Clinical psychologists' and nonpsychiatric physicians' attitudes and behaviors in sexual and confidentiality boundary violations were examined. The 171 participants' responses were analyzed by profession, sex, and status (student, resident, professional) on semantic differential, boundary violation vignettes, and a version of Pope, Tabachnick, and Keith-Spiegel's (1987) ethical scale. Psychologists rated sexual boundary violation as more unethical than did physicians (p<.001). Rationale (p<.01) and timing (p<.001) influenced ratings. Psychologists reported fewer sexualized behaviors than physicians (p<05). Professional experience (...) (p<.01) and sex (p<.05) were associated with confidence-violating behavior. Overall, 78% of the sample reported attitudes or behaviors associated with boundary violations. The behavior violations were correlated (r=.49). Actual violators rated vignette violators more leniently than did nonviolators (p<.01). (shrink)
This study sought to gauge ethical attitudes about professional boundary issues of physicians and nurses in the Kingdom of Saudi Arabia. Respondents scored 10 relevant boundary vignettes as to their ethical acceptability. The group as a whole proved “aware/ ethically conservative,” but with the physicians' score falling on the “less ethically conservative” part of the spectrum compared to nurses. The degree of ethicality was more related to profession than to gender, with nurses being more “ethical” than (...) class='Hi'>physicians. (shrink)
To explore whether market reforms in a health care system affect medical professionalethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2–3 years after a major overhaul of the Dutch health care system involving several market reforms. Surgeons now regularly advertise their work (while this was forbidden in the past) and pay more attention to patients with (...) relatively minor afflictions, thus deviating from codes of ethics that oblige physicians to treat each other as brothers and to treat patients according to medical need. Dutch GPs have abandoned their traditional reticence and their fear of medicalization. They now seem to treat more in accordance with patients’ preferences and less in accordance with medical need. Market reforms do affect medical professional principles, and it is doubtful whether these changes were intended when Dutch policy makers decided to introduce market elements in the health care system. Policy makers in other countries considering similar reforms should pay attention to these results. (shrink)
Medical ethics changed dramatically in the past 30 years because physicians and humanists actively engaged each other in discussions that sometimes led to confrontation and controversy, but usually have improved the quality of medical decision-making. Before then medical ethics had been isolated for almost two centuries from the larger philosophical, social, and religious controversies of the time. There was, however, an earlier period where leaders in medicine and in the humanities worked closely together and both fields were (...) richer for it. This volume begins with the 18th century Scottish Enlightenment when professors of medicine such as John Gregory, Edward Percival, and the American, Benjamin Rush, were close friends of philosophers like David Hume, Adam Smith, and Thomas Reid. They continually exchanged views on matters of ethics with each other in print, at meetings of elite intellectual groups, and at the dinner table. Then something happened, physicians and humanists quit talking with each other. In searching for the causes of the collapse, this book identifies shifts in the social class of physicians, developments in medical science, and changes in the patterns of medical education. Only in the past three decades has the dialogue resumed as physicians turned to humanists for help just when humanists wanted their work to be relevant to real-life social problems. Again, the book asks why, finding answers in the shift from acute to chronic disease as the dominant pattern of illness, the social rights revolution of the 1960's, and the increasing dissonance between physician ethics and ethics outside medicine. The book tells the critical story of how the breakdown in communication between physicians and humanists occurred and how it was repaired when new developments in medicine together with a social revolution forced the leaders of these two fields to resume their dialogue. (shrink)
Marketing ethics is normally marketed as a sub-specialization of business ethics. In this paper, marketing ethics serves as an umbrella term for advertising, PR and sales ethics and as an example of professionalethics. To structure the paper, four approaches are distinguished, with a focus on typical professional conflicts, codes, roles or climates respectively. Since the moral climate approachis more inclusive than the other approaches, the last part of the paper deals mainly with (...) moral climates, within the above-mentioned marketing sub-professions. (shrink)
