A review of the literature indicates that faculty, students, and employers recognize the importance of professional behaviors for a successful career. These professional behaviors were defined by business school faculty to include honesty and ethical decision making, regular attendance and punctuality, professional dress and appearance, participation in professional organizations, and appropriate behavior during meetings. This paper presents the results of a survey administered to managers, faculty, and students about how business school professors can teach these (...) professional behaviors. A hypothesis was tested that managers, professors, and students differ in their perceptions about what is appropriate professional behavior. Using a scale of strongly agree to strongly disagree to respond to critical incidents, one-way ANOVA indicated no group differences for items about cheating, plagiarism, and helping students to work projects on schedule. Group differences were found for ethics items (raising course grade for the purpose of tuition reimbursement, stopping excessive use of school printers, simplifying course work to accommodate weaker students), time management items (making accommodations for students unable to regularly attend class, refusing to admit late students), appearance items (requiring students to dress in suits for major presentations, counseling a student with facial piercing), and for items about required activities inside and outside of the classroom. (shrink)

Professional roles are often thought to bring role-specific permissions and obligation, which may allow or require role-occupants to do things they would not be permitted or required to do outside their roles, and which as individuals they would rather not do. This feature of professional roles appears to bring them into conflict both with 'ordinary' or non-role morality, and with personal integrity which is often thought to demand some form of personal endorsement of one's conduct. How are we (...) to reconcile the demands of roles with ordinary morality and with personal integrity? This collection draws together a set of papers which explore these questions as they bear upon a number of different professional roles, including those of the lawyer, the judge and the politician, and from a variety of perspectives, including contemporary analytic moral theory, jurisprudence, psychoanalytic theory, virtue ethics, and contextualism, and, more broadly, from philosophy and legal academia and practice. (shrink)

Professional statements guide neonatal resuscitation thresholds at the border of viability. A 2015 systematic review of international guidelines by Guillen et al. found considerable variability between statements’ clinical recommendations for infants at 23–24 weeks gestational age (GA). The authors concluded that differences in the type of data included were one potential source for differing resuscitation thresholds within this “ethical gray zone.” How statements present ethical considerations that support their recommendations, and how this may account for variability, has not been (...) as rigorously explored. We performed a mixed-methods exploratory analysis of 25 current international guidelines for neonatal resuscitation at 22+0−25+0 weeks GA. Qualitative analysis using a modified grounded theory yielded 34 distinct codes, eight categories, and four overarching themes. Three themes, consequentialism, principlism, and rights-based, consisted of concepts central to these ethical frameworks. The fourth theme, clinical reasoning, described counseling practices, medical management, outcomes data, and prognostic uncertainty, without any ethical context. The theme of clinical reasoning appeared in 22 of 25 guidelines. Ten guidelines lacked any ethical theme. Guidelines with an identified ethical theme were more likely to recommend comfort care than guidelines without an identified ethical theme, and recommended it at a higher average GA (22.7 weeks vs. 22.0 weeks, p = 0.03). Thus, how ethical concepts are incorporated into guidelines potentially impacts resuscitation thresholds. We argue that inclusion of explicit discussion of ethical considerations surrounding resuscitation in the “gray zone” would clarify values that inform recommendations and facilitate discussions about how neonatology ought to approach periviability as outcomes continue to evolve. (shrink)

Recent publications have argued that practical wisdom is increasingly important for medical practices, particularly in complex contexts, to stay focused on giving good care in a moral sense to each individual patient. Our empirical investigation into an ordinary medical practice was aimed at exploring whether the practice would reveal practical wisdom, or, instead, adherence to conventional frames such as guidelines, routines and the dominant professional discourse. We performed a thematic analysis both of the medical files of a complex patient (...) and her daughter’s diary. We did find practical wisdom, but only sporadically, whereas it has proved to be essential for professional care. This deficit appeared to result from several factors like: the organization of the practice; established routines; a hierarchical culture; and a traditional medical discourse. Moreover, we discerned various negative consequences. More empirical research into practical wisdom in everyday medical practices is needed for the benefit of professional and morally good care for every patient. (shrink)

Are we on the wrong track, in terms of our expectations of a code of practice, professional ethics teaching or the wider field of moral philosophy, in our search for clear answers to the ethical problems that arise in clinical practice; or are we simply wrong in believing that there are always clear answers?This article examines a particular case, an account of which appeared in Nursing Standard at the end of 1996. The conclusion reached is that we are likely (...) to be misguided in assuming that there are always clear, straightforward answers to the ethical problems of clinical practice. However, more than a fleeting acquaintance with the field of ethics may help us to begin to think with greater clarity about what we do and why we do it. The hope is that this might lead to considered, humane practice by design, with the critical understanding and support of our professional peers and employers. (shrink)

Within the context of structural theories this paper examines what health professionals say about their clinical service structures. We firstly trace various conceptual perspectives on clinical service structures, discussing multiple theoretical axes. These theories question whether clinical service structures represent either superficial or more profound changes in hospitals. We secondly explore which view is supported though a content analysis of the free text responses of 111 health professionals (44 doctors, 45 nurses and 22 allied health practitioners) about their clinical service (...) structures in a questionnaire survey in two large hospitals that had implemented clinical service structures three years previously. Commentaries unfavourable toward clinical service structures were made by 47.7% of staff, favourable by 24.3%, mixed (both favourable and unfavourable) by 17.1% and non-evaluative statements were made by 10.8%. The most frequent criticisms were inefficient organisation of change (27%), poor management (24.3%), lack of cooperation between staff (15.9%) and failure to empower health practitioners (13.5%). All professions made more negative than positive evaluations of their clinical service structures but the ratio was highest for doctors and lowest for allied health. Ranking of nurses' and allied health staffs' specific evaluations were similar but both differed significantly from doctors.' Unfavourable or negative comments predominated, and change appears more superficial and less profound than advocates of structural contributions hope. Four types of belief systems about clinical service structures are apparent. Some study participants are disposed toward the status quo; others toward restructuring; yet others are team oriented; and a final group is tribally oriented. The implication of this paper for managers is that more work is needed if clinical service structures are to realise the promise of more multi-disciplinarity and less fragmentation across professional groups. For scholars, the implication is that marrying different theoretical frames with empirical data can serve to produce fresh perspectives and perhaps new insights. (shrink)

