Although bioethics is a lively and expanding interdisciplinary field, there is not enough research about the patient‐doctor relationship, a central issue in philosophy of medicine. This article surveys the state of the field, paying attention to recent work by Alfred Tauber, and supplementing it with insights from Hans Jonas's philosophy of technology in order to propose a principle of responsible autonomy for health care. Based on a comparative look across different sub‐fields in bioethics, the resulting model claims that physician responsibility (...) is essential to professional integrity, providing an alternative to other active trends emphasizing patient autonomy, such as Robert Veatch's contractual model. (shrink)

BackgroundThe concept of evidence-based medicine has strongly influenced the appraisal and application of empirical information in health care decision-making. One principal characteristic of this concept is the distinction between "evidence" in the sense of high-quality empirical information on the one hand and rather low-quality empirical information on the other hand. In the last 5 to 10 years an increasing number of articles published in international journals have made use of the term "evidence-based ethics", making a systematic analysis and explication of (...) the term and its applicability in ethics important.DiscussionIn this article four descriptive and two normative characteristics of the general concept "evidence-based" are presented and explained systematically. These characteristics are to then serve as a framework for assessing the methodological and practical challenges of evidence-based ethics as a developing methodology. The superiority of evidence in contrast to other empirical information has several normative implications such as the legitimization of decisions in medicine and ethics. This implicit normativity poses ethical concerns if there is no formal consent on which sort of empirical information deserves the label "evidence" and which does not. In empirical ethics, which relies primarily on interview research and other methods from the social sciences, we still lack gold standards for assessing the quality of study designs and appraising their findings.ConclusionThe use of the term "evidence-based ethics" should be discouraged, unless there is enough consensus on how to differentiate between high- and low-quality information produced by empirical ethics. In the meantime, whenever empirical information plays a role, the process of ethical decision-making should make use of systematic reviews of empirical studies that involve a critical appraisal and comparative discussion of data. (shrink)

The unfinished nature of Beauchamp and Childress’s account of the common morality after 34 years and seven editions raises questions about what is lacking, specifically in the way they carry out their project, more generally in the presuppositions of the classical liberal tradition on which they rely. Their wide-ranging review of ethical theories has not provided a method by which to move beyond a hypothetical approach to justification or, on a practical level regarding values conflict, beyond a questionable appeal to (...) consensus. My major purpose in this paper is to introduce the thought of Bernard Lonergan as offering a way toward such a methodological breakthrough. In the first section, I consider Beauchamp and Childress’s defense of their theory of the common morality. In the second, I relate a persisting vacillation in their argument regarding the relative importance of reason and experience to a similar tension in classical liberal theory. In the third, I consider aspects of Lonergan’s generalized empirical method as a way to address problems that surface in the first two sections of the paper: (1) the structural relation of reason and experience in human action; and (2) the importance of theory for practice in terms of what Lonergan calls “common sense” and “general bias.”. (shrink)

Background: Ethical frameworks for organ donation following circulatory death (DCD) were established >20 years ago. However, considerable variation exists among these, indicating consensus has not been reached on all issues. Additionally, advances such as cardiac DCD transplants and normothermic regional perfusion (NRP) may have reignited old debates.Methods: We reviewed the English-language literature addressing ethical issues in DCD from 1993 to 2022, examining changes in frequency with which ethical principles and their sub-themes identified within each, were addressed.Results: Non-maleficence was the most (...) frequently addressed principle (192 of 199 articles), as well as the most varied, with 9 subthemes (versus 2-4 within each of the other bioethical principles).Conclusions: There were several changes in the terminology used to refer to DCD over time, and substantial interest in cardiac DCD and NRP in recent publications, arising in 11 and 19 of the 30 publications from 2018 to 2022. (shrink)

