_The Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants_ instructs clinical ethics consultants to preserve their professional integrity by “not engaging in activities that involve giving an ethical justification or stamp of approval to practices they believe are inconsistent with agreed-upon standards” (ASBH, 2014, p. 2). This instruction reflects a larger model of how to address value uncertainty and moral conflict in healthcare, and it brings up some intriguing and as yet unanswered questions—ones that the (...) drafters of the _Code_, and the profession more broadly, should seek to address in upcoming revisions. The objective of this article is to raise these questions as a way of urging greater clarification of the _Code’s_ overall approach to professional integrity, its meaning, and implications. (shrink)

The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the (...) American Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

An elderly patient in his early eighties is hospitalized in a long-term facility, with advanced Alzheimer disease. He is otherwise relatively strong and free from other life-threatening conditions, except for the fact that he has difficulties swallowing. After several episodes of acute aspiration pneumonia doctors prescribe “strict fast”: only hydration through an IV catheter should be administered during the night, in order to relieve the feeling of hunger, provide comfort, and stave off death. The patient is surrounded by a warm (...) and extremely close-knit Mediterranean family. His wife and six adult children take turns feeding him properly mixed food twice a day and prefer to take the risk of causing another... (shrink)

The rise of managed care initiated a steady decline in solo and small group physician practices and the emergence of new delivery models built around large health care organizations. Health care reform has only accelerated this trend as public and private payors shift to new payment methodologies that reward clinical and financial integration among providers. As a result, patients increasingly receive care from physicians and other health professionals organized into collaborative partnerships with one another and institutional providers, such as hospitals. (...) As described below, this new organizational dynamic profoundly influences the clinical judgment of physicians. No longer can society simply depend on the professionalism of individual physicians to ensure ethical integrity in the health care setting. Rather, ethical integrity in the health care setting also requires a strong foundation of organizational ethics. (shrink)

This paper proposes that billing gamesmanship occurs when physicians free-ride on the billing practices of other physicians. Gamesmanship is non-universalizable and does not exercise a competitive advantage; consequently, it distorts prices and allocates resources inefficiently. This explains why gamesmanship is wrong. This explanation differs from the recent proposal of Heath (2020. Ethical issues in physician billing under fee-for-service plans. J. Med. Philos. 45(1):86–104) that gamesmanship is wrong because of specific features of health care and of health insurance. These features are (...) aggravating factors but do not explain gamesmanship’s primary wrong-making feature, which is to cause diffuse harm not traceable to any particular patient or insurer. This conclusion has important consequences for how medical schools and professional organizations encourage integrity in billing. To avoid free-riding, physicians should ask themselves, “could all physicians bill this way?” and if not, “does the patient benefit from the distinctive service I am providing under this code?” If both answers are “no,” physicians should refrain from the billing practice in question. (shrink)

Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, (...) even if the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)

To practice medicine and ethics, physicians need wisdom and integrity to integrate scientific knowledge, patient preferences, their own moral commitments, and society's expectations. This work of integration requires a physician to pursue certain goals of care, determine moral priorities, and understand that conscience or integrity require harmony among a person's beliefs, values, reasoning, actions, and identity. But the moral and religious pluralism of contemporary society makes this integration challenging and uncertain. How physicians treat patients will depend on (...) the particular beliefs and values they and other health professionals bring to each instance of shared decision making. This book offers a framework for practical wisdom in medicine that addresses the need for integrity in the life of each health professional. In doing so, it acknowledges the challenge of moral pluralism and the need for moral dialogue and humility as professionals fulfil their obligations to patients, themselves, and society. (shrink)

Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients’ needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family Medicine residency clinics in the (...) United States are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers’ knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients’ lives. (shrink)

Critics of Western medicine have long heralded a “new paradigm” opposed to the reigning materialistic worldview of biomedical science and allopathy. This new paradigm has undergone several name changes (e.g., holistic, alternative, complementary, integrative) and presumably advances a radically new worldview. On closer inspection, it looks more like the opposite pole of the same dualistic worldview and not a radical break with the past. A truly new paradigm prepared to jettison tacit conceptual assumptions would have significant implications for medical (...) research, provided that institutional and professional constraints not inhibit the studies to follow. A research agenda is proposed comprising possible jumping-off points for investigators comfortable with working around the reigning assumptions both of current medical thinking and of a rapidly institutionalizing integrative-medicine worldview. These include proposed medical research on spirituality, alien abductions, hierophanies, thought forms, placebo pharmacology, radionics, arcane medical wisdom, prenatal ensoulment, and musical genetics. (shrink)

Medical students' professional identity formation is an adaptive, developmental process. PIF is shaped by values implicit in educational practices and in the culture of the learning environment. In 2003, educational leaders at Harvard Medical School created the Cambridge Integrated Clerkship as a new model of clinical education to support PIF intentionally. The CIC, a longitudinal integrated clerkship, differs in structure, processes, and venues from traditional block rotations, while...

