concerning clinical care in a pandemic were assessed.Methods:Key informant structured interviews of 46 respondents from 34 randomly selected emergency receiving hospitals in Los Angeles County were conducted using an Institutional Review Board-approved protocol. The interview asked about supplies/resources, triage, quality of care, and decision-making. At the conclusion of each interview, the informant was asked to provide the contact information for at least two others within their respective professional group. Interviews were transcribed and coded for key themes using qualitative analytical software.Results:There was little salience that an influx of variably ill patients with influenza would force stratified healthcare decision-making. There also was a general lack of preparation to address the ethics and practices of triaging patients in the clinical setting of a pandemic.Conclusions:Guidelines must be developed in concert with public health, medical society, and legislative authorities to help clinicians define, adopt, and communicate to the public those practice standards that will be followed in a mass population, infectious disease emergency.
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Clark, Peter A. "Medical Ethics at Guantanamo Bay and Abu Ghraib: The Problem of Dual Loyalty." Journal of Law, Medicine & Ethics 34, no. 3 (2006): 570–80. http://dx.doi.org/10.1111/j.1748-720x.2006.00071.x.
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Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation, or signs of torture. Mounting information from many sources, including Pentagon documents, the International Committee of the Red Cross (ICRC), Amnesty International, Human Rights Watch, etc., indicate that medical personnel failed to maintain medical records, conduct routine medical examinations, provide proper care of disabled and injured detainees, accurately report illnesses and injuries, and falsified medical records and death certificates. Medical personnel and medical information was also used to design and implement psychologically and physically coercive interrogations. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism.
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Semenoh, Olena, and Olena Kravchenko. "PROFESSIONAL ETHICS IN LINGUA-CULTURAL DIMENSIONS: AMERICAN EXPERIENCE." Aesthetics and Ethics of Pedagogical Action, no. 16 (September 9, 2017): 70–83. http://dx.doi.org/10.33989/2226-4051.2017.16.175981.
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The article outlines the concepts "nurse", "professional ethics of nurses." The professional ethics of nurses has been defined as a component of medical ethics which studies moral consciousness, moral and ethical aspects of professional activity, moral principles and values that regulate the moral relationship between s nurse and s patient, the patient's family, other members of the medical community and community. The analysis of foreign and Ukrainian experience of formation of nurses’ professional ethics gives grounds to characterize the quality as a set of interrelated cognitive, praxeological, communicative components; their presence allows to interact productively with the professional and social environment on the basis of professionally important ethical knowledge, skills, professional important qualities that are aimed at the effective organization of the medical-preventive process and the solution of professional tasks. The content of the professional ethics of a future nurse consists of ethical categories and professionally important ethical qualities such as: professional duty, responsibility, dignity, conscience, honor, respect, mercy, empathy, tolerance.The peculiarities of educational programs of future licensed younger nurses training (LPN) in the United States aimed at the formation of professional ethics have been outlined. A review of the linguistic- cultural aspect of the formation of nurses’ professional ethics at American higher education institutions has been conducted. The experience of classes on "Nursing Ethics", "Foreign Language" at Cherkasy Medical Academy has been presented; they are aimed at understanding the world of the profession, the culture of communication in medical community, ethical behavior, moral relations, prevention of conflict situations, and provision of psychological support.
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Fargen, Kyle M., Adam S. Arthur, Thabele Leslie-Mazwi, Rebecca M. Garner, Carol A. Aschenbrenner, Stacey Q. Wolfe, Sameer A. Ansari, et al. "A survey of burnout and professional satisfaction among United States neurointerventionalists." Journal of NeuroInterventional Surgery 11, no. 11 (April 11, 2019): 1100–1104. http://dx.doi.org/10.1136/neurintsurg-2019-014833.
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BackgroundThe toll of burnout on healthcare is significant and associated with physician depression and medical errors.ObjectiveTo assess the prevalence and risk factors for burnout among neurointerventionalists.MethodsA 39-question online survey containing questions about neurointerventional practice and the Maslach Burnout Inventory-Human Services Survey for medical personnel was distributed to members of major US neurointerventional physician societies.Results320 responses were received. Median (interquartile range) composite scores for emotional exhaustion were 25 (16–35), depersonalization 7 (4–12), and personal accomplishment 39 (35–44). 164/293 respondents (56%) met established criteria for burnout. There was no significant relationship between training background, practice setting, call frequency, or presence of a senior partner on burnout prevalence. Multiple logistic regression analysis showed that feeling underappreciated by hospital leadership (OR=3.71; p<0.001) and covering more than one hospital on call (OR=1.96; p=0.01) were strongly associated with burnout. Receiving additional compensation for a call was independently protective against burnout (OR= 0.70; p=0.005).ConclusionsThis survey of United States neurointerventional physicians demonstrated a self-reported burnout prevalence of 56%, which is similar to the national average among physicians across other specialties. Additional compensation for a call was a significant protective factor against burnout. In addition, feeling underappreciated by departmental or hospital leadership and covering more than one hospital while on call were associated with greater odds of burnout.
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Shumovetska, Svitlana. "Some Peculiarities of Forming Professional Culture in Future Officers in US Military Institutions." Comparative Professional Pedagogy 9, no. 4 (December 1, 2019): 45–50. http://dx.doi.org/10.2478/rpp-2019-0036.
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AbstractThe necessity to research the problem of forming a professional culture of future border guard officers using the experience of military personnel training in the United States has been identified in the article. It has been found that professional culture and professionalism are an important part of the US military education system. The peculiarities of vocational training in the leading educational establishments of the United States of America, first of all the Military Academy (West Point, New York), have been studied. It has been determined that the priority of the academy, as a whole system of military vocational education in the USA, is attention to what is needed in the combat situation: analytical mind, leadership, theory and practice of management, knowledge of military history, operational doctrine, national defense policy, ability to plan and make decisions, perform legal duties, and abide the professional ethics. Experimental, case-based, interactive training with the extensive use of imitation devices and practical applications prevails in teaching methodology, which is needed to improve officers’ ability to analyze and solve problems, effectively interact and apply operational doctrine. To enhance the level of professional culture and military identity in military schools, great attention is paid to the development of officers’ intellectual potential, the ability to think and critically perceive the information needed to act in situations of ambiguity and uncertainty, to achieve intellectual superiority over the enemy. In accordance with the philosophy of military education in the United States, it is stipulated that a graduate of a military school should be first and foremost a highly intelligent person who, in many respects, must outperform a graduate of any civilian university, quickly acquire the chosen specialty. In addition to training for character education, military identity, the US military estalishments also intends to work hard to develop communicative skills and abilities through speaking and writing practice.
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O.V., Dudina. "TEACHING MEDICAL ETHICS IN LEADING UNIVERSITIES OF CHINA." Collection of Research Papers Pedagogical sciences, no. 91 (January 11, 2021): 61–64. http://dx.doi.org/10.32999/ksu2413-1865/2020-91-8.
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The article examines the issue of teaching medical ethics in leading Chinese universities in the training of medical professionals and found that medical ethics courses for physicians are an innovation for Chinese medical high schools. Due to different cultural traditions, researchers of Chinese medical ethics hold conflicting views on the scientific importance and practical necessity of medical ethics and bioethics. The study found that medical ethics education in China has gradually adapted the experience of leading countries such as the United States and the United Kingdom in teaching ethics. China is now in the process of discussing how to develop its own traditional ethics in the context of globalization. It is established that in the program of masters in medicine the formation of ethical knowledge is a mandatory subject. The teaching of medical ethics takes place not only while studying in Chinese universities, but is a long-term lifelong process in which the student summarizes the results of their efforts, combining moral reflection, learning and leadership. The article analyzes the methods and content of teaching medical ethics, which include relevant cultural, social and personal development, and the education of masters in medicine at Chinese universities.Teaching ethics in medical universities is a relatively new area of medical education in China, ethics curricula have different levels of development. In order to determine the peculiarities in the contents of curricula, teaching and learning methods, forms of evaluation and quality of teaching ethics in China, it was analyzed ethical education in several leading medical universities in China: Wuhan University School of Medicine, Guangzhou Medical University and Peking University School of Medicine. In the process of scientific research on the teaching of ethics in universities, it was found that medical ethics for some time was part of the mandatory course of disciplines, with a strong tendency to emphasize the correct ideological thinking of future physicians.Key words: specialist in medicine, medical ethics, master’s degree, higher medical education in China, professional competence of doctor.
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O.V., Dudina. "TEACHING MEDICAL ETHICS IN LEADING UNIVERSITIES OF CHINA." Collection of Research Papers Pedagogical sciences, no. 91 (January 11, 2021): 61–64. http://dx.doi.org/10.32999/ksu2413-1865/2020-91-8.
Повний текст джерелаАнотація:
The article examines the issue of teaching medical ethics in leading Chinese universities in the training of medical professionals and found that medical ethics courses for physicians are an innovation for Chinese medical high schools. Due to different cultural traditions, researchers of Chinese medical ethics hold conflicting views on the scientific importance and practical necessity of medical ethics and bioethics. The study found that medical ethics education in China has gradually adapted the experience of leading countries such as the United States and the United Kingdom in teaching ethics. China is now in the process of discussing how to develop its own traditional ethics in the context of globalization. It is established that in the program of masters in medicine the formation of ethical knowledge is a mandatory subject. The teaching of medical ethics takes place not only while studying in Chinese universities, but is a long-term lifelong process in which the student summarizes the results of their efforts, combining moral reflection, learning and leadership. The article analyzes the methods and content of teaching medical ethics, which include relevant cultural, social and personal development, and the education of masters in medicine at Chinese universities.Teaching ethics in medical universities is a relatively new area of medical education in China, ethics curricula have different levels of development. In order to determine the peculiarities in the contents of curricula, teaching and learning methods, forms of evaluation and quality of teaching ethics in China, it was analyzed ethical education in several leading medical universities in China: Wuhan University School of Medicine, Guangzhou Medical University and Peking University School of Medicine. In the process of scientific research on the teaching of ethics in universities, it was found that medical ethics for some time was part of the mandatory course of disciplines, with a strong tendency to emphasize the correct ideological thinking of future physicians.Key words: specialist in medicine, medical ethics, master’s degree, higher medical education in China, professional competence of doctor.
