There are several key differences between the codes of ethics developed by the American Psychological Association and the Canadian Psychological Association. This paper tells the story behind the key differences between the U.S. and Canada codes. It starts with an introduction to the two countries and a brief history of what led up to the American Psychological Association’s (APA) decision to develop the world’s first ethics code for psychologists. This is followed by a description of the development process used by (...) APA, and the reasons why the Canadian Psychological Association (CPA) originally adopted the APA code but subsequently chose to develop its own “made-in-Canada” code of ethics. The key differences of the CPA code, the cultural, legal, and philosophical contexts that help explain the rationale for those differences, and why the differences have been maintained are discussed. In particular, attention is given to the CPA code’s strong focus on: (a) the concept of a contract with society; (b) aspiration vs. enforcement; (c) ethical reasoning and decision making; and (d) organizing standards around ethical principles. (shrink)

The development of nursing ethics as a field of inquiry has largely relied on theories of medical ethics that use autonomy, beneficence, and/or justice as foundational ethical principles. Such theories espouse a masculine approach to moral decision-making and ethical analysis. This paper challenges the presumption of medical ethics and its associated system of moral justification as an appropriate model for nursing ethics. It argues that the value foundations of nursing ethics are located within the existential phenomenon of human caring within (...) the nurse/patient relationship instead of in models of patient good or rights-based notions of autonomy as articulated in prominent theories of medical ethics. Models of caring are analyzed and a moral-point-of-view (MPV) theory with caring as a fundamental value is proposed for the development of a theory of nursing ethics. This type of theory is supportive to feminist medical ethics because it focuses on the subscription to, and not merely the acceptance of, a particular view of morality. (shrink)

Today's constrained healthcare environment can make it very difficult for nurses to provide compassionate, competent, and ethical care, and yet their continued commitment to care is viewed as requisite. Nurses' commitment to care of patients, enmeshed with professional identity, may be understood as heroic. A few nursing scholars have advanced the concept of a nurse‐patient covenant to explain or inspire nurses' commitment to care. Covenant describes an enduring relationship characterised by mutual promises and generous responsiveness. However, recent critique has revealed (...) a general misunderstanding and misuse of the term covenant in much of the nursing literature whereby individual nurses are improperly and impossibly idealised as holding sole responsibility in the commitment to care. Such an interpretation obscures society's responsibilities in caring for both patients and nurses and contributes to the idealisation of nurses' commitment to extend themselves to fill in healthcare system gaps. Yet, the concept of a covenant relationship, when reframed as occurring between society and the profession of nursing, may lead us toward solutions to the very problems the originally misused concept sustained. Evidence within healthcare systems globally suggests that nurses' commitments are fragile or fragmented under duress due to increasing pressure, demands, and even risks. A reframing of covenant has the common good for society and nursing at its core and, we argue, may lead to a more sustainable nursing identity. We present the results of an exploratory project, undertaken to examine the utility and suitability of covenant as a relational framework for nursing. We explore a reframing of a covenant of care as a relationship between nursing and society, which may provide a fruitful path toward a sustainable, shared commitment for healthcare. This covenant of care re‐centres shared work—a joint responsibility between society and nursing—as necessary for the common good. (shrink)

Derek Parfit’s view of personal identity raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be self-determining at all. However, rather than accepting that an unknown metaphysical ‘further fact’ underpins agential unity, one can accept Parfit’s view but offer a different account of what it implies morally. Part II of this article argues that contractual obligations provide a moral basis for honoring (...) advance decisions refusing life-saving and/or life-sustaining medical treatment; advance decisions have similarities to contracts, such as life insurance policies and will-contracts, that come into effect when the psychological discontinuity is through death. (shrink)

Members of the legal, medical and accounting professions are guided in their professional behavior by their respective codes of ethics. These codes of ethics are not static. They are ever evolving, responding to forces that are exogenous and endogenous to the professions. Specifically, changes in the ethical codes are often due to economic and social events, governmental influence, and growth and change within the professions. This paper presents an historical analysis of the major events leading to changes in the legal, (...) medical and accounting codes of ethics. (shrink)

