Ethical consequences for professionals from the globalization of food, nutrition and health.

BackgroundThe coronavirus 2019 pandemic placed unprecedented pressures on healthcare services and magnified ethical dilemmas related to how resources should be allocated. These resources include, among others, personal protective equipment, personnel, life-saving equipment, and vaccines. Decision-makers have therefore sought ethical decision-making tools so that resources are distributed both swiftly and equitably. To support the development of such a decision-making tool, a systematic review of the literature on relevant ethical values and principles was undertaken. The aim of this review was to identify ethical values and principles in the literature which relate to the equitable allocation of resources in response to an acute public health threat, such as a pandemic.MethodsA rapid systematic review was conducted using MEDLINE, EMBASE, Google Scholar, LitCOVID and relevant reference lists. The time period of the search was January 2000 to 6th April 2020, and the search was restricted to human studies. January 2000 was selected as a start date as the aim was to capture ethical values and principles within acute public health threat situations. No restrictions were made with regard to language. Ethical values and principles were extracted and examined thematically.ResultsA total of 1,618 articles were identified. After screening and application of eligibility criteria, 169 papers were included in the thematic synthesis. The most commonly mentioned ethical values and principles were: Equity, reciprocity, transparency, justice, duty to care, liberty, utility, stewardship, trust and proportionality. In some cases, ethical principles were conflicting, for example, Protection of the Public from Harm and Liberty.ConclusionsAllocation of resources in response to acute public health threats is challenging and must be simultaneously guided by many ethical principles and values. Ethical decision-making strategies and the prioritisation of different principles and values needs to be discussed with the public in order to prepare for future public health threats. An evidence-based tool to guide decision-makers in making difficult decisions is required. The equitable allocation of resources in response to an acute public health threat is challenging, and many ethical principles may be applied simultaneously. An evidence-based tool to support difficult decisions would be helpful to guide decision-makers.

The Limits of Confidentiality: Informed Consent and Psychotherapy.

OBJECTIVES: To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups....

Although bioethics has become an established part of medical school curricula, relatively little is known about how students apply didactic material to clinical problem-solving situations. Each of 92 second-year students (54 men and 38 women) at the University of California, Irvine, College of Medicine in 1991-92 wrote a paper identifying and attempting to resolve a clinical ethical dilemma of his or her choice. The papers were then coded for content, use of ethical theories and principles, degree of resolution, and level of personal orientation (i.e., evidence of personal involvement in the dilemmas). Data were analyzed by student sex and age, using chi-square tests of significance and correlational analysis. The students had no difficulty in identifying a range of ethical dilemma. Most students appeared to have understood and become familiar with the major ethical theories and principles currently in use, and to have employed them correctly. A majority of the students were able to successfully resolve their ethical dilemmas. Differences between the men and the women students were found regarding choice of topic, ethical principles used (p = .03), and level of personal orientation (p < .01). The women tended to be interested in issues involving broad social perspectives; to favor arguments emphasizing the rights of patients and families; and to incorporate personal responses, as well as abstract theories, in their assays. The men tended to be interested in issues involving personal control, authority, and responsibility; to advocate utilitarian, cost-containment thinking, and to rely exclusively on abstract, logical arguments. Further research should determine whether these differences can be identified in actual clinical decision making, and whether the differences have implications for the nature or quality of clinical decisions.

The ethical principles in research are universal and serve as a humanizing guide throughout the research process. Their application requires keeping in mind the local health, socio-cultural, and economic conditions where research is conducted. Higher education institutions and researchers share the responsibility of ensuring application of ethical research principles in science, technology, and innovation activities. This article reports findings from a mixed methods study on the perspectives of university faculty regarding the application of research ethical principles to research endeavors. Utilizing a Q-method approach to capturing subjectivity, 52 faculty-researchers participated in an online Q-sort exercise which also included an open-ended questionnaire. The study looked at similarities and differences in viewpoints regarding the application of ethical research principles. The study research questions included: (1) what are the participants’ perspectives applying research ethical principles? (2) what are the similarities and differences in viewpoints when looking at the participants’ years of research experience, research ethics preparation, and field of expertise? This article presents the results analyzing the responses of the participating faculty researchers. Similarities and differences of their perspectives were documented by looking at years of research experience, research ethics background, and field of expertise. Study findings point to the need to offer more opportunities for training to better prepare experienced and less experienced researchers on how to anticipate and plan for ethical dilemmas that may arise while conducting research. Emerging and experienced researchers can benefit from such training and self-awareness. Keywords: Q-sort, Ethical Research, Ethical Dilemmas, Scientific Research, Faculty Perspectives.

