Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...) was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medical ethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the central focus of health care ethics. The case is made for empirical work in health care ethics and it is suggested that a good way of setting about this (...) is to ask practising nurses about the real ethical problems they encounter. (shrink)

Gestational surrogacy as a treatment for infertility is being practised in some well-known medical institutions in Tehran and some other cities in Iran. While the majority of Muslims in the world are Sunni, the majority of Iranians are Shiite. Most Sunni scholars do not permit surrogate motherhood, since it involves introducing the sperm of a man into the uterus of a woman to whom he is not married. Most Shiite scholars, however, have issued jurisprudential decrees (fatwas) that allow surrogate motherhood (...) as a treatment for infertility, albeit only for legal couples. They regard this practice as transferring an embryo or fetus from one womb to another, which is not forbidden in Shiite jurisprudence. Nevertheless, there are some controversies concerning some issues such as kinship and inheritance. The main ethical concern of Iran’s experience with gestational surrogacy is the monetary relation between the intended couple and the surrogate mother. While monetary remuneration is practised in Iran and allowed by religious authorities, it seems to suffer from ethical problems. This article proposes that this kind of monetary relation should be modified and limited to reimbursement of normal costs. Such modification requires new legislation and religious decrees. (shrink)

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may (...) be as important as that of the students. (shrink)

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions (...) the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context. (shrink)

Arguments about the morality of the use of deception in patient care have been conducted largely in an empirical vacuum, with few data about the situations in which deception occurs. Do staff frequently deceive their patients and, if so, under what conditions? Can the consequences of deception always be foreseen? What justifications do staff use to explain their behaviour? The small-scale study reported here on the uses of deception by nurses when attempting to reassure patients provides information on these questions. (...) The results suggest that deception can have deleterious effects on trust and increase the emotional distance between patients and staff. (shrink)

OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology (...) were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs. (shrink)

Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autonomy' and its dimensions, such as being aware of the patient's vulnerability, caring for and caring about the patient, were identified. The findings in this study make clear the need for further research into the experiential aspect of ethical decision-making (...) in psychiatric practice. (shrink)

Clinician gate-keeping is the process whereby healthcare providers prevent access to eligible patients for research recruitment. This paper contends that clinician gate-keeping violates three principles that underpin international ethical guidelines: respect for persons or autonomy; beneficence or a favourable balance of risks and potential benefits; and justice or a fair distribution of the benefits and burdens of research. In order to stimulate further research and debate, three possible strategies are also presented to eliminate gate-keeping: partnership with professional researchers; collaborative research (...) design and clinician education. (shrink)

In this paper some of the general issues surrounding recently published guidelines for the practice of research ethics committees are outlined, concentrating in particular on the difficulties raised by research with psychiatric patients. Research is distinguished from ordinary clinical practice by the intention to advance knowledge. So defined, research with psychiatric patients should be governed by the same four principles as research with any other group--knowledge, necessity, benefit and consent. In applying these principles, however, particularly the principle of consent, many (...) acute difficulties are raised by psychiatric patients. A number of proposals for addressing these difficulties are discussed. It is suggested that, notwithstanding the value of published guidelines, and the help that may be available from research ethics committees, the primary responsibility for maintaining high standards of practice in research rests with research workers themselves. (shrink)

A crucial debate currently raging in the fields of cognitive and social science centers around general and specific approaches to understanding the actions of others. When we understand the actions of another person, do we do so on the basis of a general theory of psychology, or on the basis of an effort to place ourselves in the particular position of that specific person? Hans Herbert Kögler and Karsten R. Stueber's Empathy and Agency addresses this other issues vital to current (...) social science in an advanced and diverse analysis of the foundations of social-scientific methodology based on recent cognitive psychology. The book serves as both an introduction to the debate for non-academic audiences and as a catalyst for further discussion for serious theorists. Empathy and Agency provides a solid foundation of the fundamental issues in social and cognitive science, but also presents the most influential paradigms in the field at this time. (shrink)