Definition of the problem Commercialisation of hospitals undermines medical professionalism and modifies patient care. What should be enforced by or expected from or required of the institutional actors in the health care system to do in order to preserve these values? Arguments The said three types of commitment in colloquial language are corroborated by referring to Kant’s moral philosophy and applied to the main actors. Conclusion Defense against organisational measures that devaluate professionalism can be required of legislation only if the (...) medical profession obliges itself publicly to use its means to resist unprofessional incentives. (shrink)

In the first part of the paper, the author discusses the origin and obligation of the medical profession and argues that the duty of fidelity in the context of a patient–professional relationship (PPR) is the central obligation of medical professionals. The duty of fidelity entails seeking the patient’s best interests even at the expense of the professional’s own, and refusing to treat a risk-patient infected by SARS is a breach of fidelity because the medical professional is involved in a situation (...) of conflict of interests and places his/her own health interests ahead of the patient. The author attributes the failure to the fact that professional ethical codes are not legally enforceable, and this failure at the microethical level damages the integrity of the profession at the macroethical level. The author argues that professional autonomy must be subordinated to professional fidelity for the medical profession to survive as a social institution. In the second part of the paper, the author shows that the PPR has most of the important attributes of a fiduciary relationship, and analyzes several important court cases in some common law jurisdictions to illustrate the increasing importance of fiduciary law in adjudicating disputes between patients and medical professionals, and appeals to law courts and legislatures to apply more stringent fiduciary principles on the medical profession to ensure that the professional duty of fidelity is enforced and the goal of medicine fulfilled for the interests of members of the community who has established the medical profession in the first place. (shrink)

Since the 1980’s, surrogacy has become a popular reproductive alternative for individuals experiencing infertility. The ethical and legal analyses of surrogacy have been rich and varied. Some bioethicists have charged the commercial surrogacy industry with the exploitation of global southern women or with the impermissible commodification of children and women’s reproductive capacities. Others have praised the potential for economic empowerment and bodily autonomy that surrogacy may accord to women. However, throughout these explorations of the ethics of surrogacy, comparatively little attention (...) has been paid to the moral status of a crucial actor: the fertility doctor. Without doctors willing to provide prenatal and postnatal care to surrogates and make use of assisted reproductive technologies (ARTs), commercial surrogacy would not take place. Yet, doctors’ involvement in surrogacy is far from morally neutral. In my thesis, I aim to explore what duties doctors have in the context of commercial surrogacy. To do so, I take up the framework of fiduciary obligation. I argue that doctors have fiduciary obligations to surrogates, and that these obligations shape if and when doctors can ethically facilitate surrogacy. My thesis is divided into four chapters. The first defends the view that the doctor-patient relationship is fiduciary in nature. The second chapter extends this view to the realm of commercial surrogacy, arguing that doctors also owe the surrogates they treat fiduciary obligations. The third chapter addresses a challenge posed by my view, namely that surrogacy seems to place doctors in positions where they constantly face conflicts of interest, and are therefore unable to uphold their fiduciary duty of loyalty to surrogates. I address this concern by arguing that conflicts of interest are not inherent in surrogacy, but that surrogacy arrangements must be substantially rethought in order to safeguard the doctor-surrogate fiduciary relationship. The final chapter considers the obligations doctors have to the children they help create through surrogacy and through assisted reproduction more generally. (shrink)

Seit der Einführung der G‑DRGs als Instrument zur Vergütung von Krankenhausleistungen steht das Gesundheitswesen als System unter Kritik. Denn die Ausrichtung der Krankenhäuser auf wirtschaftlichen Erfolg relativiert den Anspruch aller Bürgerinnen und Bürger auf gute medizinische Versorgung. Der Artikel geht der Frage nach, von welchem Akteur im System welche Aktivität erzwungen, erwartet, oder verlangt werden kann, dem entgegenzuwirken. Die genannten alltagsmoralischen Urteile werden unter Rückgriff auf Kants Moralphilosophie validiert und auf die wichtigsten Akteure angewandt. Ergebnis: Der Kern des Ökonomisierungs‑/Kommerzialisierungs-Problems besteht (...) in der Entwertung der Professionalität der patientennahen Berufe. Die Neujustierung des Systems kann vom Gesetzgeber nur dann verlangt werden, wenn die verfasste Ärzteschaft sich dazu bekennt, mit den ihr zu Gebote stehenden Mitteln gegen professionswidrige Handlungsanreize vorzugehen. (shrink)

