The present study is a cross-sectional survey that investigates ethical practices among Chinese psychotherapists from the perspective of a large representative sample of Chinese clients (N?=?1,100). In reports from clients, we found that psychotherapists did poorly in providing informed consent and had other ethical difficulties in the therapeutic setting and with dual relationships. We conclude that Chinese culture, especially Confucianism, had significant impact on the attitudes toward the psychotherapists' ethical practices, which complicated ethical dilemmas. It is important for cross-cultural (...) psychotherapists to become sensitive to the influences of traditional Chinese culture when counseling Chinese clients. (shrink)

A survey form sent to psychologists (Pope, Keith-Spiegel, & Tabachnick, 1986) was adapted and sent to 1,000 clinical social workers (return rate = 45%). Most participants reported sexual attraction to a client, causing (for most) guilt, anxiety, or confusion. Some reported having sexual fantasies about a client while engaging in sex with someone other than a client. Relatively few (3.6% men; 0.5% women) reported sex with a client; training was related to likelihood of offending, though the effect is small (...) and complex. An analysis of eight national studies (data from 5,148 therapists) found significant effects for gender (more male offenders) and year of study (about 10% annual decrease in reported offenses since 1977) but not profession (i.e., no difference among psychiatrists, psychologists, and social workers). Most social workers reported no graduate training whatsoever about sexual attraction; only 10% reported adequate training. (shrink)

In this third article on the role of international comparative practices in the formation of national health care systems I discuss a familiar group of systems-builders--medical professional organisations--and so focus on some early comparisons undertaken by organised groups of doctors. So far in this series I have argued that any attempt to make international comparisons--whether in the 19th-century or today--is bound to be based on a 'characteristically national' understanding. Not infrequently such an understanding finds its clearest expression in (...) the very act of undertaking practical tasks like 'comparing'. Dependent on whether comparisons are carried out by individuals privately, collectively by larger groups within the medical profession, or by government agencies the descriptions of 'national characteristics' (of medical organisation, institutional formation, clinical practice, research, public health and education) will differ in emphasis. -/- The examination of collective professional attempts at international comparison can enhance our understanding of the cultural distinctions that were incorporated by emerging national medical professions. This process can show which aspects of foreign medical systems were deemed pertinent, and also reveals methodology. What did such collective endeavours add to the more biographically coloured comparisons undertaken by the individual mid-century authors I discussed in part II of this series? (shrink)

In June 1992, a national mail survey was directed to 204 state inpatient psychiatric institutions. This study was implemented following the 1992 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirement that hospitals put in place some means with which to address ethical issues. The goals of the study were: 1. to examine state mental hospital characteristics and their response to the JCAHO requirements; 2. to describe healthcare ethics committee (HEC) composition, function, and role; 3. to study patient (...) and family access to a HEC; and 4. to discover ethical issues most frequently addressed. The survey response rate was 71%. Of the 145 responders, 62 had HECs in place, and 53 were in the process of implementing HECs. There were no differences between JCAHO accredited institutions and non-accredited facilities with regard to having HECs. Physicians accounted for 22% of HEC membership, followed by nurses (15%), and administrators (12%). Twenty-six percent of facilities systematically notified patients about existence of the HEC; 71% of facilities had no patient request for HEC services in the last year. A patient's danger to others, and resuscitation policy were issues most frequently (23%) heard by HECs. (shrink)

Based on a national survey of Chinese scientific personnel in 2008, this paper sheds new light on the relationship between social networks and scientific performance. In this study, we used position generator to measure scientists’ ego-centered social networks. The scientists’ performance was measured by multiple indexes, including recognitions from the academic, governmental, and market sectors. The findings show that size and composition of scientists’ social networks have significant effect on their scientific performance. The notions of “information communication mechanism” (...) and “resource acquisition mechanism” are introduced to explain how network composition affects scientific performance along multiple dimensions. The policy implications of the study are also discussed. (shrink)

Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire (...) survey administered to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. (shrink)