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Dresser, Rebecca S. "Freedom of Conscience, Professional Responsibility, and Access to Abortion." Journal of Law, Medicine & Ethics 22, no. 3 (1994): 280–85. http://dx.doi.org/10.1111/j.1748-720x.1994.tb01308.x.
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Access to abortion is becoming increasingly restricted for many women in the United States. Besides the longstanding financial barriers facing low-income women in most states, a newer source of scarcity has emerged. The relatively small number of physicians willing to perform the procedure is compromising the ability of women in certain parts of the country to obtain an abortion.Do physicians have a duty to respond to this situation? Do they have a professional responsibility to ensure that abortions are reasonably available to the women who want to terminate their pregnancies? Or, is abortion so morally and socially controversial as to remove any professional obligation to provide reasonable access?Both law and medical ethics have traditionally protected physicians’ freedom to refuse to perform any procedure, including abortion, that conflicts with their religious or other moral beliefs.
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Carroll, Aaron E., Parul Divya Parikh, and Jennifer L. Buddenbaum. "The Impact of Defense Expenses in Medical Malpractice Claims." Journal of Law, Medicine & Ethics 40, no. 1 (2012): 135–42. http://dx.doi.org/10.1111/j.1748-720x.2012.00651.x.
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Whenever health care reform is debated, the state of the medical professional liability (MPL) system (i.e., medical malpractice system) in the United States re-emerges as an issue of importance. What exactly is broken with the MPL system and what the implications are is a point of contention among different stakeholder groups. Recent data demonstrate that medical liability premiums have been improving in recent years and the majority of premiums remained flat in 2010. General agreement still exists, however, that medical professional liability insurance premiums have become unaffordable for many physicians, and coverage has become less available, especially for certain medical specialties and in specific areas of the country.Multiple factors go into the determination of medical professional liability insurance premiums including return on investments, reinsurance costs, claims frequency, average amount paid out on malpractice claims, defense expenses, and administrative costs such as underwriting expense.
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Sullivan, Brian T., Mikalyn T. DeFoor, Brice Hwang, W. Jeffrey Flowers, and William Strong. "A Novel Peer-Directed Curriculum to Enhance Medical Ethics Training for Medical Students: A Single-Institution Experience." Journal of Medical Education and Curricular Development 7 (January 2020): 238212051989914. http://dx.doi.org/10.1177/2382120519899148.
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Background: The best pedagogical approach to teaching medical ethics is unknown and widely variable across medical school curricula in the United States. Active learning, reflective practice, informal discourse, and peer-led teaching methods have been widely supported as recent advances in medical education. Using a bottom-up teaching approach builds on medical trainees’ own moral thinking and emotion to promote awareness and shared decision-making in navigating everyday ethical considerations confronted in the clinical setting. Objective: Our study objective was to outline our methodology of grassroots efforts in developing an innovative, student-derived longitudinal program to enhance teaching in medical ethics for interested medical students. Methods: Through the development of a 4-year interactive medical ethics curriculum, interested medical students were provided the opportunity to enhance their own moral and ethical identities in the clinical setting through a peer-derived longitudinal curriculum including the following components: lunch-and-learn didactic sessions, peer-facilitated ethics presentations, faculty-student mentorship sessions, student ethics committee discussions, hospital ethics committee and pastoral care shadowing, and an ethics capstone scholarly project. The curriculum places emphasis on small group narrative discussion and collaboration with peers and faculty mentors about ethical considerations in everyday clinical decision-making and provides an intellectual space to self-reflect, explore moral and professional values, and mature one’s own professional communication skills. Results: The Leadership through Ethics (LTE) program is now in its fourth year with 14 faculty-clinician ethics facilitators and 65 active student participants on track for a distinction in medical ethics upon graduation. Early student narrative feedback showed recurrent themes on positive curricular components including (1) clinician mentorship is key, (2) peer discussion and reflection relatable to the wards is effective, and (3) hands-on and interactive clinical training adds value. As a result of the peer-driven initiative, the program has been awarded recognition as a graduate-level certification for sustainable expansion of the grassroots curriculum for trainees in the clinical setting. Conclusions: Grassroots medical ethics education emphasizes experiential learning and peer-to-peer informal discourse of everyday ethical considerations in the health care setting. Student engagement in curricular development, reflective practice in clinical settings, and peer-assisted learning are strategies to enhance clinical ethics education. The Leadership through Ethics program augments and has the potential to transform traditional teaching methodology in bioethics education for motivated students by offering protected small group discussion time, a safe environment, and guidance from ethics facilitators to reflect on shared experiences in clinical ethics and to gain more robust, hands-on ethics training in the clinical setting.
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Dudikova, Larysa. "Tendencies of Future Doctors’ Ethical Competence Formation at Medical Universities in Europe and the USA." Comparative Professional Pedagogy 7, no. 4 (December 1, 2017): 82–88. http://dx.doi.org/10.1515/rpp-2017-0054.
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Abstract The materials presented in this article are the result of a documentary-bibliographic study, which is based on the use of methods of analysis, synthesis, comparison and generalization. The results of the study have shown that the problem of professional ethics and culture of health care professionals is of significant interest. Problems of ethics, culture and deontology are the subject of consideration by scholars from the countries of Europe and the United States. There have been defined the main modern tendencies of training doctors for their professional activity in the leading countries of the world in the context of the professional and ethical competence formation. It has been found out that the development of higher medical education is carried out on the basis of the Bologna process principles, which involves introduction of two degrees (Bachelor and Master of Science), implementation of the ECTS system, introduction of the single diploma supplement, etc. It has been estimated that the educational programs for future doctors' training are aimed at the development of the students’ analytical and critical thinking; behavioral and social sciences, medical ethics, bioethics, provide knowledge, skills and abilities in the field of communication, clinical decision making, application of ethical norms, work in the multi-staff teams etc. The integrated programs play an important role in the educational process. Over the last decades studying bioethics is a compulsory component of the medical education. However, not only bioethics is the basis for the formation of future doctors’ professional and ethical competence at medical Universities abroad. The Oath of Hippocrates is of great significance for the students who devote themselves to medicine. In various countries it has been transformed into codes, oaths, etc., and now it is carried out by the students (future physicians) during their studies at higher medical educational institutions.
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DOUKAS, DAVID J. "Where Is the Virtue in Professionalism?" Cambridge Quarterly of Healthcare Ethics 12, no. 2 (April 2003): 147–54. http://dx.doi.org/10.1017/s0963180103122037.
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There is a wind of change about to affect the training of all house officers in the United States. The Accreditation Council of Graduate Medical Education (ACGME) has promulgated a set of general competencies for all U.S.-trained residents, with a major thrust focused on bioethics and professionalism that will likely catch residency directors unaware. The ACGME's General Competencies document globally addresses many relationship-based ethical roles and responsibilities of house officers in healthcare. Of note, this document contains a specific section on professionalism. However, the entire document is woven with a sustained thread of medical ethics throughout its other sections. The intent is to imbue each physician with those skills, rules, and aspects of character that will be a foundation for humane, ethical, professional conduct. Professionalism does indeed go beyond ethical principles, accounting for competency and commitment to excellence and, most of all, implying a virtue ethics account of medical practice. The need to address the central place of virtue ethics in house-staff education is apparent, and we now have the right tool for the job—the ACGME General Competencies.
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Sautkina, V. "The Labor of Medical Workers in the USA: A Social Aspect." World Economy and International Relations 67, no. 5 (2023): 111–21. http://dx.doi.org/10.20542/0131-2227-2023-67-5-111-121.
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The shortage of medical personnel is becoming a heavy burden on modern healthcare systems around the world. All countries, without exception, turned out to be vulnerable, regardless of the level of income and available forms of medical care. This study addresses the issue of staffing at the time of transition to a new technological level of the healthcare system in the United States. The paper shows that at the present stage in the country there is a need for fundamental changes in the personnel policy in the medical field. The challenges caused by the COVID‑19 pandemic not only exposed all the vulnerabilities of the national health system, but also opened up opportunities considering the lessons learned to rethink the long-term vision of solving the workforce problems directly related to the use of new technologies. Based on the analysis of statistical data and sociological research, the author identified the latest trends of overcoming barriers in the field of training and retraining of personnel in the context of the transition to digital medicine. Overexertion among medical personnel associated with increased workload has exacerbated the problem of their professional burnout. The mass protests of physicians necessitated the development of new approaches to the labor protection of employees in the medical field. Solution of such important social problems will require a long time and financial costs and is possible only through the joint efforts of the state and the entire community as a whole.
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Capone, Ralph A. "AMA Reconsiders Opposition to Physician-Assisted Suicide." Ethics & Medics 41, no. 10 (2016): 1–3. http://dx.doi.org/10.5840/em2016411019.
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In 1847, the American Medical Association established the first professional code of ethics for physicians in the United States. Expanded over the years to meet the needs of the medical profession, its most recent edition, adopted in 2016, includes a statement of AMA principles of medical ethics and eleven sets of opinions on various topics. After 169 years of opposition to physician involvement in directly causing patients’ deaths, the AMA is considering a change in its position—a position that has always averred the sacredness of every human life, asserting that the physician’s role is to cure when possible, care always, and ultimately err on the side of protecting and preserving human life. Following its annual meeting this past June, the AMA House of Delegates recommended that the Council on Ethical and Judicial Affairs study aid-in-dying as an end-of- life option and report back at the annual meeting in 2017.
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Hoekelman, Robert A. "A Program to Increase Health Care for Children: The Pediatric Nurse Practitioner Program, by Henry K. Silver, MD, Loretta C. Ford, EdD, and Susan G. Stearly, MS, Pediatrics, 1967;39:756–760." Pediatrics 102, Supplement_1 (July 1, 1998): 245–47. http://dx.doi.org/10.1542/peds.102.s1.245.
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The increase in population of the United States is occurring at a much more rapid rate than the increase in medical and nursing personnel available to maintain health services at an optimum level. Unless the pattern of furnishing health care, particularly to lower socioeconomic groups in both urban and rural areas, is drastically improved, these groups will suffer from increasingly inadequate health supervision. This paper describes an educational and training program in pediatrics for professional nurses (the “pediatric nurse practitioner” program), which prepares them to assume an expanded role in providing increased health care for children in areas where there are limited facilities for such care.