Harris’ reply to our defence of the National Institute for Clinical Excellence’s (NICE) current cost-effectiveness procedures contains two further errors. First, he wrongly draws a conclusion from the fact that NICE does not and cannot evaluate all possible uses of healthcare resources at any one time and generally cannot know which National Health Service (NHS) activities would be displaced or which groups of patients would have to forgo health benefits: the inference is that no estimate is or can be made (...) by NICE of the benefits to be forgone. This is a non-sequitur. Second, he asserts that it is a flaw at the heart of the use of quality-adjusted life years (QALYs) as an outcome measure that comparisons between people need to be made. Such comparisons do indeed have to be made, but this is not a consequence of the choice of any particular outcome measure, be it the QALY or anything else. (shrink)

Developing the Horizons of the Mind is a comprehensive book on Relational and Contextual Reasoning, a theory of the human mind which powerfully addresses key areas of human conflict such as the ideological conflict between nations, the conflict in close relationships and the conflict between science and religion. K. Helmut Reich provides a clear and accessible introduction to the fresh RCR way of thinking that encourages people to adopt an inclusive rather than an oppositional approach to conflict and problem-solving. Part (...) one outlines the key aspects of RCR theory and supporting empirical data and part two provides examples of its application in the world. RCR provides a stimulating and challenging tool to several disciplines, including philosophy, psychology, religious studies and education, and this book will be a valuable resource for cognitive scientists, psychotherapists, theologians, educators and all those involved in conflict resolution. (shrink)

As exemplified by three cases, difficulties in the dialogue between religion and science not infrequently arise from differing views of God's omnipotence and omniscience. From the side of theology, reflections on the biblical and church‐related sources of those views, on Auschwitz and theproblem of theodicy, on God as Creator of the universe, and on how to read and interpret the Bible show that a view of a God who self‐limits almightiness and all‐knowing in order to grant freedom and functional integrity (...) to a Creation about which God cares can be multiply justified. Such a view is not dissonant with regard to a self‐organized, open universe, producing “unexpected” emergent features as seen by science. (shrink)

OBJECTIVES: To compare the perceptions of physician executives and clinicians regarding ethical issues in Saudi Arabian hospitals and the attributes that might lead to the existence of these ethical issues. DESIGN: Self-completion questionnaire administered from February to July 1997. SETTING: Different health regions in the Kingdom of Saudi Arabia. PARTICIPANTS: Random sample of 457 physicians (317 clinicians and 140 physician executives) from several hospitals in various regions across the kingdom. RESULTS: There were statistically significant differences in the perceptions of physician (...) executives and clinicians regarding the existence of various ethical issues in their hospitals. The vast majority of physician executives did not perceive that seven of the eight issues addressed by the study were ethical concerns in their hospitals. However, the majority of the clinicians perceived that six of the same eight issues were ethical considerations in their hospitals. Statistically significant differences in the perceptions of physician executives and clinicians were observed in only three out of eight attributes that might possibly lead to the existence of ethical issues. The most significant attribute that was perceived to result in ethical issues was that of hospitals having a multinational staff. CONCLUSION: The study calls for the formulation of a code of ethics that will address specifically the physicians who work in the kingdom of Saudi Arabia. As a more immediate initiative, it is recommended that seminars and workshops be conducted to provide physicians with an opportunity to discuss the ethical dilemmas they face in their medical practice. (shrink)

Introduction of deep neural networks to the machine translation research ameliorated conventional machine translation systems in multiple ways, specifically in terms of translation quality. The ability of deep neural networks to learn a sensible representation of words is one of the major reasons for this improvement. Despite machine translation using deep neural architecture is showing state-of-the-art results in translating European languages, we cannot directly apply these algorithms in Indian languages mainly because of two reasons: unavailability of the good corpus and (...) Indian languages are morphologically rich. In this paper, we propose a neural machine translation (NMT) system for four language pairs: English–Malayalam, English–Hindi, English–Tamil, and English–Punjabi. We also collected sentences from different sources and cleaned them to make four parallel corpora for each of the language pairs, and then used them to model the translation system. The encoder network in the NMT architecture was designed with long short-term memory (LSTM) networks and bi-directional recurrent neural networks (Bi-RNN). Evaluation of the obtained models was performed both automatically and manually. For automatic evaluation, the bilingual evaluation understudy (BLEU) score was used, and for manual evaluation, three metrics such as adequacy, fluency, and overall ranking were used. Analysis of the results showed the presence of lengthy sentences in English–Malayalam, and the English–Hindi corpus affected the translation. Attention mechanism was employed with a view to addressing the problem of translating lengthy sentences (sentences contain more than 50 words), and the system was able to perceive long-term contexts in the sentences. (shrink)