OBJECTIVES: To identify the factors that influence the assessment of reported cases of physician-assisted death by members of the public prosecution. DESIGN/SETTING: At the beginning of 1996, during verbal interviews, 12 short case-descriptions were presented to a representative group of 47 members of the public prosecution in the Netherlands. RESULTS: Assessment varied considerably between respondents. Some respondents made more "lenient" assessments than others. Characteristics of the respondents, such as function, personal-life philosophy and age, were not related to the assessment. Case (...) characteristics, i.e. the presence of an explicit request, life expectancy and the type of suffering, strongly influenced the assessment. Of these characteristics, the presence or absence of an explicit request was the most important determinant of the decision whether or not to hold an inquest. CONCLUSIONS: Although the presence of an explicit request, life expectancy and the type of suffering each influenced the assessment, each individual assessment was dependent on the assessor. The resulting danger of legal inequality and legal uncertainty, particularly in complicated cases, should be kept to a minimum by the introduction of some form of protocol and consultation in doubtful or boundary cases. The notification procedure already promotes a certain degree of uniformity in the prosecution policy. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

According to the recovery model, mental healthcare should be aimed towards a conception of recovery articulated by a patient or service user in accord with his or her own specific values. The model thus presupposes and emphasises the agency of the patient and opposes paternalism. Recent philosophical work on the relations between respect, self-respect, self-esteem, shame, and agency suggests, however, two ways in which mental illness itself can undermine self-respect, promote shame and undermine agency, suggesting a tension within the recovery (...) model. I argue, however, that this is a tension rather than a fatal flaw by distinguishing between paternalist and non-paternalist clinical responses to this failure of agency. (shrink)

As climate change risks intensify, I welcome Ray and Cooper’s call for bioethicists to engage with environmental injustice, though I am pessimistic it is another false dawn for bioethics engagement...

Since the publication of the first edition of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics there has been much debate about what a proper method in medical ethics should look like. The main rival for Beauchamp and Childress’s account, principlism, has consistently been casuistry, an account that recommends argument by analogy from paradigm cases. Admirably, Beauchamp and Childress have modified their own view in successive editions of Principles of Biomedical Ethics in order to address the concerns proponents of (...) casuistry and others have had about principlism. Given these adjustments to their view, some have claimed that principlism and casuistry no longer count as distinct methods. Even so, many still consider these two conceptions of bioethical methodologies as rivals. Both accounts of the relationship between casuistry and principlism are wrong. These two conceptions of methodology in biomedical ethics are significantly different, but the differences are not the ones pointed out by those who still claim that they are distinct positions. In this article, I explain where the real similarities and differences lie between these two views. (shrink)

Advances in science and technology has led to the rise of different issues in relation to human life and security as well as the environment. These issues also paved the way for the field of Bioethics with its principles aiming to uphold moral standards on these issues. This study aimed to test and modify the theoretical models of the factors influencing the conviction schemas of BS Biology Bioethics students of a state university toward bioethical issues. One hundred ten (110) undergraduate (...) students were pre-tested and post-tested for comprehension of Bioethics principles, moral disengagement, and convictions toward bioethical issues. Identified personal factors were also retrieved for testing. Results showed that the Bioethics course has increased the participants’ comprehension of Bioethics principles, moral disengagement, and convictions. Stepwise multiple regression results revealed that anxiety, extraversion, exposure to media, and moral disengagement can predict pre-convictions. On the other hand, only moral disengagement was found to predict post-convictions. Furthermore, moral disengagement can be predicted by convictions before the course while anxiety, openness to change, and convictions were the predictors after the course. The proposed theoretical model was for tested goodness of fit using Structural Equation Modeling (SEM) and acceptance was based on the model fit criteria. Since the proposed model was not found to fit the data, this was revised based on the results of multiple regression and correlation among exogenous variables. Three models were constructed and found to fit the data adequately. These models show the direct and indirect effects of personal factors and moral disengagement on convictions. The mediating effects of moral disengagement and convictions to each other were also shown. Findings further imply that the ability to understand the principles does not influence convictions, but rather moral disengagement has a greater influence on the said factor. Improving moral education by integrating Bioethics to the curriculum is recommended to further strengthen the moral judgement and reasoning of students. (shrink)