Medical professionals are expected to act in the interest of patients, the public, and the pursuit of medical knowledge. Their disinterested pursuit offers them credibility and authority. But what happens when doctors' supposed impartiality comes under fire? Medicine and Morality considers the ways in which moral and scientific norms in Canadian medicine have emerged and evolved over time. Critics of biomedicine tend to discuss conflict of interest as a contemporary phenomenon - namely in relation to the damaging influence (...) of the pharmaceutical industry on medical practice and research. But Helen Kang examines three moments in the history of the medical profession in Canada, spanning more than 150 years, when doctors' moral and scientific authority was questioned. Kang shows that, in these moments of crisis, the profession was compelled to re-examine its priorities, strategize in order to regain credibility, and redefine what it means to be a good doctor. Medicine and Morality reveals that professional medicine defines integrity, objectivity, accountability, neutrality, and other ideals according to its social, political, historical, and economic struggles with the state, the media, and even the public. In other words, moral and scientific standards in medicine are determined in direct relation to, not in spite of, conflict of interest. (shrink)

Health disparities education is an integral and required part of medical professional training, and yet existing curricula often fail to effectively denaturalize injustice or empower learners to advocate for change. We discuss a novel collaborative intervention that weds the health humanities to the field of health equity. We draw from the health humanities an intentional focus retraining provider imaginations by centering patient narratives; from the field of health equity, we draw the linkage between stigmatized social identities and health disparities. (...) We describe a longitudinal health equity curriculum for the Hospice and Palliative Medicine fellowship in Memphis, Tennessee, to give trainees exposure to the concept of structural violence and how it affects clinical care. The curriculum was developed in partnership with humanities and social sciences faculty who staff a Health Equity academic program at a small liberal arts college in Memphis. This curriculum has been implemented for the past four years in support of 22 hospice and palliative medicine fellows. Group debriefs and a mixed methods survey have revealed widespread and lasting impact towards understanding health equity concepts, enhanced communication and treatment of patients, and empowerment to address the broader needs and policies affecting patients and the communities in which they live. Ultimately, we model an educational initiative that integrates equity across the full scope of healthcare practice and equips learners with skills for sustaining compassionate practices, focusing on equity-oriented, person-centered care across the full scope of healthcare practice. (shrink)

In Moral Case Deliberation, healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals’ moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. (...) The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient’s nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient’s autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients’ influence and at the same time take responsibility for their needs as vulnerable humans. (shrink)

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

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

The art of medicine stimulates the attitude of mind which concedes that on certain issues the patient knows what is right for him or her, and the public senses what is best for it. Not because they are right, but because on these issues there is no absolute right. —Anthony MooreThe benefits of fine literature, narrative analysis, and the listening to and telling of stories in education are well known (Carson 2001; Guillemin and Gillam 2006; Hunter 1996; Moore 1978; (...) Nussbaum 1990). Literature must not be overlooked in the planning or the delivery of health education and care. Narrative opens readers’ minds by promoting a plethora of viewpoints about stories and life. Through the facilitation of student-centred activities students can critically mull over central points of the story. In discerning meaning, conversations between students are generated around the crucial question, “Whose story is it?” Coincidentally this question drives, or ought to drive, medical integrity.Practitioners m. (shrink)

Conflicts of interest are rampant in the American medical community. Today it is not uncommon for doctors to refer patients to clinics or labs in which they have a financial interest (40% of physicians in Florida invest in medical centers); for hospitals to offer incentives to physicians who refer patients (a practice that can lead to unnecessary hospitalization); or for drug companies to provide lucrative give-aways to entice doctors to use their "brand name" drugs (which are much more expensive than (...) generic drugs). In Medicine, Money and Morals, Marc A. Rodwin draws on his own experience as a health lawyer--and his research in health ethics, law, and policy--to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors' decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor's choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals --lawyers, government officials, and businessmen--all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians' conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change. (shrink)