are ambiguous. In the mouth of someone who cannot remember whether it was Michael, or rather someone else, who was top scorer, can express the epistemic possibility that Michael led the league in scoring. But from someone who knows that Michael did not even play last season, but is wondering what would have happened if he had, means something quite different. Now where it has this quite different meaning, may still turn out to be the expression of some epistemic possibility. (...) Perhaps where does not express the epistemic possibility of ‘Michael led the league in scoring’, it expresses the epistemic possibility of ‘Michael would have led the league in scoring’. Analysis of this ‘would have’ statement, together with an exploration of the suspicion that the ‘might have’ statement is ambiguous between these two epistemic possibilities, will have to await another occasion. The important point for present purposes is that is ambiguous between an expression of the epistemic possibility of ‘Michael led the league in scoring’ and some quite different reading. (shrink)

An Institute of Medical Ethics working party supports the view that explicit permission should normally be sought in the case of testing for HIV antibody. It discusses this in relation to anonymised HIV testing for epidemiological purposes, concluding that this is to be welcomed, given certain safeguards. It next argues that pregnant women may have a greater and more immediate need than others to know their HIV status. It concludes that this need does not justify testing them without their permission, (...) but can be met by voluntary diagnostic testing on an 'opting-out' basis, supported by adequate briefing. (shrink)

During 1995, there was a major shift in the United Kingdom in the debate of whether it is right for nurses to strike. The Royal College of Nursing, the former advocate of a non-industrial action policy, moved towards the UNISON position that industrial action is ethical in some circumstances, as well as the necessary thing to do. The authors, both nurses and UNISON officials, look at the reasons for this change and why UNISON’s historical position sees industrial action as an (...) effective weapon in defending services, as well as wages and jobs. It can be right to strike. (shrink)

Nobel Laureate in physics Wolfgang Pauli studied philosophy and the history of ideas intensively, especially in his later years, to form an accurate ontology vis-à-vis quantum theory. Pauli's close contacts with the Swiss psychiatrist C.G. Jung gave him special qualifications for also understanding the basic problems of empirical knowledge. After Pauli's sudden death in 1958, this work was maintained mainly in his posthumously published correspondence, which so far extends only to 1939. Because Pauli's view differs essentially from the direction physics (...) research took after the deaths of the founding fathers of quantum theory, this article attempts to describe the main features in Pauli's revolutionary thought, which is based on nature's “epistemological lesson” as revealed by Pauli's atomic research. Pauli's conclusions have important implications for various issues in Western culture, not least with the limits of science and the relation of science to religion. (shrink)

During the 70s and 80s ethical debate concerning the fetus became intensive. The great advances made in medical technology and research and improvements in prenatal diagnosis as well as in embryological research have led us to believe that the fetus is an individual with recognised claims to protection. In Sweden the aborted fetus has previously been considered merely as a risk-disposal problem, equivalent to dangerous and infected material and there have been no specific guidelines for the treatment of the fetus (...) after abortion. In July 1990 treatment of aborted fetuses was changed with the general guidelines from the National Board of Health and Welfare. The present paper sets out the main contents of the guidelines and discusses the gradually changing views concerning the status of the human fetus in Sweden, as well as the public debate which has been a contributing factor to these changes. (shrink)

Men have been talking of death from time immemorial - sometimes sublimely in prose and poetry, in painting and sculpture and in music - till silence seemed to fall in the recent past. Now men are again talking about death - interminably but colloquially. They talk on television, on the radio, in books and in pamphlets. Dr Kenneth Boyd therefore finds it entirely timely to offer this historical sketch of attitudes to death. The earlier part of his paper covers fairly (...) familiar ground but his final and longest section on the work of a social historian, Philippe Ariès, may be new to many. Ariès is reinterpreting the long history of attitudes to death in a form which may well interest those who today are concerned with helping modern man to accept his own death - death which still, for most people, is the death of another, not of oneself. (shrink)

The Edinburgh Medical Group Research Project is unique in Britain. Part of its function is to experiment with teaching medical ethics both inside and outside of the Medical School. The papers which follow have been written by two full-time reseach fellows working with the Project and two of the professional advisers, one nursing and one medical. Together they give a picture of the wide scope of exerimental teaching taking place in Edinburgh and present some preliminary results from these experiments.