Most current dental ethics curricula use a deontological approach to biomedical and dental ethics that emphasizes adherence to duties and principles as properties that determine whether an act is ethical. But the actual ethical orientation of students is typically unknown. The purpose of the current study was to determine the ethical orientation of dental students in resolving clinical ethical dilemmas. First-year students from one school were invited to participate in an electronic survey that included eight vignettes featuring ethical conflicts common (...) to the health care setting. The Multidimensional Ethics Scale was used to evaluate the students’ ethical judgments of these conflicts. Students rated each vignette along 13 ethically relevant items using a 7-point scale. Nine of the thirteen items were analyzed because they represent the dominant ethical theories, including deontology. One hundred sixteen dental students successfully completed the survey. Of the analyzed items, those associated with deontology had comparatively weak associations with whether students judged the action to be ethical and whether students judged themselves likely to perform the action. Whether an action was judged to be caring had the strongest association with whether the action was judged to be ethical and whether students judged themselves likely to perform the action. These results suggest that adherence to duties or principles has weaker association with students’ ethical judgments and behavior compared to caring, which was found to be more influential in their ethical judgments and behavior. Current dental school curricula with a primary focus on deontology may no. (shrink)

Some ethicists argue that patient confidentiality is absolute and thus should never be broken. I examine these arguments that when critically scrutinised, become porous. I will explore the concept of patient confidentiality and argue that although, this is a very important medical and bioethical issue, this needs to be wisely delivered to reduce third party harm or even detriment to the patient. The argument for absolute confidentiality is particularly weak when it comes to genetic information and inherited disease.

Many problems that arise when providing pharmacy services may contain some ethical components and the aims of this study were to develop and validate a scale that could assess difficulties of ethical issues, as well as the frequency of those occurrences in everyday practice of community pharmacists. Development and validation of the scale was conducted in three phases: generating items for the initial survey instrument after qualitative analysis; defining the design and format of the instrument; validation of the instrument. The (...) constructed Ethical Issue scale for community pharmacy setting has two parts containing the same 16 items for assessing the difficulty and frequency thereof. The results of the 171 completely filled out scales were analyzed. The Cronbach’s α value of the part of the instrument that examines difficulties of the ethical situations was 0.83 and for the part of the instrument that examined frequency of the ethical situations was 0.84. Test–retest reliability for both parts of the instrument was satisfactory with all Interclass correlation coefficient values above 0.6,. The 16-item scale, as a self assessment tool, demonstrated a high degree of content, criterion, and construct validity and test–retest reliability. The results support its use as a research tool to asses difficulty and frequency of ethical issues in community pharmacy setting. The validated scale needs to be further employed on a larger sample of pharmacists. (shrink)

In this article I use a case study of 3 newspaper pieces about assisted suicide and euthanasia to show how journalists can use analysis and commentary to highlight the ethical dimension of an important public issue. Using an approach grounded in ethical theory, I examine how these pieces-from the Christian Science Monitor, Los Angeles Times, and New York Times-shed light on ethical issues including matters of duties and consequences. It is argued that an analytical approach that openly frames a topic (...) as having a moral dimension is particularly appropriate for ethics coverage in light of the value-laden nature of writing about ethics. (shrink)

Media scholars have used ethical theory extensively to evaluate journalists' own ethical practices. However, they have given little attention to how ethical theory could be used to assess the way journalists cover the ethics of others. In light of the important role that medicine and other professions play in the lives of individuals and society, this article proposes a framework to evaluate news coverage of ethical issues that involve professions and in society. After making the case for the need for (...) this framework, the article describes the framework itself and the rationale for each component. Finally, ideas for applying the framework in future research are suggested. (shrink)