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Bremer, Anders, Karin Dahlberg, and Lars Sandman. "Balancing Between Closeness and Distance: Emergency Medical Services Personnel’s Experiences of Caring for Families at Out-of-Hospital Cardiac Arrest and Sudden Death." Prehospital and Disaster Medicine 27, no. 1 (February 2012): 42–52. http://dx.doi.org/10.1017/s1049023x12000167.
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AbstractIntroduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members.Problem: Decisions to continue or terminate resuscitation at OHCA are influenced by factors other than patient clinical characteristics, such as EMS personnel’s knowledge, attitudes, and beliefs regarding family emotional preparedness. However, there is little research exploring how EMS personnel care for bereaved family members, or how they are affected by family dynamics and the emotional contexts. The aim of this study is to analyze EMS personnel’s experiences of caring for families when patients suffer cardiac arrest and sudden death.Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviews were conducted with 10 EMS personnel from an EMS agency in southern Sweden.Results: The EMS personnel interviewed felt responsible for both patient care and family care, and sometimes failed to prioritize these responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care implied a movement from well-structured guidance to a situational response, where the personnel were forced to balance between interpretive reasoning and a more direct emotional response, at their own discretion. With such affective responses in decision-making, the personnel risked erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people’s existential questions and needs was essential. It was dependent on the EMS personnel’s balance between closeness and distance, and on their courage in facing the emotional expressions of the families, as well as the personnel’s own vulnerability. The presence of family members placed great demands on mobility (moving from patient care to family care) in the decision-making process, invoking a need for ethical competence.Conclusion: Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.
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Khassenov, M. K. "Some issues of labor regulation of medical and pharmaceutical workers in selected OECD countries." BULLETIN of L.N. Gumilyov Eurasian National University. Law Series 137, no. 4 (2021): 98–109. http://dx.doi.org/10.32523/2616-6844-2021-137-4-98-109.
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The article presents the results of a study of the legal basis for the labor activity of medical and pharmaceutical workers in some states that are members of the Organization for Economic Cooperation and Development (hereinafter - OECD). The author provides general features and specifics of labor regulation models in the healthcare sector. The article analyzes legislation and law enforcement. Thus, the European (continental) and Anglo-American models stand out, which differ in the direction of regulation. The first model is distinguished by the social orientation of labor regulation and public law regulation of disciplinary liability issues through quasi-state bodies of control and supervision. Whereas the second model provides for more autonomy to the parties to labor relations in establishing working conditions and private law regulation of disciplinary liability issues through self-regulatory professional organizations. The second model is more flexible, allowing more freedom to build labor relations with medical and pharmaceutical personnel, contributing to the development of the market for medical services and the efficiency of the health care system. The article substantiates the need for the reception of individual institutions and norms of labor and medical law of the states in question in the legislation of the Republic of Kazakhstan. In particular, there is a need for an independent law regulating the legal status of medical and pharmaceutical workers by analogy with foreign laws on the regulation of medical professions, in order to differentiate the norms that establish the specifics of the application of disciplinary measures, compliance with professional ethics and quality standards.
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Choi, Eun-Kyoung, Valita Fredland, Carla Zachodni, J. Eugene Lammers, Patricia Bledsoe, and Paul R. Helft. "Brain Death Revisited: The Case for a National Standard." Journal of Law, Medicine & Ethics 36, no. 4 (2008): 824–36. http://dx.doi.org/10.1111/j.1748-720x.2008.00340.x.
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The concept of brain death evolved because advancements in medical science permitted unprecedented artificial maintenance of vital body functions by external means. Although the concept of brain death is accepted clinically, ethically, and legally in the United States, there is no national standard for the determination of brain death. There is evidence that variability and inconsistency in the process of determining brain death exist both in clinical settings and in State statutes. Several studies demonstrate that medical personnel determine brain death in variable ways, and have variable understandings of the definition of brain death. The declaration of death has significant legal consequences such as probate proceedings and liability issues for wrongful death. Inconsistencies in the determination of death may therefore be medically, ethically, and legally problematic.
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Mazurek, Renee. "The Effectiveness of using Movies to Teach Ethics and Professionalism in an Online Course." Teaching Ethics 20, no. 1 (2020): 15–29. http://dx.doi.org/10.5840/tej20214691.
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Higher education continues to see a shift toward online course delivery. Many professional graduate programs offer online courses when content does not necessarily require face-to-face contact. The use of movies to teach ethics and professionalism to medical students is not a new pedagogical approach. At a university in the United States, a shift in a tracked physical therapy curriculum triggered a course in ethics and professionalism to be delivered earlier in the program, leaving students without prior clinical experience before starting the course. The instructor revised this online course using movies to provide context for the topics covered making them relatable to physical therapy practice. This article describes student reactions to the implementation of movies into this course. Students valued the addition of the movies as they provided context using relevant health care situations, ultimately helping them relate the concepts to the physical therapy profession.
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Jongbloed, Lyn, and Toby Wendland. "The Impact of Reimbursement Systems on Occupational Therapy Practice in Canada and the United States of America." Canadian Journal of Occupational Therapy 69, no. 3 (June 2002): 143–52. http://dx.doi.org/10.1177/000841740206900304.
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Different funding and cost-control mechanisms in Canada and the United States of America (USA) have a powerful influence on occupational therapy practice in each country. Canada's public health insurance system emphasizes access to health care services based on medical need. Costs are controlled at the provincial government level by limiting the capacity of facilities and personnel. Occupational therapists in publicly-funded settings have considerable professional autonomy to use occupational therapy theoretical models and to be client-centred. The measurement of outcomes is not always required and the interventions of individual occupational therapists are infrequently scrutinized. The USA has no universal, publicly-funded, comprehensive health insurance. Health care policies are driven by financial priorities and cost control occurs at the service delivery level. Insurance companies define the scope of occupational therapy practice by identifying what services they will pay for and they scrutinize occupational therapy interventions. The emphasis on effectiveness and efficiency leads to critical examination of interventions by therapists. Canadian occupational therapists can learn much from their colleagues in the USA in this area.
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Kelly, Carly N., and Michelle M. Mello. "Are Medical Malpractice Damages Caps Constitutional? An Overview of State Litigation." Journal of Law, Medicine & Ethics 33, no. 3 (2005): 515–34. http://dx.doi.org/10.1111/j.1748-720x.2005.tb00515.x.
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The United States is in its fifth year of what is now widely referred to as “the new medical malpractice crisis.” Although some professional liability insurers have begun to report improvements in their overall financial margins, there are few signs that the trend toward higher costs is reversing itself - particularly for doctors and hospitals. In 2003-2004, the presidential election and tort reform proposals in Congress brought heightened public attention to the need for some type of policy intervention to ease the effects of the crisis.The darling of tort reformers at both the federal and state levels has been legislation to limit, or “cap,” damages awarded to plaintiffs in malpractice cases. Health care provider groups, liability insurers, and the Bush Administration have all seized on the example of California's MICRA law, which since 1975 has capped noneconomic damages in malpractice cases at a flat $250,000, as the path to financial recovery.
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Brown, Kate H. "Outside the Garden of Eden: Rural Values and Healthcare Reform." Cambridge Quarterly of Healthcare Ethics 3, no. 3 (1994): 329–37. http://dx.doi.org/10.1017/s0963180100005144.
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It should surprise no one familiar with the problems in rural healthcare that 87% of a randomly selected sample of Nebraskans recently called for either fundamental or complete change of the healthcare system. Rural communities in the United, States have been hard hit by the rising cost of healthcare at a time of economic and demographic decline. Unable to sustain operating costs and personnel needs, rural hospitals and medical, practices have been forced to close their doors at an, alarming rate.Furthermore, rural patients are decreasingly able to afford what services are available to them. Most must purchase insurance privately because they are unlikely to be insured through employment. Therefore, they pay dearly because they are not eligible for corporate rates and because insurance companies use experience instead of community rating to assess risk.
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Maeda, Shoichi, Eisuke Nakazawa, Etsuko Kamishiraki, Eri Ishikawa, Maho Murata, Katsumi Mori, and Akira Akabayashi. "An Exploratory Study on Information Manipulation by Doctors: Awareness, Actual State, and Ethical Tolerance." Clinics and Practice 12, no. 5 (September 8, 2022): 723–33. http://dx.doi.org/10.3390/clinpract12050075.
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(1) Background: To what extent is information manipulation by doctors acceptable? To answer this question, we conducted an exploratory study aimed at obtaining basic data on descriptive ethics for considering this issue. (2) Methods: A self-administered questionnaire survey was conducted on a large sample (n = 3305) of doctors. The participants were queried on (1) whether they consider that information manipulation is necessary (awareness), (2) whether they have actually manipulated information (actual state), and (3) their ethical tolerance. (3) Result: The response rate was 28.7%. Sixty percent of the doctors responded that information manipulation to avoid harm to patients is necessary (awareness), that they have actually manipulated information (actual state), and that information manipulation is ethically acceptable. (4) Conclusion: While the present survey was conducted among doctors in Japan, previous studies have reported similar findings in the United States and Europe. Based on our analysis, we hypothesize that a relationship of trust between patients and medical personnel is crucial and that information manipulation is not needed when such a relationship has been established.
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Lee, Jeong Hyeok. "Improvement Plan for Overseas 119 Air Ambulance Service." Liberal Arts Innovation Center 12 (July 31, 2023): 175–203. http://dx.doi.org/10.54698/kl.2023.12.175.
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Following the tourist falling accident in the Grand Canyon of the United States, the need for medical services for overseas Koreans is on the rise. In this study, I tried to suggest an improvement plan for the 119 Air Ambulance Service, which is an unmet emergency service need, because overseas Koreans must receive the same emergency service as domestic citizens. According to a literature review, air ambulance services have been universalized worldwide when considering goal setting, strategy setting, organizational structure, and geographical conditions step-by-step. Fixedwing aircraft, the core equipment of air ambulance services, may incur high costs; therefore, it is necessary to consider the uncertainty of the initial business, and to utilize Incheon International Airport in consideration of the regional conditions of an international airport for overseas dispatches in relation to the operation of the organization. As operating personnel, an Air Ambulance Transfer Team Leader, Air Ambulance Medical Team Leader (specialist), and EMS Provider are required, starting with the central 119 EMS Captain, and it is recommended to have advanced life support (ALS)-level professional equipment capable of transporting critical patients.
