Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 20 Heft: 1 Seiten: 237-240.

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law (...) and medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Attempting to determine solutions for unethical practices in the field, this research was designed to assess the effectiveness of public relations firms’ ethics statements in decreasing the incidence of malpractice. This study revealed an encouraging finding that practitioners working in firms with ethical parameters were significantly more likely to engage in ethical practices. Moreover, educating public relations practitioners about the content of ethics statement could positively influence their ethical practices. At the same time, this study’s findings suggest (...) further questions for consideration in future scholarship and in the application of ethics statements to practice within the field. (shrink)

This study was designed to examine the prevalence of a code of ethics and to analyze its content among public relations agencies in the United States. Of the 1,562 public relations agencies reviewed, 605 (38.7%) provided an ethical statement. Among the ethical statements provided by these public relations agencies, ‹respect to clients,’ ‹service,’ ‹strategic,’ and ‹results’ were the values most frequently emphasized. On the other hand, ‹balance,’ ‹fairness,’ ‹honor,’ ‹social responsibility,’ and ‹independence’ were the least frequently mentioned in (...) the ethical codes. Also, none of the sampled agencies included any sanctions regarding enforcement of their particular codes of ethics. (shrink)

This paper reports on a study of large U.S. based corporations concerning the status of formal ethics statements. Almost all responding firms (91%) have promulgated a formal code of ethics while one-half have published values statements and about one-third have a corporate credo. Analysis of these statements concentrated on to whom they are communicated; whether codes of ethics contain information pertinent to the industry, include sanctions for violations and provide specific guidance regarding gifts. Conclusions and implications for (...) managers and researchers are drawn. (shrink)

This text presents and comments on 80 exemplary ethics statements from leading corporations and organizations worldwide. It offers these seven principles to follow in developing such statements: write it; tailor it; communicate it; promote it; revise it; live it; and enforce/reinforce it.

Should companies make explicit external statements of their ethical stance? If so, at what point in their ethical development? And, what form might such a statement take? The authors, MBA students at London Business School, researched these questions among the stakeholders of a large financial services organisation in the UK, and recommended what they term “the drip effect” approach. The implications of the project offer insights to other companies which may be deliberating whether and how to produce an external (...) statement of ethics. (shrink)

Should companies make explicit external statements of their ethical stance? If so, at what point in their ethical development? And, what form might such a statement take? The authors, MBA students at London Business School, researched these questions among the stakeholders of a large financial services organisation in the UK, and recommended what they term “the drip effect” approach. The implications of the project offer insights to other companies which may be deliberating whether and how to produce an external (...) statement of ethics. (shrink)

The UK accountancy industry has traded upon its professional status as a means of expanding and legitimating its activities. Extensive appeals are made to ethical codes and disciplinary arrangements as part of its claim to professional status. This study examines some recent events relating to audit failures and alleged unprofessional conduct by accountancy firms and their partners in the UK with a view to assessing the validity of the claims to professional status. It concludes that the rhetoric of the claims (...) is belied by the failure/inability of the professional accountancy bodies to take effective action against the offending firms or their partners. (shrink)

This paper reports on the findings of the third in a series of surveys of large U.S.-based and multinational corporations on their ethics statements. Focusing on four types – values statement, corporate credo, code of ethics and Internet privacy policy – we find growth in the use of these statements over the last decade. We discuss the external communication of these statements, including the avenues that are now used for promotion and their intended audiences. The paper concludes (...) with a number of research issues to be addressed. (shrink)

It is proposed to open the possibility for natural scientists to make an ethical statement in public immediately after passing the examination giving the right to practise a scientific profession. A concept of a possible text of this statement is presented.