This article is based on a qualitative empirical project about a distinct kinship group who were among the first identified internationally as having a genetic susceptibility to cancer. 50 were invited to participate. 15, who had all accepted testing, were interviewed. They form a unique case study. This study aimed to explore interviewees’ experiences of genetic testing and how these influenced their family relationships. A key finding was that participants framed the decision to be tested as ‘common sense’; the idea (...) of choice around the decision was negated and replaced by a moral imperative to be tested. Those who did not follow ‘common sense’ were judged to be imprudent. Family members who declined testing were discussed negatively by participants. The article addresses what is ethically problematic about how test decliners were discussed and whether these ethical concerns extend to others who are offered genetic testing. Discussions showed that genetic testing was viewed as both an autonomous choice and a responsibility. Yet the apparent conflict between the right to autonomy and the moral imperative of responsibility allowed participants to defend test decliners’ decisions by expressing a preference for or defending choice over responsibility. The ‘right not to know’ seemed an important moral construct to help ethically manage unpopular decisions made by close family who declined testing. In light of this research, the erosion of the ‘right not to know’ in the genomic age could have subtle yet profound consequences for family relationships. (shrink)

There has been increasing interest in developing practical, non-theoretical tools for analyzing ethical problems in public health, biomedicine, and other scientific disciplines so that professionals can make and justify ethical decisions in their own research or practice. Tools for ethical decisionmaking, together with case studies on ethics, are often used in graduate education programs and in continuing professional education. Students can benefit from opportunities to further develop their analytical skills, to recognize ethical issues, and to develop their moral sensitivity. One (...) practical approach for illustrating and facilitating ethical analysis uses cases with contrary facts and circumstances, an approach which complements rather than replaces theoretical approaches to moral reasoning. Cases with contrary facts and circumstances are presented in two or more alternative ways so that the facts, circumstances, or framing of one version runs counter to that of the other version (s). Cases with contrary facts, together with practical steps for identifying and analyzing ethical issues, are likely to be useful tools for illustrating and facilitating ethics analysis and stimulating the moral imagination. (shrink)

The study of the neuroscience and genomics of mental illness are increasingly intertwined. This is mostly due to the translation of medical technologies into psychiatry and to technological convergence. This article focuses on psychosis. I argue that the convergence of neuroscience and genomics in the context of psychosis is morally problematic, and that ethics scholarship should go beyond the identification of a number of ethical, legal, and social issues. My argument is composed of two strands. First, I argue that we (...) should respond to technological convergence by developing an integrated, patient-centred approach focused on the assessment of individual vulnerabilities. Responding to technological convergence requires that we integrate insights from several areas of ethics, translate bioethical principles into the mental health context, and proactively try to anticipate future ethical concerns. Second, I argue that a nuanced understanding of the concept of vulnerability might help us to accomplish this task. I borrow Florencia Luna’s notion of ‘layers of vulnerability’ to show how potential harms or wrongs to individuals who experience psychosis can be conceptualised as stemming from different sources, or layers, of vulnerability. I argue that a layered notion of vulnerability might serve as a common ground to achieve the ethical integration needed to ensure that biomedical innovation can truly benefit, and not harm, individuals who suffer from psychosis. (shrink)

The European Union faced high risks from personal data proliferation to individuals’ privacy. Legislation has emerged that seeks to articulate all interests at stake, balancing the need for data flow from EU countries with protecting personal data: the General Data Protection Regulation. One of the mechanisms established by this new law to strengthen the individual’s control over their data is the so-called “right to be forgotten”, the right to obtain from the controller the erasure of records. In gender transition, this (...) right represents a powerful form of control over personal data, especially health data that may reveal a gender with which they do not identify and reject. Therefore, it is pertinent to discern whether the right to have personal data deleted—in particular, health data—is ethically acceptable in gender transition. Towards addressing the ethical dimensions of the right to be forgotten in this case, this study presents relevant concepts, briefly outlines history, ethics and law of records considering the evolution from paper to electronic format, the main aspects of identity construction and gender identity, and explores the relationship between privacy, data protection/information control and identity projection. Also, it discusses in gender transition the relation between “the right to self-determination”, “the right to delete”, and “the right to identity and individuality”. Conclusions on the ethical admissibility of the ‘right to be forgotten’ to control gender-affirming information are presented. (shrink)