Background Among the myriad voices advocating diverging ideas of what general practice ought to be, none seem to adequately capture its ethical core. There is a paucity of attempts to integrate moral theory with empirical accounts of the embodied moral knowledge of GPs in order to inform a general normative theory of good general practice. In this article, we present an empirically grounded model of the professional morality of GPs, and discuss its implications in relation to ethical theories to (...) see whether it might be sustainable as a general practice ethic. Methods We observed and interviewed sixteen GPs and GP residents working in health care centres in four Swedish regions between 2015–2017. In keeping with Straussian Grounded Theory, sampling was initially purposeful and later theoretically guided, and data generation, analysis and theoretical integration proceeded in parallel. The focal concept of this article was refined through multidimensional property supplementation. Results The voice of the profession is one of four concepts in our emerging theory that attempt to capture various motives that affect GPs’ everyday moral decisionmaking. It reflects how GPs appreciate the situation by passing three professional–moral judgments: Shall I see what is before me, or take a bird’s-eye view? Shall I intervene, or stay my hand? And do I need to speak up, or should I rather shut up? By thus framing the problem, the GP narrows down the range of considerations, allowing them to focus on its morally most pertinent aspects. This process is best understood as a way of heeding Løgstrup’s ethical demand. Refracted through the lens of the GP’s professional understanding of life, the ethical demand gives rise to specific moral imperatives that may stand in opposition to the express wishes of the other, social norms, or the GP’s self-interest. Conclusions The voice of the profession makes sense of how GPs frame problematic situations in moral terms. It is coherent enough to be sustainable as a general practice ethic, and might be helpful in explaining why ethical decisions that GPs intuitively understand as justified, but for which social support is lacking, can nevertheless be legitimate. (shrink)

International cooperation is an integral part of furthering medical and scientific progress. Many specilist societies exist for that purpose and have written into their constitutions that such cooperation and coordination is their aim. They hope to achieve their aims by exchange, in all languages, of information and by so doing strengthen the relations between individual physicians and scentists as well as between corporate professional bodies from different countries. However, at the same time emphasis is laid on the political neutrality (...) of such organsations. Increasingly, this 'neutrality' is being questioned as doctors and scientists become aware of abuse and distortion of their profession taking place in other countries. H Merskey highlights the problems and offers his opinion on the ethics of maintaining these professional relationships with colleagues abroad who are involved in such abuse and distortion. (shrink)

Some health-care professionals refuse to perform certain services because doing so would violate their conscientiously held beliefs. Arguments for and against their accommodation claims continue both in the public square and in the courts, as well as in bioethics. This chapter introduces this debate by discussing jurisdictions in which accommodation is granted. We offer evidence of the detrimental effects it has on access to health-care services. An overview of influential ethical arguments for and against conscientious objection accommodation, including but not (...) limited to the incompatibility thesis and the moral integrity defense, is presented. We conclude with a discussion of arguments based on the values of diversity and equality of opportunity. (shrink)

Over the past decade, scores of articles have been published debating whether and when it is ethical for physicians to refuse requests from patients for legal, professionally permitted interventions. Numerous voices have condemned "conscientious refusals" for obstructing patients' access to needed and "standard" health-care services, for imposing physicians' personal ideologies on patients, and for contradicting physicians' professional ethical obligations. Conversely, other voices argue that conscientious refusals are essential for maintaining the integrity of clinicians as moral agents, for assuring (...) the renown of the broader medical profession, and for preventing the imposition of moral viewpoints onto minorities... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Understanding Major Turning Points in the History of Medical EthicsLaurence B. McCullough (bio)AbstractAt different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenomenon of laying medicine open has sometimes resulted in major turning points in the history medical ethics. In this paper, I examine two examples of when the laying open of (...) class='Hi'>medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724–1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician’s fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.Reading the Histories of Medicine, Bioethics, and Medical EthicsThere are many ways in which to read the history of medi-cine and therefore of medical ethics and bioethics. For example, the history of medicine can be usefully understood in terms of successive advances or revolutions in biomedical science and its clinical applications, with medical ethics understood as a moral response to scientific and technological change. On this reading, which has been common in the history of bioethics for the past three decades, moral response is required to address scientific and technological changes that are unprecedented and therefore threaten to outstrip society’s moral capacities [End Page 7] to understand and manage those changes well. Much recent work on the ethical, legal, and social issues raised by the genome project appeals to this reading. The history of medicine can also be read in social terms, with medicine understood as a major social institution shaped by various factors, not limited to science. In this perspective, medicine and society are understood in terms of a complex and dynamic synergy. Bioethics and medical ethics become part of this synergy and are to be explained—perhaps even explained away—by social historical factors. There are, of course, other ways to read the history of medicine and therefore of bio-ethics and medical ethics—e.g., in terms of key figures and movements that are thought to have shaped developments in crucial ways.I want to suggest another way to read these histories, namely, the successive laying open of medicine to accountability that sometimes results in key turning points in the development of medical ethics and bioethics. On this reading, ethics is understood as an intellectual and practical discipline that makes medicine as a social institution and its practitioners, physicians, morally accountable for their clinical judgment, decision making, and behavior. This differs from Robert Veatch’s (1981) reading of the history of medical ethics either as particular—informed by intellectual, moral, and experiential resources thought to be available only to physicians—or universal—informed by intellectual, moral, and experiential resources generally available in the culture (present and past). Veatch sees medical ethics as open when it is universal and closed, and unacceptable, when it is particular. I read the history of medical ethics as always universal and medicine as a social institution and practice as sometimes closed—i.e, not accountable for its scientific and moral integrity—and sometimes as open, accountable for such integrity. When medicine is “laid open,” medical ethics itself is sometimes transformed. The same may well be the case for the other health care professions. The histories of medical ethics and bioethics, therefore, can be usefully read as responses to the laying open of medicine and the health care professions generally at various times in their histories. In what follows, I examine two important examples of laying medicine open that create key turning points in the history of medical ethics—Scottish medicine from the eighteenth century and American medicine from the end of the twentieth century.The... (shrink)