BackgroundNational guidelines require programmes use subjective assessments of social support when determining transplant suitability, despite limited evidence linking it to outcomes. We examined how transplant providers weigh the importance of social support for kidney transplantation compared with other factors, and variation by clinical role and personal beliefs.MethodsThe National survey of the American Society of Transplant Surgeons and the Society of Transplant Social Work in 2016. Using a discrete choice approach, respondents compared two hypothetical patient profiles and selected one (...) for transplantation. Conditional logistic regression estimated the relative importance of each factor; results were stratified by clinical role and beliefs.ResultsFive hundred and eighy-four transplant providers completed the survey. Social support was the second most influential factor among transplant providers. Providers were most likely to choose a candidate who had social support, always adhered to a medical regimen, and had a 15 years life expectancy with transplant. Psychosocial providers were more influenced by adherence and quality of life compared with medical/surgical providers, who were more influenced by candidates' life expectancy with transplant. For providers concerned with avoiding organ waste, social support was the most influential factor, while it was the least influential for clinicians concerned with fairness.ConclusionsSocial support is highly influential in listing decisions and may exacerbate transplant disparities. Providers’ beliefs and reliance on social support in determining suitability vary considerably, raising concerns about transparency and justice. (shrink)

Background Institutional review board (IRB) expertise is necessarily limited by maintaining a manageable board size. IRBs are therefore permitted by regulation to rely on outside experts for review. However, little is known about whether, when, why, and how IRBs use outside experts.Methods We conducted a national survey of U.S. IRBs to characterize utilization of outside experts. Our study uses a descriptive, cross-sectional design to understand how IRBs engage with such experts and to identify areas where outside expertise is (...) most frequently requested.Results The survey response rate was 18.4%, with 55.4% of respondents reporting their institution’s IRB uses outside experts. Nearly all respondents who reported using outside experts indicated they do so less than once a month, but occasionally each year (95%). The most common method of identifying an outside expert was securing a previously known subject matter expert (83.3%). Most frequently, respondents sought consultation for scientific expertise not held by current members (69.6%). Almost all respondents whose IRBs had used outside experts reported an overall positive impact on the IRB review process (91.5%).Conclusions Just over half of the IRBs in our sample report use of outside experts; among them, outside experts were described as helpful, but their use was infrequent overall. Many IRBs report not relying on outside experts at all. This raises important questions about what type of engagement with outside experts should be viewed as optimal to promote the highest quality review. For example, few respondents sought assistance from a Community Advisory Board, which could address expertise gaps in community perspectives. Further exploration is needed to understand how to optimize IRB use of outside experts, including how to recognize when expertise is lacking, what barriers IRBs face in using outside experts, and perspectives on how outside expert review impacts IRB decision-making and review quality. (shrink)

This paper provides an overview of results from an Australian Research Council-funded project "Sentiments and Risks: The Changing Nature of Human-Animal Relations in Australia." The data discussed come from a survey of 2000 representative Australians at the capital city, state, and rural regional level. It provides both a snapshot of the state of involvement of Australians with nonhuman animals and their views on critical issues: ethics, rights, animals as food, risk from animals, native versus introduced animals, hunting, fishing, and (...) companionate relations with animals. Its data point to key trends and change. The changing position of animals in Australian society is critical to understand, given its historic export markets in meat and livestock, emerging tourism industry with its strong wildlife focus, native animals' place in discourses of nation, and the centrality of animal foods in the national diet. New anxieties about risk from animal-sourced foods and the endangerment of native animals from development and introduced species, together with tensions between animals' rights and the privileging of native species, contribute to the growth of a strongly contested animal politics in Australia. © 2007 Brill Academic Publishers. (shrink)

A national survey sent to 450 female and 450 male licensed psychologists (return rate = 42%) found that about 73% of the participants reported encountering at least one patient who claimed to recover previously forgotten memories of childhood sex abuse. About 21% of the therapists concluded that, for at least one patient, the memory was false; about 50% of the therapists reported that at least one patient had found external validation for the abuse; about 12% of the therapists (...) reported at least one client who later decided that the memory was false; and about 15% of the therapists reported that at least one client who recovered memories filed a civil or criminal complaint. About 15% of the therapists reported encountering at least one patient alleged to have sexually abused a child who later recovered previously forgotten memories of the abuse. About 21% of these therapists concluded that, in at least one case, the memory was false; about 6% of the therapists concluded that, in at least one case, there appeared to be external validation for the memories; about 1% reported that, in at least one case, the person recovering the memories concluded that the memories had been false; and about 6% of these therapists reported at least one case in which a civil or criminal complaint had been filed against their client. Findings were analyzed in terns of therapist gender, patient gender, and theoretical orientation. (shrink)