Within the world of pharmacology, the male body has traditionally been taken as the biological norm. Coupled with this, concern about danger to the unborn foetus has meant that, until very recently, ‘women of childbearing potential’ were routinely excluded from most of the early phases of clinical drug testing. Consequently, most drugs tested during Phase I trials were initially carried out on healthy male volunteers. During subsequent phases when drugs were tested on patients, women remained largely under-represented. As a result, (...) some drugs prescribed for women have later been discovered to be lacking in efficacy, and women are more likely to suffer adverse drug reactions than men. The exclusion of women during the early phases of clinical drug trials has now been lifted and drugs are currently being more widely tested on women. This paper examines the differing political and ethical positions adopted by the pharmaceutical industry, drug regulators, pharmacologists, women's groups and patient activists in relation to the exclusion and inclusion of women in clinical drug trials. (shrink)

As case management is under development in France for elderly people, this study sets out to identify and analyse key situations responsible for ethical dilemmas for French case managers. We based our study on the analyses of individual interviews made with case managers and focus-group discussions, bringing together all case managers working in local organisations running for at least a year. We identified three situations giving rise to ethical dilemmas: in the order of importance, the refusals of care, the practicalities (...) of collecting and sharing personal data and the allocation of resources. These three situations can lead to conflict between the principle of beneficence and those of respect for autonomy, non-maleficence and justice. We describe here how French case managers practically deal with these situations. (shrink)

This essay is a critique of medical/clinical ethics from the personal perspective of a medical historian in an academic health science centre who has interacted with ethicists. It calls for greater transparency and accountability of ethicists involved in ‘bedside consulting;’ it questions the wisdom of the four principles of biomedical ethics and their American cultural origins with respect to training; challenges the authority of ‘core competencies’ for ethicists as identified by the American Society for Bioethics and Humanities; and muses over (...) the apparent reintroduction of religion into clinical medicine through the medium of bioethics. This essay is designed to provoke reflection on the putative ‘professionalism’ of the consulting ethics enterprise for which educational baselines and curricula are not standardized. By analysing sources such as the professional material communicated by the Canadian Bioethics Society, it also critiques the collective ethical shortcoming... (shrink)

Renewing the deontology tradition of moral obligation requires, especially in relation to catastrophe and disaster, a broader methodological perspective which would enable deontology to transcend its own limits. The demand for pluralistic research approaches brings with challenging requirements that have to be considered when shaping a hybrid moral theory that incorporates a proactive approach. The personalist approach to the individual, based on the principles of integrity, responsibility and solidarity and seeking the wellbeing of a person, may prove inspirational in shaping (...) such a proactive approach. (shrink)

The aim of this essay is to consider how the dominant moral theories can be applied to the discourse of disaster situations. In specific times, specific values take priority. Therefore, this article will consider how moral theory deals with time. Kant’s moral philosophy has influenced ethics enormously, but rejects the idea of a temporal dimension in ethics; consequently, modern ethics has not devoted sufficient attention to the temporal dimension. Nonetheless, Kantian ethics established the basic principles of respect for human beings (...) as ends in themselves, and for autonomy of rational beings; thus it cannot be ignored. In political decision-making, simply having good intentions does not suffice; they must be accompanied by responsibility. Both the ethics of consequentialism and virtue ethics (the virtue of wisdom) deal with responsibility for the future. Hans Jonas developed a concept of responsibility concerned particularly with the risks associated with new technologies and the ethical requirement to avoid disasters. “Uncertainty may be our permanent fate - which has moral consequences” (Jonas). Public policy should be precautionary. The ethics of disaster preparation planning is distinct from the ethics of disaster response planning. (shrink)

Moral theory has generally focused on resolving ethical dilemmas by identifying ethically sound options. Whether the focus is on consequences, duties, principles or virtues, ethical cases are often approached in ways that assume morally sound solutions can be found and followed. Such ‘ideal morality’ assumes that moral goodness is always possible, leaving people confident they have done the right thing. Such an approach becomes inadequate in disaster settings where any good solution is often difficult to see. This paper examines recent (...) work on nonideal moral theory as a useful model for disaster bioethics. This approach views moral dilemmas as situations where no choice is ideal and every option involves some element of unavoidable wrongdoing. Rather than straining for ideal answers, this approach acknowledges that sometimes the lesser of two evils is the best that can be done. Such situations inevitably lead to feelings of regret or guilt, commonly encountered in discussions of disaster bioethics. This paper explores the practical implications of nonideal approaches for disaster responders working in tragic situations. (shrink)

