Professional Values in Modern Clinical Practice

Introduction: The Journal of Clinical Ethics, the MacLean Center, and the Future of Clinical Ethics.

Introduction: Medical ethics means the moral principles, which should guide the members of the medical profession in the course of their practice of medicine and in relationship with their patients and other members of the profession. Objective: To recapitulate the matter to the medical practitioners so that they can apply them in course of their practice. Methodology: A search focused on the basic terminologies on medical ethics was made in Medline, PubMed and Cochrane database. The search captured citation on history of medical ethics. Both advances in medical ethics and advances in medicine and science with ethical ramifications were included. The topics span clinical medicine (end of life care and medical error), healthcare management (priority setting), science (biotechnology), and education (of medical ethics). Discussion & Conclusion: Core issues in in medical ethics: Autonomy, beneficence, non-malfeasance, justice – dignity, truthfulness and honesty. Different terms in the Field of Medical Ethics: Medical Etiquette, Professional infamous conduct, Professional death sentence, Professional secrecy, A physician should not commit any negligence or mal-practice. Islamic Medical Ethics: A Muslim physician derives his /her conclusion from rules of Islamic laws (Shariah). The goal of medical ethics is to improve the quality of patient care by identifying, analyzing, and attempting to resolve the ethical problems that arise in the practice of clinical medicine. Medical ethics is an important part of the undergraduate medical curriculum. It should not be left to a 'laissez-faire' process of osmosis from teachers to students. DOI: 10.3329/bjms.v9i3.6467Bangladesh Journal of Medical Science Vol.09 No.3 July 2010, pp.131-135

Ethics: an essential dimension of clinical obstetric anesthesia.

Objective.This study was carried out to examine professional and ethical values related to the profession from nurses' perspectives.Methods.This was a cross-sectional survey carried out among 124 randomly selected nurses working at a tertiary care hospital in South India. The data was collected using Nursing Professional Values scale (NPVS-3). This tool consisted of 28 items to assess nurses’ professional values in three domains namely; Caring (10 items), activism(10items), and professionalism (8items). The maximum range of scores is 28-140. The higher the score, the stronger the nurse’s professional value orientation.Results.The mean total score of the Professional Value scale was high (121.07±15.32). The mean score of the participants was higher in the caring domain (44.02±5.75) than activism (42.19±6.33) and professionalism domains (34.86±4.27). Pearson correlational analysis revealed that nurses with less experience had greater mean professional values score than nurses with higher experience (p<0.01).Conclusion.The present study showed that nurses have high professional and ethical values, although they perceive that the most important values are those related to direct patient care. Continuing education programs should be designed so that nurses understand that nonclinical professional values are also equally important in promoting the nursing profession.

Applying professional values is an important issue in nursing practice. It is also crucial to find out nurses’ perspectives toward ethical and professional values in the clinical environment. For this purpose, we aimed to utilize a standard tool to survey perspectives on applying these values in nursing care in hospitals of Isfahan, Iran.This is a descriptive-analytical study in which 150 nurses working in hospitals of Isfahan, Iran in 2010 were recruited by quota convenience sampling, and their perspectives on professional values were assessed. Data were collected by the Nurses Professional Values Scale (NPVS) and analyzed using SPSS Software version 16 applying descriptive and interpretive statistics.In the present study, 84% of the participants were female and 88% had bachelor’s degree in nursing. The average age was 34.2 (SD=7.3), and the average years of working in a hospital were 11 (SD=7.3). No significant association was present between demographic characteristics such as age, sex, educational level or work records and applying professional and ethical values. Results also demonstrated that respect for professional values is similar among nurses of different employment types.In this study, we addressed the most and the less important professional values specified by nurses with different types of employment and also different experiences. Iranian nurses believe in respecting the legal and ethical rights of patients as the most prominent value in the nursing profession. We suggest that these professional values be specified and assessed based on Iranian culture.

To compare Spanish nursing students' and registered nurses' perception of professional values from the perspective of gender and professional experience. Nursing has traditionally been a female profession; however, the analysis of professional nursing values from a gender perspective has received little attention. The integration of professional values typically begins during academic life and is, thereafter, reinforced during professional activities. A descriptive cross-sectional study was conducted with 159 students (97.4% females) and 386 registered nurses (86.8% females) from primary healthcare centres, hospitals and management positions within the public health system. The validated Spanish adaptation of the Nurses Professional Values Scale was used. This instrument measures three dimensions: ethics, commitment and professional mastery. Descriptive statistics were used to analyse the data, together with bivariate analysis using the chi-squared test. Females granted more importance to professional values. Important gender differences among students were detected. Ethical values were considered to be the most important for both students and nurses, followed by professional mastery and commitment. The importance given to values progressively decreased in the groups under study: students, less-experienced nurses and expert nurses (in decreasing order). Significant gender differences exist with regard to professional nursing values. The values related to professional commitment and mastery should be integrated and promoted during academic education and specifically focus on male students' perceptions. As professional experience increases, the importance attributed to professional values decreases. Professional nursing values should be promoted among universities, health services and professional organizations, encouraging their dissemination, implementation and evaluation.

Introduction:Professional values are standards of behavior for performance that provide a framework for appraising beliefs and attitudes that influence behavior. Development of professional values has been a continuous and long process and it is influenced by different factors. The aim of this study is “assessing different factors influencing development of professional values among nursing students and instructors”.Method:In this systematic review, a broad research was performed to find articles from Persian and English databases: pub Med, Pro quest, Elsevier, SID, Google scholar, Ovid and Iran Doc; nursing student, instructors, ethics, professional value, ethical value and educators were used as the key words. Among 3205 achieved articles, by eliminating repeated ones, 22 articles were assessed during the period 1995–2013. Data achieved from the articles were summarized, categorized and analyzed based on the research question.Results:In this study “education and achieving professional experiences”, “Students and instructors’ perspectives on professional values”, “the role of culture in considering and developing professional special values” and “the effect of learners’ individual characteristics” were extracted as the four main themes.Conclusion:Considering the effect of educational, cultural and individual factors in developing nurses’ professional values; it is recommended to the educational and health centers to consider value-based cares in clinical environments for the patients in addition to considering the content of educational programs based on ethical values in the students’ curriculum.