This analysis of the National Survey of Families and Households confirmed earlier findings: Much of the violence between married partners occurred in couples in which both partners were reported as perpetrators, and women as well as men committed violent acts in married couples. However, the NSFH data indicated that the probabilities of injury for male and female respondents differed significantly, with wives more likely to be injured than husbands. The NSFH differentiated between violent acts and injurious outcomes and (...) provided an empirical rebuttal of the “battered husband syndrome.” At the same time, the NSFH reproduced many of the problems of quantitative surveys as they are currently used to measure the incidence and consequences of intimate violence. The article discusses the major problems with both the content and the context of currently employed survey methodology, as exemplified by the NSFH. (shrink)

Background: Patient participation in clinical ethics support services has been marked as an important issue. There seems to be a wide variety of practices globally, but extensive theoretical or empirical studies on the matter are missing. Scarce publications indicate that, in Europe, patient participation in CESS varies from region to region, and per type of support. Practices vary from being non-existent, to patients being a full conversation partner. This contrasts with North America, where PP seems more or less standard. While (...) PP seems to be on the rise in Europe, there is no data to confirm this. This study sought a deep understanding of both habits and the attitudes towards PP in the Netherlands, including respondents’ practical and normative perspectives on the matter. Methods and Results: We developed a national survey on PP for Dutch CESS staff. Our survey comprised a total of 25 open and close-ended questions, focused on four topics related to PP goals of CESS, status quo of PP, ideas and ideals concerning PP, and obstacles for PP. Discussion: The four most important findings were that: Patient participation in Dutch CESS is far from standard. Views on patient participation are very much intertwined with the goals of ethics support. Hesitations, fears and perceived obstacles for PP were not on principle and Most respondents see PP as a positive opportunity, yet requiring additional training, practical guidance and experience. Conclusions: Various normative reasons require PP. However, PP seems far from standard and somewhat rare in Dutch CESS settings. Our respondents did not raise many principled objections to PP. Instead, reasons for the lack of PP are intertwined with viewpoints on the goals of CESS, which seemingly focus on supporting health care professionals. Training and practical guidance was thought to be helpful for gaining experience for both CESS staff and HCPs. (shrink)

The Medical Research Council National Survey of Health and Development (NSHD) is Britain’s longest-running birth cohort study. From their birth in 1946 until the present day, its research participants, or study members, have filled out questionnaires and completed cognitive or physical examinations every few years. Among other outcomes, the findings of these studies have framed how we understand health inequalities. Throughout the decades and multiple follow-up studies, each year the study members have received a birthday card from the (...) survey staff. Although the birthday cards were originally produced in 1962 as a method to record changes of address at a time when the adolescent study members were potentially leaving school and home, they have become more than that with time. The cards mark, and have helped create, an ongoing evolving relationship between the NSHD and the surveyed study members, eventually coming to represent a relationship between the study members themselves. This article uses the birthday cards alongside archival material from the NSHD and oral history interviews with survey staff to trace the history of the growing awareness of importance of emotion within British social science research communities over the course of the 20th and early 21st centuries. It documents changing attitudes to science’s dependence on research participants, their well-being, and the collaborative nature of scientific research. The article deploys an intertextual approach to reading these texts alongside an attention to emotional communities drawing on the work of Barbara Rosenwein. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used (...) and the responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

Objective: To report results from a national survey of coordinators and managers of clinical research studies in the US on their perceptions of and experiences with scientific misconduct.Methods: Data were collected using the Scientific Misconduct Questionnaire-Revised. Eligible responses were received from 1645 of 5302 surveys sent to members of the Association of Clinical Research Professionals and to subscribers of Research Practitioner, published by the Center for Clinical Research Practice, between February 2004 and January 2005.Findings: Overall, the perceived frequency (...) of misconduct was low. Differences were noted between workplaces with regard to perceived pressures on investigators and research coordinators, and on the effectiveness of the regulatory environment in reducing misconduct. First-hand experience with an incident of misconduct was reported by 18% of respondents. Those with first-hand knowledge of misconduct were more likely to report working in an academic medical setting, and to report that a typical research coordinator would probably do nothing if aware that a principal investigator or research staff member was involved in an incident of misconduct.Conclusion: These findings expand the knowledge on scientific misconduct by adding new information from the perspective of research coordinators. The findings provide some data supporting the influence of workplace climate on misconduct and also on the perceived effectiveness of institutional policies to reduce scientific misconduct. (shrink)

