Few residency training programmes explicitly require substantive exposure to issues in medical ethics and fewer still have a formal curriculum in this area. Traditional undergraduate medical ethics courses teach preclinical students to identify ethical issues and analyse them at a theoretical level. Residency training, however, is the ideal time to establish the critical behavioural link which makes ethics truly useful in clinical medicine. The General Internal Medicine Residency Training Program at Rhode Island Hospital has developed an integrated, three-year curriculum with (...) the goals of helping residents to perceive ethical issues in clinical practice, to utilise basic philosophical principles in resolving ethical dilemmas and to communicate these issues clearly and sensitively to patients. The curriculum has been well received by residents and has had a hospital-wide impact. We believe that training residents in medical ethics and communication skills is an effective approach to developing physicians' humane qualities. (shrink)
To investigate the current status of hospital clinical ethics committees (CEC) and how they have evolved in Canada over the past 20 years, this paper presents an overview of the findings from a 2008 survey and compares these findings with two previous Canadian surveys conducted in 1989 and 1984. All Canadian hospitals over 100 beds, of which at least some were acute care, were surveyed to determine the structure of CEC, how they function, the perceived achievements of these committees and (...) opinions about areas with which CEC should be involved. The percentage of hospitals with CEC in our sample was found to be 85% compared with 58% and 18% in 1989 and 1984, respectively. The wide variation in the size of committees and the composition of their membership has continued. Meetings of CEC have become more regularised and formalised over time. CEC continue to be predominately advisory in their nature, and by 2008 there was a shift in the priority of the activities of CEC to meeting ethics education needs and providing counselling and support with less emphasis on advising about policy and procedures. More research is needed on how best to define what the scope of activities of CEC should be in order to meet the needs of hospitals in Canada and elsewhere. More research also is needed on the actual outcomes to patients, families, health professionals and organisations from the work of these committees in order to support the considerable time committee members devote to this endeavour. (shrink)
In his pioneering work of moral phenomenology, K. E. Løgstrup offered a phenomenological articulation of a central moment of ethical life: the experience in which “one finds oneself with the life of another more-or-less in one’s hands”. In such circumstances we encounter what Løgstrup calls simply the ethical demand. Løgstrup’s preferred formulation of the content of that demand is taken from the Bible: Love thy neighbor. This neighborly love is expressed in the form of spontaneous, selfless care for the other. (...) We shall have occasion in what follows to return to the content that Løgstrup associates with the ethical demand, but my primary focus here is not its content but its distinctive modality. Løgstrup specifies that modality in a fourfold analysis: the ethical demand is radical, silent, one-sided, and unfulfillable. My concern in what follows will be with the fourth element in this analysis – or what I shall refer to simply as Løgstrup’s unfulfillability thesis. My discussion addresses three specific questions: Is it coherent to suppose that the ethical demand is unfulfillable? Why does Løgstrup hold that the ethical demand is unfulfillable? What kind of response is appropriate in the face of an unfulfillable ethical demand? (shrink)
This collection of papers in epistemic logic is oriented towards applications to game theory and individual decision theory. Most of these papers were presented at the inaugural conference of the LOFT (Logic for the Theory and Games and Decisions) conference series, which took place in 1994 in Marseille. Among the notions dealt with are those of common knowledge and common belief, infinite hierarchies of beliefs and belief spaces, logical omniscience, positive and negative introspection, backward induction and rationalizable equilibria in game (...) theory. (shrink)
In 2011, the Department of Health and Human Services proposed changes to the regulations that govern human subjects protection in federally funded research. The proposed changes involve modifying inclusion standards for minimal-risk research and removing the necessity of review from certain categories of noninvasive research. All studies would instead be required to comply with privacy protections as initiated by the Health Information Portability and Accountability Act . We argue that relying on HIPAA to protect participants from participation-related risks in noninvasive (...) research is insufficient to protect the autonomy and psychological health of potential research participants. Instead, we suggest a streamlined review format for these categories of research. (shrink)