In Ethiopia, conscientious objection (CO) to abortion provision is not allowed due to government regulations. We here report findings from a qualitative interview study of 30 healthcare professionals from different professions working with abortion in Addis Ababa, Ethiopia. CO is practised despite the regulations forbidding it. Most informants appeared to be unfamiliar with the prohibition or else did not accord it weight in their moral reasoning. Proponents of institutionalization/toleration of CO claimed that accommodation was often feasible in a hospital setting (...) because colleagues could take over. Opponents pointed to threats to patient access in rural settings especially. Both proponents and opponents invoked tenets of professional ethics, viz., the right not to be coerced into actions one deems unacceptable, or the duty to provide care, respectively. More societal and professional discussion of the ethics and regulation of CO, and a clearer link between legal regulation and ethical guidance for professionals, are called for. (shrink)

The main objective of this paper is to describe how quality of care may be improved during an involuntary admission process of patients suffering from Korsakoff's syndrome. It presents an empirically grounded analysis with different perspectives on ‘doing good’ during this process. Family carers', healthcare professionals' and legal professionals' ways of understanding and ordering this problematic situation appear very different. This could prevent patients from getting the proper care they need, with risk of more suffering and quality of life below (...) the minimum acceptable. All this possibly lead to immoral dehumanizing situations. Firstly, the background of our empirical study is sketched. Secondly, the different perspectives on ‘doing good’ are summarized and compared. Thirdly, the tensions arising from the different conceptualizations of autonomy and different types of responsibilities of the actors are clarified. A common ‘doing good’ during involuntary admission necessitates removal of any tensions within the relational network by weighing and balancing the different perspectives on autonomy and the resulting responsibilities. With this in mind, we propose a renewed time/action table for involuntary admission, which tends to address all patients' needs at the right time. The solution presented might help healthcare professionals, who are squeezed in between patients, family carers, legal professionals and overall rules, to create practices in which patients suffering from Korsakoff's syndrome can maintain their dignity and receive the care they need. Earlier interventions, timely and adequate diagnosis, and diminishment of tensions between the different actors by fine‐tuning their paradigmatic frameworks are suggested to be part of a solution. (shrink)

Are we on the wrong track, in terms of our expectations of a code of practice, professional ethics teaching or the wider field of moral philosophy, in our search for clear answers to the ethical problems that arise in clinical practice; or are we simply wrong in believing that there are always clear answers? This article examines a particular case, an account of which appeared in Nursing Standard at the end of 1996. The conclusion reached is that we are (...) likely to be misguided in assuming that there are always clear, straightforward answers to the ethical problems of clinical practice. However, more than a fleeting acquaintance with the field of ethics may help us to begin to think with greater clarity about what we do and why we do it. The hope is that this might lead to considered, humane practice by design, with the critical understanding and support of our professional peers and employers. (shrink)

In a recent article in this journal, Savulescu and Schuklenk defend and extend their earlier arguments against a right to medical conscientious objection in response to criticisms raised by Cowley. I argue that while it would be preferable to be less accommodating of medical conscientious than many countries currently are, Savulescu and Schuklenk's argument that conscientious objection is ‘simply unprofessional’ is mistaken. The professional duties of doctors should be defined in relation to the interests of patients and society, and (...) for reasons set out in this article, these may support limited accommodation of conscientious objection on condition that it does not impede access to services. Moreover, the fact that conscientious objection appears to involve unjustifiable compromise from the objector's point of view is not a reason for society not to offer that compromise. Arguing for robust enforcement of the no-impediment condition, rather than opposing conscientious objection in principle, may be a more effective way of addressing the harms resulting from an over-permissive conscientious objection policy. (shrink)

The context in which the British Medical Association first considered publishing specific guidelines on decisions about attempting cardiopulmonary resuscitation , in the early 1990s, needs to be remembered. At that time the subject was often seen as far too sensitive to be mentioned to patients. Many hospitals had no formal policy about how CPR decisions should be made, apart from an expectation that these were purely medical matters. Advance decision making about CPR, where it existed, appears to have been generally (...) on an ad hoc basis by doctors. Patients, their relatives and the rest of the health care team were often unaware of it. After several cases in which nurses had been disciplined–unfairly in the eyes of some–for complying with their patients' known wishes about non-resuscitation in cases where no advance medical decision had been recorded, there was a demand for guidance.The BMA was approached by nurses' representatives with a view to publishing some very basic advice. This advice, issued in 1993 jointly with the Royal College of Nursing, and in association with the Resuscitation Council, was under 1000 words. Whether this brevity reflects difficulties in achieving consensus or lower expectations about what was required is a matter for speculation. Throughout the 1990s the guidance was distributed widely and used as a basis for many hospitals' local policies. Recently, however, the demands on the BMA and other professional bodies for ethical advice have changed and grown. Discussion of sensitive decisions about potentially life-prolonging interventions is now …. (shrink)

This study investigates the relationship between the ethical, educational, and disciplinary development of professional accountancy organizations in a given country and the development of that country’s stock market. Using a comprehensive measure based on the responses of the major PAOs in 36 countries to a questionnaire designed by the International Federation of Accountants to assess the development of PAOs internationally, we find a significantly positive association between the development of PAOs and stock market development. In addition, we find the (...) positive association between the development of PAOs and stock market development to be more pronounced in countries with higher levels of investor protection, a stronger public enforcement environment, or lower levels of corruption, suggesting the importance of complementary institutions in the relationship between PAOs and stock market development. We also find that better-developed PAOs are associated with better-quality financial reporting. Finally, our result also shows that relative to the investigation and discipline mechanism and educational requirements imposed by PAOs, the ethical development of a country’s professional accountants appears to have the strongest positive association with a country’s stock market development. (shrink)