Little is known about the mechanisms by which psychology graduate programs transmit responsible conduct of research (RCR) values. A national sample of 968 current students and recent graduates of mission-diverse doctoral psychology programs completed a Web-based survey on their research ethics challenges, perceptions of RCR mentoring and department climate, whether they were prepared to conduct research responsibly, and whether they believed psychology as a discipline promotes scientific integrity. Research experience, mentor RCR instruction and modeling, and department RCR policies (...) predicted student RCR preparedness. Mentor RCR instruction, department RCR policies, and faculty modeling of RCR behaviors predicted confidence in the RCR integrity of the discipline. Implications for training are discussed. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., (...) and in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians? experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors (...) hold nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5]. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online (...) survey, 97% of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

Based on a national social studies survey that included over 10,000 respondents from 44 states, this study examined the emphasis on diversity of religious view (EDRV) in public school P-12 social s...

Clinical ethics consultants provide a range of services in hospital settings and in teaching environments. Training to achieve the skills needed to meet the expectations of employers comes in various forms, ranging from on-the-job training to formal fellowship training programs. We surveyed graduates of clinical ethics fellowships to evaluate their self-reported preparedness for their first job after fellowship training. The results indicated several areas of need, including greater exposure to program-building skills, quality improvement skills, and approaches to working with members (...) of higher administration. These data will be of use to educators as well as to fellows who advocate for elements of training in preparation for their first position. (shrink)

Context Conflicts over treatment decisions have been linked to physicians' emotional states. Objective To measure the prevalence of emotional exhaustion and conflicts over treatment decisions among US obstetrician/gynaecologists (ob/gyns), and to examine the relationship between the two and the physician characteristics that predict each. Methods Mailed survey of a stratified random sample of 1800 US ob/gyn physicians. Criterion variables were levels of emotional exhaustion and frequency of conflict with colleagues and patients. Predictors included physicians' religious characteristics and self-perceived empathy. (...) Results Response rate among eligible physicians was 66% (1154/1760). 36% of ob/gyns reported high levels of emotional exhaustion, and majorities reported conflict with colleagues (59%) and patients (61%). Those reporting conflict were much more likely to report emotional exhaustion (58% vs 29% who never conflict, OR, 95% CI 2.8, 1.6 to 4.8 for conflict with colleagues; 55% versus 26%, OR, 95% CI 2.2, 1.4 to 3.5 for conflict with patients). Physicians with lower self-perceived empathy were more likely to report physician-patient conflicts (65% vs 58% with higher empathy, OR, 95% CI 1.4, 1.0 to 1.9), as were female ob/gyns (66% vs 57% of males, OR, 95% CI 1.5, 1.1 to 2.0). Foreign-born physicians were less likely to report such conflicts (47% vs 64% of US born, OR, 95% CI 0.5, 0.4 to 0.8). Physicians' religious characteristics were not significantly associated with reporting conflict. Conclusions Conflicts over treatment decisions are associated with physicians' empathy, gender, immigration history and level of emotional exhaustion. With respect to the latter, conflict in the clinical encounter may represent an overlooked source or sign of burnout among ob/gyns. (shrink)

Trust has been identified as an indicator within Social Quality theory. As an important component of social quality, trust has become increasingly important in modern society because literature suggests that trust in a number of democratic countries is declining. Modern technologies and specialties are often beyond the understanding of lay individuals and thus, the need for trusting relations between lay individuals and organizations/individuals has grown. The purpose of the study was to examine the extent to which Australians (dis)trust individuals and (...) organizations/institutions. A national postal survey was conducted with 1,044 respondents recruited using the electronic white pages directory. Findings from multivariate analyses suggest that income, age, sex, and health status are associated with trust in groups of individuals and trust in organizations/institutions. The findings highlight populations where trust needs to be (re)built. Future government policy and practice should utilize these findings as a means of facilitating social quality. (shrink)