The paper develops a responsibility-based account of professional ethics in banking. From this perspective, bankers have duties not only toward clients—the traditional focus of professional ethics—but also regarding the prevention of systemic harms to whole societies. When trying to fulfill these duties, bankers have to meet three challenges: epistemic challenges, motivational challenges, and a coordination challenge. These challenges can best be met by a combination of regulation and ethics that aligns responsibilities, recognition, and incentives and creates what Parsons (...) has called “integrated situations”. Professional associations play an important role for this purpose, especially as spaces in which peer recognition is earned. But financial incentives equally need to be brought in line, for example, through deferred bonuses or claw backs. Such measures can create a new culture of accountability in banking. (shrink)

Arguments in favor of greater research-practice integration in medicine have tended to be ethical, political, or pragmatic. There are good epistemic reasons to pursue greater integration, and it is important to think through these reasons in order to avoid inadvertently designing new systems in ways that replicate the epistemic elitism common within current systems. Meaningful transformation within health care is possible with close attention to all reasons in favor of greater research-practice integration, including epistemic reasons.

Typically, a refusal to provide a medical service is an instance of conscientious objection only when the medical service is legal, professionally accepted, and clinically appropriate. That is, conscientious objection typically occurs only when practitioners reject prevailing norms or practices. Insofar as refusing to provide antibiotics for a viral infection does not violate prevailing clinical norms, there is no need for the physician in Case 1 to justify his refusal to provide antibiotics by appealing to his conscience.1 By contrast, insofar (...) as emergency contraception is legal and does not violate prevailing norms of good medical practice, the physician in Case 6 cannot justify his refusal to provide EC by... (shrink)

Modern scientific medicine is increasingly challenged by complementary and alternative therapies. Reviewing policy options for contemporary healthcare development, the World Health Organization's first global strategy on traditional and alternative medicine, released in May 2002, advocates integration. However, experience in East Asia, the only part of the world where state of the art modern scientific facilities are commonly found alongside thriving traditional practices, reveals that medical integration can take several forms. To clarify the available policy options, this article categorizes (...) those forms, identifying three types of integration (unification, equalization and subjugation), plus one type of non-integration (marginalization). It marks out a zone of balanced healthcare development that cuts across two of the integrationist types, and comprises non-discriminatory state treatment of separate but linked sectors of traditional and modern medicine. The article closes by exploring arguments for and against locating state policy in this zone, and holds that policy should be situated here for medical practices that can meet broadly acceptable professional standards, demonstrate an existing social demand, and generate an adequate supply of medical practitioners, possibly through some state subsidy. (shrink)