This paper examines two issues about professionalism and business that appear at first blush to be entirely separate. The first is the question of who counts as a “professional,” and whether, in particular, business people are “professionals.” The second issue is howacknowledged professionals that regularly interact with business, such as accountants, lawyers, and physicians, can find the moral free space necessary to maintain professional integrity in the face of financial pressures. Conflicts of interest for professionals working incorporations recur (...) with disturbing regularity, and often have serious consequences. In the end I will show how both issues share a common solution. The solution involves understanding the normative function of the manager in the modern corporation, a function, I will argue, made more conspicuous by work over the last two decades done in the areas of stakeholder theory, corporate social performance (CSP), and social contract theory. The remainder of the paper is devoted to articulating these two problems and clarifying their common solution. (shrink)

Background Trust is an essential phenomenon of relationship between patients and healthcare professionals and can be described as an accepted vulnerability to the power of another person over something that one cares about in virtue of goodwill toward the trustor. This characterization of interpersonal trust appears to be adequate for patients suffering from chronic illness. Trust is especially important in the context of chronic cardiovascular diseases as one of the main global health problems. Research Aim The purpose of the qualitative (...) study was to gain a deeper understanding of how people with chronic cardiovascular disease experience and make sense of trust in healthcare professionals. Research Design Eleven semi-structured interviews with participants analysed using interpretative phenomenological analysis to explore in detail their lived experience of trust as a relational phenomenon. Participants and Research Context Participants with chronic cardiovascular disease were purposively recruited from inpatients on the cardiology ward of the university hospital located in central Slovakia. Ethical Considerations The study was approved by the faculty ethics committee. Participants gave their written informed consent. Findings Four Interrelated Group Experiential Themes Sense of co-existence; Belief in competence; Will to help; Ontological security with eight subthemes were identified. The findings describe the participants' experience with trust in healthcare professionals as a phenomenon of close co-existence, which is rooted in the participants’ vulnerability and dependence on the goodwill and competence of health professionals to help with the consequence of (re)establishing a sense of ontological security in the situation of chronic illness. Conclusion Findings will contribute to an in-depth understanding of trust as an existential dimension of human co-existence and an ethical requirement of healthcare practice, inspire patient empowerment interventions, support adherence to treatment, and person-centred care. (shrink)

In a world befuddled by the concept of ‘fake news’, where words like ‘post-truth’ are common parlance, it is essential that we consider exactly what we think we know, what we do not and how we come to acquire such knowledge. The analysis of truth should come from an unbiased perspective and be critical of the various shibboleths that we take to heart. Appearance and Inference aims to identify the nonsense in as many knowledge-related platitudes or false assumptions as (...) possible in just over a hundred pages. Intentionally short and aphoristic, Appearance and Inference will undoubtedly provoke debate, whether or not its readers have previously considered the nature of knowledge. It is also expected to excite its academically astute readers to develop some of the analyses further. It aims to encourage the reader to think through a number of difficult matters and to exercise their own judgment, instead of supplying answers in a pre-packaged form. Inspired by the aphoristic philosophical style of philosophers such as Wittgenstein and Nietzsche, this is a book on the theory of knowledge, written by a philosopher who has had the benefit of a scientific and forensic training. It is designed for both the professional philosopher and the general reader. (shrink)

BackgroundThe merits and drawbacks of moral relevance models of addiction have predominantly been discussed theoretically, without empirical evidence of these potential effects. This study develops and evaluates a novel survey measure for assessing moral evaluations of patient substance misuse (ME-PSM).MethodsThis measure was tested on 524 health professionals (i.e., physicians, nurses, and other health professionals) in California (n = 173), urban France (n = 102), and urban China (n = 249). Demographic factors associated with ME-PSM were investigated using analyses of variance (...) (ANOVAs) and t-tests, with results suggesting that ME-PSM is higher among younger health professionals, nurses (when compared with physicians and other health professionals), and Chinese health professionals (when compared with French and American health professionals).ResultsResults provide preliminary support for the psychometric quality of the survey measure introduced in this study, including the existence of a single latent structure and partial invariance of collected data across countries.ConclusionThe survey measure for ME-PSM which was developed and tested in the current study appears to hold potential utility for use as a measure of moral views of patient substance misuse. With development, this measure may be used to examine moral evaluations, both as factors of stigma and of other clinical factors associated with the treatment of patients with substance use disorders. (shrink)

ExcerptIn 2021, in the pages of this journal, I contended that a coalition of interests in the United States had coalesced in opposition to the presidency of Donald Trump and duly taken power through the vehicle of Joe Biden.1 This coalition includes the Democratic Party, corporate elites, the media, academia, and—the subject of the present article—the national security (natsec) state. In that earlier piece, I focused on particular components of this coalition: legacy and social media. I went on in a (...) subsequent Telos piece to examine another of its elements: the academy.2 These fractions all appear, however, to be relatively minor players. While I argue that the legacy media have staged a counterrevolution to seize back control of the public sphere, this exhausts their parochial, pecuniary agenda; beyond this, they are simply part of a wider activist liberal cause. Contemporary liberal activism is in turn ideologically rooted in ideas propagated by sectors of the academy and hegemonic within it, but this has not, on my analysis, empowered the academy so much as the forces that make it increasingly redundant. (shrink)

During the sixteenth and early seventeenth centuries, physics was regularly taught as part of instruction in philosophy and the arts at Central European schools and universities. However, physics did not have a special or privileged status within that instruction. Three general indicators of this lack of special status are suggested in this article. First, teachers of physics usually were paid less than teachers of most other university-level subject-matters. Second, very few Central European academics during this period appear to have made (...) a career out of teaching physics. And third, Reformation Era schools and universities in Central Europe emphasized language instruction; such instruction not only was instrumental in promoting the confessional-i.e., Calvinist, Lutheran, and Roman Catholic-agendas of those same schools and universities, but also helped to prepare students for service in nascent but growing state governments. (shrink)