Allocating Scarce Resources in Disasters: Emergency Department Principles

Call to action for equitable access to human milk for vulnerable infants

A primary purpose of a code of ethics is to assist members of an organization in making consistent choices when faced with ethical dilemmas. In instances where two or more ethical principles are in conflict with one another, decision-makers are typically left to determine which of the two should be given most weight. Nonetheless, in the code of ethics adopted by the Canadian Psychological Association (CPA), principles are ranked in order of importance. This provides decision-makers with guidance in situations of conflict between ethical principles. In contrast to CPA's code of ethics, other professional codes do not provide such guidance. In a previous paper, we provided a philosophical rationale for a ranking of the ethical principles adopted by the American Psychological Association (APA) in order to help guide decision-making (Hadjistavropoulos & Malloy, 1999). In the present study, we investigated whether APA members collectively believe that some ethical principles are more important than others, and whether their views about the relative importance of ethical principles are consistent with the order (i.e., ranking) outlined in the CPA code. The results suggest that although APA members view all principles of their code as being important, they also view certain principles as carrying more weight. A discussion of the similarities and differences between a ranking of ethical principles that was based on our participants' responses and that of the CPA code is provided. The implications of the findings for ethical decision-making are also discussed. A primary purpose of any code of ethics is to provide members of an association with guidance for making consistent ethical choices. Principles and standards are used to specify for members the nature of what the organization/association deems to be ideal and/or expected conduct (Railborn & Payne, 1990). The ethical principles listed in the code of ethics adopted by the Canadian Psychological Association (CPA, 1991, 2000) are ranked in order of importance. This approach was intended to increase consistency of ethical decision-making in situations where ethical principles are in conflict with one another (Hadjistavropoulos & Malloy, 2000; Sinclair, 1998). In contrast to the CPA code, the code of ethics adopted by the American Psychological Association (APA, 1992) does not include a ranking of ethical principles. The APA (1992) code is of interest to Canadian psychologists because it reflects the practices of the largest psychological association in the world and is a highly visible and influential document within international psychology. Moreover, approximately 2,000 Canadian psychologists are members of APA (APA, 2000). The code of ethics of the american psychological association (APA, 1992) includes six ethical principles (Competence, Integrity, Professional and Scientific Responsibility, Respect for People's Rights and Dignity, Concern for Others' Welfare, and Social Responsibility). It is not difficult to think of situations in which some of these principles can come into conflict with other principles. Consider, for example, a well-meaning parent who wishes to make a choice for his child that the psychologist believes is not in the best interest of the child (Hadjistavropoulos & Malloy, 1999). In such a situation, principles that relate to client autonomy (e.g., Respect for People's Rights and Dignity) would conflict with those that pertain to concern for the welfare of others (e.g., Concern for Others' Welfare). Most codes of ethics do not provide guidance with respect to the manner in which such conflicts should be dealt with, thus, increasing the probability of inconsistent decision-making among psychologists. As mentioned earlier, the issue of conflict among ethical principles has been addressed by CPA (1991, 2000). The four principles of CPA's code are ranked as follows: 1) Respect for the Dignity of Persons; 2) Responsible Caring; 3) Integrity in Relationships; and 4) Responsibility to Society. …