Brain dead organ donors are the principal source of transplantable organs. However, it is controversial whether brain death is the same as biological death. Therefore, it is unclear whether organ removal in brain death is consistent with the ‘dead donor rule’, which states that organ removal must not cause death. Our aim was to evaluate the public9s opinion about organ removal if explicitly described as causing the death of a donor in irreversible apneic coma. We conducted a cross-sectional internet (...) class='Hi'>survey of the American public (n=1096). Questionnaire domains included opinions about a hypothetical scenario of organ removal described as causing the death of a patient in irreversible coma, and items measuring willingness to donate organs after death. Some 71% of the sample agreed that it should be legal for patients to donate organs in the scenario described and 67% agreed that they would want to donate organs in a similar situation. Of the 85% of the sample who agreed that they were willing to donate organs after death, 76% agreed that they would donate in the scenario of irreversible coma with organ removal causing death. There appears to be public support for organ donation in a scenario explicitly described as violating the dead donor rule. Further, most but not all people who would agree to donate when organ removal is described as occurring after death would also agree to donate when organ removal is described as causing death in irreversible coma. (shrink)

Objectives -/- Surveys in various countries suggest 17% to 80% of doctors prescribe ‘placebos’ in routine practice, but prevalence of placebo use in UK primary care is unknown. Methods -/- We administered a web-based questionnaire to a representative sample of UK general practitioners. Following surveys conducted in other countries we divided placebos into ‘pure’ and ‘impure’. ‘Impure’ placebos are interventions with clear efficacy for certain conditions but are prescribed for ailments where their efficacy is unknown, such as antibiotics for suspected (...) viral infections. ‘Pure’ placebos are interventions such as sugar pills or saline injections without direct pharmacologically active ingredients for the condition being treated. We initiated the survey in April 2012. Two reminders were sent and electronic data collection closed after 4 weeks. Results -/- We surveyed 1715 general practitioners and 783 (46%) completed our questionnaire. Our respondents were similar to those of all registered UK doctors suggesting our results are generalizable. 12% (95% CI 10 to 15) of respondents used pure placebos while 97% (95% CI 96 to 98) used impure placebos at least once in their career. 1% of respondents used pure placebos, and 77% (95% CI 74 to 79) used impure placebos at least once per week. Most (66% for pure, 84% for impure) respondents stated placebos were ethical in some circumstances. Conclusion and implications -/- Placebo use is common in primary care but questions remain about their benefits, harms, costs, and whether they can be delivered ethically. Further research is required to investigate ethically acceptable and cost-effective placebo interventions. (shrink)

BackgroundMedical professionalism has been developing in the Peoples’ Republic of China as one way to better address perennial and new challenges in healthcare in an ever-changing society. Among many recent developments in this area is promotion by the national Chinese Medical Doctor Association of the principles and values contained in the international document, “Medical Professionalism in the New Millennium: A Physician Charter.”ObjectiveTo discover Chinese physicians’ attitudes toward and understanding of medical professionalism.MethodologyThe authors distributed a self-reporting questionnaire that included 34 (...) statements and four case scenarios concerning the general principles of medical professionalism: the primacy of patients’ welfare, respect for patients’ autonomy, promotion of social justice, and professional self-regulation. The questionnaire included controversial issues such as the role of the family in decision making and reporting medical errors. A total of 2,966 practicing physicians, randomly selected from the Chinese Medical Association database, were surveyed, and 1,198 valid questionnaires were returned. Our sample covered 23 provinces and 51 cities throughout the Peoples’ Republic of China.ResultsMore than 80 percent of the physicians who responded agreed that the physician-patient relationship should be a relationship of trust founded on professional altruism, and that informed consent is necessary. More than 95 percent agreed that physicians should promote professional self-regulation as well as social justice. More than half agreed with the principle of the primacy of patients’ welfare (62.8 percent), and that physicians have a responsibility to report medical errors and incompetent colleagues (51.0 percent). In certain cases, a great majority of Chinese physicians favored familism and paternalism.LimitationsThe study does not include data on how Chinese physicians practice medical professionalism, or the perspectives of physicians working in smaller cities and in rural areas.ConclusionsBased on responses to the survey, Chinese physicians strongly support the majority of the fundamental principles and responsibilities of medical professionalism, including dedication, altruism, social justice, self-regulation, and informed consent. However, their support for the primacy of patients’ welfare as a general principle, and the physician’s responsibility to report medical errors and incompetent colleagues, is relatively low. To help advance medical professionalism in the People’s Republic of China, professional development programs and medical ethics education should not only emphasize the general principles involved, but also formulate guidelines on how these principles can be carried out in practice. (shrink)