Background In Canadian jurisdictions without specific legislation pertaining to research consent, the onus is placed on researchers to determine whether a child is capable of independently consenting to participate in a research study. Little, however, is known about how child health researchers are approaching consent and capacity assessment in practice. The aim of this study was to explore and describe researchers' current practices. Methods The study used a qualitative descriptive design consisting of 14 face-to-face interviews with child health researchers and (...) research assistants in Southern Ontario. Transcribed interviews were analysed for common themes. Results Procedures for assessing capacity varied considerably from the use of age cutoffs to in-depth engagement with each child. Three key issues emerged from the accounts: (1) requirements that consent be provided by a single person thwarted researchers' abilities to support family decision-making; (2) little practical distinction was made between assessing if a child was capable, versus determining if study information had been adequately explained by the researcher; and (3) participants' perceived that review boards' requirements may conflict with what they considered ethical consent practices. Conclusion The results suggest that researchers' consent and capacity knowledge and skills vary considerably. Perceived discrepancies between ethical practice and ethics boards' requirements suggest the need for dialogue, education and possibly ethics board reforms. Furthermore we propose, where appropriate, a ‘family decision-making’ model that allows parents and their children to consent together, thereby shifting the focus from separate assent and consent procedures to approaches that appropriately engage the child and family. (shrink)
This review of issues and research is in two parts: 1) practical problems surrounding patient-held records and 2) ethical arguments for and against patient-held records. We argue that research on patient-held records indicates that there are no substantial practical drawbacks and considerable ethical benefits to be derived from giving patients custody of their medical records.
Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.
This is the first of four papers to be published in Research Ethics Review in 2009 that address methodological issues of relevance to research ethics committees. These will be practical papers, intended to assist ethics committee members to determine whether a research method is both ethically justified and likely to lead to high quality research. This paper prepares the way for the series through a consideration of the relationship between research ethics and methodology.
BACKGROUND -/- The importance of ontologies in the biomedical domain is generally recognized. However, their quality is often too poor for large-scale use in critical applications, at least partially due to insufficient training of ontology developers. -/- OBJECTIVE -/- To show the efficacy of guideline-based ontology development training on the performance of ontology developers. The hypothesis was that students who received training on top-level ontologies and design patterns perform better than those who only received training in the basic principles of (...) formal ontology engineering. -/- METHODS -/- A curriculum was implemented based on a guideline for ontology design. A randomized controlled trial on the efficacy of this curriculum was performed with 24 students from bioinformatics and related fields. After joint training on the fundamentals of ontology development the students were randomly allocated to two groups. During the intervention, each group received training on different topics in ontology development. In the assessment phase, all students were asked to solve modeling problems on topics taught differentially in the intervention phase. Primary outcome was the similarity of the students’ ontology artefacts compared with gold standard ontologies developed by the authors before the experiment; secondary outcome was the intra-group similarity of group members’ ontologies. -/- RESULTS -/- The experiment showed no significant effect of the guideline-based training on the performance of ontology developers (a) the ontologies developed after specific training were only slightly but not significantly closer to the gold standard ontologies than the ontologies developed without prior specific training; (b) although significant differences for certain ontologies were detected, the intra-group similarity was not consistently influenced in one direction by the differential training. -/- CONCLUSION -/- Methodologically limited, this study cannot be interpreted as a general failure of a guideline-based approach to ontology development. Further research is needed to increase insight into whether specific development guidelines and practices in ontology design are effective. (shrink)