Spies, like soldiers, do a job and employ tactics that need justifying. I offer an argument for how Christian ethics may handle the moral problems of spying and do so by looking at the morally troubling tactics used by spies through the eyes of those who played an important role in shaping Christian theology and philosophy and have become normative in Christian moral thinking on the use of force. I argue that spying may be justifiable when we conceive the profession (...) as a kind of use of force that is governed by the just war criteria. Spying is a particular kind of use of force that takes its moral character from those who authorize it, with what justification, to what ends, and with what methods. Particular attention is given to the tactics of disregarding the rules of war, the telling and living of lies, running covert operations, and assassinating military and political leaders. (shrink)

Subjects of ectogenesis—human beings that are developing in artificial wombs (AWs)—share the same moral status as newborns. To demonstrate this, I defend two claims. First, subjects of partial ectogenesis—those that develop in utero for a time before being transferred to AWs—are newborns (in the full sense of the word). Second, subjects of complete ectogenesis—those who develop in AWs entirely—share the same moral status as newborns. To defend the first claim, I rely on Elizabeth Chloe Romanis’s distinctions between fetuses, newborns and (...) subjects of ectogenesis. For Romanis, the subject of partial ectogenesis ‘is neither a fetus nor a baby’ but is, instead, a ‘new product of human reproduction’. In this essay, I begin by, expanding upon Romanis’s argument that subjects of partial ectogenesis are not fetuses while arguing that those subjects are newborns. Next, I show that the distinction that Romanis draws between subjects of partial ectogenesis and newborns needs to be revised. The former is a kind of the latter. This leads us to an argument that shows why different moral statuses cannot be justifiably assigned to subjects of partial ectogenesis and subjects of complete ectogenesis, respectively. As subjects of partial ectogenesis share the same moral status as newborns, it follows that subjects of complete ectogenesis share the same moral status as newborns as well. I conclude by considering implications that this essay may have for the research and development of AW technology and conceptual links between a subject’s moral status and birth. (shrink)

McCarthy et al.’s proposal gains much of its plausibility by relying on a superficial treatment of justice, human dignity, sin, and the common good within the Christian tradition. Upon closer inspection of what these terms mean within the context of Christianity, it becomes clear that despite using the same phrases (e.g., a commitment to “protecting vulnerable populations,” the goal of “promoting justice,” etc.) contemporary secular bioethical goals are often deeply at odds with goals of Christian bioethics. So, while the authors (...) are right that there is room for dialogue (and even agreement) concerning general moral principles, the process of specification and application of these principles will often be heavily influenced by competing ethical traditions. Such divergent influences will often frustrate cooperative ventures between secular and religious bioethical projects. Thus, when put into action, McCarthy et al.’s proposal will—at best—produce a divided kingdom; one that cannot hope to stand. (shrink)

Background Paramedicine is a newly regulated profession in Australia and with the introduction of regulation in 2018 for this profession came increased responsibilities – including the introduction of a professional code of conduct. Several countries now have regulation of paramedicine and associated professional codes to guide ethical and professional behaviour. Despite this, there has been no published research into paramedic understanding and use of their professional codes. Objectives To explore Australian paramedics’ use and understanding of their professional code of conduct. (...) Research design: This study used a qualitative descriptive design, underpinned by hermeneutic theory. Reflexive thematic analysis was used to analyse the interview data and identify Australian paramedic perceptions surrounding the use of their code of conduct. Results 11 Registered Paramedics from several states and territories were interviewed. Participants were invited to interview by advertisement on social media and the Australasian College of Paramedicine Web site. Participants had varied professional backgrounds including clinical work, education providers and policymakers/managers. Four themes were identified as follows: Theme 1 – ‘You don’t know, what you can’t know’; Theme 2 – ‘I don’t need the code – the code is for others’; Theme 3 – ‘It’s about time’; Theme 4 – ‘Navigating the new profession’. Ethical considerations: Ethics approval was granted by the Monash University Human Research Ethics Committee (MUHREC) Project ID: 28921. All participants provided informed consent. Conclusions The results of this study suggest that paramedics’ knowledge and use of their code is limited, and participants appeared to mostly rely instead on ‘common sense’ morals. Participants did appear to want to understand the broad concepts of the code more and have this better integrated into the profession. The code was also interpreted as important to the paramedic profession and its new professional status, helping to legitimise it as a health profession in Australia. (shrink)