ObjectiveTo examine health and social care professionals’ understanding of the legislation governing research involving adults lacking mental capacity in England and Wales.MethodsA cross-sectional online survey was conducted using a series of vignettes. Participants were asked to select the legally authorised decision-maker in each scenario and provide supporting reasons. Responses were compared with existing legal frameworks and analysed according to their level of concordance.ResultsOne hundred and twenty-seven professionals participated. Levels of discordance between responses and the legal frameworks were high across (...) all five scenarios. Nearly half of the participants provided responses that were discordant in all scenarios. Only two participants provided concordant responses across all five scenarios.DiscussionParticipants demonstrated a lack of knowledge about the legal frameworks, the locus of authority and the legal basis for decision-making. The findings raise concern about the accessibility of research for those who lack capacity, the ability to conduct research involving such groups and the impact on the evidence base for their care.ConclusionThis is the first study to examine health and social care professionals’ knowledge and understanding of the dual legal frameworks in the UK. Health and social care professionals’ understanding and attitudes towards research involving adults with incapacity may warrant further in-depth exploration. The findings from this survey suggest that greater training and education is required. (shrink)

Institutional Review Boards have expressed concern that research into sensitive topics such as mental disorder will cause participants undue distress. This study investigated the emotional responses of 5,220 Australians to a survey on mental-health-related discrimination. Participants were interviewed about their mental health and experiences of discrimination across 10 life domains and then the emotional impacts of the survey. Results suggested that a minority experienced a negative reaction in contrast to 88% reporting positive experiences. A mental health problem was (...) associated with both negative and positive reactions. (shrink)

Drug Safety Communications are used by the Food and Drug Administration to inform health care providers, patients, caregivers, and the general public about safety issues related to FDA-approved drugs. To assess patient knowledge of the messaging contained in DSCs related to the sleep aids zolpidem and eszopiclone, we conducted a large, cross-sectional patient survey of 1,982 commercially insured patients selected by stratified random sampling from the Optum Research Database who had filled at least two prescriptions for either zolpidem or (...) eszopiclone between July 1, 2012 and June 30, 2013. Among the 594 respondents, two-thirds reported hearing generally about drug safety information prior to starting a new drug, with the remaining one-third “rarely” or “never” hearing such information. Providers and pharmacists were primary sources of drug safety information. Two-thirds of zolpidem users and half of eszopiclone users reported having heard about the related DSC messages, ability to accurately identify the major factual messages was limited. Respondents reacted to new drug safety information about their sleep aids by reporting that they would want to learn about alternative ways to help them sleep and seek out more information about the safety of their specific sleeping pill. Opportunities may exist for the FDA to work with providers and pharmacies to help ensure the DSC information is more widely received and is more fully understood by those taking the affected medications. (shrink)

Purpose: to characterize ethics course content, structure, resources, pedagogic methods, and opinions among academic administrators and course directors at U.S. medical schools. Method: An online questionnaire addressed to academic deans and ethics course directors identified by medical school websites was emailed to 157 Association of American Medical Colleges member medical schools in two successive waves in early 2022. Descriptive statistics were utilized to summarize responses. Results: Representatives from 61 (39%) schools responded. Thirty-two (52%) respondents were course directors; 26 (43%) were (...) deans of academic affairs, medical education, or curriculum; and 3 with other roles also completed the survey (5%). All 61 schools reported some form of formal ethics education during the first year of medical school, with most (n = 54, 89%) reporting a formal mandatory introductory course during preclinical education. Schools primarily utilized lecture and small-group teaching methods. Knowledge-based examinations, attendance, and participation were most commonly used for assessment. A large majority regarded ethics as equally or more important than other foundational courses, but fewer (n = 37, 60%) provided faculty training for teaching ethics. Conclusions: Despite a response rate of 39 percent, the authors conclude that medical schools include ethics in their curricula in small-group and lecture formats with heterogeneity regarding content taught. Preclinical curricular redesigns must innovate and implement best practices for ensuring sound delivery of ethics content in future curricula. Additional large-scale research is necessary to determine said best practices. (shrink)