Cultural forces such as film create and reinforce rigidly-defined images of a doctor's identity for both the public and for medical students. The authoritarian and hierarchical institution of medical school also encourages students to adopt rigidly-defined professional identities. This restrictive identity helps to perpetuate the power of the patriarchy, limits uniqueness, squelches inquisitiveness, and damages one's self-confidence. This paper explores the construction of a physician's identity using cultural theorists' psychoanalytic analyses of gender and race as a framework of analysis. (...) Cultural theorists' politically-motivated work provides an excellent point of departure for destabilizing parts of the authoritarian medical hierarchy that can damage a student's professional development. Drawing on such discourse, this paper examines the processes by which a doctor's identity becomes rigidly defined and fixed by daily training. It finally proposes a way for a medical student to extrapolate himself from the current definitions of this identity and create a broader, more malleable concept of professional identity by defining himself from outside of, rather than through, difference. (shrink)

Justifying the existence of professional ethics in medicine is usually connected with the traditions of a profession and with a humanistic dimension of these ethics, pointing at the same time to their culture-forming character. With such an attitude, professional ethics is treated as a part of all mankind’s output, and its teaching turns out to be an important element of preparation for taking part in culture. Taking into account the cultural meaning of professional ethics, one should (...) notice that all discussions about the character of relations of medicine and ethics exceed the very health care system. The dilemma outlined in the article deals with the problem whether the existence of medical ethics requires external regulations or is this also a creation of the very representatives of medicine and only they can formulate it. If the latter is to be assumed, ethics in medicine would have to be independent of other detailed ethics and it would not need to be included in any other more general theory. In the first solution, medical ethics is becoming a part of general ethics and, therefore, it would be justified to include it in a more general theory – bioethics. The authors indicate that professional ethics does not limit freedom of the staff but gives a special opportunity to use it. Records constituting its contents are mostly standardized by a professional group which sets criteria of recruitment on its own and general duties resting on their members. (shrink)

Aim The aim is to understand current research into the impact of undergraduate nursing education on the development of professional values. Background Values are evident in the professional standards for nurses and the guidelines and healthcare policies of many countries. These professional values guide decisions and behaviour and are recognised as an essential component in the professions ability to provide safe and professional care. This literature review presents the current research on the impact of education on (...) professional values in undergraduate nurse education. Design An integrative review of the findings was conducted to provide insight into the current research on the professional value development in undergraduate nurses. Data sources CINAHL, PubMed and Scopus. Review methods A literature search was undertaken within defined date parameters 2010–2021 using a systematic approach. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guide PRISMA was used to guide and illustrate the process. Papers were assessed for quality using the Mixed Methods Appraisal Tool. Results Two distinct areas of inquiry were identified. (a) Changes in professional values as an outcome of undergraduate nursing education or (b) changes in professional values as an outcome of specifically designed educational content. These areas were further explored to better understand the influences of undergraduate education on students’ professional values. Conclusion There is a lack of evidence in the literature to support the premise that professional values develop in line with academic year progression; however, there is strong evidence to support the inclusion of explicit learning in undergraduate education that engages students in education specifically designed to explore and develop professional values. (shrink)

The concept of reproductive health promises to play a crucial role in improving health care provision and legal protection for women around the world. This is an authoritative and much-needed introduction to and defence of the concept of reproductive health, which though internationally endorsed, is still contested. The authors are leading authorities on reproductive medicine, women's health, human rights, medical law, and bioethics. They integrate their disciplines to provide an accessible but comprehensive picture. They analyse 15 cases from different (...) countries and cultures, and explore options for resolution. The aim is to equip readers to fashion solutions in their own health care circumstances, compatibly with ethical, legal and human rights principles. (shrink)

This book discusses Asian medicine, which puts enormous emphasis on prevention and preservation of health, and examines how, in recent decades, medical schools in Asia have been increasingly shifting toward a curative approach. It offers an ethnographic investigation of the scenarios in China and India and finds that modern students and graduates in these countries perceive Asian medicine to be as important as Western medicine. There is a growing tendency to integrate Asian medicine with Western medical (...) thought in the academic curriculum that has led to a gradual decline of Asian medical thought and practices. At the same time, there has been a massive rise in patent drugs, health products and cosmetics being sold under the brand names of Asian medicine or herbal medicine. Most of these drugs and health products do not follow the classical formulas found in the Asian medical texts. The book analyses these texts and concludes that contemporary Asian medicine rarely follows the classical texts, and in fact uses Asian medicine brands to sell Western health products and practices. With a particular focus on the formal and professional sector of Chinese herbal medicine and Indian ayurvedic medicine in urban areas, this book appeals to a broad readership, including undergraduate students and academics as well as non-experts. Md. Nazrul Islam is an Associate Professor in the General Education Office, United International College, Beijing Normal University-Hong Kong Baptist University. He was a Visiting Associate Professor in the School of Population and Public Health, University of British Columbia (2015-16) during which time he completed this book manuscript. (shrink)