Numerous articles in the popular press together with an examination of websites associated with the medical, legal, engineering, financial, and other professions leave no doubt that the role of professions has been impacted by the Internet. While offering the promise of the democratization of expertise – expertise made available to the public at convenient times and locations and at an affordable cost – the Internet is also driving a reexamination of the concept of professional identity and related claims of (...) expertise and standards of integrity. This paper begins with a presentation of case studies illustrating the ease by which impostors infiltrate the ranks of professionals. Reports of individuals masquerading as professionals via the Internet often reveal that these imposters cause harm to the unwary victims who rely on assertions of professional expertise. Such reports motivated the authors to examine the origins and evolution of the traditional roles of professions and professionals in today’s society, as well as question how, or whether, the standards for professional practice have been adapted to the challenges posed by technology, i.e., do statements of professionalethics provide a ‘guiding light’ for practitioners and their clients in the cyber age? The authors challenge the professions to consider the notion that technology forces a confrontation between the guild-like aspects of a profession that have served, on the one hand, to protect a profession from encroachment and, on the other hand, have purportedly protected the public. (shrink)
Despite the apparently universal recognition of a pervasive "success at any cost" amorality in the professional and business world, and the need to do something about it, attempts to establish a campus-wide professionalethics curriculum continue to encounter resistance at many colleges and universities. The main stumbling block seems to be a purely practical one: How do you fit a course on professionalethics into academic worksheets that are already over-crowded with essential technical courses in (...) every professional discipline? I maintain, to the contrary, that the real problem is one of attitude and will, and these in turn rest upon a set of mistaken notions about the nature of professionalethics. In this essay I highlight what I take to be a number of fallacies about professionalethics and then suggest a better way to think about its place in the formal education of professionals. (shrink)
Professional associations, like the Academy of Management, exist to foster and promote scholarship, exchange among faculty, and an environment conducive to member professionalethics development. However, this last purpose of such organizations has received the least amount of attention. Moreover, previous research has demonstrated that there are differences in perceived needs for professionalethics development between tenured and untenured faculty. In the current research 260 Academy of Management members were surveyed. The research identified differences between (...) tenured and untenured management faculty with respect to expectations for the Academy of Management to provide ethics education and research with respect to the professional code of conduct. Implications of the findings are discussed from a developmental perspective. Directions for future research are provided. (shrink)
This study examines the effects of individual ethical values and organizational factors on the professionalethics of PR practitioners in Korea by considering a person–situation interactionist model. Individual ethical values are used as individual factors, and organizational factors consist of an organization’s reward and punishment for ethical/unethical behavior, the behavior of peers, and the ethical integrity of the chief ethics officer. The professionalethics of PR practitioners (the dependent variable) are classified into the following three (...) dimensions: professionalethics for the public, the client, and the PR industry. The results indicate that agency practitioners were more likely to be committed to their profession than to their organization, whereas in-house practitioners were more likely to be committed to their organization than to their profession. That is, in-house practitioners showed weak professional commitment, indicating that they perceived themselves as employees, not as PR professionals. Organizational factors such as reward, punishment, and peers’ ethical behavior had considerable influence on the professionalethics of in-house practitioners, whereas they had little influence on agency practitioners. Organizational factors as well as individual ethical values were more likely to influence the professionalethics of in-house practitioners than that of agency practitioners. Thus, to foster in-house practitioners’ professionalethics and commitment, professional associations in the PR industry should make efforts to provide in-house practitioners with more information on the PR industry and more opportunities for interacting and maintaining communication with their colleagues in the industry. (shrink)