This empirical study explores aspects of how companies that are positively recognized by their workforce as “Best Companies to Work For” convey the underlying principles of their “trustworthy” culture. The study examines the normative ethical frameworks and affective language utilized in the ethics statements. Although multiple studies have considered normative ethical frameworks in individual ethical decision making, few have considered normative ethical frameworks in organization ethics statements. In addition, this study expands the analysis to include the ethic of (...) care. Of the “Best Companies to Work for” in this study, 93 had accessible online ethics statements. Findings indicated 70 % of the ethics statements utilized combinations of three types of normative ethics studied, while 30 % used a single framework. In statements with combined frameworks, the deontological framework had the highest frequency, while the ethic of care was present in 33 % of statements and the teleological framework had the lowest frequency. In ethics statements with a singular framework, the framework rankings were consistent with findings for combined frameworks. Using the Dictionary of Affect in Language, there were statistically significant differences on pleasantness between statements that mentioned ethic of care and those that did not. This study sheds light on how these trustworthy companies communicate by publishing their ethics statements and by using a multidimensional approach in their ethics statements that has greater pleasantness when an ethic of care is utilized. (shrink)

Background This paper addresses sedation at the end of life. The use of sedation is often seen as a last resort for patients whose death is imminent and whose symptoms cannot be treated in any other way. This paper asks how to assess constellations, where patients want to hasten their death by refusing (further) life-sustaining treatment, or by voluntarily stopping eating and drinking (VSED), and wish this to be accompanied by sedation. Argument We argue that sedation is ethically and legally (...) permissible not only as a last resort, but in principle. Furthermore, we see a clear obligation to sedate in cases of acute suffering of any kind, while in some other constellations individual physicians’ objections to supposedly premature or unnecessary sedation must be respected. Such possible reservations should, however, be reconsidered in light of the fundamental ethical and legal right to a self-determined death. Conclusion In general, sedation practices should be less restrictive, and existing guidelines should be revised accordingly. (shrink)

BackgroundMany studies have been published about ethics committees and the clarifications requested about the submitted applications. In Finland, ethics committees require a separate statement on ethical aspects of the research in applications to the ethics committee. However, little is known about how researchers consider the ethical aspects of their own studies.MethodsThe data were collected from all the applications received by the official regional ethics committee in the Hospital District of Northern Savo during 2004–2009 (n = (...) 688). These included a total of 56 studies involving research on tissue other than blood. The statements by the researchers about the ethics about their own research in these applications were analyzed by thematic content analysis under the following themes: recruitment, informed consent, risks and benefits, confidentiality and societal meaning.ResultsThe researchers tended to describe recruitment and informed consent process very briefly. Usually these descriptions simply stated who the recruiter was and that written consent would be required. There was little information provided on the recruitment situation and on how the study recruiters would be informed. Although most of the studies were clinical, the possibility was hardly ever discussed that patients could fail to distinguish between care and research.ConclusionThe written guidelines, available on the webpages of the ethics committee, do not seem to be enough to help researchers achieve this goal. In addition to detailed guidelines for researchers, investigators need to be taught to appreciate the ethical aspects in their own studies. (shrink)

Background: Patients today interact with physicians, physician groups, and health plans, each of which may follow distinct ethical guidelines.Method: We systematically compared physician codes of ethics with ethics policies at physician group practices and health plans, using the 1998–99 policies of 38 organisations—18 medical associations , nine physician group practices , and 12 health plans —selected using random and stratified purposive sampling. A clinician and a social scientist independently abstracted each document, using a 397-item health care ethics (...) taxonomy; a reconciled abstraction form was used for analysis. This study focuses on ethics policies regarding professional obligation towards patients, resource allocation, and care for the vulnerable in society.Results: A majority in all three groups mention “fiduciary obligations” of one sort or another, but associations generally address physician/patient relations but not health plan obligations, while plans rarely endorse physicians’ obligations of advocacy, beneficence, and non-maleficence. Except for occasional mentions of cost effectiveness or efficiency, ethical considerations in resource allocation rarely arise in the ethics policies of all three organisational types. Very few associations, groups, or plans specifically endorse obligations to vulnerable populations.Conclusions: With some important exceptions, we found that the ethics policies of associations, groups, and plans are narrowly focused and often ignore important ethical concerns for society, such as resource allocation and care for vulnerable populations. More collaborative work is needed to build integrated sets of ethical standards that address the aims and responsibilities of the major stakeholders in health care delivery. (shrink)