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Shepherd, Lois, and Margaret Foster Riley. "In Plain Sight: A Solution to a Fundamental Challenge in Human Research." Journal of Law, Medicine & Ethics 40, no. 4 (2012): 970–89. http://dx.doi.org/10.1111/j.1748-720x.2012.00725.x.
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The physician-researcher conflict of interest, a long-standing and widely recognized ethical challenge of clinical research, has thus far eluded satisfactory solution. The conflict is fairly straightforward. Medical research and medical therapy are distinct pursuits; the former is aimed at producing generalizable knowledge for the benefit of future patients, whereas the latter is aimed at addressing the individualized medical needs of a particular patient. When the physician-researcher combines these pursuits, he or she serves two masters and cannot — no matter how well-intentioned — avoid the risk of compromising the duties owed in one of the professional roles assumed. Because of the necessary rigidity of a research protocol, the more demanding of the two masters is frequently the research.The problem of the physician-researcher conflict has been evident since the first attempts to regulate human research in the United States. Otto E. Guttentag, a physician at the University of California School of Medicine in San Francisco, addressed the conflict in a 1953 Science magazine article.
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Ross, Lainie Friedman. "Predictive Genetic Testing of Children and the Role of the Best Interest Standard." Journal of Law, Medicine & Ethics 41, no. 4 (2013): 899–906. http://dx.doi.org/10.1111/jlme.12099.
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The genetic testing and screening of children has been fraught with controversy since Robert Guthrie developed the bacterial inhibition assay to test for phenylketonuria and advocated for rapid uptake of universal newborn screening in the early 1960s. Today with fast and affordable mass screening of the whole genome on the horizon, the debate about when and in what scenarios children should undergo genetic testing and screening has gained renewed attention. United States (US) professional guidelines — both the American College of Medical Genetics (ACMG)/American Society of Human Genetics (ASHG) statement (1995) and the American Academy of Pediatrics (AAP) Statement on the genetic testing of children (2001) and the new AAP and ACMG joint policy statement (2013) and technical report (2013) — as well as the old UK guidelines by the Working Part of the Clinical Genetics Society (1994) and the new United Kingdom (UK) guidelines by the British Society of Human Genetics (BSHG) (2010) all give the same answer: genetic testing and screening should only be done if it is in the child’s best interest.
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Desselle, Shane P., Ryan Hoh, Charlotte Rossing, Erin R. Holmes, Amanpreet Gill, and Lemuel Zamora. "Work Preferences and General Abilities Among US Pharmacy Technicians and Danish Pharmaconomists." Journal of Pharmacy Practice 33, no. 2 (August 9, 2018): 142–52. http://dx.doi.org/10.1177/0897190018792369.
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Introduction: The importance of pharmacy support personnel is increasingly recognized. Studies have evaluated workplace issues and evolving roles; however, needed information from technicians themselves is scarce. The purpose of this study was to examine preferences for work activities and the general abilities of US pharmacy technicians and Danish pharmaconomists. Methods: Surveys were administered to random samples of US technicians in 8 states and the general population of Danish pharmaconomists. Respondents indicated their preference for involvement in a set of work activities in community or hospital pharmacy on numeric scales. They also self-assessed their level of ability on facets associated with professional practice, in general. Descriptive results were tabulated, and bivariate tests were conducted on total general abilities ratings. Results: The 494 technicians and 313 pharmaconomists provided similar ratings on many activities. In community pharmacy, US technician ratings for performance of activities were generally higher than those of pharmaconomists; however, pharmaconomists rated certain “higher order” communication activities quite highly, such as discussing lifestyle changes with the patient. In hospital practice, Danish pharmaconomists provided low preferences for medication handling but high preferences for communication activities. General ability ratings were given high self-evaluations, but lower on some components, such as keeping up with the profession. Employer commitment was a strong correlate for both. Conclusions: Evaluation of preferred work activities and general abilities were likely reflected in different scopes of practice between the two and could be insightful for education and work redesign in both countries, particularly the United States, as leaders evaluate shifts in technician professionalization.
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Grimes, Cara L., Gabriela Halder, A. Jenna Beckham, Shunaha Kim-Fine, Rebecca Rogers, and Cheryl Iglesia. "Anticipated Impact of Dobbs v Jackson Women's Health Organization on Training of Residents in Obstetrics and Gynecology: A Qualitative Analysis." Journal of Graduate Medical Education 15, no. 3 (June 1, 2023): 339–47. http://dx.doi.org/10.4300/jgme-d-22-00885.1.
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ABSTRACT Background On June 24, 2022, the Supreme Court of the United States in the case of Dobbs v Jackson Women's Health Organization ended constitutional protection for abortion, thus severely restricting access to reproductive health care for millions of individuals. Concerns have arisen about the potential impact on medical students, residents, and fellows training in restricted areas and the effect on gynecologic training and the future provision of competent comprehensive women's health care in the United States. Objective To qualitatively explore the anticipated impacts of the Dobbs ruling on training in obstetrics and gynecology (OB/GYN). Methods A participatory action research approach employing methods of qualitative analysis was used. Trainees and leaders in national OB/GYN professional and academic organizations with missions related to clinical care and training of medical students, residents, and fellows in OB/GYN participated. Two focus groups were held via Zoom in July 2022. Using an iterative process, transcripts underwent coding by 2 independent researchers to identify categories and common themes. Themes were organized into categories and subcategories. An additional reviewer resolved discrepancies. Results Twenty-six OB/GYN leaders/stakeholders representing 14 OB/GYN societies along with 4 trainees participated. Eight thematic categories were identified: competency, provision of reproductive health care, residency selection, inequity in training, alternative training, law-based vs evidence-based medicine, morality and ethics, and uncertainty about next steps. Conclusions This qualitative study of leaders and learners in OB/GYN identified 8 themes of potential impacts of the Dobbs ruling on current and future training in OB/GYN.
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Lavingia, Richa, Rajeev Raghavan, and Stephanie R. Morain. "Emergency-Only Hemodialysis Policies." Journal of Law, Medicine & Ethics 48, no. 3 (2020): 527–34. http://dx.doi.org/10.1177/1073110520958877.
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An estimated 6,500 undocumented immigrants in the United States have been diagnosed with end-stage renal disease (ESRD). These individuals are ineligible for the federal insurance program that covers dialysis and/or transplantation for citizens, and consequently are subject to local or state policies regarding the provision of healthcare. In 76% of states, undocumented immigrants are ineligible to receive scheduled outpatient dialysis treatments, and typically receive dialysis only when presenting to the emergency center with severe life-threatening symptoms. ‘Emergency-only hemodialysis’ (EOHD) is associated with higher healthcare costs, higher mortality, and longer hospitalizations. In this paper, we present an ethical critique of existing federal policy. We argue that EOHD represents a failure of fiduciary and professional obligations, contributes to moral distress, and undermines physician obligations to be good stewards of medical resources. We then explore potential avenues for reform based upon policies introduced at the state level. We argue that, while reform at the federal level would ultimately be a more sustainable longterm solution, state-based policy reforms can help mitigate the ethical shortcomings of EOHD.
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Petrich, John, Dominic Marchese, Chris Jenkins, Michael Storey, and Jill Blind. "Gene Replacement Therapy: A Primer for the Health-system Pharmacist." Journal of Pharmacy Practice 33, no. 6 (June 27, 2019): 846–55. http://dx.doi.org/10.1177/0897190019854962.
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Purpose: Comprehensive review of gene replacement therapy with guidance and expert opinion on handling and administration for pharmacists. Summary: There are currently ∼2600 gene therapy clinical trials worldwide and 4 Food and Drug Administration (FDA)-approved gene therapy products available in the United States. Gene therapy and its handling are different from other drugs; however, there is a lack of guidance from the National Institutes of Health (NIH), FDA, Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and professional associations regarding their pharmaceutical application. Although the NIH stratifies the backbone biologicals of viral vectors in gene therapies into risk groups, incomplete information regarding minimization of exposure and reduction of risk exists. In the absence of defined guidance, individual institutions develop their own policies and procedures, which often differ and are often outdated. This review provides expert opinion on the role of pharmacists in institutional preparedness, as well as gene therapy handling and administration. A suggested infrastructural model for gene replacement therapy handling is described, including requisite equipment acquisition and standard operating procedure development. Personnel, patient, and caregiver education and training are discussed. Conclusion: Pharmacists have a key role in the proper handling and general management of gene replacement therapies, identifying risk level, establishing infrastructure, and developing adequate policies and protocols, particularly in the absence of consensus guidelines for the handling and transport of gene replacement therapies.
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Schommer, Jon C., Caroline A. Gaither, Nancy A. Alvarez, SuHak Lee, April M. Shaughnessy, Vibhuti Arya, Lourdes G. Planas, Olajide Fadare, and Matthew J. Witry. "Pharmacy Workplace Wellbeing and Resilience: Themes Identified from a Hermeneutic Phenomenological Analysis with Future Recommendations." Pharmacy 10, no. 6 (November 23, 2022): 158. http://dx.doi.org/10.3390/pharmacy10060158.
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This study applied a hermeneutic phenomenological approach to better understand pharmacy workplace wellbeing and resilience using respondents’ written comments along with a blend of the researchers’ understanding of the phenomenon and the published literature. Our goal was to apply this understanding to recommendations for the pharmacy workforce and corresponding future research. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacy personnel was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Usable responses were from those who wrote an in-depth comment detailing stories and experiences related to pharmacy workplace and resilience. There were 614 respondents who wrote such comments. The findings revealed that business models driven by mechanized assembly line processes, business metrics that supersede patient outcomes, and reduction of pharmacy personnel’s professional judgement have contributed to the decline in the experience of providing patient care in today’s health systems. The portrait of respondents’ lived experiences regarding pharmacy workplace wellbeing and resilience was beyond the individual level and revealed the need for systems change. We propose several areas for expanded inquiry in this domain: (1) shared trauma, (2) professional responsibility and autonomy, (3) learned subjection, (4) moral injury and moral distress, (5) sociocultural effects, and (6) health systems change.
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Stotland, Nada L. "Abortion: Perspectives from an APA Past-President." Psychodynamic Psychiatry 51, no. 1 (March 2023): 1–5. http://dx.doi.org/10.1521/pdps.2023.51.1.1.