The circumscribed quadrature of professionalethics aims to show the necessary shift from deontology to professionalethics, from deontological codes to ethical codes. While deontology and the deontological codes that materialise from it set their sights on professionals' responsibilities, professionalethics and the ethical codes that should derive from it would set their sights on the professional act, on its successful performance. In this way, the stress comes to be placed not only on (...) the professional's responsibility, although that too, but also on the necessary orchestration of the responsibilities shared at numerous levels by everyone involved in the performance of the professional act. The author identifies and typifies five elements present in the professional act. Four of them involve direct the protagonism of the professional, the recipient of the professional service, the institution that makes the service possible and from which the professionals' service is offered, and finally the human factor, the people who are behind the aforementioned factors and their nature, the professional, the recipient of the services and institutions. And each of these factors paves the way for a series of diversified protagonisms: inter-professional cooperation, receiver of professional services and their human environment around them, macro and micro institutions, diverse human profiles. However, all of this takes place within the framework of the fifth important element in professionalethics: a given, specific society as a circumscription of the four elements cited above, which sets the moral bar, a set of convictions and desired collective ethics which unquestionably also affect the performance of professional acts. With this reflection, we take note of the necessary co-responsibility in the provision of professional services, a co-responsibility which we could express simply in healthcare terms: it is not enough to merely have sound healthcare professionals if we do not have good patients with favourable affective environments, nor sound healthcare institutions, nor serious people who are socially committed to their work and their role, nor a society that believes in and fosters given identifiers of the personal and professional health to which we aim. The reflections in this proposal embark on a pathway of reflection which, we believe, deserves to be further explored. (shrink)
Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more (...) expensive than generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)
In this paper, we discuss the ethical responsibility of the Information Technology (IT) industry towards its female workforce. Although the growing IT industry experiences skills shortages, there is a declining trend in the representation of women. The paper presents evidence that the IT industry is not gender-neutral and that it does little to promote or retain its female workforce. We urge that professional codes of ethics in IT should be revised to take into account the diverse needs of (...) its staff. (shrink)
As commonly understood, professionalethics consists of shared duties and episodic dilemmas--the responsibilities incumbent on all members of specific professions joined together with the dilemmas that arise when these responsibilities conflict. Martin challenges this "consensus paradigm" as he rethinks professionalethics to include personal commitments and ideals, of which many are not mandatory. Using specific examples from a wide range of professions, including medicine, law, high school teaching, journalism, engineering, and ministry, he explores how personal commitments (...) motivate, guide, and give meaning to work. (shrink)
In ProfessionalEthics and Civic Morals , Emile Durkheim outlined the core of his theory of morality and social rights which was to dominate his work throughout the course of his life. In Durkheim's view, sociology is a science of morals which are objective social facts, and these moral regulations form the basis of individual rights and obligations. This book is crucial to an understanding of Durkheim's sociology because it contains his much-neglected theory of the state as a (...) moral institution, and it provides an understanding of his critique of anomie and egoistic individualism. The growing interest in cultural revolution and moral regulation make this edition of Durkheim's classic work especially timely. The new preface by Bryan Turner sets the book in its intellectual and historical context, and illustrates the relevance of this work to present day debates on the state, society, and moral regulation. (shrink)
Philosophy is a vast subject and it is growing day by day in many branches although it has many traditional branches like epistemology, metaphysics, ethics and logic etc. Professionalethics is a discipline of philosophy and a part of subject called as ETHICS. In professionalethics we study the morals and code of conduct to be used while one practices in his/her profession. Media is also a profession and there is also a code of (...) conduct to this profession better. If media professional be ready to work according to its professionalethics, he/she can have a good approach and it will direct him/her to play an important role in shaping good governance. In this paper it is an attempt made to draw a relation between all these conceptions and presents a theoretical interpretation of the above. (shrink)