Discussions on public sector ethics essentially cover three main issues. First, how to establish a theoretical argument capable of providing answers to queries about what is considered an ethical and unethical conducts in public sector management. Second, how to develop ethical instruments and standards capable of helping resolve ethical dilemmas that commonly occur in the public sector. Third, how to institutionalize ethical principles and instruments developed in public institutions. Both theoretical studies and empirical experiences indicate that the essence of the various forms of a dilemma in the public sector is the conflict between personal virtue and public virtue. These ethical dilemmas may be subdued by institutionalizing ethical principles in public institutions, and it basically involves two substantial activities, namely integration, and revitalization of ethical principles in public institutions. These ethical principles should be integrated within a system of conducts covering standard values and norms that serve as a reference in conducting oneself and in minimizing unethical conducts and in preventing maladministration in public sector management. Legal instruments remain necessary in order to ensure the effectiveness of ethical principles as a code of conduct for government personnel to carry out their tasks and functions. Of no less importance is the effort to improve leadership that highly reveres ethical principles in the public bureaucracy.

School nurses must consider the ethical principles that guide everyday practice. Autonomy, beneficence, justice, and nonmaleficence are the ethical principles most often confronted in the school setting. When beneficent care-giving begins to conflict with the family's decision-making autonomy, paternalism, a form of beneficence, affects the family's autonomy. This creates an ethical dilemma for the school nurse who guides his or her practice by ethical principles but who also must decide when it is appropriate to refer a child or family to a medical provider for further evaluation. A case study is presented to illustrate a specific ethical dilemma. The ethical dilemma is described using a model that examines external factors, professional responsibilities, and possible courses of action. The discussion includes cultural considerations and barriers pertinent to the case example.

The source

Uvod: Medicinske sestre v enotah intenzivnih terapij se soočajo z zahtevnostjo zdravstvene oskrbe kritično bolnih pacientov. Namen raziskave je bil ugotoviti etične dileme, ki se pojavljajo pri izvajanju zdravstvene nege v enotah intenzivne terapije.Metode: Uporabljen je bil sistematični pregled znanstvene literature. Vključena je bila literatura iz obdobja od 2007 do 2017. Pregled zajema naslednje baze: COBIB.SI, CINAHL in PubMed. Iskanje je potekalo z uporabo ključnih besed: »etične dileme«, »medicinske sestre«, »etična načela«, »kritično bolni pacienti«, »zdravstvena nega v intenzivni terapiji« v slovenskem in angleškem jeziku. Iz iskalnega nabora 78 zadetkov je bilo v končno analizo vključenih 14 člankov. Izvedena je bila vsebinska analiza spoznanj raziskav.Rezultati: Medicinske sestre med najbolj pogostimi etičnimi dilemami navajajo dileme v povezavi z zdravljenjem in aktivnostmi zdravstvene nege, organizacijo zdravstvene oskrbe in paliativno oskrbo. Med najbolj pogostimi etičnimi načeli navajajo neškodljivost, dobronamernost in avtonomijo kritično bolnih pacientov.Diskusija in zaključek: Ugotovitve raziskave prispevajo k prepoznavanju najbolj pogostih etičnih dilem pri izvajanju zdravstvene nege v enoti intenzivne terapije. Pomembno bi bilo podrobneje raziskati posamezne etične dileme medicinskih sester, ki se pojavijo v času izvajanja zdravstvene nege pri kritično bolnih pacientih.

This article addresses debates surrounding ethical issues and dilemmas faced by scientists conducting research with human participants. Through the analysis of different stories of abuse, the research shows how ethical principles, codes, guidelines, and organizations emerged. Although various ethical rules and guidelines provide significant recommendations today, controversies in research and practice remain. In addition, the increasing process of formalizing ethical principles is causing concern among researchers. A critique of the processes of bureaucratization in the field of ethical regulation of research and practice is presented using the example of Canadian experience. Drawing on various ethical codes and recommendations, current principles for ethical research involving human subjects are identified. Risks are discussed, including those related to social sciences. The literature review demonstrates which issues are becoming more pressing today and how professional practitioners face ethical dilemmas and risks. It is concluded that the complex dilemmas that arise in research practices require interdisciplinary discussions and the introduction of research ethics courses in various academic and other institutions. Good professional practice in resolving ethical dilemmas should be taken into account when developing and improving one's own national guidelines and codes. We believe the article will contribute to broadening discussions about research ethics and professional practice.