This paper proposes a critical analysis of that interpretation of the Nāgārjunian doctrine of the two truths as summarized—by both Mark Siderits and Jay L. Garfield—in the formula: “the ultimate truth is that there is no ultimate truth”. This ‘semantic reading’ of Nāgārjuna’s theory, despite its importance as a criticism of the ‘metaphysical interpretations’, would in itself be defective and improbable. Indeed, firstly, semantic interpretation presents a formal defect: it fails to clearly and explicitly express that which it contains logically; (...) the previously mentioned formula must necessarily be completed by: “the conventional truth is that nothing is conventional truth”. Secondly, after having recognized what Siderits’ and Garfield’s analyses contain implicitly, other logical and philological defects in their position emerge: the existence of the ‘conventional’ would appear—despite the efforts of semantic interpreters to demonstrate quite the contrary—definitively inconceivable without the presupposition of something ‘real’; moreover, the number of verses in Nāgārjuna that are in opposition to the semantic interpretation (even if we grant semantic interpreters that these verses do not justify a metaphysical reconstruction of Nagarjuna’s doctrine) would seem too great and significant to be ignored. (shrink)
This is the second of four papers to be published in Research Ethics Review in 2009 that address methodological issues of relevance to research ethics committees. It focuses on three issues: the appropriateness of the research question, the different types of study design available, including both qualitative and quantitative, and the need for, and choice of, a control group. The paper argues that these issues are key to ethical consideration since inappropriate design may not be salvageable and can lead to (...) unusable data, in which case the risks and burdens to participants would be unjustified. (shrink)
Hospitals in many countries have had clinical ethics committees for over 20 years. Despite this, there has been little research to evaluate these committees and growing evidence that they are underutilized. To address this gap, we investigated the question ‘What are the barriers and facilitators nurses and physicians perceive in consulting their hospital ethics committee?’ Thirty-four nurses, 10 nurse managers and 31 physicians working at four Canadian hospitals were interviewed using a semi-structured interview guide as part of a larger investigation. (...) We used content analysis of the interview data related to barriers and facilitators to use of hospital ethics committees to identify nine categories of barriers and nine categories of facilitators. These categories as well as their subcategories are discussed and those specific to nurses or physicians are identified. The need to increase health professionals' use of clinical ethics committees through reducing barriers and maximizing facilitators is discussed. (shrink)
Nurses and physicians may experience ethical conflict when there is a difference between their own values, their professional values or the values of their organization. The distribution of limited health care resources can be a major source of ethical conflict. Relatively few studies have examined nurses' and physicians' ethical conflict with organizations. This study examined the research question ‘What are the organizational ethical conflicts that hospital nurses and physicians experience in their practice?’ We interviewed 34 registered nurses, 10 nurse managers, (...) and 31 physicians as part of a larger study, and asked them to describe their ethical conflicts with organizations. Through content analysis, we identified themes of nurses' and physicians' ethical conflict with organizations and compared the themes for nurses with those for physicians. (shrink)
The rationalization of a choice function, in terms of assumptions that involve expansion or contraction properties of the feasible set, over non-finite sets is analyzed. Schwartz's results, stated in the finite case, are extended to this more general framework. Moreover, a characterization result when continuity conditions are imposed on the choice function, as well as on the binary relation that rationalizes it, is presented.