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The United States Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, eliminating the national right to abortion, poses challenges to psychiatrists and patients. Abortion laws now vary widely from state to state and are constantly changing and being challenged. The laws affect both patients and health care professionals; some prohibit not only the performance of abortion but efforts to inform and assist patients seeking abortion. Patients may become pregnant during and/or because of episodes of clinical depression, mania, or psychosis, and recognize that their current circumstances will not allow them to become adequate parents. Some laws allowing abortion to protect a woman's life or health explicitly exclude mental health risks; many prohibit transfer of a patient to a permissive venue. Psychiatrists working with patients contemplating abortion can convey the scientific evidence that abortion does not cause mental illness and help them identify and work through their own beliefs, values, and likely responses to the decision. Psychiatrists will also have to decide whether medical ethics or state laws will govern their own professional behavior.
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Conant, Loring, and Arlene Lowney. "The Role of Hospice Philosophy of Care in Nonhospice Settings." Journal of Law, Medicine & Ethics 24, no. 4 (1996): 365–68. http://dx.doi.org/10.1111/j.1748-720x.1996.tb01880.x.
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Many advances in public health and medical technology have contributed to the improved wellbeing and overall longevity of Americans. Such benefits, however, have been offset by a change in the nature and prolongation of the dying process. Daniel Callahan offers a challenge to caregivers in his observation of violent death by technological attenuation, and he sets an agenda to identify a more appropriate approach to the needs of the dying.Over the past quarter century, hospice has increasingly been used as a resource for care at the end of life. However, according to 1995 estimates by the National Hospice Organization (NHO), hospice care presently accounts for only about 15 percent of the care of terminally ill patients in the United States. We will review issues of access and use of hospice services and examine the various institutional, professional, societal, and cultural barriers to hospice principles of care, and consider various options to promote optimal care at the end of life.
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Pomerance, Philip L. "The Ethical Health Lawyer." Journal of Law, Medicine & Ethics 33, no. 2 (2005): 375–79. http://dx.doi.org/10.1111/j.1748-720x.2005.tb00503.x.
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Health care may be the most regulated industry in the United States, at least in terms of the volume of State and Federal laws and regulations that affect business practices. Lawyers who counsel health care clients often face a dilemma: is the client seeing legitimate advice about the legal limitations on his or her conduct, or is the client seeking to use the lawyer's skills to evade the law? The history of health care fraud prosecutions involving lawyers and other professional advisors in recent years makes this an issue of more than academic interest. The well publicized case of U.S. v. Anderson, in which health care counsel faced charges as co-defendants for purported kickback violations, the recent prosecution of Ernst & Young for allegedly aiding Medicare fraud on behalf of client hospitals, and the recent indictment and conviction of an in-house lawyer in a national durable medical equipment fraud case, make clear that the wrongful use of legal advice by health care clients can lead to significant criminal and civil charges against attorneys.
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Sarsembaikyzy, Gulbanu, and Zhanar Tyulyubayeva. "Applicability of the Clinical Care Classification in the Electronic Document Management of Nursing Staff to Improve the Efficiency of Medical Services in the Health System of the Republic of Kazakhstan: Policy Brief." Journal of Health Development, no. 40 (2021): 36–43. http://dx.doi.org/10.32921/2225-9929-2021-40-36-43.
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Currently, the nursing process is at the core of nursing education and practice, creating a scientific base for nursing care. The nursing process is one of the basic and integral concepts of the modern model of nursing service. This concept was given birth in the United States in the mid-50s and over the years of testing in clinical settings has proved its feasibility. In the health system, the professional group of secondary medical personnel is the most numerous and has a significant impact on ensuring the quality, availability of medical care, and efficiency of the entire system. Over the years, nurses from different countries have sought to gain recognition for their profession. The main goal was to establish the boundaries of their professional activities, the differences between medical and nursing duties, to create a terminological and conceptual apparatus of the profession and to determine the scientific method of providing nursing care to patients (clients). One of the most relevant areas of healthcare reforms in Kazakhstan is the development and expansion of the functions of nursing staff, including the maintenance of nursing documentation, the establishment of a nursing diagnosis, monitoring and management of patients, etc. What is the problem? 1. Lack of a single terminological and conceptual apparatus for all nurses; 2. Workload of general practitioners; 3. Implementation of patient attendance by nurses under the doctor's login; 4. Lack of payment to nurses for services rendered; 5. In appreciation of the role of the average medical worker in the treatment process; 6. Low potential in the nursing service. Policy options Scenario 1. Institutionalization of CCC in the health system of the Republic of Kazakhstan through the gradual introduction into information systems of the international classification of nursing diagnoses and nursing interventions in the practice of secondary medical workers. Scenario 2. Interaction of vertical links in the implementation of the CCC by making appropriate changes to regulatory legal acts. Scenario 3. Financing of nursing services by including nursing services in the medical services tariff. The vision for the implementation of the scenarios/policy options. Each of these policy options can contribute to improving the efficiency of providing medical care to the population, the status of secondary medical personnel, and the development of their critical thinking. However, given the different options in the direction of actions, resources and methods used, these policy options can provide a more significant achievement of the goal in improving the quality and effectiveness of introduction when they are implemented in association.
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Hereth, Blake, and Nicholas Evans. "Can We Justify Military Enhancements? Some Yes, Most No." Cambridge Quarterly of Healthcare Ethics 31, no. 4 (October 2022): 557–69. http://dx.doi.org/10.1017/s0963180122000421.
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AbstractThe United States Department of Defense has, for at least 20 years, held the stated intention to enhance active military personnel (“warfighters”). This intention has become more acute in the face of dropping recruitment, an aging fighting force, and emerging strategic challenges. However, developing and testing enhancements is clouded by the ethically contested status of enhancements, the long history of abuse by military medical researchers, and new legislation in the guise of “health security” that has enabled the Department of Defense to apply medical interventions without appropriate oversight. This paper aims to reconcile existing legal and regulatory frameworks on military biomedical research with ethical concerns about military enhancements. In what follows, we first outline one justification for military enhancements. The authors then briefly address existing definitional issues over what constitutes enhancement before addressing existing research ethics regulations governing military biomedical research. Next, they argue that two common justifications for rapid military innovation in science and technology, including enhancement, fail. These justifications are (a) to satisfy a compelling military need and (b) strategic dominance. The authors then turn to an objection that turns on the idea that we need not have these justifications if warfighters are willing to adopt enhancement, and argue that laissez-faire approaches to enhancement fail in the context of the military due to pressing and historically significant concerns about coercion and exploitation. The paper concludes with what is referred to as the “least-worst” justification: Given the rise of untested enhancements in civilian and military life, we have good reason to validate potential enhancements even if they do not satisfy reasons (a) or (b) above.
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Amlie, Thomas T. "Do As We Say, Not As We Do: Teaching Ethics In The Modern College Classroom." American Journal of Business Education (AJBE) 3, no. 12 (December 1, 2010): 95–104. http://dx.doi.org/10.19030/ajbe.v3i12.969.
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In the past decade, there has been an increasing level of distress over the perceived lack of ethics exhibited by members of the accounting profession. This distress has resulted in a call for a greater emphasis on ethics coverage as part of a college-level accounting education. However, one could argue that the various organizations that are leading these calls, and the academic institutions which are charged with implementing this enhanced ethical education, often suffer from ethical failings of their own. The purpose of this paper is to examine the degree to which these organizations “practice what they preach.” Recent history is rife with examples of ethical shortcomings on the part of accounting professionals; Enron, Worldcom, and Tyco come to mind as examples which have received extensive media coverage. The resultant public concern over ethics in accounting has led several governmental and professional bodies to mandate or promote codes of ethical conduct. The Congress of the United States, the Securities and Exchange Commission, the American Institute of Certified Public Accountants, and other bodies have all made public pronouncements which explicitly insist upon the importance of ethical behavior. Similarly, many education-related organizations (i.e., universities and accrediting bodies) have taken the position that education in ethics is an essential part of any college-level education. Finally, although the Financial Accounting Standards Board (FASB), which formulates generally accepted accounting practices for commercial firms in the United States, has not made an explicit statement regarding the importance of ethics, the standards which they promulgate are the measure of what is and is not adequate financial disclosure. Since a failure to follow generally accepted accounting principles is usually thought of as misleading and hence, an ethical violation, it could be argued that the FASB is, in fact, charged with “codifying” ethical behavior as far as financial disclosure is concerned. All of the organizations mentioned above can be criticized, to some extent, for ethical failings of their own. Political bodies, such as the Congress and the Securities and Exchange Commission, can often be accused of bowing to special interests and entities which enforce codes of ethics (whether the AICPA in accounting or the American Bar Association in the legal profession or the AMA in the medical profession) are often justly accused of turning a blind eye to all but the most egregious behavior of their members. The FASB, while ostensibly independent, is also subject to pressures in its standard setting process. Finally, the educational establishment has exhibited ethical shortcomings of its own. These problems run from well-publicized institution-wide problems in discrimination and college athletics down to the individual class and faculty member who engages in less-than-ethical behaviors. The paper will examine the recent ethical failings in business and the resultant calls for greater ethical behavior on the part of the accounting profession. A brief summary of some of the literature related to ethical education and development will then be presented. After this, the behaviors of the various regulatory, standard setting and educational institutions will be examined to determine the extent to which their individual behaviors coincide with their stated positions on ethical behavior and the degree to which these behaviors match the standards that we are encouraged to teach to our students.
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Groups, African Pathologists' Summit Working. "Proceedings of the African Pathologists Summit; March 22–23, 2013; Dakar, Senegal: A Summary." Archives of Pathology & Laboratory Medicine 139, no. 1 (June 25, 2014): 126–32. http://dx.doi.org/10.5858/arpa.2013-0732-cc.