The near-universal scope of sustainable development and climate change inevitably brings ethical dilemmas. A means to address an environmental problem in one area may conflict with policy goals in a different field. How should we handle conflicting ethical values or principles in pursuit of these key objectives? This paper examines two such ethical dilemmas which arise out of Ann Bruce’s study on reducing methane and nitrous emissions from ruminant livestock to help to lower overall greenhouse gas emissions, which have a wider significance than agriculture. Firstly, her findings suggest that among the most effective measures to reduce livestock emissions may be to move further towards intensive production systems. This conflicts with key ethical goals in sustainable development, adopting more extensive production and maintaining biodiversity. Does climate change therefore provide a higher ethical value, requiring the reassessment of some ‘sacred cows’ of environmental ethics? A similar case has arisen with proposals to increase nuclear power to reduce fossil fuel emissions from electricity generation. The paper considers how we should prioritise environmental principles in the real world, and how far ethical principles can be compromised in the light of their adverse impacts.

The principles in the Canadian Code of Ethics for Psychologists (CCEP; Canadian Psychological Association, 2000) are ranked in order of importance. Although there is some support for the ranking, it is unclear whether its utilization leads to more ethical making. We investigated whether medical residents and undergraduate students who were given information about the ranking would provide more ethical (i.e., in accordance with the CCEP) and consistent responses to dilemmas and would be more confident in their decisions than participants not provided with ranking information. Forty-seven medical residents and 45 students were taught about the CCEP principles. Half of the participants were provided with information about the ranked order. Participants responded to 6 vignettes describing ethical dilemmas with courses of action, by rating whether the course of action was ethical and providing a by rationale. Participants, who knew about the ranking, provided ratings that were more consistent with the CCEP although the pattern varied across vignettes. Moreover, participants in the ranked condition made decisions faster than participants in the unranked condition. We found no evidence that participants were more likely to agree with each other when familiar with the CCEP hierarchy. Finally, students in the ranked condition were less confident than students in the unranked condition whereas ranking did not affect the residents' confidence. Thematic analysis of participants' rationales revealed that, among those who responded inconsistently with the CCEP, some had misunderstood the ethical principles, misinterpreted the relative vulnerability of the parties depicted in the vignettes, and/or provided rationales that were consistent with the code whereas their ratings were not. Specific contextual factors that affected are discussed as are the implications of these findings for the CCEP. Keywords: code of ethics, ethical principles, making, training The Canadian Code of Ethics for Psychologists (CCEP, Canadian Psychological Association [CPA], 2000) was developed to reflect the collective wisdom of Canadian psychologists (Sinclair, Poizner, Gilmour-Barrett, & Randall, 1987) and is considered to be one of the most influential and well-respected psychological codes of ethics around the world (Hadjistavropoulos, 2008). One of the objectives in the development of the CCEP was to provide rules (i.e., ethical principles) (Sinclair et al., 1987, p. 5) to aid psychologists in the process of ethical making. As such, the code is comprised of four ethical principles. These principles are I: Respect for the Dignity of Persons, II: Responsible Caring, III: Integrity in Relationships, IV: Responsibility to Society. These principles are not necessarily discrete; a degree of overlap may occur among them and it is recommended that all four principles be included and balanced in ethical making (Sinclair & Pettifor, 2001, p. 19). Moreover, to further guide psychologists, the CCEP also provided a ranked order of importance of its ethical principles wherein Principle I is weighted more heavily than Principle II (and III and IV), which is weighted more than Principle ?? and so on (Sinclair et al., 1987). The ranking was developed based on the code development committee's impression of the manner in which a sample of psychologists tended to resolve ethical dilemmas and was confirmed through consultations with psychologists' organisations (Sinclair et al., 1987). In conjunction with the principles' hierarchical organisation, the code also outlines 10 specific steps intended to facilitate ethical making. Step 1, for example, involves identification of the individuals and groups potentially affected by the decision (CPA, 2000, p. 3). Step 2 involves Identification of ethically relevant issues and practices, including the interests, rights and any relevant characteristics of the individuals and groups involved and of the system or circumstances in which the ethical problem arose (CPA, 2000, p. …