Modern educational thoughts have made a powerful impact on civilized persons. The learner is a partner in the process of learning in our age. He is a disciple and is going to be a consumer as well as customer. There is a shift from education as a means of welfare and awareness to commercialization of education. In this background, ProfessionalEthics is partly comprised of what a professional should or should not do in the work -place. It (...) also encompasses a much greater part of the professional’s life. If a professional is to have ethics then that person needs to adopt that conduct in all of his dealings. Another aspect of this is the enhancement of the profession and the industry within which the professional works. It concerns a professional’s conduct and behaviour while carrying out their professional work that is work for the good of the community and mankind. In this paper it is an attempt to draw out a relation between ProfessionalEthics and Morality. (shrink)
The complexities of professionalethics are best understood and interpreted within their sociohistorical context. This paper focuses on the experience of 20 rural psychologists from across Canada, a context rife with demographic and practice characteristics that may instigate ethical issues. Employing hermeneutic phenomenology, these qualitative research results are indicative of professional struggles that impacted the participants’ experience of professionalethics and raised key questions about policy and practise. Concerns regarding competition highlight potential professional vulnerability, (...) beget the idea of fostering general psychological practice, and question the role of professional bodies in addressing rural shortages. Dependency on government funding models and decisions highlights the benefits and medical cost-offset effect of psychological services’ role in funded medical care. The controversial prescriptive authority debate for psychologists raises myriad concerns that are particularly salient to rural practitioners. These include changes to training and practice, with risks of psychopharmacology gaining prominence over behavioural health interventions. National inconsistencies in level of registration add to the growing shortage of practitioners. Finally, the results illuminate the need for advocacy to move beyond the literature and into public policy to increase public awareness, decrease the stigma of mental illness, and develop rural Canadian psychology. Although limited to this study, these results allowed for a fuller and more robust understanding of rural practice in consideration of professionalethics, which may inform policy, science, or ethical clinical practice. (shrink)
The article explores the communist ideology that has guided the formation of professionalethics of medicine in China. It first explores the constitutions of the People’s Republic of China and the Chinese Communist Party and codes of practice for medicine enforced since 1949, showing that the core of the ideology in relation to health provision and doctor–patient relationship has always been ‘serving the people wholeheartedly’. The ideological undertaking, however, has never been successfully exercised. In the pre-reform era, the (...) bureaucratisation of health professionals led to the emergence of ‘bureaucratic medicine’ featuring negligence of patients’ interests. In the reform era, the prevailing commercialisation of health care is in fundamental conflict with the ideological commitment to serving the people. As a result, the socialist professionalethics of medicine has not been satisfactorily practiced in reality. (shrink)
ProfessionalEthics, viewed as a managerial challenge and opportunity in this study, deals with the often overlooked conceptions, actions and behavior of individuals who see themselves both as members of a profession and as members of an organization. Managers have to deal with this dual loyalty and inherent potential for conflict. This is of particular importance for new types of organizations when wanting to develop and sustain an ethical platform for the ultimate goal - assuring that future business (...) decisions of individuals are in "ethical balance" with the organization's own values and goals. (shrink)
A barrier to the development and refinement of ethics education in and across health professional schools is that there is not an agreed upon instrument or method for assessment in ethics education. The most widely used ethics education assessment instrument is the Defining Issues Test (DIT) I & II. This instrument is not specific to the health professions. But it has been modified for use in, and influenced the development of other instruments in, the health professions. (...) The DIT contains certain philosophical assumptions (“Kohlbergian” or “neo-Kohlbergian”) that have been criticized in recent years. It is also expensive for large institutions to use. The purpose of this article is to offer a rubric—which the authors have named the Health ProfessionalEthics Rubric—for the assessment of several learning outcomes related to ethics education in health science centers. This rubric is not open to the same philosophical critiques as the DIT and other such instruments. This rubric is also practical to use. This article includes the rubric being advocated, which was developed by faculty and administrators at a large academic health science center as a part of a campus-wide ethics education initiative. The process of developing the rubric is described, as well as certain limitations and plans for revision. (shrink)