Background: Professional ethical codes are an important part of healthcare. They are part of the professionalisation of an occupation, are used for regulation of the professions and are intended to guide ethical behaviour in healthcare. However, so far, little is known about the practical use of professional codes in healthcare, particularly in paramedicine. Objective: The aim of this scoping review was to determine what is known in the existing literature about health professionals’ knowledge, awareness and use of their professional codes. (...) Method: A scoping review was performed based on a six-stage framework as described by Levac et al. Six databases were searched: OVID Medline, EMBASE, EMCARE, CINAHL, ProQuest and Scopus, in September 2020. Google Scholar, Trove and Google using.gov and.org websites were also searched for grey literature. Two reviewers independently assessed study eligibility. Results: The search yielded 1162 results after duplicate removal. Thirty-nine studies remained after title and abstract review. Twenty-five articles were included after full-text review. Sixteen examined nursing, eight examined medicine and one examined both nursing and medicine. No studies were identified that examined paramedicine. Twenty-one studies were of a cross-sectional design and four studies were of a qualitative design. Conclusion: Most health professionals know the codes exist, but do not think they know the content. Despite valuing professional codes highly, healthcare professionals do not use them regularly in clinical practice. Further research is needed, and professional codes should be made useful for practice and consideration given to how codes can be written, communicated and implemented to increase their actualisation in healthcare. Research should also begin in paramedicine to identify clinician’s knowledge and use of codes in this profession. Review registration: Open Science Framework – doi:10.17605/OSF.IO/NKBY4 Ethics Statement: This article does not contain any studies involving human participants performed by any of the authors. The review followed good scientific conduct. (shrink)

There are numerous ways in which “the particular”—particular individuals, particular ideologies, values, beliefs, and perspectives—are sometimes overlooked, ignored, or even driven out of the healthcare profession. In many such cases, this is bad for patients, practitioners, and the profession. Hence, we should seek to find a place for the particular in health care. Specific topics that I examine in this essay include distribution of health care based on the particular needs of patients, the importance of protecting physicians’ right to conscientious (...) objection, the value in tolerating a plurality of moral and medical perspectives within the field, and more. Ultimately, as the imagery in the essay’s title suggests, I argue that if one cares about the “well-being” of the medical profession, then one should seek to avoid destroying the many diverse and particular entities that constitute it. (shrink)

Nursing professionals in a variety of practice settings routinely use implied consent. This form of consent is used in place of or in conjunction with informed or explicit consent. This article looks at one aspect of a qualitative exploratory study conducted in a Day of Surgery Admission unit. This article focuses on the examination of nurses’ understandings of implied consent and its use in patient care in nursing practice. Data were collected through one-on-one interviews and analysed using a thematic analysis. (...) Nurses participating in this study revealed that they routinely used implied consent in their nursing practice. This article will look at whether implied consent supports or impedes a patient’s autonomy. (shrink)

This case study appeared in full in the last issue of Research Ethics Review : 108). It concerned the supervision of Simon Shaw, a senior radiographer undertaking an MSc, whose research focused on the professional and parental response to fetal tissue abnormalities.