This article investigates whether acts of plagiarism are predictable. Through a deductive, quantitative method, this study examines 517 students and their motivation and intention to plagiarize. More specifically, this study uses an ethical theoretical framework called the Theory of Reasoned Action and Planned Behavior to proffer five hypotheses about cognitive, relational, and social processing relevant to ethical decision making. Data results indicate that although most respondents reported that plagiarism was wrong, students with strong intentions to plagiarize had a more positive (...) attitude toward plagiarizing, believed that it was important that family and friends think plagiarizing is acceptable, and perceived that plagiarizing would be an easy task. However, participants in the current study with less intention to plagiarize hold negative views about plagiarism, do not believe that plagiarism is acceptable to family, friends or peers, and perceive that the act of plagiarizing would prove difficult. Based on these findings, this study considers implications important for faculty, librarians, and student support staff in preventing plagiarism through collaborations and outreach programming. (shrink)
Introduction: The objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.Methods: Participants from within Baylor Health Care System completed an online seven-point Likert scale moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.Results: More than 2,700 healthcare professionals responded to the survey ; survey respondents represented (...) multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.Conclusions: Moral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)
All languages, both spoken and signed, make a formal distinction between two types of terms in a proposition – terms that identify what is to be talked about (nominals) and terms that say something about this topic (predicates). Here we explore conditions that could lead to this property by charting its development in a newly emerging language – Nicaraguan Sign Language (NSL). We examine how handshape is used in nominals vs. predicates in three Nicaraguan groups: (1) homesigners who are not (...) part of the Deaf com- munity and use their own gestures, called homesigns, to communicate; (2) NSL cohort 1 signers who fashioned the first stage of NSL; (3) NSL cohort 2 signers who learned NSL from cohort 1. We compare these three groups to a fourth: (4) native signers of American Sign Language (ASL), an established sign language. We focus on handshape in predicates that are part of a productive classifier system in ASL; handshape in these predicates varies sys- tematically across agent vs. no-agent contexts, unlike handshape in the nominals we study, which does not vary across these contexts. We found that all four groups, including home- signers, used handshape differently in nominals vs. predicates – they displayed variability in handshape form across agent vs. no-agent contexts in predicates, but not in nominals. Variability thus differed in predicates and nominals: (1) In predicates, the variability across grammatical contexts (agent vs. no-agent) was systematic in all four groups, suggesting that handshape functioned as a productive morphological marker on predicate signs, even in homesign. This grammatical use of handshape can thus appear in the earliest stages of an emerging language. (2) In nominals, there was no variability across grammatical con- texts (agent vs. no-agent), but there was variability within- and across-individuals in the handshape used in the nominal for a particular object. This variability was striking in homesigners (an individual homesigner did not necessarily use the same handshape in every nominal he produced for a particular object), but decreased in the first cohort of NSL and remained relatively constant in the second cohort. Stability in the lexical use of handshape in nominals thus does not seem to emerge unless there is pressure from a peer linguistic community. Taken together, our findings argue that a community of users is essential to arrive at a stable nominal lexicon, but not to establish a productive morpholog- ical marker in predicates. Examining the steps a manual communication system takes as it moves toward becoming a fully-fledged language offers a unique window onto factors that have made human language what it is. (shrink)
Maternity careproviders often have strong views concerning a woman’s choice of where to give birth. These views may be based on the ethical principle of autonomy, or on the principle of beneficence. The authors propose that an approach utilizing shared decision making allows careproviders and women to move beyond disagreements regarding which evidence on risk should “count,” instead adopting a process of increased knowledge and support for women and their partner while they make choices regarding place of birth.
In this paper, we introduce the methodology and techniques of meta-argumentation to model argumentation. The methodology of meta-argumentation instantiates Dung’s abstract argumentation theory with an extended argumentation theory, and is thus based on a combination of the methodology of instantiating abstract arguments, and the methodology of extending Dung’s basic argumentation frameworks with other relations among abstract arguments. The technique of meta-argumentation applies Dung’s theory of abstract argumentation to itself, by instantiating Dung’s abstract arguments with meta-arguments using a technique called flattening. (...) We characterize the domain of instantiation using a representation technique based on soundness and completeness. Finally, we distinguish among various instantiations using the technique of specification languages. (shrink)
This study presents findings from an ontological and contextual determination of the concept of dignity. The study had a caritative and caring science perspective and a hermeneutical design. The aim of this study was to increase caring science knowledge of dignity and to gain a determination of dignity as a concept. Eriksson’s model for conceptual determination is made up of five part-studies. The ontological and contextual determination indicates that dignity can be understood as absolute dignity, the spiritual dimension characterized by (...) responsibility, freedom, duty, and service, and relative dignity, characterized by the bodily, external aesthetic dimension and the psychical, inner ethical dimension. Dignity exists in human beings both as absolute and relative dignity. (shrink)