The evidence-based practice and evidence-based medicine movements have promoted standardization through guideline development methodologies based on systematic reviews and meta-analyses of best available research. EBM has challenged clinicians to question their reliance on practical reasoning and clinical judgement. In this paper, we argue that the protagonists of EBM position their mission as reducing uncertainty through the use of standardized methods for knowledge evaluation and use. With this drive towards uniformity, standardization and control comes a suspicion towards intuition, creativity and (...) uncertainty as integral parts of medical practice. We question the appropriateness of attempts to standardize professional practice through a discussion of the importance of uncertainty. Greenhalgh’s taxonomy of uncertainty is used to inform an analysis of the clinical reasoning occurring in a potentially life threatening emergency situation with a young patient. The case analysis is further developed by the use of the Canadian philosopher Bernard Lonergan’s theory about understanding and objective knowing. According to Lonergan it is not by getting rid of or even by reducing uncertainty, but by attending systematically to it and by relating to it in a self-conscious way, that objective knowledge can be obtained. The paper concludes that uncertainty is not a regrettable and unavoidable aspect of decision making but a productive component of clinical reasoning. (shrink)

The paper addresses the integration of ethics into professional education related to the disciplines responsible for the conception and creation of the artificial (artefactual or technology). The ontological-epistemological paradigm of those disciplines is understood within the frame of the sciences of the artificial as established by Herbert Simon (1969). According to that paradigm, those sciences include disciplines not only related to the production of artefacts (technology), such as engineering, architecture, industrial design, etc, but also disciplines related to devised courses (...) of action aimed at changing existing situations into preferred ones, like medicine, law, education, etc. They are centered on intentional action and at their core is the activity of design, which is their common foundation and attitude, or their common culture. The science of design becomes the broader foundational discipline for any professions engaged in the intentional transformation of the world. The main distinction between design disciplines and scientific ones rests on the object-project dichotomy. Indeed, contrary to Science that sees the world as an object to be observed, Design sees the world as a project and acts upon the world through projects, which are grounded in intentions, ends, and values. Design disciplines are meant to transform the world, or part of it, and are teleological. Being so, they are embodied in an act that is ethical and their ontology-epistemology must be addressed also through practical reason to resituate all professional disciplines according to their involved nature. (shrink)

The advent of moral pluralism in the post-modern age leads to a set of issues about how pluralistic societies can function. The questions of biomedical ethics frequently highlight the larger issues of moral pluralism and social cooperation. Reflection on these issues has focused on the decision making roles of the health care professionals, the patient, and the patient's family. One species of actor that has been neglected has been those institutions which are part of the public, secular realm and which (...) have a particular moral heritage. Keywords: approval, compromise, condemnation, integrity, toleration CiteULike Connotea Del.icio.us What's this? (shrink)

This paper sets out to examine the integrity and professional standing of “Bioethics.” It argues that professions have certain responsibilities that start with setting criteria for and credentialing those that have met the criteria and goes on to ultimately have social responsibilities to the community. As it now stands we claim that Bioethics—while it certainly has achieved some progress in the way medicine has developed—has failed to become a profession and has to a large extent failed in (...) its social responsibility. We feel that Bioethics has to define itself, set criteria for membership in the profession, police itself and—above all—meet its social responsibility to become a profession meriting that name. (shrink)

Despite substantial controversy, the use of futility judgments in medicine is quite common, and has been backed by the implementation of hospital policies and professional guidelines on medical futility. The controversy arises when health care professionals (HCPs) consider a treatment futile which patients or families believe to be worthwhile: should HCPs be free to refuse treatments in such a case, or be required to provide them? Most physicians seem convinced that professional autonomy protects them from being forced (...) to provide treatments they judge medically futile, given the lack of patient benefit as well as the waste of medical resources involved. The argument from professional autonomy has been presented in a number of articles, but it has not been subjected to much critical scrutiny. In this paper I distinguish three versions of the argument: 1) that each physician should be free to exercise his or her own medical judgment; 2) that the medical profession as a whole may provide futility standards to govern the practice of its members; and 3) that the moral integrity of each physician serves as a limit to treatment demands. I maintain that none of these versions succeeds in overcoming the standard objection that futility determinations involve value judgments best left to the patients, their designated surrogates, or their families. Nor do resource considerations change this fact, since they should not influence the properly patient-centered judgment about futility. (shrink)

