To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly (...) distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)

ZusammenfassungZwischenfälle, Behandlungsfehler und tragische Verläufe können im Medizinalltag schwerwiegende Auswirkungen auf Patientinnen und Patienten haben, aber auch auf beteiligte Gesundheitsfachpersonen. Don Berwick, ehemaliger Leiter des Institute for Healthcare Improvement in Boston, hob in einem Interview die Unterstützung von „second victims“ als „ethische Angelegenheit“ hervor. Es besteht aber keine Klarheit darüber, was darunter zu verstehen ist. Der vorliegende Beitrag unternimmt eine Klärung dieser Frage aus der Perspektive der Organisationsethik. Ausgehend von Daten aus der Literatur zur Wirksamkeit der Unterstützung von „second victims“ (...) werden Herausforderungen beschrieben und aus organisationsethischer Sicht beurteilt. Es gibt Hinweise, dass Angebote der Unterstützung von „second victims“ zwar bestehen, aber nicht wirksam genug sind, um die psychischen Folgen von unerwünschten Ereignissen zu bewältigen. Dies wirkt sich auf betroffene Fachpersonen negativ aus und kann zu einer erneuten Gefährdung der Patientensicherheit führen. Angesichts dieser Befunde bedarf es eines organisationsethischen Ansatzes, um Don Berwicks Forderung nachzukommen, den Umgang mit „second victims“ als „ethische Angelegenheit“ wahrzunehmen. Dieser Ansatz fördert die Kongruenz zwischen den deklarierten und den faktisch gelebten Werten der Organisation. Sein normatives Fundament besteht in den Fürsorgepflichten der Organisation, gegenüber Patientinnen, Patienten und Mitarbeitenden. Die Organisationsethik ermöglicht es, die Unterstützung von „second victims“ verbindlich und sichtbar in der Sicherheitskultur der Organisation zu verankern. Sie konkretisiert sich in ihrer Verpflichtung, für die Mechanismen der Entstehung des Phänomens zu sensibilisieren und Ressourcen bereitzustellen, die einen effektiven Umgang damit ermöglichen. Dazu gehören evidenzbasierte ethische Leitlinien, standardisierte Prozesse, Schulungen sowie niederschwellige Coaching-Angebote. (shrink)

Institutions create their own internal cultures, including the culture of ethics that pervades scientific research, academic policy, and administrative philosophy. This paper addresses some of the issues involved in institutional enhancement of its culture of research ethics, focused on individual empowerment and strategies that individuals can use to initiate institutional change.

One of the most striking findings of the study by Foglia and colleagues (2009) was that clinicians and managers were most concerned with limited resources while ethics committee chairpersons focuse...

Research on ethical dilemmas in health care has become increasingly salient during the last two decades resulting in confusion about the concept of moral distress. The aim of the present paper is to provide an overview and a comparative analysis of the theoretical understandings of moral distress and related concepts. The focus is on five concepts: moral distress, moral stress, stress of conscience, moral sensitivity and ethical climate. It is suggested that moral distress connects mainly to a psychological perspective; stress (...) of conscience more to a theological–philosophical standpoint; and moral stress mostly to a physiological perspective. Further analysis indicates that these thoughts can be linked to the concepts of moral sensitivity and ethical climate through a relationship to moral agency. Moral agency comprises a moral awareness of moral problems and moral responsibility for others. It is suggested that moral distress may serve as a positive catalyst in exercising moral agency. An interdisciplinary approach in research and practice broadens our understanding of moral distress and its impact on health care personnel and patient care. (shrink)

The goal of an ethics case discussion is to find the best decision for the patient and the other persons involved (relatives, doctors, nurses and others) from an ethical point of view, in a communicative respect and from a psychosocial view. In the end, it may not mean changing one’s view or even one’s own position, but rather to exchange arguments, weight them and come to a consensus as to further action. The latter is important as the topics concern patients (...) and require action. For the moderator an ethics case discussion in this sense is no judgement, no taking over of responsibility for the decision result, no taking over of a leading role, and no team supervision. However, ethics case discussion has become a valuable tool to deal with moral conflicts in hospitals. Opportunities and problems of ethics case discussions are discussed. A 4-step approach for structuring the course of an ethics case discussion is presented. (shrink)

BackgroundThe biopharmaceutical industry operates at the intersection of life sciences, clinical research, clinical care, public health, and business, which presents distinct operational and ethical challenges. This setting merits focused bioethics consideration to complement legal compliance and business ethics efforts. However, bioethics as applied to a biopharmaceutical industry setting often is construed either too broadly or too narrowly with little examination of its proper scope.Main textAny institution with a scientific or healthcare mission should engage bioethics norms to navigate ethical issues that (...) arise from the conduct of biomedical research, delivery of clinical care, or implementation of public health programs. It is reasonable to assume that while bioethics norms must remain constant, their application will vary depending on the characteristics of a given setting. Context “specification” substantively refines ethics norms for a particular discipline or setting and is an expected, needed and progressive ethical activity. In order for this activity to be meaningful, the scope for bioethics application and the relevant contextual factors of the setting need to be delineated and appreciated. This paper defines biopharmaceutical bioethics as: the application of bioethics norms (concepts, principles, and rules) to the research, development, supply, commercialization, and clinical use of biopharmaceutical healthcare products. It provides commentary on this definition, and presents five contextual factors that need to be considered when applying bioethics norms to a biopharmaceutical industry setting: (1) dual missions; (2) timely and pragmatic guidance; (3) resource stewardship; (4) multiple stakeholders; and (5) operational complexity.ConclusionUnderstanding the scope of the biopharmaceutical enterprise and contextual factors of a biopharmaceutical industry setting is foundational for the application of bioethics norms. Establishing a common language and approach for biopharmaceutical bioethics will facilitate breadth and depth of discussion and subsequent implementation to benefit patients, the healthcare system and society. (shrink)

Pharmaceutical companies are major sponsors of biomedical research. Most scholars and policymakers focus their attention on government and academic oversight activities, however. In this article, I consider the role of pharmaceutical companies’ internal ethics statements in guiding decisions about corporate research and development (R&D). I review materials from drug company websites and contributions from the business and medical ethics literature that address ethical responsibilities of businesses in general and pharmaceutical companies in particular. I discuss positive and negative uses of pharmaceutical (...) companies’ ethics materials and describe shortcomings in the companies’ existing ethics programs. To guide employees and reassure outsiders, companies must add rigor, independence, and transparency to their R&D ethics programs. (shrink)