The General Medical Council’s Outcome for Graduates, published in 2018,1 is the latest guidance for medical schools on the GMC’s expectations of the undergraduate medical curriculum. One of its three top level outcomes—Professional Values and Behaviours—refers to medical ethics and law, professionalism and patient safety competencies. Furthermore, the recent proliferation of patient safety inquiries in the UK2–4 has elevated the emphasis on ethical medical practice5 and critical medical ethics and law competencies for future doctors. In response to these (...) developments and to ensure an up to date offering, the Institute of Medical Ethics Education Committee has updated the consensus statement on the core curriculum for medical ethics and law for doctors of tomorrow.6 This refined curriculum is the result of a national consultation process. We asked for the views of all lead teachers of medical ethics and law in all UK medical schools, the UK’s chief medical officers, the GMC, and delegates at our annual education conference in 2017 who …. (shrink)

Many journals in the physical sciences require authors to submit assurances of compliance with human subjects and other research ethics standards. These requirements do not cover all disciplines equally, however. In this paper we report on the findings of a survey of perceptions of ethical and managerial problems from journal editors in political science and related disciplines. Our results show that few journals in political science require assurance statements common to journals for other scientific disciplines. We offer some reasons (...) for this as well as some recommendations for implementing ethical assurance safeguards for political science. (shrink)

The humanitarian sector continually faces organizational and operational challenges to respond to the needs of populations affected by war, disaster, displacement, and health emergencies. With the goal of improving the effectiveness and efficiency of response efforts, humanitarian innovation initiatives seek to develop, test, and scale a variety of novel and adapted practices, products, and systems. The innovation process raises important ethical considerations, such as appropriately engaging crisis-affected populations in defining problems and identifying potential solutions, mitigating risks, ensuring accountability, sharing benefits (...) fairly, and managing expectations. This paper aims to contribute to knowledge and practice regarding humanitarian innovation ethics and presents two components related to a value-sensitive approach to humanitarian innovation. First is a mapping of how ethical concepts are mobilized in values statements that have been produced by a diverse set of organizations involved in humanitarian innovation. Analyzing these documents, we identified six primary values (do-no-harm, autonomy, justice, accountability, sustainability, and inclusivity) around which we grouped 12 secondary values and 10 associated concepts. Second are two proposed activities that teams engaged in humanitarian innovation can employ to foreground values as they develop and refine their project’s design, and to anticipate and plan for challenges in enacting these values across the phases of their project. A deliberate and tangible approach to engaging with values within humanitarian innovation design can help to ground humanitarian innovation in ethical commitments by increasing shared understanding amongst team members, promoting attentiveness to values across the stages of innovation, and fostering capacities to anticipate and respond to ethically challenging situations. (shrink)

The increasing use of cluster randomised trials in low-resource settings raises unique ethical issues. The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomised Trials is the first international ethical guidance document specific to cluster trials, but it is unknown if it adequately addresses issues in low-resource settings. In this paper, we seek to identify any gaps in the Ottawa Statement relevant to cluster trials conducted in low-resource settings. Our method is to analyse a prototypical cluster (...) trial conducted in a low-resource setting with the Ottawa Statement; to identify ethical issues in the design or conduct of the trial not captured adequately and to make recommendations for issues needing attention in forthcoming revisions to the Ottawa Statement. Our analysis identified six ethical aspects of cluster randomised trials in low-resource settings that require further guidance. The forthcoming revision of the Ottawa Statement should provide additional guidance on these issues: streamlining research ethics committee review for collaborating investigators who are affiliated with other institutions; the classification of lay health workers who deliver study interventions as health providers or research participants; the dilemma experienced by investigators when national standards seem to prohibit waivers of consent; the timing of gatekeeper engagement, particularly when researchers face funding constraints; providing ancillary care in health services or implementation trials when a routine care control arm is known to fall below national standards and defining vulnerable participants needing protection in low-resource settings. (shrink)