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Context This report presents the proceedings of the African Pathologists Summit, held under the auspices of the African Organization for Research and Training in Cancer. Objectives To deliberate on the challenges and constraints of the practice of pathology in Sub-Saharan Africa and the avenues for addressing them. Participants Collaborating organizations included the American Society for Clinical Pathology; Association of Pathologists of Nigeria; British Division of the International Academy of Pathology; College of Pathologists of East, Central and Southern Africa; East African Division of the International Academy of Pathology; Friends of Africa–United States and Canadian Academy of Pathology Initiative; International Academy of Pathology; International Network for Cancer Treatment and Research; National Cancer Institute; National Health and Laboratory Service of South Africa; Nigerian Postgraduate Medical College; Royal College of Pathologists; West African Division of the International Academy of Pathology; and Faculty of Laboratory Medicine of the West African College of Physicians. Evidence Information on the status of the practice of pathology was based on the experience of the participants, who are current or past practitioners of pathology or are involved in pathology education and research in Sub-Saharan Africa. Consensus Process The deliberations were carried out through presentations and working discussion groups. Conclusions The significant lack of professional and technical personnel, inadequate infrastructure, limited training opportunities, poor funding of pathology services in Sub-Saharan Africa, and their significant impact on patient care were noted. The urgency of addressing these issues was recognized, and the recommendations that were made are contained in this report.
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Cornish, Nancy, Sheldon Campbell, and Elizabeth Weirich. "CDC and Clinical Laboratory Partners: Analysis of Biosafety Gaps Revealed During the Ebola Outbreak." American Journal of Clinical Pathology 152, Supplement_1 (September 11, 2019): S139. http://dx.doi.org/10.1093/ajcp/aqz128.001.
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Abstract Objectives Patient care and public health in the United States depend on timely and reliable clinical laboratory testing. A third of the roughly 500 million yearly patient visits to health care providers involve at least one laboratory test, and approximately 70% of medical decisions are based upon test results. However, the performance of clinical laboratory testing could be compromised by patient specimens potentially contaminated with highly infectious materials. The importance of biosafety in clinical laboratories was highlighted during the 2014 Ebola crisis, where fears about safety resulted in some institutions refusing or delaying tests on patient specimens, which resulted in delayed diagnoses and contributed to patient deaths. Methods In collaboration with subject matter experts from academia, medical centers, and federal institutions, the Centers for Disease Control and Prevention has reviewed the capability of clinical laboratories to safely test patient specimens potentially contaminated with highly infectious materials, like Ebola. Current biosafety guidance for clinical laboratories has been largely based on biosafety practices in research laboratories, so the guidelines do not always correspond to clinical laboratories and may be incomplete or occasionally inconsistent. While essential to patient care, clinical laboratories are also unique environments with specialized equipment, processes, and therefore distinct challenges. Here we discuss the complexity of clinical laboratories and describe how applying current biosafety guidance to clinical laboratories may be difficult and confusing at best or inappropriate and harmful at worst. We describe biosafety gaps and opportunities for improvement in the areas of ethics; risk assessment and management; automated and manual laboratory disciplines; specimen collection, processing, and storage; test utilization; waste management; laboratory personnel training and competency assessment; and accreditation processes. Conclusion These identified gaps in knowledge and practice could inform future research and education in clinical laboratory biosafety.
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Sari, Komala, Mitra Mitra, Jasrida Yunita, Budi Hartono, and Dedi Afandi. "Predictors of Quality Leadership and Quality of Health Services in Hospital." Jurnal Kesehatan Manarang 6, no. 1 (July 28, 2020): 50. http://dx.doi.org/10.33490/jkm.v6i1.131.
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Law Republic Indonesia Number 44 of 2009 on Hospitals states health care institutions must improve higher quality and affordable services to highest health level. Quality leadership is continuous work method and process improve service quality, competitiveness and productivity. Health services quality is reference to the ideal level of health services. Hospitals health services quality will be good if the leadership carried out properly. In general hospital there was an absence Performance Report, disintegration and not sinergy between stakeholders in terms of health services quality. There was nothing of a Minimum Services Standards measurement, has not implemented a customer satisfaction based service pattern, service quality has not met national standards, which indicates that service quality is not optimum. Quality control activities not yet implemented, Standard Operational Procedure was also not optimal. Research objective was to know the effect of quality leadership on the quality of health services. Quantitative research type with analytic cross-sectional design. The study conducted in July 2017 in the Outpatient Installation. The population were all medical personnel and health workers with a sample of 100 people. Techniques for collected data using a questionnaire. The variables in this study were exogenous variables of quality leadership and endogenous variables of health services quality. Data analysis used Structural Equation Modeling - Partial Least Square. The results of the study obtained Values, Vision, Inspiration, Innovative, Systems View, Empowering, Customer Focus, were predictors of quality leadership. Professional standards, service standards, codes of ethics and standard operating procedures were predictors of health services quality. The value of T-Statistic 0.669 with a statistical value of 1.96 there was no significant effect of quality leadership on the health services quality.
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Fereidouni, Armin, Esmaeil Teymoori, Tayebeh Bahmani, Hamid Reza Sabet, Zahra Maleki, and Mina Gharibi. "Correlation between critical thinking and emotional intelligence: a national cross-sectional study on operating room nursing students in Iran." Frontiers of Nursing 11, no. 1 (March 1, 2024): 99–104. http://dx.doi.org/10.2478/fon-2024-0010.
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Abstract Objective According to the World Federation of Medical Education, critical thinking should be part of the training of medical and paramedical students. Professionals can improve the quality of care of patients after surgery by having or acquiring this skill in health care. Also, Emotional intelligence is introduced as an important and effective factor on the professional performance and mental health of healthcare professionals. Thus, the present study was designed and implemented to determine the relationship between emotional intelligence and critical thinking among operating room nursing students of medical sciences universities in Iran. Methods This cross-sectional study was done on 420 operating room students in 10 top medical sciences universities of Iran in 2022. The sampling method in this research was multistage sampling. The data collection instruments included demographic characteristics, Rickett’s critical thinking, and Bradberry-Greaves’ emotional intelligence questionnaires. After receiving the ethics code, data collection was done for 2 months. For data analysis, descriptive and inferential analyses including independent t-tests, analysis of variance, and Pearson correlation were used. The collected data were analyzed by SPSS 18 (IBM Corporation, Armonk, New York, United States). P-value <0.05 was considered significant. Results The mean age of the students participating in this study was 23.02 ± 3.70 years, with women constituting 67.4% of them. The results of data analysis indicated that the mean total score of critical thinking and emotional intelligence was 124.10 ± 37.52 and 114.12 ± 43.63, respectively. A direct significant correlation between critical thinking and emotional intelligence (r = 0.459, P-value <0.001) and a significant relationship between gender and emotional intelligence (P-value = 0.028) were found. Conclusions Based on the present study results, educational managers in the Ministry of Health are suggested to consider suitable educational programs for improving critical thinking and emotional intelligence to enhance the quality of care provided by students in operating rooms.
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Bogan, R. "OVERSEAS RECRUITING IN THE OIL AND GAS INDUSTRY — A CASE STUDY." APPEA Journal 25, no. 1 (1985): 134. http://dx.doi.org/10.1071/aj84013.
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Early in 1982 CSR Limited established an Oil and Gas Division. By 1983 this Division had recruited twenty-six overseas technical personnel mainly from Canada and the United Kingdom. The Company needed to recruit overseas because the skills required were not available in Australia.During 1983 a review of the recruitment and settlement of these personnel and their families was undertaken. The objectives of this review were to:improve the Company performance in the recruitment, induction and settlement of overseas recruits and their families;increase the likely "length of stay" in Australia of overseas recruits and their families;to address specific problems faced by recruits and their families in settlement in Australia.In depth interviews were conducted with twenty-one of the twenty-six recruits and their families using a structured interview format.The analysis of the interviews results revealed that:on average it took longer for those recruited in the United Kingdom to obtain immigration "approvals" and to physically relocate than those recruited in Canada;families with previous experience in relocating adapted and coped better with the physical move and resettlement than families without previous experience.The detailed results showed further that:While there was sufficient information provided about the job and department, there was dissatisfaction with the lack of detailed information about aspects of living in Australia, particularly: taxation; housing; bank mortgage arrangements; cost of living data and medical insurance.There were gaps in the expectations that many- recruits and their families had about living in Australia, such as climate, lifestyle and housing. This was attributed to an "oversell" through glossy brochures and "word pictures".The attention given to staff and their families on arrival was seen as a positive introduction to Australia and CSR's Oil and Gas Division.The provision of initial temporary accommodation in a single apartment complex for all overseas recruits and families in Adelaide assisted greatly in the induction and settlement process. It provided a high level of support especially for wives with young children. The "welcome waggon" group together with the assistance provided by the wives of senior executives were also positive influences in the settlement process.The most positive features seen in the move to Australia were career and lifestyle opportunities. On the other hand loss of disposable income was seen as a significant negative.From the results and analysis a detailed set of recommendations and actions were developed to improve company performance in recruitment and settlement. These recommendations were implementated prior to the 1984 recruiting mission to Canada, the United States and the United Kingdom.The preliminary results from the 1984 recruiting mission have resulted in:a reduction in recruiting lead time;quicker and more informed decision making by candidates and their families in accepting job offers;more professional preparation of both the recruiting teams and the company's agents overseas.
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Newton, Andy, Barry Hunt, and Julia Williams. "The paramedic profession: disruptive innovation and barriers to further progress." Journal of Paramedic Practice 12, no. 4 (April 2, 2020): 138–48. http://dx.doi.org/10.12968/jpar.2020.12.4.138.
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The paramedic profession in the UK evolved from a small number of pilot programmes in the early 1970s that focused on training selected NHS ambulance crews in advanced resuscitation techniques. Similar initiatives occurred almost simultaneously in the United States, Australia, New Zealand and Canada. This case study focuses primarily on the UK, and England in particular. The purpose of the initiatives described was to address the unmet needs of patients with serious injury and illness. Over the following decades, paramedics developed a clear identity and became fully professionally recognised and regulated as allied health professionals, becoming an example of the phenomenon termed ‘disruptive Innovation’; this is something that creates a new market and value network while disrupting existing ones. The steep developmental trajectory of paramedics has not been mirrored by a comparable pace of reform and modernisation in NHS ambulance services which, in comparison, have lagged behind and also failed to adapt to significant changes in the pattern, quantity and epidemiological characteristics of patient demand. This has led to a mismatch between the capabilities offered by paramedics and the professional opportunities available to them in ambulance services, and hampered these practitioners' ability to make full use of their skills. The consequence of this has often manifested as low levels of paramedic and other ambulance staff satisfaction, resulting in high rates of staff turnover. Parallel developments in medical personnel deployment have increased the quantity of medical labour available to patients with serious or life-threatening injuries, with medical staff added to helicopter emergency medical crews. While many patients with urgent conditions would have benefited from general practitioners being available out of hours, proportionally fewer doctors are available to fulfil this role today and those that are attracted to working with the ambulance service often prefer to respond to cases involving major injury. For these reasons and given the reality that the ambulance service is morphing into primarily an urgent care organisation, de-emphasising the transport aspect of the service, changes are needed to its model of operation and to staff management and support.