Teaching ethics to professionals pursuing a university degree programme requires a method that engages them with the realities and problematic nature of their workplace environment. In this paper we examine some of the history of Professional Ethics from a philosophical and political standpoint. Unfortunately this analysis appears to produce more questions than answers with the terms professional and expert seemingly poorly defined. In order to demonstrate some of the generic problems likely to be encountered by anyone teaching (...) class='Hi'>Professional Ethics we make use of our case study. Whilst this is concerned largely with what can be termed Business and Computing Ethics, the case study does highlight problems that occur across the curricula. We look at the concerns and problems surrounding the teaching of issues such as Integration into the Curricula, Codes of Ethics, Ethical Decision Making and Ethical Standards. We stress the value in universities moving away from traditional methods, based purely in direct value, of decision making to an alternative ethical evaluative framework based on Social, Economic, Environmental and Rights information. This model should be introduced early in the student calendar and used as a vehicle for discussion of later issues such as Whistleblowing. (shrink)

The primary purpose of this study was to assess the ethics of purchasing management professionals. A multidimensional scale of ethics was used to measure their predispositions to act morally. The ethics measure from this scale was correlated to a series of ethical vignettes specific to the purchasing function to further assess the value of the scale. In addition, the consistency of values as rationale for decision making was also examined. The findings of the study indicate that purchasing professionals appear to (...) be more ethical than indicated in previous studies as measured by both the multidimensional scale of ethics and their responses to ethical situations similar to those faced in their day-to-day work experiences. The utility of a multidimensional scale of ethics is further validated, and some preliminary assessments of the nature of values impacting on ethical decision making are also evaluated. (shrink)

"[This book is] focused on the place of character and virtue in professional practice. Professional practices usually have codes of conduct designed to ensure good conduct; but while such codes may be necessary and useful, they appear far from sufficient, since many recent public scandals in professional life seem to have been attributable to failures of personal moral character. This book argues that there is a pressing need to devote more attention in professional education to the (...) cultivation or development of such moral qualities as integrity, courage, self-control, service and selflessness... [This] volume looks beyond traditional professions to explore the ethical dimensions of a broad range of important professional practices. Inspired by a successful international and interdisciplinary conference on the topic, the book examines various ways of promoting moral character and virtue in professional life from the general ethical perspective of contemporary neo-Aristotelian virtue theory."--. (shrink)

Background:Research suggests that nurses generally do not participate in ethical decision-making in accordance with ethical guidelines for nurses. In addition to completing their training, nurses need to reflect on and use ethically grounded arguments and defined ethical values such as patient’s dignity in their clinical work.Objectives:The purpose of this article is to gain a deeper understanding of how nurses deal with ethical decision-making in daily practice. The chosen research question is “How do nurses participate in ethical decision-making for the patient?”Design (...) and method:We use Gadamer’s philosophical hermeneutics as well as Kvale and Brinkmann’s three levels of understanding in interpreting the data material. Nine registered nurses were interviewed.Ethical considerations:The Ombudsman of Norwegian Social Science Data and the head of the hospital approved the investigation. The participants received both oral and written information about the study and they gave their consent. We informed the participants that the participation was voluntary and that they were free to withdraw at any point in the course of the study. The requirement of anonymity and proper data storage was in accordance with the World Medical Association Declaration of Helsinki. The participants were assured that privacy, and confidentiality would be duly protected.Results:Four key themes emerged: confusion in relation to professional and operational expectations of role, ideal somnolence, inadequate argumentation skills, and compound pressure.Conclusion:Ethical ideals appear to be latent in the mindset of the participants; however, the main finding of this investigation is that nurses need to activate the ideals and apply them into practice. Furthermore, management needs to initiate professional reasoning and interdisciplinary discussions leading to common goals for patients. (shrink)

This paper considers the way in which Christian Religious Education (RE) teachers articulate the difficulties and challenges they experience both in school and with their peers as they navigate their way through their Initial Teacher Education. The paper offers a unique exploration of the relationship between elements of the three discourses of faith identity, emerging professional identity and the requirements of a performative teacher training context. Semi-structured interviews were undertaken with 184 student RE teachers across three universities. It became (...) clear that all students interpreted the Standards and policy guidelines ambiguously, as being value-laden or value-free. The idea of the 'good teacher' as someone who was, by very definition, neutral and objective immediately made the faith position of students problematic. This is a key point in relation to the notion of performativity and education and the disproportionate impact it made on Christian students. It appeared as though many Christian students were concerned to stress that although their faith was personally important for them it was not something that contributed to their understanding of a 'good teacher'. (shrink)

This book puts forth the concept and practice of hip-hop mindfulness as a way for minoritized communities to take creative risks in the face of cultural oppression within educational institutions. Written for students of social justice and diversity education, foundations of education, and ethnic studies, this book introduces the hip-hop mindset as a professional practice that holds relevance for ambitious leaders in any profession who seek to innovate, trailblaze, and create so much professional magic, that they appear to (...) walk on air. (shrink)

Creating what sort of professional? Master's level nurse education as a professionalising strategy This paper reports on a detailed analysis of selected findings from a larger study of master's level nurse education. It locates some features of such education within the contemporary situation of nursing as a profession and interprets the role of master's level nurse education as a professionalising strategy. In‐depth interviews were undertaken with a purposive sample of 18 nurse lecturers drawn from eight universities in the United (...) Kingdom. The interview agenda explored participants’ perspectives of the characteristics of master's level performance in practice. Interview transcripts were interpreted by drawing upon hermeneutic methodology.The following themes emerged. (a) The credibility of the master's level nurse was of central importance. In terms of the literature of professionalisation, this may be interpreted as a factor in enhancing the legitimacy of nursing as an occupation. (b) The clinical capability attributed to the nurse is interpreted as leading to an increase in the authority commanded by the expert professional. Thus, the individual capability of the master's level nurse enhances the attribution of autonomous skill to the occupation as a whole. (c) The master's level nurse is seen to exercise influence and leadership and this strengthens the power and status of nursing.Nursing does not have the appearance of a ‘traditional’ profession, neither has it a clear stance as a ‘new profession’. Rather it appears to be especially responsive to the tide of public opinion manifest through government edicts. While nursing is employing rhetoric that espouses both positions, the direction of master's level education is anomalous. (shrink)