James Lorimer Halliday (1897–1983) pioneered the development of the concept of psychosocial medicine in Britain in the 1930s and 1940s. He worked in Glasgow, first as a public health doctor, and then as part of the corporatist National Health Insurance scheme. Here he learned about links between poverty, the social environment, emotional stress and psychological and physical ill-health, and about statistical tools for making such problems scientifically visible. The intellectual development of his methodologically and epistemologically integrated medicine – (...) a hybrid of biomedical and psychological approaches – was embedded in the context of this practice with its particular medical culture and socio-economic circumstances. Halliday’s ideas are part of the wider, heterogeneous turn towards medical modernism and holism within mainstream medicine in Britain, western Europe and the United States in the inter-war period, and their evolution underlines the varied nature of contemporary anti-reductionist thinking in medicine. It also points to the diversity of the sources of holism and the many routes by which psychological and especially psychosocial discourses about health and illness entered professional and public arenas in Britain in this period. (shrink)

James Lorimer Halliday pioneered the development of the concept of psychosocial medicine in Britain in the 1930s and 1940s. He worked in Glasgow, first as a public health doctor, and then as part of the corporatist National Health Insurance scheme. Here he learned about links between poverty, the social environment, emotional stress and psychological and physical ill-health, and about statistical tools for making such problems scientifically visible. The intellectual development of his methodologically and epistemologically integrated medicine – a (...) hybrid of biomedical and psychological approaches – was embedded in the context of this practice with its particular medical culture and socio-economic circumstances. Halliday’s ideas are part of the wider, heterogeneous turn towards medical modernism and holism within mainstream medicine in Britain, western Europe and the United States in the inter-war period, and their evolution underlines the varied nature of contemporary anti-reductionist thinking in medicine. It also points to the diversity of the sources of holism and the many routes by which psychological and especially psychosocial discourses about health and illness entered professional and public arenas in Britain in this period. (shrink)

Religion and medicine -- Theology and medical ethics -- The profession and its integrity -- Life and its sanctity -- Health and healing -- Death and its (in)dignity -- Nature and its mastery -- Care of patients and their suffering -- Respect for persons and their agency -- Contraception -- Technological reproduction -- Genetic control -- Abortion -- Choosing death and letting die -- Care of neonates -- The physician-patient relationship: advise and consent -- Psychiatric care: professional (...) commitments and social responsibilities -- Research and experimentation -- Allocation and distribution.; This collection includes a wide range of contemporary theological essays dealing with medicine ethics, as well as some material from Scripture and from classical theologians. It contains the work of Catholics and Protestants, "liberals" and "evangelicals," as well as some contemporary essays not written by Christian theologians but of great importance for theological reflection. Together the essays provide a rich introduction to theological reflection on medical ethics and a convincing demonstration of the contribution theology can make to the consideration of issues in medical ethics. (shrink)

Introduction The Brazilian national curriculum guidelines for undergraduate medicine courses inspired and influenced the groundwork for knowledge acquisition, skills development and the perception of ethical values in the context of professional conduct. Objective The evaluation of ethics education in research involving human beings in undergraduate medicine curriculum in Brazil, both in courses with active learning processes and in those with traditional lecture learning methodologies. Methods Curricula and teaching projects of 175 Brazilian medical schools were analyzed using a (...) retrospective historical and descriptive exploratory cohort study. Thirty one medical schools were excluded from the study because of incomplete information or a refusal to participate. Active research for information from institutional sites and documents was guided by terms based on 69 DeCS/MeSH descriptors. Curriculum information was correlated with educational models of learning such as active learning methodologies, tutorial discussions with integrated curriculum into core modules, and traditional lecture learning methodologies for large classes organized by disciplines and reviewed by occurrence frequency of ethical themes and average hourly load per semester. Results Ninety-five medical schools used traditional learning methodologies. The ten most frequent ethical themes were: 1 – ethics in research (26); 2 – ethical procedures and advanced technology (46); 3 – ethic-professional conduct (413). Over 80% of schools using active learning methodologies had between 50 and 100 hours of scheduled curriculum time devoted to ethical themes whereas more than 60% of traditional learning methodology schools devoted less than 50 hours in curriculum time to ethical themes. Conclusion The data indicates that medical schools that employ more active learning methodologies provide more attention and time to ethical themes than schools with traditional discipline-based methodologies. Given the importance of ethical issues in contemporary medical education, these findings are significant for curriculum change and modification plans in the future of Brazilian medical education. (shrink)