The use of charged-particle radiation therapy is an increasingly important development in the treatment of cancer. One of the most pressing controversies about the use of this technology is whether randomised controlled trials are required before this form of treatment can be considered to be the treatment of choice for a wide range of indications. Equipoise is the key ethical concept in determining which research studies are justified. However, there is a good deal of disagreement about how this concept is (...) best understood and applied in the specific case of CPRT. This report is a position statement on these controversies that arises out of a workshop held at Wolfson College, Oxford in August 2011. The workshop brought together international leaders in the relevant fields , including proponents on both sides of the debate, in order to make significant progress on the ethical issues associated with CPRT research. This position statement provides an ethical platform for future research and should enable further work to be done in developing international coordinated programmes of research. (shrink)

In pluralist societies, stakeholders in healthcare may have different experiences of and moral perspectives on health, well-being, and good care. Increasing cultural, religious, sexual, and gender diversity among both patients and healthcare professionals requires healthcare organizations to address these differences. Addressing diversity, however, comes with inherent moral challenges; for example, regarding how to deal with healthcare disparities between minoritized and majoritized patients or how to accommodate different healthcare needs and values. Diversity statements are an important strategy for healthcare organizations to (...) define their normative ideas with respect to diversity and to establish a point of departure for concrete diversity approaches. We argue that healthcare organizations ought to develop diversity statements in a participatory and inclusive way in order to promote social justice. Furthermore, we maintain that clinical ethicists can support healthcare organizations in developing diversity statements in a more participatory way by fostering reflective dialogues through clinical ethics support. We will use a case example from our own practice to explore what such a developmental process may look like. We will critically reflect on the procedural strengths and challenges as well as on the role of the clinical ethicist in this example. (shrink)

Many large corporations now have written codes of ethics to guide the business/marketing activities of employees. The purpose of this study was to determine the frequency and types of topics which are covered in the ethics policy statements of large U.S. corporations. The results indicated that the topics covered most often (respectively) were: misuse of funds/improper accounting, conflicts of interest, political contributions, and confidential information. It is concluded that in addition to written ethics policy statements, top management (...) should communicate ethical values and demonstrate by example. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both (...) vertically and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

Australian immigration detention has been called state sanctioned abuse and a crime against humanity. The Australian healthcare community has been closely involved with these policies, calling for their reform and working within detention centres to provide healthcare. As well as having a devastating impact on health, immigration detention changes the scope and nature of healthcare, with its delivery described as a Sisyphean task. In this article I will explore the guidance that is available to clinicians who work within detention centres (...) and argue that codes, guidelines and positions statements provide little help in relation to ethical decision making. First I will outline guidance that can be found in codes of ethics and position statements, focusing on particularly relevant principles, such as advocacy, clinical independence and the clinicians’ relationship to human rights. I will then highlight the disparity between this guidance and the delivery of healthcare within detention by drawing on the testimony of clinicians who formerly worked in these environments. While this disparity should be cause for alarm and at a minimum call into question how codes and positions statements are being used, there are more fundamental reasons why codes and position statements fail to provide guidance in these circumstances. I will outline a more general criticism of codes of ethics and use this to suggest a way forward, including looking beyond codes and position statements to guide action within Australian immigration detention. (shrink)

Australian immigration detention has been called state sanctioned abuse and a crime against humanity. The Australian healthcare community has been closely involved with these policies, calling for their reform and working within detention centres to provide healthcare. As well as having a devastating impact on health, immigration detention changes the scope and nature of healthcare, with its delivery described as a Sisyphean task. In this article I will explore the guidance that is available to clinicians who work within detention centres (...) and argue that codes, guidelines and positions statements provide little help in relation to ethical decision making. First I will outline guidance that can be found in codes of ethics and position statements, focusing on particularly relevant principles, such as advocacy, clinical independence and the clinicians’ relationship to human rights. I will then highlight the disparity between this guidance and the delivery of healthcare within detention by drawing on the testimony of clinicians who formerly worked in these environments. While this disparity should be cause for alarm and at a minimum call into question how codes and positions statements are being used, there are more fundamental reasons why codes and position statements fail to provide guidance in these circumstances. I will outline a more general criticism of codes of ethics and use this to suggest a way forward, including looking beyond codes and position statements to guide action within Australian immigration detention. (shrink)