BackgroundMental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods31 MHPs working in court-mandated treatment settings were interviewed. The interviews (...) were semi-structured and our in-depth analysis followed the thematic analysis approach.ResultsWe first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. ConclusionsEven though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system. (shrink)

Living kidney donation provides a promising opportunity in situations where the scarcity of cadaveric kidneys is widely acknowledged. While many patients and their relatives are willing to accept its benefits, others are concerned about living kidney programs; they appear to feel pressured into accepting living kidney transplantations as the only proper option for them. As we studied the attitudes and views of patients and their relatives, we considered just how actively health care professionals should encourage living donation. We argue that (...) active interference in peoples’ personal lives is justified - if not obligatory. First, we address the ambiguous ideals of non-directivity and value neutrality in counselling. We describe the main pitfalls implied in these concepts, and conclude that these concepts cannot account for the complex reality of living donation and transplantation. We depict what is required instead as truthful information and context-relative counselling. We then consider professional interference into personal belief systems. We argue that individual convictions are not necessarily strong, stable, or deep. They may be flawed in many ways. In order to justify interference in peoples’ personal lives, it is crucial to understand the structure of these convictions. Evidence suggests that both patients and their relatives have attitudes towards living kidney donation that are often open to change and, accordingly, can be influenced. We show how ethical theories can account for this reality and can help us to discern between justified and unjustified interference. We refer to Stephen Toulmin’s model of the structure of logical argument, the Rawlsian model of reflective equilibrium, and Thomas Nagel’s representation of the particularistic position. (shrink)

Current empirical studies of moral behavior of healthcare professionals are almost entirely focused on self-reports, usually collected under the assumption that an ethical disposition characterizes individuals across various contexts. It is well known, however, that individuals adjust their behavior to what they see being done by those in their peer group. That presents a methodological challenge to traditional research within a community of peers because the behavior of each individual is both the result of norms and a contributor to the (...) norms of others. Computer simulations can be used to address this methodological challenge. A Markov replicator model that runs on an Excel spreadsheet was used to investigate a community with four agent types in the dental community: devious practitioners, ethical practitioners who avoid involvement in the poor ethics of others, ethical practitioners who accept it as part of their professional responsibility to challenge colleagues who act unprofessionally, and those who enforce ethical standards. A panel of leaders in the profession independently estimated parameters for the model and criteria for a possible distribution of agent types in the community. The simulation converged on distributions of the agent types that were very similar to the expectations of the panel. The simulation suggests the following characteristics of such moral communities: The structure of such communities is robust across a wide distribution. It appears that reduction in unethical behavior is more sensitive to the way ethical practitioners interact with each other than to sanctions the enforcement community imposes on unethical practitioners, and that large external interventions will be short lived. (shrink)

Psychotherapy and counselling services are now available on-line, and expanding rapidly. Yet there appears almost no ethical analysis of this on-line mode of delivery of such professional services. In this paper I present such an analysis by considering the limitations on-line contact imposes on the nature of the professional–client relationship. The analysis proceeds via the contrast between the face-to-face case and the on-line case. At the core of the problem must be the recognition that on-line interaction imposes a (...) physical barrier largely permitting only those disclosures of self we choose to make available, and greatly restricting the range of involuntary features and behaviours. I show why this is problematic, first, for the development of a close professional–client relationship, with particular emphasis on such failures as diagnosis and monitoring of the patient. Second I describe the importance of the development of professional character, and of how the on-line environment fails to provide a context for such character traits to emerge and develop. (shrink)

We examined the effects of order of presentation on the moral judgments of professional philosophers and two comparison groups. All groups showed similar-sized order effects on their judgments about hypothetical moral scenarios targeting the doctrine of the double effect, the action-omission distinction, and the principle of moral luck. Philosophers' endorsements of related general moral principles were also substantially influenced by the order in which the hypothetical scenarios had previously been presented. Thus, philosophical expertise does not appear to enhance the (...) stability of moral judgments against this presumably unwanted source of bias, even given familiar types of cases and principles. (shrink)

The main aim of this paper is to investigate the views of healthcare professionals in Portugal about healthcare rationing, and compare them with the views of college students. A self-administered questionnaire was used to collect data from a sample of 60 healthcare professionals and 180 college students. Respondents faced a hypothetical rationing dilemma where they had to order four patients and justify their choices. Multinomial logistic regressions were used to test for differences in orderings, and content analysis to categorize the (...) written justifications. The findings suggest that both groups appeared to support three main rationing principles: health maximization, priority to the severely ill and priority to the young. However, professionals seemed to give less weight to the latter principle. In conclusion, professionals have similar views to students about healthcare rationing, though may be slightly less inclined to give priority to the young. (shrink)

The authors had been using a system for stimulating discussion and debate among professionals as part of their education and continuing professional development. Hand-held technology for gathering and reflecting upon individual judgements had been shown to work, and the participants liked it. But a theoretical foundation of why and how it worked appeared to be lacking. The authors find the work of Vygotsky extremely helpful in explaining why student-student conversations can be a positive support to the learning process. In (...) this paper they present a description of one of the professional settings in which student-student conversations have been used in stimulating learning. They relate this to a theoretical framework of conversations in intellectual development drawn from Vygotsky, and contrast it with alternative frameworks that place greater emphasis upon the role of the tutor who knows the ‘right’ answers and ‘corrects’ the learners. (shrink)