The clinical relationship has been underexplored in dementia care. This is in part due to the way that the clinical relationship has been articulated and understood in bioethics. Robert Veatch’s social contract model is representative of a standard view of the clinical relationship in bioethics. But dementia presents formidable challenges to the standard clinical relationship, including ambiguity about when the clinical relationship begins, how it weathers changes in narrative identity of patients with dementia, and how the intimate involvement of family (...) fits alongside a paradigmatically dyadic relationship. Drawing on work in recent feminist theory, a critique is offered of the standard clinical relationship in bioethics as underwritten by an individualistic conception of autonomy. An alternative view of the clinical relationship in dementia, one that embraces a relational account of autonomy, is put forward. (shrink)

The healthcare crisis that has developed in the last two decades during China's economic reform has caused healthcare and hospital financing reforms to be largely experienced by patients as a crisis in the patient–healthcare professional relationship (PPR) at the bedside. The nature and magnitude of this crisis were epitomized by the "Harbin Scandal"—an incident that took place in August 2005 in a Harbin teaching hospital in which the family of an elderly patient hospitalized in the intensive care unit (ICU) for (...) 66 days paid over RMB ¥6 million. The news was publicized globally and ended in the firing of six top hospital administrators including the hospital president and the ICU director. This paper seeks to show that the Chinese healthcare crisis is ultimately linked to a conflict of interests between patients and healthcare professionals (HCPs), which is inherent in the reformed healthcare system of China. Hence the crisis is, at its core, a crisis of fidelity and confidence that must be restored to the PPR. At the "macro" level, it is simplistic to blame the crisis on the failure of the market system, and at the "micro" level, it is naïve to expect that a contractual understanding of the PPR will effectively restore the confidence of patients. This paper will show that the fiduciary relationship and medical professionalism share similar attributes, with fidelity being the core value of both. It concludes that the loss of medical fidelity implies the dissolution of the PPR and the demise of the medical profession and challenges Chinese HCPs to keep their fidelity as a means to both protect their patients’ interests and to preserve their profession's survival. (shrink)

W artykule w trojaki sposób dowodzę odrębności profesjonalnej etyki lekarskiej, mianowicie: 1. ukazując różnice pozycji normatywnej obowiązków w etyce profesjonalnej i ogólnej, 2. uzasadniając przynależność lekarskiej etyki profesjonalnej do modelu zapożyczenia jako typu etyki aplikacyjnej, 3. podając racje za profesjonalizmem historycznym jako etyką właściwą dla stanu lekarskiego. Odrębność profesjonalnej etyki lekarskiej stanowi ważny argument za jej umieszczeniem w planie edukacji etycznej studentów medycyny i lekarzy. W końcowej części pracy rekonstruuję rzeczywiste i postulowane relacje między etyką profesjonalną a profesjonalizmem, bioetyką akademicką (...) i bioetyką publiczną. Celem rekonstrukcji jest wskazanie optymalnego dla edukacji etycznej miejsca etyki profesjonalnej w systemie kształcenia etycznego profesjonalistów. (shrink)

The physician-patient relationship has changed over the last several decades, requiring a systematic reevaluation of the competing demands of patients, physicians, and families. In the era of genetic testing, using a model of patient care known as the family covenant may prove effective in accounting for these demands. The family covenant articulates the roles of the physician, patient, and the family prior to genetic testing, as the participants consensually define them. The initial agreement defines the boundaries of autonomy and benefit (...) for all participating family members. The physician may then serve as a facilitator in the relationship, working with all parties in resolving potential conflicts regarding genetic information. The family covenant promotes a fuller discussion of the competing ethical claims that may come to bear after genetic test results are received. (shrink)