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Pronin, M. A., and V. V. Ananishnev. "IMPACT OF THE COVID-19 PANDEMIC ON THE PSYCHOLOGICAL STATE OF CITIZENS THROUGH THE PRISM OF LINGUISTIC PSYCHOLOGY." Scientific Review: Theory and Practice 10, no. 8 (August 31, 2020): 1753–68. http://dx.doi.org/10.35679/2226-0226-2020-10-8-1753-1768.
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The coronavirus pandemic, which has become a challenge not only for doctors, but also for psychologists around the world, will have a long-term psychological effect for Russians. At the same time, a way out of the crisis can, on the contrary, make people stronger and speed up the economic recovery, as it was after the plague and the Spanish flu, experts say. According to historical data on the consequences of plague and Spanish flu epidemics in Europe and the United States, given in a report by Dmitry Ushakov, Director of the Institute of psychology of the Russian Academy of Sciences, it often turned out that people who survived them lived longer, and the most affected regions showed higher recovery rates. Experts note the growing demand for psychological assistance among people who have witnessed a global pandemic. Problems related to the consequences of stress that people faced in self-isolation have become more acute. These are also problems related to the violation of the traditional way of life, being isolated, in General, there is a certain aggression around the world, an increase in domestic violence, and many other issues. Psychologists found themselves in the situation of an included experiment. Despite the absence of a “mental epidemic”, citizens of various countries, experiencing fear and confusion, turned to its Internet to get the necessary information about the pandemic in order to eliminate fears for their health and the health of their relatives, including mental health. Its Internet today contains a lot of chats (correspondence) both in the professional language among medical personnel, as well as non-specialists. Thus, the pandemic has started to have an impact not only on health but also on the language itself. Some of the opportunities that can give science and society to learn the language of the pandemic are discussed in this article.
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Aryal, Kamal Raj, Chelise Currow, Sarah Downey, Raaj Praseedom, and Alexander Seager. "Work-Based Assessments in Higher General Surgical Training Program: A Mixed Methods Study Exploring Trainers' and Trainees' Views and Experiences." Surgery Journal 06, no. 01 (January 2020): e49-e61. http://dx.doi.org/10.1055/s-0040-1708062.
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Abstract Introduction In the United Kingdom, work-based assessments (WBAs) including procedure-based assessments (PBAs), case-based discussions (CBDs), clinical evaluation exercises (CEXs), and direct observation of procedural skills (DOPS) have been used in Higher General Surgical Training Program (HGSTP) since the introduction of Modernising Medical Careers. Although the Intercollegiate Surgical Curriculum Project states that they should be used for the formative development of trainees using feedback and reflection, there is no study to look at the perception of their usefulness and barriers in using them, particularly in HGSTP. The aim of this study is to investigate trainer's and trainee's perception of their usefulness, barriers in using them, and way forward for their improvement in HGSTP. Methods This was a mixed method study. In phase I, after ethics committee approval, an online survey was sent to 83 trainers and 104 trainees, with a response rate of 33 and 37%, respectively, using Online Surveys (formerly Bristol Online Survey) from July 2018 to December 2018. After analysis of this result, in phase II, semistructured interviews were conducted with five trainees and five trainers who had volunteered to take part from phase I. Thematic analysis was performed to develop overarching themes. Results For professional formative development, 15% of the trainers and 53% of the trainees felt that WBAs had a low value. Among 4 WBAs—CEX, CBD, PBA, and DOPS—PBA was thought to be the most useful WBA by 52% trainers and 74% trainees.More trainers than trainees felt that it was being used as a formative tool (33 vs. 16%). The total number of WBAs thought to be required was between 20 and 40 per year, with 46% of the trainers and 53% of the trainees preferring these numbers.The thematic analysis generated four themes with subthemes in each: theme 1, “factors affecting usefulness,” including the mode of validation, trainer/trainee engagement, and time spent in validating; theme 2, “doubt on utility” due to doubt on validity and being used as a tick-box exercise; theme 3, “pitfalls/difficulties” due to lack of time to validate, late validation, e-mail rather than face-to-face validation, trainer and trainee behavior, variability in feedback given, and emphasis on number than quality; and theme 4, “improvement strategies.” Conclusions The WBAs are not being used in a way they are supposed to be used. The perception of educational impact (Kirkpatrick levels 1 and 2) by trainers was more optimistic than by trainees. Improvements can be made by giving/finding more time, trainer training, more face-to-face validation, and better trainer trainee interactions.
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Koshias, Andreas, Emma Gray, Graeme Currie, and Jennifer Cleland. "28 Do not attempt resuscitation: university of aberdeen student perspectives." BMJ Supportive & Palliative Care 7, no. 3 (September 2017): A357.2—A358. http://dx.doi.org/10.1136/bmjspcare-2017-001407.28.
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IntroductionDo Not Attempt Resuscitation Orders(DNAR) and their contemporary counterparts are cornerstones of End of Life care and as such, of importance within medical education. Previous research indicates the need for a better understanding of patient and physicians perceptions of DNAR topics.Aims and methodsThe objective of the study was to explore medical students(MS) and non-medical students perspectives on DNAR discussions(DNARD), and explore any differences. This was a cross-sectional questionnaire study. MS and Education students(ES) were asked how they felt regarding DNARD taking place in 5 scenarios, a number of questions regarding previous experience, knowledge of DNARD, future preferences, and basic demographics.ResultsThe number of valid respondents was 601 (375[MS],226[ES]) representing a response rate of over 70%. There were statistically significant differences between MS and ES in the presented clinical scenarios and future preferences. Ranking of clinical scenarios, highest agreement to lowest, for DNARD to take place were: before surgery, when critically ill, at a GP appointment, on admission to hospital, at an outpatient appointment. Statistically significant demographic differences were also found: 93% of MS having heard of DNAR previously as compared to 59% of ES. Both groups held the view that a DNARD would be beneficial for them in the future but that they should have the final decision regarding DNAR.ConclusionMS and ES were found to hold differing views regarding DNARD in scenario preferences and personal future preferences. However, the majority of both groups felt that DNARD would be beneficial to them in the future.References. Mary Catherine Beach, R Sean Morrison. The Effect of Do-Not-Resuscitate Orders on Physician Decision-Making.Ethics, public policy, and medical economics2002;50:2057–206.. Cathy Charles, Tim Whelan, Amiram Gafni. What do we mean by partnership in making decisions about treatment?BMJ1999;319:780.. James Downar, Tracy Luk, Robert W Sibbald, Tatiana Santini, Joseph Mikhael, Hershl Berman, Laura. Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients. Journal of internal medicine2011;26(6):582–587.. Thomas H. Gallagher, Steven Z. Pantilat, Bernard Lo & Maxine A. Papadakis (1999) Teaching Medical Students to Discuss Advance Directives: A Standardised Patient Curriculum, Teaching and Learning in Medicine, 11:3, 142–147, DOI: 10.1207/S15328015TL110304. Paul Garrud. (2011). Who applies and who gets admitted to UK graduate entry medicine? - an analysis of UK admission statistics. BMC Medical Education. 11:71.. General Medical Council. (2013). Chapter1: The changing shape of the profession and medical education. In:The state of medical education and practice in the UK report: 2013. General Medical Council. 32.. GMC, 2010. End of life treatment and care: Good practice in decision-making. Specifically paragraphs 11, 132 and 134. Can be accessed at: http://www.gmcuk.org/guidance/ethical_guidance/end_of_life_care.asp. Todd E. Gorman, MD, FRCP(C), Ste'phane P. Ahern, MD, FRCP(C), Jeffrey Wiseman, MD, FRCP(C), MA, and Yoanna Skrobik, MD, FRCP(C). (2005). Residents’ End-of-Life Decision Making with Adult Hospitalised Patients: A Review of the Literature. Academic Medicine. 80 (7), 622–633.. Gorton, A.J., Jayanthi, N.V.G., Lepping, P., Scriven, M.W., 2008. Patients’ attitudes towards “do not attempt resuscitation” status.J Med Ethics. Vol 34; 624–626.. W. Hafferty, Joseph F. O’Donnell (2015).The Hidden Curriculum in Health Professional Education. United States of America: Dartmouth College Press. 5.. Karen Hancock, Josephine M Clayton, Sharon M Parker, Sharon Wal der, Phyllis N Butow, Sue Carrick, David Currow, Davina Ghersi, Paul Glare, Rebecca Hagerty, Martin HN Tattersall . (2007). Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review.Palliative Medicine. 21 , 507–517.. Jan C. Hofmann, Neil S. Wenger, Roger B. Davis, Joan Teno, Alfred F. Connors, Norman Desbiens, Joanne Lynn, Russell S. Phillips. (1997). Patient Preferences for Communication with Physicians about End-of-Life Decisions .Annals of Internal Medicine. 1 July 1997.. NHS Scotland. (2016).NHSScotland.Available: http://www.gov.scot/Topics/Health/About/NHS-Scotland. Last accessed 25th Nov 2016.. NRS: National Records of Scotland. (2013).Religion, Scotland, 2001 and 2011.Available: http://www.scotlandscensus.gov.uk/documents/censusresults/release2a/rel2asbtable7.pdf. Last accessed 25th Nov 2016. ONS: Office for National Statistics. (2011).Full story: What does the Census tell us about religion in 2011?.Available: http://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/religion/articles/fullstorywhatdoesthecensustellusaboutreligionin2011/2013-05-16. Last accessed 25th Nov 2016.. Stephen R. Porter and Michael E. Whitcomb. (2005). NON-RESPONSE IN STUDENT SURVEYS: The Role of Demographics, Engagement and Personality.Research in Higher Education. 46 (2).. Amy Sanderson, David Zurakowski, Joanne Wolfe. (2013). Clinician Perspectives Regarding the Do-Not-Resuscitate Order.JAMA paediatrics. 167 (10), 954–958.. Scottish Government, 2010. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR): Integrated Adult Policy. Reviewed 2015. Can be accessed at: http://www.gov.scot/Topics/Health/Quality-sImprovement-Performance/peolc/DNACPR. Clive Seale. (2010). The role of doctors’ religious faith and ethnicity in taking ethically controversial decisions during end-of-life care.Journal of Medical Ethics. doi:10.1136/jme.2010.036194.. C O Sham, Y W Cheng, K W Ho, P H Lai, L W Lo, H L Wan, C Y Wong, Y N Yeung, S H Yuen, A Y C Wong. (2007). Do-not-resuscitate decision: the attitudes of medical and non medical students.Clinical Ethics. 33 (5), 261–265.. UKMCRG: UK Medical Careers Research Group (2001).1999 cohort of UK Medical Graduates: Report of First Survey. Oxford: Institute of Health Sciences, University of Oxford. 14.. Jacqueline K. Yuen, M. Carrington Reid, and Michael D. Fetters. (2011). Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them.Journal of General Internal Medicine. 26 (7), 791–797.. Rocksheng Zhong, Joshua Knobe, PhD, Neal Feigenson, JD, and Mark R. Mercurio, MD, MA. (2011). Age and Disability Biases in Paediatric Resuscitation Among Future Physicians.Clinical Paediatrics., 1–4.