The aim of this article is to present some of the results of empirical research on the communication process at a trial conducted in Polish courts. These results will concern the participation of non-professional participants of a trial and the ways in which they deal with the communication process in the courtroom. The article presents the results of the analysis of the research material conducted in accordance with the detailed research questions and analytical categories. The analysis has especially shown (...) that: (1) the non-professional participants used some legal terminology, but the statements without legal terminology were also communicatively effective; (2) the level of activity of non-professional participants related to participation at the trial varied depending on what the activity concerned; the activity in asking questions to the presiding judges regarding legal issues and the course of the court proceedings appeared to be significant; (3) the non-professional participants’ had a real and significant problem with asking questions during the examination (the proper realization of this element of the trial); (4) the statements of the non-professional participants of a trial were very protective; they used many different “linguistic means of protection” (e.g., acts of supposition or acts of doubt) which are connected with the obligation to tell the truth, the prohibition of concealing the truth and giving false testimony during examination; (5) the non-professional participants of a trial reach for adequate argumentative acts, which are suitable for influencing the perception of specific events or persons, and they strengthen their statements by using appropriate linguistic means of persuasion. (shrink)

This paper studies the construction of ethics in interactions between professionals in meetings, in relation to the rationing of resources. The research context is a supported housing unit targeted at clients with mental health and substance abuse problems. The service is provided for a municipality, which expects good progress of the clients. The research question is: how do the professionals produce implicit ethical justifications for setting limits to helping, even though the need for professional help is not called into (...) question? Five types of justification appear in the data covering 28 meetings. However, these types of justification do not solve the central ethical difficulty arising in the conversations. Limiting help would easily push people out of reach of all help. Thus, in spite of the talk about ethical justification, workers do not ultimately resort to limiting help in situations with no real alternatives for getting help. The ethical principle of following non-exclusionary practices is highly prioritized. (shrink)

Perhaps the most difficult part of the famous inscription from Heraclea is the opening section of the extant text, where from a given form of procedure it is required to determine the subject matter. A solution of this puzzling problem, which I proposed some months ago, has recently been made the subject of an interesting article in this journal by Dr. E. G. Hardy. Mr. Hardy has long been engaged in this field, and has rendered much useful service. In this (...) article, however, he seems to be interested in my views chiefly in their relation to his own theory. This is apparent in his agreements with me. For example, one aim of my study was to identify the professiones of Cicero's letters ad Att. xiii. 33, 1, and ad Fam. xvi. 23, 1, with those provided for in the first section of the inscription. It appeared that the returns mentioned by Cicero were registrations of property, that they were to be made yearly, and that they had their prototype in the annual property census of Egypt. It also seemed clear that Caesar's recensus populi of 46 was modelled on the Egyptian kατ' oίkíαm άπoγραφήiKíαν. With these preliminary conclusions Mr. Hardy is not unwilling to agree. He even goes so far as to say that I have made a good case for ‘a new system of professiones somehow relating to property and introduced in 46.’ He thinks too that the settlement of the frumentations as a part of a more comprehensive legislative scheme would be most appropriate. So far so good, but when it comes to the vital point of admitting a connection between these matters and vv. 1–19 of the Tablet he draws back as if from some fatal step. (shrink)

To date, little understanding exists of how first-year students in professionally oriented higher-education programs experience their academic transition process. In the present study, we first argued how the constructs of academic adjustment and academic integration can provide complementary perspectives on the academic transition of first-year students in HE. Next, we examined what first-year students in professional HE contexts perceive to be the most important experiences associated with their academic transition process in the first semester of their first year of (...) higher education. To this end, we adopted the fundamentals of the critical incident technique and asked 104 students in a Flemish university college to complete “reflective logs” with open questions at the start of the second semester of their FYHE, wherein they reflected on three critical academic experiences during their first semester. An inductive, cross-case content analysis of the collected narratives showed that students reported on nine themes of academic experiences, which relate to five adjustment themes and four integration themes. Further analyses showed that although some of the nine themes of academic experiences appear to be more important at different times in the first semester, they all seem to be meaningful throughout the whole semester. (shrink)

Ethics has been identified as an important factor that potentially affects auditors’ professional skepticism. For example, prior research finds that auditors who are more concerned with professional ethics exhibit greater professional skepticism. Further, the literature suggests that professional skepticism may lead the auditor to more vigilantly resist the client’s position in financial reporting disputes. These reporting disputes are generally resolved through negotiations between the auditor and client to arrive at the final reported amounts. To date, the (...) role that professional skepticism potentially plays in the negotiation process has been relatively unexplored. The literature prior to the enactment of Sarbanes–Oxley (SOX) suggests that auditors are more likely to approve a client position when the matter in dispute is relatively ambiguous and when changing the client’s position will result in the client failing to meet analysts’ expectations. However, changes resulting from SOX have led auditors to be more vigilant and therefore results found in the pre-SOX environment may not hold in the current environment where auditors are held more accountable for their actions. Results from an experiment with experienced audit managers and partners suggest that in the post-SOX climate, auditors’ negotiations do not appear to be substantively influenced by management being able to meet or beat forecasts. Moreover, we find that when auditors exhibit heightened professional skepticism, they are more ethical by being conservative and they stand more resolute than when auditors do not exhibit heightened professional skepticism. Finally, although we do not find a main effect for the influence of earnings forecast, we do find a significant interaction between earnings forecast and heightened professional skepticism. Implications for practice and research are then presented. (shrink)

To date, little is known about when and to what degree science students begin to participate in authentic scientific graphing practices. This article presents the results of a series of studies on the production, transformation, and interpretation of graphical representation from Grade 8 to professional scientific practice both in formal testing situations and in the course of field/laboratory work. The results of these studies can be grouped into two major areas. First, there is a discontinuity in the graph-related practices (...) that marks a boundary between people who engage in work that requires them to transform data into graphical representations and people who do not have such experiences. Second, the didactic practices of high school textbooks and university lectures exhibit a marked discontinuity relative to graphing practices in scientific journals. Graphs used in didactic circumstances may be associated with students’ difficulties in interpreting “real data.” It appears that school teachers and university professors do little to put their students on trajectories of increasing participation in authentic scientific graphing practices. (shrink)