We use the format of a hypothetical case study to review issues related to pharmaceutical product approval and physician prescribing practices. In this case, a new FDA-approved drug is recommended for a patient who subsequently experiences an adverse event that may or may not be related to the prescription. This case raises a number of ethical and legal considerations physicians routinely face when deciding whether to recommend such drugs for their patients. Despite the need for ongoing observation by the regulatory (...) apparatus, physicians should be cognizant of the limitations of the drug approval system and the post-approval prescription drug surveillance system. We discuss physicians’ ethical obligations when faced with a newly approved drug, including seeking out independent sources of learning, reporting adverse effects, and notifying patients about limitations in available knowledge about therapeutic recommendations. (shrink)

The aim of the present article is to contribute empirically derived knowledge about Swedish researchers’ experience of ethical problems, conflicts and dilemmas in their research practice in relation to the ethical vetting legislation and procedure. The study has been carried out using the critical incident technique, with researchers from various disciplines providing examples from their own research practice of problems relating to research ethics. The analysis of the researchers’ responses indicates three phenomena, partly in line with similar studies in other (...) countries: the law of ethical vetting puts limits on the relevant research ethical questions; it is not possible to anticipate all questions of research ethics; and there are consequences to the fact that the boards for ethical vetting ignore problems that fall outside the law. (shrink)

Ethical arguments about assisted dying often focus on whether or not respect for an individual’s autonomy gives a reason to offer them an assisted death if they want it. In this paper, I present an argument for legalising assisted dying which appeals to the autonomy of people who don’t want to die. Adding that option can transform the nature of someone’s choice set, enabling them to pursue other options voluntarily where that would otherwise be harder or impossible. This does not (...) contradict the more familiar arguments for legalising assisted dying based on the autonomy of those who seek to die. But it does suggest that a wider constituency of support for that legislative change might be created by emphasising that one need not be in that position to be benefited by the change. (shrink)

The mental illness of substance dependence or addiction is responsible for major economic, social, and personal costs. If we are to elucidate its etiology, understand its mechanisms, and eventually bring it under control, scientific investigation is essential. Research in animals and humans has enhanced our understanding of this disease through examination of genetic, neurophysiological, biochemical, and behavioral factors. But because animals cannot verbalize their subjective responses to drugs and because significant symptoms of addiction cannot be observed in non-drug-dependent humans, it (...) is not surprising that certain investigations of substance dependence have required the participation of addicted or substance-dependent humans. (shrink)

The mental illness of substance dependence or addiction is responsible for major economic, social, and personal costs. If we are to elucidate its etiology, understand its mechanisms, and eventually bring it under control, scientific investigation is essential. Research in animals and humans has enhanced our understanding of this disease through examination of genetic, neurophysiological, biochemical, and behavioral factors. But because animals cannot verbalize their subjective responses to drugs and because significant symptoms of addiction cannot be observed in non-drug-dependent humans, it (...) is not surprising that certain investigations of substance dependence have required the participation of addicted or substance-dependent humans. (shrink)

Beneficence and respect for autonomy are two of the most fundamental moral duties in general and in bioethics in particular. Beyond the usual questions of how to resolve conflicts between these duties in particular cases, there are more general questions about the possible forms of the interactions between them. Only recognition of the full spectrum of possible interactions will ensure optimal moral deliberation when duties potentially conflict. This paper has two simultaneous objectives. The first is to suggest a typological scheme (...) of all possible modes of interaction; these will be classified under the “discrete,” “semi-discrete,” and “non-discrete” categories, according to whether the meaning and/or forms of expression of each duty are treated as independent from or rather as constrained by the other. The second objective is to show that all logical possibilities of interaction indeed have real expressions in medical ethics, to provide clear illustrations of each, and in particular to stress those that have usually escaped recognition. (shrink)

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment and (...) Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions.In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy. (shrink)

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment and (...) Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions.In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy. (shrink)

During the summer of 1999 and in April 2002 Iwent to the Netherlands in order to meet someof the leading authorities on the euthanasiapolicy. They were asked multiple questions.This study reports the main findings to thequestion: should doctors suggest euthanasia totheir patients? Some interviewees did notobserve any significant ethical concernsinvolved in suggesting euthanasia. For variousreasons they thought physicians should offereuthanasia as an option. Two intervieweesasserted that doctors don''t propose euthanasiato their patients. Five interviewees objectedto physician''s initiative.