One element of the American Society for Bioethics and Humanities’ recently-piloted quality attestation portfolio for clinical ethics consultants is a “philosophy of clinical ethics consultation statement” describing the candidate’s approach to clinical ethics consultation. To date, these statements have been under-explored in the literature, in contrast to philosophy statements in other fields such as academic teaching. In this article, I argue there is merit in expanding the content of these statements beyond clinical ethics consultation alone (...) to describe the author’s approach to other important “domains” of healthcare ethics practice. I also claim such statements have at least three additional uses outside quality attestation: as a reflective practice learning tool to increase role clarity among practicing healthcare ethicists and bioethics fellows; assisting practicing healthcare ethicists in clarifying role expectations with those they work with; and helping inform developing professional practice standards. (shrink)

In August 2011, a group of medical doctors, ethicists, academic and medical physicists were asked to debate and reach consensus on the potential need for randomised control trials to test charged particle radiation therapy for treating tumours. The outcome of the meeting was a paper recently published in the Journal of Medical Ethics entitled “Position statement on ethics, equipoise and research on charged particle therapy” by Sheehan et al. However 6 of the 30 meeting participants withdrew from (...) authorship of the ‘position statement’ because their views were not adequately represented. The ‘position statement’ did not state our reasons for withdrawing from the statement, which is a considerable omission. We had two principal objections: the case for the benefits to patients and society of randomized trials to test CPRT was not adequately represented, and the complexities and potential harms of CPRT were not clearly stated. In this response we explain and justify our objections. Patients, doctors and policymakers seeking to make independent judgments about whether equipoise exists for the relative benefits of CPRT should therefore read this document alongside the ‘position’ statement. (shrink)

Owing to unique features of their design, cluster randomized trials complicate the interpretation of standard ethics guidelines. The recently published Ottawa statement on the ethical design and conduct of cluster randomized trials provides researchers and research ethics committees with detailed guidance on the design, conduct and review of cluster trials. The Ottawa statement sets out 15 recommendations, including guidance on the justification of study design, the need for research ethics committee review, the identification of research (...) participants, obtaining informed consent, the role of gatekeepers in protecting cluster interests, the assessment of benefits and harms, and the protection of vulnerable participants. (shrink)

Owing to unique features of their design, cluster randomized trials complicate the interpretation of standard ethics guidelines. The recently published Ottawa statement on the ethical design and conduct of cluster randomized trials provides researchers and research ethics committees with detailed guidance on the design, conduct, and review of cluster trials. The Ottawa statement sets out 15 recommendations, including guidance on the justification of study design, the need for research ethics committee review, the identification of research (...) participants, obtaining informed consent, the role of gatekeepers in protecting cluster interests, the assessment of benefits and harms, and the protection of vulnerable participants. (shrink)

Schelling's 1806 polemic against Fichte, and his last major work on the philosophy of nature. The heat of anger can concentrate the mind. Convinced that he had been betrayed by his former collaborator and colleague, Schelling attempts in this polemic to reach a final reckoning with Fichte. Employing the format of a book review, Schelling directs withering scorn at three of Fichte’s recent publications, at one point likening them to the hell, purgatory, and would-be paradise of Fichtean philosophy. The central (...) bone of contention is the understanding of nature: Fichte sees it as lifeless matter in motion, sheer opposition to be overcome, while Schelling waxes poetic in his defense of a living, organic nature of which humanity is a vital part. Indeed, we do not know ourselves without understanding our connection to nature, argues Schelling, anticipating many thinkers in contemporary environmental ethics. Dale E. Snow’s introduction sets the stage and explains the larger context of the conflict, which was already visible in the correspondence of the two philosophers, which broke off by 1802. Notes are included throughout the text, providing background information and identifying the many references to Fichte. Dale E. Snow is Associate Professor of Philosophy at Loyola University of Maryland and the author of Schelling and the End of Idealism, also published by SUNY Press. (shrink)