It is argued that dignity can be considered both subjectively, taking into account individual differences and idiosyncrasies, and objectively, as the foundation of human rights. Dignity can and should also be explored as both an other-regarding and a self-regarding value: respect for the dignity of others and respect for one’s own personal and professional dignity. These two values appear to be inextricably linked. Aristotle’s doctrine of the mean enables nurses to reflect on the appropriate degree of respect for the (...) dignity of others and of respect for themselves. To develop an understanding of the rationale for and the significance and implications of dignity in health care practice, a view of human nature is proposed that implies vulnerability and fallibility, and that urges that an ethic of aspiration is embraced. Anonymized vignettes are included to illustrate points about the everyday nature of dignity. (shrink)

Background: The health professionals are involved in the paths of care for patients with different medical conditions. Their life is frequently characterized by psychopathological outcomes so that it is possible to identify consistent burdens. Besides the possibility to develop pathological outcomes, some protective factors such as resilience play a fundamental role in facilitating the adaptation process and the management of maladaptive patterns. Personal characteristics and specific indexes such as burdens and resilience are essential variables useful to study in-depth ongoing conditions (...) and possible interventions. The study was aimed at highlighting the presence and the relations among factors as personal variables, burdens, and resilience, to understand health professionals' specific structure and functions.Methods: The observation group was composed of 210 participants, 55 males, and 155 females, aged from 18 to 30 years old with a mean age of 25.92 years old. The study considered personal characteristics of the subjects, such as age, gender, years of study, days of work per week, hours of work per week, and years of work. Our study had been conducted with the use of measures related to burdens and resilience.Results: The performed analyses consisted of descriptive statistics, correlations, and regressions among the considered variables. Several significant correlations emerged among personal characteristics, CBI, and RSA variables. Specifically, age and work commitment indexes appeared to be significantly related to the development of burdens, differently from the years of study. Significant correlations emerged among personal and RSA variables, indicating precise directions for both domains. Age and gender were identified as predictors to perform multivariate regression analyses concerning CBI factors. Significant dependence relations emerged with reference to all CBI variables.Conclusion: Pathological outcomes and resilience factors represent two sides of the health professionals' experiences, also known as “invisible patients.” Greater knowledge about present conditions and future possibilities is a well-known need in literature so that the current analyses considered fundamental factors. In line with state of the art, future studies are needed in order to deepen elusive phenomena underlying maladjustment. (shrink)

In this paper I shed light on the connection between respect, trust and patients’ satisfaction with their medical care. Using data collected in interviews with 49 women who had managed, or were in the process of managing, their risk of ovarian cancer using prophylactic surgery or ovarian screening, I examine their reported dissatisfaction with medical encounters. I argue that although many study participants appeared to mistrust their healthcare professionals’ (HCPs) motives or knowledge base, their dissatisfaction arose not from a lack (...) of trust, but from HCPs’ failure to treat them as persons or take their concerns seriously. I conclude by describing how respect, as evidenced by “being taken seriously”, is important for the development of trusting Patient–HCP relationships. (shrink)

Prior research on the impact of ethics education within the business curriculum has yielded mixed results. Although the impact is often found to be positive, it appears to be both small and short-lived. Interpretation of these results, however, is subject to important methodological limitations. The present research employed a longitudinal methodology to evaluate the impact of an M.B.A. program versus a law program on the values and ethical decision making behavior of a cohort of students at two major universities in (...) the northeast. The results suggest that the M.B.A. curriculum remains a value-neutral experience for most students. In contrast, the law school program had a significant impact on both values and ethical decision making. (shrink)

The term “normal” is culturally ubiquitous and conceptually vague. Interestingly, it appears to be a descriptive-normative-hybrid which, unnoticedly, bridges the gap between the descriptive and the normative. People’s beliefs about normality are descriptive and prescriptive and depend on both an average and an ideal. Besides, the term has generally garnered popularity in medicine. However, if medicine heavily relies on the normal, then it should point out how it relates to the concept of health or to statistics, and what, after all, (...) normal means. Most importantly, the normativity of the normal needs to be addressed. Since the apparently neutral label “normal” can exclude, stigmatize, and marginalize people who are defined in contrast to it as abnormal, health professionals should think twice before using the term with patients. The present critical perspective advocates against using the term “normal,” as long as no understanding of a person’s individual normality has been attained. It advocates for the right to autonomously determine one’s own normality. For health professionals I do not see worthwhile benefits of subscribing to the concept of “normality” and imposing it on their patients. But I do see many risks. (shrink)

How can a course on engineering ethics affect an undergraduate student’s feelings of responsibility about moral problems? In this study, three groups of students were interviewed: six students who had completed a specific course on engineering ethics, six who had registered for the course but had not yet started it, and six who had not taken or registered for the course. Students were asked what they would do as the central character, an engineer, in each of two short cases that (...) posed moral problems. For each case, the role of the engineer was successively changed and the student was asked how each change altered his or her decisions about the case. Students who had completed the ethics course considered more options before making a decision, and they responded consistently despite changes in the cases. For both cases, even when they were not directly involved, they were more likely to feel responsible and take corrective action. Students who were less successful in the ethics course gave answers similar to students who had not taken the course. This latter group of students seemed to have weaker feelings of responsibility: they would say that a problem was “not my business.” It appears that instruction in ethics can increase awareness of responsibility, knowledge about how to handle a difficult situation, and confidence in taking action. (shrink)