A cutting-edge survey of formal methods directed specifically at dealing with the deep mathematical problems engendered by the study of developing systems, in particular dealing with developing phase spaces, changing components, structures and functionalities, and the problem of emergence. Several papers deal with the modelling of particular experimental situations in population biology, economics and plant and muscle developments in addition to purely theoretical approaches. Novel approaches include differential inclusions and viability theory, growth tensors, archetypal dynamics, ensembles with variable structures, (...) and complex system models. The papers represent the work of theoreticians and experimental biologists, psychologists and economists. The areas covered embrace complex systems, the development of artificial life, mathematics, computer science, biology and psychology. (shrink)

Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design (...) and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives. (shrink)

Company support for employee volunteerism (CSEV) benefits companies, employees, and society while helping companies meet the expectations of corporate social responsibility (CSR). A nationally representative telephone survey of 990 Canadian companies examined CSEV through the lens of Porter and Kramer's (2006, 'Strategy and society: the link between competitive advantage and corporate social responsibility', Harvard Business Review, 78-92.) CSR model. The results demonstrated that Canadian companies passively support employee volunteerism in a variety of ways, such as allowing employees to take (...) time off without pay (71%) or adjusting their work schedules (78%). These Responsive CSR efforts contribute to the company's value chain by enhancing employee morale, a perceived CSEV benefit. More active forms of support requiring company time or money are less common; for example, 29% allow time off with pay. Companies perceive that support for employee volunteering enhances their public image, a Responsive CSR strategy when employed to ameliorate a damaged reputation or a Strategic CSR strategy when contributing to a competitive position. A minority perceive challenges like covering the workload. Many companies target and/or exclude particular causes and link CSEV efforts with other philanthropic donations, suggesting a Strategic CSR application of CSEV. Where programs exist, they frequently are neither tracked nor evaluated, suggesting that companies are not using these programs as strategically as they might. (shrink)

Context: Although ethics consultation is commonplace in United States hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the “best informant” within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services were found in 81% of all general hospitals in the U.S., and in (...) 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians, nurses, social workers, or chaplains. Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Chinese health authorities have not set up a very clear legal framework or ethical guideline on genetic research involving a huge number of human genetic samples. A nationwide mail survey was conducted to identify whether Chinese research communities identified the fundamental ethical issues. This paper provides in-depth analysis about the attitudes of target groups towards ownership, commercial conflict of interest, international cooperation and ethical review mechanism that may be used to inform national guidelines related to genetic databases in (...) China. (shrink)

Data from a survey on the sexual harassment of women in Canada reveal that 83.2 percent of the 1,990 women interviewed had received obscene or threatening telephone calls. Divorced and separated women, young women, and women living in major metropolitan areas were most likely to have been victims of this harassment. The “most disturbing” calls usually came at night when the respondent was home alone. The typical caller was an adult male unknown to the woman. Relatively few women reported (...) these calls to the police or the phone company, and those who did tended to get an unhelpful response. Most women said that the calls affected them emotionally, with fear being by far the most prevalent response. The results provide strong support for feminist theorizing about violence, fear, and the social control of women. (shrink)

This paper applies models of the onset of adolescent sexual intercourse using national data from Denmark and the USA. The model gave excellent fits to data on Danish Whites and a good fit to American Whites, but the model-fits for American Blacks and Hispanics were not as good. The weakness of the latter model fits may reflect either real processes that the model does not capture or problems in the reliability of adolescent sexuality data.

In 1992, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) passed a mandate that all its approved hospitals put in place a means for addressing ethical concerns.Although the particular process the hospital uses to address such concernsmay vary, the hospital or healthcare ethics committee (HEC) is used most often. In a companion study to that reported here, we found that in 1998 over 90% of U.S. hospitals had ethics committees, compared to just 1% in 1983, and that many (...) have some and a few have sweeping clinical powers in hospitals. (shrink)

The ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using (...) a stratified purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)