Justifying the existence of professionalethics in medicine is usually connected with the traditions of a profession and with a humanistic dimension of these ethics, pointing at the same time to their culture-forming character. With such an attitude, professionalethics is treated as a part of all mankind’s output, and its teaching turns out to be an important element of preparation for taking part in culture. Taking into account the cultural meaning of professional (...) class='Hi'>ethics, one should notice that all discussions about the character of relations of medicine and ethics exceed the very health care system. The dilemma outlined in the article deals with the problem whether the existence of medical ethics requires external regulations or is this also a creation of the very representatives of medicine and only they can formulate it. If the latter is to be assumed, ethics in medicine would have to be independent of other detailed ethics and it would not need to be included in any other more general theory. In the first solution, medical ethics is becoming a part of general ethics and, therefore, it would be justified to include it in a more general theory – bioethics. The authors indicate that professionalethics does not limit freedom of the staff but gives a special opportunity to use it. Records constituting its contents are mostly standardized by a professional group which sets criteria of recruitment on its own and general duties resting on their members. (shrink)
This study explored several proposed relationships among professional ethical standards, corporate social responsibility, and the perceived role of ethics and social responsibility. Data were collected from 313 business managers registered with a large professional research association with a mailed self-report questionnaire. Mediated regression analysis indicated that perceptions of corporate social responsibility partially mediated the positive relationship between perceived professional ethical standards and the believed importance of ethics and social responsibility. Perceptions of corporate social responsibility also (...) fully mediated the negative relationship between perceived professional ethical standards and the subordination of ethics and social responsibility. The results suggested that professions should develop ethical standards to encourage social responsibility, since these actions are associated with enhanced employee ethical attitudes. (shrink)
This short work examines what the Hippocratic Oath said to Greek physicians 2400 years ago and reflects on its relevance to medical ethics today. Drawing on the writings of ancient physicians, Greek playwrights, and modern scholars, each chapter explores one passage of the Oath and concludes with a modern case discussion. This book is for anyone who loves medicine and is concerned about the ethics and history of the profession.
Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians.
The study of business ethics has led to the development of various principles that are the foundation of good and ethical business practices. A corresponding study of Information Technology (IT) professionals’ ethics has led to the conclusion that good ethics in the development and uses of information technology correspond to the basic business principle that good ethics is good business. Ergo, good business ethics practiced by IT professionals is good IT ethics and vice versa. (...) IT professionals are professionals in businesses; a difficulty presented to these professionals, however, is the number and diversity of codes of ethics to which they may be held. Considering the existence of several formalized codes of ethics prepared by various IT professionals’ associations, a more harmonized approach seems more reasonable. This paper attempts to present a review of the purpose of codes of ethics, the persons who should be covered by such codes and to organize codes of ethics for business in general and IT professionals in particular and to make the argument that, once again, good ethics is good business practice, regardless of the profession or occupation concerned. (shrink)
This paper reports an analysis of the content of the codes of ethics of 15 professional business organizations in the United States, representing the broad range of disciplines found in business. The analysis was conducted to identify common ethical issues faced by business professionals. It was also structured to highlight ethical issues that are either unique to or of particular importance for business professionals. No attempt is made to make value judgments about either the codes of ethics (...) studied or of their content. General ethical values identified include honesty and integrity, general legal compliance, discreditable or harmful acts, and obligations related to social values. More business-specific issues include confidentiality, responsibilities to employers/clients, obligations to the profession, independence and objectivity, and business-specific legal and technical compliance issues. (shrink)
(Re)framing ethics at work -- Starting conversations about professionalethics -- Working for a good life -- Being a professional : problems and promises -- Reconsidering organizations as cultures of integrity -- Seeking something more in the market -- Finding new ways to talk about everyday ethics.