Background Nurses are challenged with many situations that require them to solve ethical dilemmas and make moral decisions based on professional values and a sense of accountability and responsibility. To support their decisions, it is important to know how they perceive and relate their ethical ideology, professional values, and clinical accountability in their workplace. Purpose The study’s aim was twofold: to investigate the ethical ideology and perceived importance of professional values and accountability among nurses. Further, explore the (...) relationship between each of ethical ideology and professional values with nurses’ work accountability. Methods A correlational study was conducted in an Egyptian hospital. All nurses were invited to participate = 192, and 150 nurses (78.3%) completed the study questionnaires. The Ethical Position Questionnaire, the Professional Values Scale, and the Clinical Vignettes Assessment for Clinical Accountability were proven to be reliable study measures. Ethical considerations Ethics Committee approval, written informed consent, data privacy and confidentiality, and participants’ right to voluntary participation and withdrawal were maintained. Results Nurses showed good ethical ideology (75 ± 6.2) and are more idealistic while maintaining professional values (108 ± 10.8). Most nurses believed they were accountable for documenting errors, completing incident reports, and calling physicians to discuss or manage the situations. Ethical ideology and the idealism subscale were positively correlated with overall nurses’ professional values (r = 0.321, p < 0.004, r =0.464, p 0.000), respectively. On the other hand, work accountability showed a partial correlation in some areas with ethical ideology and professional values. Discussion Professional values and nurses' accountability appear to be influenced by ethical positions and ideology. Conclusion Healthcare organizations should provide a supportive work environment to help nurses develop self-awareness, and knowledge of their ethical ideologies, which improve professional values and clinical accountability in their practice. Ethical ideology and professional values should be emphasized more in nursing curricula. (shrink)

The problem of harmful, unnecessary and neglected pain has been studied extensively in many health care settings over the past decade. Research has documented the incidence of untreated pain, and scholars and advocates have given the problem several names: “public health crisis,” “oligoanalgesia, and “moral failing,” among them. Articles have identified a litany of now familiar “obstacles” or “barriers” to effective pain relief. Each of these individual obstacles or barriers has been the subject of targeted remedial action in at least (...) some context.The checklist approach to improving care for patients in pain, however, is likely to have only limited effect. What really appears to be operating is a complex ecosystem that supports ambivalence, denial, and even suspicion of the circumstance of patients in pain and efforts to treat them. Pain relief in emergency medicine, a relatively new setting for the study of challenges to treating pain, provides a revealing context for viewing discrete obstacles to effective pain management in medicine as part of an integrated environment into which patients with pain enter for treatment. (shrink)

The problem of harmful, unnecessary and neglected pain has been studied extensively in many health care settings over the past decade. Research has documented the incidence of untreated pain, and scholars and advocates have given the problem several names: “public health crisis,” “oligoanalgesia, and “moral failing,” among them. Articles have identified a litany of now familiar “obstacles” or “barriers” to effective pain relief. Each of these individual obstacles or barriers has been the subject of targeted remedial action in at least (...) some context.The checklist approach to improving care for patients in pain, however, is likely to have only limited effect. What really appears to be operating is a complex ecosystem that supports ambivalence, denial, and even suspicion of the circumstance of patients in pain and efforts to treat them. Pain relief in emergency medicine, a relatively new setting for the study of challenges to treating pain, provides a revealing context for viewing discrete obstacles to effective pain management in medicine as part of an integrated environment into which patients with pain enter for treatment. (shrink)

Lists of paid registrants at Pacific Division meetings of the American Philosophical Association from 2006–2008 were compared with lists of people appearing as presenters, commentators or chairs on the meeting programme those same years. These were years in which fee payment depended primarily on an honour system rather than on enforcement. Seventy-four per cent of ethicist participants and 76% of non-ethicist participants appear to have paid their meeting registration fees: not a statistically significant difference. This finding of no difference survives (...) scrutiny for several possible confounds. Thus, professional ethicists seem no less likely to free-ride in this context than do philosophers not specializing in ethics. These data fit with other recent findings suggesting that on average professional ethicists behave no morally better than do professors not specializing in ethics. (shrink)

BackgroundThe Ethiopian law on abortion was liberalized in 2005. However, as a strongly religious country, the new law has remained controversial from the outset. Many abortion providers have religious allegiances, which begs the question how to negotiate the conflicting demands of their jobs and their commitment to their patients on the one hand, and their religious convictions and moral values on the other.MethodA qualitative study based on in-depth interviews with 30 healthcare professionals involved in abortion services in either private/non-governmental clinics (...) or in public hospitals in Addis Ababa, Ethiopia. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework.ResultsFor the participants, religious norms and the view that the early fetus has a moral right to life count against providing abortion; while the interests and needs of the pregnant woman supports providing abortion services. The professionals weighed these value considerations differently and reached different conclusions. One group appears to have experienced genuine conflicts of conscience, while another group attempted to reconcile religious norms and values with their work, especially through framing provision of abortion as helping and preventing harm and suffering. The professionals handle this moral balancing act on their own. In general, participants working in the private sector reported less moral dilemma with abortion than did their colleagues from public hospitals.ConclusionsThis study highlights the difficulties in reconciling tensions between religious convictions and moral norms and values, and professional duties. Such insights might inform guidelines and healthcare ethics education. (shrink)

McCullough and colleagues draw an historical line from the writings of Percival, who found himself resolving arguments (sometimes violent) between physicians, surgeons and apothecaries, to the concept of civility as a professional virtue and duty. The authors show that civility is a prerequisite to effective cooperation, which itself underpins patient safety and positive clinical outcomes—desirable endpoints of any discussion about healthcare. They exhort academic leaders to teach, role model and reward correct behaviours.1 Why then, as a clinician manager with (...) a deep interest in fostering civility and psychological safety, am I not satisfied? Three reasons: the paper does not adequately explore the reasons why, its focus is largely restricted to academic institutions, and it does not encompass the non-clinical workforce; as a result, its proposed solutions appear ungrounded. Why are ‘good people’, who were attracted to careers that demand altruism and empathy, uncivil in the workplace? What are the competing goals that result in curt, disrespectful or downright rude exchanges? This has been studied. Leape et al concluded that endogenous factors such as personality, insecurity, anxiety, depression, narcissism and responses to prior …. (shrink)