Professional, Ethical, Legal, and Educational Lessons in Medicine: A Problem Based Approach provides a comprehensive review of the complex and challenging field of professional medical practice. Its problem-based format incorporates a vast pool of practical, board-exam-style multiple-choice questions for self-assessment, and is an ideal resource for exam preparation as well as ongoing clinical education among trainees and clinicians The practice of medicine is not only about clinical care of patients. Physicians must navigate ethical conundrums, legal pitfalls, (...) and quality improvement issues while maintaining scrupulous professionalism and being exemplary educators. This volume addresses common issues in the realm of professional medical practice not typically covered in other texts. Each of the 73 chapters presents a problem-based case that branches out into an oral board examination type stem questions. A discussion section with brief review articles summarizes the most recent literature. Multiple-choice questions with answers allows for comprehensive self-assessment or interactive group quizzes. This book will appeal to medical and allied health professionals in all specialties of medicine. It is an excellent and hands-on reference for the related but diverse domains associated with professional healthcare practice by students, physicians, and other healthcare providers compacted into one volume. (shrink)

This critical notice argues for the existence of a new trend in bioethics, a complex and dynamic field of philosophical enquiry that goes beyond applied ethics and professional deontological codes. This trend supplements their traditionally “minimalist” ethics—and its concern with harm, rights or justice—with “inflationary” positions open to an integration of medicine with the humanities. By comparing and contrasting the views of two quite different philosophers, Diego Gracia and Alfred Tauber, and placing them within the theoretical background delineated (...) by George Khushf, I argue that the main contribution of this “inflationary bioethics” is an understanding of health and disease as intrinsically normative concepts, which in turn brings about a blurring of the distinction between facts and values. By refusing to construe the distinction as a dichotomy, a post-positivist philosophy of medicine must become more epistemological in order to help us clarify concepts in which the evaluative and the factual are impossible to separate. As a result, the “language of principles” in standard bioethics is being substituted by a more encompassing “language of values”; health and disease are increasingly understood as biopsychosocial phenomena; and the field is open to a process of moralization that challenges traditional models of patient autonomy and physician responsibility. (shrink)

This study proposes a conceptual model for utilization of Facebook for professional integration of ethnic minorities, based on the social capital and weak social ties theories. In particular, the research focuses on differences among ethnic groups of Facebook users in their willingness to create intergroup work relations and its various influence factors. A designated questionnaire was composed and administered to 120 subjects from three ethnic groups in Israel: Jewish, Muslim-Arab and Druze. We found that the proportion of intergroup (...) class='Hi'>professional relations was higher on Facebook than in the offline workspace in all three groups. There were numerous differences between the three examined groups: self-disclosure was significantly higher for Druze and Jewish users than for the Arab users, while the willingness to create intergroup professional connections was much higher for the two minorities than for the Jewish users. This study contributes to understanding the factors that influence social network behaviour of different ethnic groups. Our results indicate that social networking sites can catalyse creation of intergroup professional relations. Utilization of social networking sites as a platform for professional promotion might constitute a first step in the process of professional and cultural integration of minorities in the ethnically heterogeneous society. (shrink)

Background Structured training in research integrity, research ethics and responsible conduct of research is one strategy to reduce research misconduct and strengthen reliability of and trust in scientific evidence. However, how researchers develop their sense of integrity is not fully understood. We examined the factors and circumstances that shape researchers’ understanding of research integrity. Methods This study draws insights from in-depth, semi-structured interviews with 33 researchers in the life sciences and medicine, representing three seniority levels across (...) five research universities in Switzerland. Results The results of this study indicate that early education, moral values inculcated by the family and participation in team sports were the earliest influences on notions of honesty, integrity and fairness among researchers. Researchers’ personality traits, including degree of ambition and internal moral compass, were perceived as critical in determining the importance they attributed to conducting research with high ethical standards. Positive and negative experiences in early research life also had a significant impact on their views regarding research integrity. Two thirds of the study participants had not received any formal training in research integrity. Their awareness of training opportunities at their institutions was also limited. Conclusion Age-appropriate development of honesty and integrity starts as early as primary education. Research integrity training should be offered from the bachelors level and continue throughout the entire professional life of researchers. Although these courses may not imbue researchers with integrity itself, they are essential to improving the research culture, reinforcing integrity norms, and discouraging researchers who lack personal integrity from engaging in research misconduct. (shrink)