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CHAN, Ho-mun. "末期病人的決策倫理: 三個模式的比較". International Journal of Chinese & Comparative Philosophy of Medicine 3, № 4 (1 січня 2001): 45–55. http://dx.doi.org/10.24112/ijccpm.31411.
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LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文討論末期病人的決策過程的三個模式，即個人主義、家長主義和家庭本位主義。個人主義過份偏重病人的抉擇，家長主義只強調從專業角度照顧病人的個人最佳利益，這兩個模式均會令家庭角色邊緣化。本丈認為家庭本位主義，更符合東方社會文化，從倫理角度來看亦較其他兩個模式可取。This paper critically examines the liberal, the medical paternalist, and the familial models of decision making for the terminally ill. It is argued that the liberal model is excessively patient centered while the medical paternalist model overemphasizes the role of the physician. The paper concludes that since both models marginalize the role of the family in the decision-making process, they are morally inadequate and not suitable for societies with strong family ethics, particularly those in Asia.The liberal model is predominant in the United States. According to this model, a competent patient can express in an advance directive her prior wish of how she is to be treated when she lapses into incompetency. In the absence of an advance directive or in cases where the directive is vague or ambiguous, the surrogate decision-making process will be invoked, which is normally a procedure in which the family makes the decision on the patient's behalf. In this process, the family serves to assist the incompetent patient to exercise her self-determination by figuring out and then following her counterfactual choice in accordance with the substituted judgment standard. If it is impossible to arrive at a decision by following this standard, the family, with the assistance of the physician, will follow the standard of best interests to promote the well-being of the patient. In sum, in the process of surrogate decision making, only the individual choice and interests of the patient are a matter of concern. Thus, the liberal model is entirely patient-centered. The role of the family is marginalized in the sense of being subordinated to the (previous or counterfactual) choice and interests of the patient. The family therefore becomes a "shadow" of the patient with no independent status and is deprived of its self-sufficiency.In the United Kingdom, medical paternalism is more influential. There is a preference for a code of practice to legislation for advance directives, and the prevalence of the best interest standard. Yet, unlike the liberal model, the best interests of the patient are not determined by the family in accordance with the standard of a reasonable person. Rather the doctor is expected to make decision for the patient in accordance with a responsible and competent body of relevant professional opinion in determining the patient's best interests. Though the family will often be consulted, the principal decision maker is the physician. So the role of the family is also marginal in this model.In Asian societies, e.g., Japan, Mainland China and Hong Kong, the family plays a fundamental role in the decision making for the terminally ill, so the model of familialism prevails. In these societies, it is common that the patient will not be informed directly of her terminal illness by the physician. The decision for the incompetent patient is regarded not as an individual but a family decision, and the dying process is viewed a sharing process, the last journey that the patient undergoes together with her significant others.In the familial model, the decision for a terminally ill patient is regarded not entirely as an individual matter because other members will be affected by the patient's choice. Should a son merely consider the wishes or the best interests of his father without considering the burden of care and the feelings of his mother while his father is going through the last stage of his life? Should the mother also consider the financial burden that her son might have to bear for his father if he were to be kept alive at all costs? Such issues would not have a place in the liberal and the medical paternalist models, for what matters is only the choice or the best interests of the patient. On the contrary, due considerations are given to these issues in the familial model, which makes it more plausible than the other two models.DOWNLOAD HISTORY | This article has been downloaded 15 times in Digital Commons before migrating into this platform.
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Modell, Stephen, Toby Citrin, and Sharon Kardia. "Laying Anchor: Inserting Precision Health into a Public Health Genetics Policy Course." Healthcare 6, no. 3 (August 3, 2018): 93. http://dx.doi.org/10.3390/healthcare6030093.
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The United States Precision Medicine Initiative (PMI) was announced by then President Barack Obama in January 2015. It is a national effort designed to take into account genetic, environmental, and lifestyle differences in the development of individually tailored forms of treatment and prevention. This goal was implemented in March 2015 with the formation of an advisory committee working group to provide a framework for the proposed national research cohort of one million or more participants. The working group further held a public workshop on participant engagement and health equity, focusing on the design of an inclusive cohort, building public trust, and identifying active participant engagement features for the national cohort. Precision techniques offer medical and public health practitioners the opportunity to personally tailor preventive and therapeutic regimens based on informatics applied to large volume genotypic and phenotypic data. The PMI’s (All of Us Research Program’s) medical and public health promise, its balanced attention to technical and ethical issues, and its nuanced advisory structure made it a natural choice for inclusion in the University of Michigan course “Issues in Public Health Genetics” (HMP 517), offered each fall by the University’s School of Public Health. In 2015, the instructors included the PMI as the recurrent case study introduced at the beginning and referred to throughout the course, and as a class exercise allowing students to translate issues into policy. In 2016, an entire class session was devoted to precision medicine and precision public health. In this article, we examine the dialogues that transpired in these three course components, evaluate session impact on student ability to formulate PMI policy, and share our vision for next-generation courses dealing with precision health. Methodology: Class materials (class notes, oral exercise transcripts, class exercise written hand-ins) from the three course components were inspected and analyzed for issues and policy content. The purpose of the analysis was to assess the extent to which course components have enabled our students to formulate policy in the precision public health area. Analysis of student comments responding to questions posed during the initial case study comprised the initial or “pre-” categories. Analysis of student responses to the class exercise assignment, which included the same set of questions, formed the “post-” categories. Categories were validated by cross-comparison among the three authors, and inspected for frequency with which they appeared in student responses. Frequencies steered the selection of illustrative quotations, revealing the extent to which students were able to convert issue areas into actual policies. Lecture content and student comments in the precision health didactic session were inspected for degree to which they reinforced and extended the derived categories. Results: The case study inspection yielded four overarching categories: (1) assurance (access, equity, disparities); (2) participation (involvement, representativeness); (3) ethics (consent, privacy, benefit sharing); and (4) treatment of people (stigmatization, discrimination). Class exercise inspection and analysis yielded three additional categories: (5) financial; (6) educational; and (7) trust-building. The first three categories exceeded the others in terms of number of student mentions (8–14 vs. 4–6 mentions). Three other categories were considered and excluded because of infrequent mention. Students suggested several means of trust-building, including PMI personnel working with community leaders, stakeholder consultation, networking, and use of social media. Student representatives prioritized participant and research institution access to PMI information over commercial access. Multiple schemes were proposed for participant consent and return of results. Both pricing policy and Medicaid coverage were touched on. During the didactic session, students commented on the importance of provider training in precision health. Course evaluation highlighted the need for clarity on the organizations involved in the PMI, and leaving time for student-student interaction. Conclusions: While some student responses during the exercise were terse, an evolution was detectable over the three course components in student ability to suggest tangible policies and steps for implementation. Students also gained surety in presenting policy positions to a peer audience. Students came up with some very creative suggestions, such as use of an electronic platform to assure participant involvement in the disposition of their biological sample and personal health information, and alternate examples of ways to manage large volumes of data. An examination of socio-ethical issues and policies can strengthen student understanding of the directions the Precision Medicine Initiative is taking, and aid in training for the application of more varied precision medicine and public health techniques, such as tier 1 genetic testing and whole genome and exome sequencing. Future course development may reflect additional features of the ongoing All of Us Research Program, and further articulate precision public health approaches applying to populations as opposed to single individuals.
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Segon, Michael, Chris Booth, and Andrew Roberts. "Are HRM practitioners required to possess competence in corporate ethics? A content analysis of qualifications in Australia and Asia." Asian Journal of Business Ethics, May 27, 2024. http://dx.doi.org/10.1007/s13520-024-00206-8.
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AbstractEthical cultures, corporate social responsibility (CSR), and sustainability strategies are increasingly being addressed through formal organisational policies and structures. This is evidenced by codes of ethics, conduct, whistle-blowing reporting lines, anti-bribery and corruption policies, and broader stakeholder and environmental engagement strategies. In the United States, corporate ethics managers are responsible for these functions, supported by specific professional and university-level qualifications. However, this is not the case in Australia and Asia where the role appears delegated to human resource personnel in organisations. Human resource management (HRM) is increasingly advanced as a formal profession, yet whether corporate ethics content features as a significant component of the HRM profession is unclear. Expert knowledge is a foundation of a profession along with the duty to act within the limits of that knowledge and expertise. This paper scopes what constitutes professional expert knowledge. It examines corporate ethics expertise and HRM within this context. Major Australian and Asian organisations are examined to verify that HRM Departments, and thus HRM practitioners, are responsible for managing corporate ethics. Given the seniority and strategic importance of this function, the content of selected Masters in HRM and related fields are examined to identify the extent of ethics content. This is considered in the light of the expertise required to manage corporate ethics, and conclusions are drawn whether the HRM discipline is appropriately qualified to manage this function. Finally, recommendations and further research towards advancing the role and function of corporate ethics managers in general are proposed.