BackgroundContemporary medical practice is complicated by many dilemmas requiring ethical sensitivity and moral reasoning.ObjectiveTo investigate physicians’ experience in ethical decision-making and their attitude towards ethics consultation.MethodsIn a cross-sectional survey 126 physicians representing the main clinics of Pleven University hospital were investigated by a self-administered questionnaire. The following variables were measured: occurrence, nature and ways of resolving ethical problems; physicians’ attitudes towards ethics consultation; physicians’ opinions on qualities and skills of an ethics consultant, and (...) socio-demographic characteristics. Data analysis included descriptive statistics, χ2 and t-test.ResultsResponse rate was 88.9% (n = 112). Men and women were equally represented (48.2%–51.8%). The sample consisted of experienced physicians: 42.9% had 11–20 years experience, and 33% had 21–30 years. According to 84.8% of respondents, ethical problems have been discussed in their specialty. Predominant dilemmas included relationships with patients and relatives (76.8%) and team work (67.6%). Over ¾ of physicians needed an advice in solving ethical problems. Ninety six percent responded positively to ethics consultation. They would mainly request it for resolving conflicts (72.5%), and in case of concern for the rightness of their decisions (52.7%). The image of an ethics consultant was built of clinical competence (70.9%), ability to deal with conflicts (59.1%), communication skills (58.2%), tolerance for different views (55.4%), and a special qualification in ethics (52.7%).ConclusionsThe study underlined that Pleven University hospital physicians face similar ethical dilemmas as their colleagues in other countries do. The expressed positive attitudes to ethics consultation should serve as a basis for further research and development of ethics consultation services. (shrink)
The domain of professionalethics -- Virtue, ethics, and professional life -- Virtues, vices, and situations -- Professional wisdom -- Care -- Respectfulness -- Trustworthiness -- Justice -- Courage -- Integrity.
Professionals, it is said, have no use for simple lists of virtues and vices. The complexities and constraints of professional roles create peculiar moral demands on the people who occupy them, and traits that are vices in ordinary life are praised as virtues in the context of professional roles. Should this disturb us, or is it naive to presume that things should be otherwise? Taking medical and legal practice as key examples, Justin Oakley and Dean Cocking develop a (...) rigorous articulation and defence of virtue ethics, contrasting it with other types of character-based ethical theories and showing that it offers a promising new approach to the ethics of professional roles. They provide insights into the central notions of professional detachment, professional integrity, and moral character in professional life, and demonstrate how a virtue-based approach can help us better understand what ethical professional-client relationships would be like. (shrink)
Should environmental, social, and economic sustainability be of primary concern to engineers? Should social justice be among these concerns? Although the deterioration of our natural environment and the increase in social injustices are among today’s most pressing and important issues, engineering codes of ethics and their paramountcy clause, which contains those values most important to engineering and to what it means to be an engineer, do not yet put either concept on a par with the safety, health, and welfare (...) of the public. This paper addresses a recent proposal by Michelfelder and Jones (2011) to include sustainability in the paramountcy clause as a way of rectifying the current disregard for social justice issues in the engineering codes. That proposal builds on a certain notion of sustainability that includes social justice as one of its dimensions and claims that social justice is a necessary condition for sustainability, not vice versa. The relationship between these concepts is discussed, and the original proposal is rejected. Drawing on insights developed throughout the paper, some suggestions are made as to how one should address the different requirements that theory and practice demand of the value taxonomy of professional codes of ethics. (shrink)
Termination of pregnancy after a certain gestational age and following prenatal diagnosis, in many nations seem to be granted with a special status to the extent that they by law have to be discussed within a predominantly medical context and have physicians as third parties involved in the decision-making process (‘indication-based’ approach). The existing legal frameworks for indication-based approaches, however, do frequently fail to provide clear guidance for the involved physicians. Critics, therefore, asked for professionalethics (...) and professional institutions in order to provide normative guidance for the physicians in termination of pregnancy on medical grounds. After outlining the clinical pathway in an indication-based approach and the involved types of (clinical) judgements, this paper draws upon different understandings of professionalethics in order to explore their potential to provide normative guidance in termination of pregnancy on medical grounds. The analysis reveals that professionalethics will not suffice—neither as a set of established norms nor as internal morality—in order to determine the normative framework of indication-based approaches on termination of pregnancy. In addition, there seem to be considerable inconsistencies regarding the target and outcome between prenatal testing on the one hand and following termination of pregnancy on the other hand. A source of morality external to medicine has to be the basis of evaluation if a consistent and workable normative framework for termination of pregnancy and prenatal testing should be established. (shrink)
This paper examines several key aspects of the ethical environment facing the insurance industries of Poland, The Czech Republic and Hungary as they complete the transition from Communist insurance systems built upon state-owned monopolies to viable private domestic insurance markets, and then seek to harmonize their markets with the single insurance market of the European Union. Since many types of ethical problems encountered during the transition are unlikely to diminish significantly as a result of either privatization or regulation of the (...) insurance markets of these countries, measures are identified that should help to improve the ethical environments of these markets. (shrink)
The topic of professionalism has dominated the content of major academic medicine publications (e.g. Journal of the American Medical Association, New England Journal of Medicine, Academic Medicine, Annals of Internal Medicine, The Lancet) during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of (...) skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges (representing the nation's 126 accredited medical schools and nearly 400 major teaching hospitals), the American Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations" (note the preoccupation with assessment). Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing (attributes of professionalism), describing (activities that may foster it), decrying (the environment that works against it), and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted (or not) in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)
Medical error is a leading problem of health care in the United States. Each year, more patients die as a result of medical mistakes than are killed by motor vehicle accidents, breast cancer, or AIDS. While most government and regulatory efforts are directed toward reducing and preventing errors, the actions that should follow the injury or death of a patient are still hotly debated. According to Nancy Berlinger, conversations on patient safety are missing several important components: religious voices, traditions, and (...) models. In After Harm, Berlinger draws on sources in theology, ethics, religion, and culture to create a practical and comprehensive approach to addressing the needs of patients, families, and clinicians affected by medical error. She emphasizes the importance of acknowledging fallibility, telling the truth, confronting feelings of guilt and shame, and providing just compensation. After Harm adds important human dimensions to an issue that has profound consequences for patients and health care providers. (shrink)
In a wide ranging paper the author, a barrister, considers medical ethics in the context of divided loyalties, particularly those of a doctor employed by the National Health Service and those of doctors in occupational medicine. He argues for more specific professional codes of medical ethics, especially in relation to the need to obtain patients' explicit consent before medical details are transmitted to third parties. On the thorny question of when, if ever, can the good of society (...) override the doctor's special duty to his patient of confidentiality, he urges medical organisations to be more explicit at least on how members can set about resolving such dilemmas - mere assertion that a problem exists and that individual doctors must resolve it according to their consciences is not good enough, he says. Extolling honesty and openness as fundamental values he ends by suggesting that part of a binding code of medical ethics might be a requirement that doctors display in their waiting rooms information about their personal moral stances concerning major dilemmas of medical ethics. The paper was given as the Lucas lecture under the aegis of the Royal College of Physicians' Faculty of Occupational Medicine, in whose journal it is also published. (shrink)
Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services (...) such as clinical ethics committees (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)
The first code of professionalethics must: (1)be a code of ethics; (2) apply to members of a profession; (3) apply to allmembers of that profession; and (4) apply only to members of that profession. The value of these criteria depends on how we define “code”, “ethics”, and “profession”, terms the literature on professions has defined in many ways. This paper applies one set of definitions of “code”, “ethics”, and “profession” to a part of what (...) we now know of the history of professions, there by illustrating how the choice of definition can alter substantially both our answer to the question of which came first and (more importantly) our understanding of professional codes (and the professions that adopt them). Because most who write on codes of professionalethics seem to take for granted that physicians produced the first professional code, whether the Hippocratic Oath, Percival’s Medical Ethics, the 1847 Code of Ethicsof the American Medical Association (AMA), or some other document, I focus my discussion on these codes. (shrink)
General Practice and Ethics explores the ethical issues faced by general physicans in their everyday practice, addressing two central themes: the uncertainty of outcomes and effectiveness in general practice and the changing pattern of general practitioners' responsibilities.
This paper explores issues of professionalethics that are relevant to those who engage in the ethical review of research with human subjects. Codes of ethics of a number of professional groups are examined for guidance offered to research ethics board members. The thought of the philosopher, Mike Martin, is introduced as a way to highlight some of the ethical issues that reviewers encounter in their work. Martin believes that ideals contribute to the coherence of (...) an individual’s life by shaping character. His discussion of caring, justice, trust, and professional distance offer a resource for reviewers to refl ect on the ethicaldimensions of their work. (shrink)