Practical wisdom is a key concept in the field of virtue ethics, and it has played a significant role in the thinking of those who make use of virtue when theorising medical practice and ethics. In this article, we examine how storytelling and practical wisdom play integral roles in the medical ethics education of junior doctors. Using a qualitative approach, we conducted 46 interviews with a cohort of junior doctors to explore the role doctors feel phronesis has in their medical ethics practice and how they acquire practical wisdom through storytelling as an essential part of their medical ethics education. Through thematic analysis of the interviews, we discuss the key role storytelling about moral exemplars and role models plays in developing medical ethics education, and how telling stories about role models is considered to be one of the most useful ways to learn medical ethics. We finish by developing an argument for why practical wisdom should be an important part of medical ethics training, focusing on the important role that phronesis narratives should have in teaching medical ethics.

The present paper discusses the relevance and significance of the Hippocratic Oath to contemporary medical ethical and moral values. It attempts to answer the questions about some controversial issues related to the Oath. The text is divided in two parts. Part I discusses the general attributes and ethical values of the Oath, while Part II presents a detailed analysis of each passage of the Oath with regard to perennial ethical principles and moral values. Part I starts with the contribution of Hippocrates and his School of Cos to medicine. It continues by examining the moral dilemmas concerning physicians and patients in the Classical Times and in the Modern World. It also investigates how the Hippocratic Oath stands nowadays, with regard to the remarkable and often revolutionary advancements in medical practice and the significant evolution in medical ethics. Further, it presents the debate and the criticism about the relevance of the general attributes and ethical values of the Oath to those of modern societies. Finally, it discusses the endurance of the ethical values of the Hippocratic Oath over the centuries until today with respect to the physicians' commitment to the practice of patient-oriented medicine. Part I concludes with the Oath's historic input in the Judgment delivered at the close of the Nuremberg "Doctors' Trial"; this Judgement has become legally binding for the discipline in the Western World and was the basis of the Nuremberg Code. The ethical code of the Oath turned out to be a fundamental part of western law not only on medical ethics but also on patients' rights regarding research.

On Winter 2016, an article published in Medical Education Journal entitled “Medical Oath: The Educational Impact”. In this article the author emphasized on setting educational goals on inducing professional behaviors according to medical oaths and professional codes and recommended planned programs to reinforce this issue. Medical professionalism is presented in the form of medical oaths (e.g. Hippocratic Oath) since ancient times. Today, it is obvious that performing medical practice in accordance with national and international codes and medical oaths results in an effective doctorpatient relationship and a successful diagnosis, treatment and prevention of diseases (1). So professionalism and professional values are taught in creditable universities these days. The Accreditation Council for Graduate Medical Education (ACGME) in the US has emphasized six core competencies in all residency “training and assessment” programs and professionalism constitutes one of the six competencies. Professional competence is the constant and conscious use of communication, knowledge, technical skills, clinical reasoning, emotions and values and is reflected in daily practices through serving the interests of individuals and the society (2). We conducted a study on 150 medical interns, clinical residents, physicians and professors working in hospitals, the results showed that only 44.7% of participants had heard the term “medical professionalism” and an average of 49.57% of participants responded correctly to the items on the knowledge of professionalism (The related article is in publishing process). The results of this and similar studies shows that despite the importance of the issue, the medical professionals appear to have not a favorable theoretical knowledge about medical professionalism (3); although this unfavorable status does not indicate that their practices are unethical, it should be noted that one of the prerequisites for establishing a proper relationship between the medical community and the patients is possessing a proper knowledge of this essential concept. Improving behaviors and performances in medical professions requires adequate training on the concepts of medical professionalism and consequently the assessment of the levels of professionalism achieved in medical professionals (4). As a final word, a course on medical professionalism and professional values that its contents are based on medical oats is recommended to be added to the curriculum of students in all fields of medicine which can be followed by a pre-graduation assessment of the professional performance of the students.

CONTEXT:Medical ethics is a practical subject as well as a branch of ethical philosophy and an integral part of the proper practice in medicine. However, the ethics changes in places and over time and is variable. Furthermore, many issues that have occurred as a result of advances in technology add to the complexity of the ethical issues. Therefore, the objective of this research was to explore medical teachers' and interns' experiences regarding professional ethics.METHODS:This study was a qualitative content analysis conducted on 10 professionals and 10 interns of the surgery and internal departments of medical and educational centers in Qom University of Medical Sciences to discover their experiences of the medical professional ethics. The sampling method was purposive, and data were collected through semi-structured interviews. Data analysis was performed using a qualitative content analysis method with a conventional approach.RESULTS:Three main categories were obtained from the data analysis, including adherence to professional values, organizational conditions, and individual characteristics.CONCLUSIONS:Adherence to professional values, paying attention to individual characteristics, and organizational conditions are among the factors affecting the promotion of medical professional ethics; therefore, it seems that appropriate interventions on these important components can help promote the professional ethics training in the clinical practice.

Avariety of medical professional societies have developed ethics practice guidelines or position statements regarding specific ethics issues (1–6). The Endocrine Society published its Code of Ethics for practice in 2001 (1); however, none of the practice guidelines are specific to thyroidology. In the field of thyroidology, specific clinical ethics issues arise in different clinical contexts. For example, autoimmune thyroid disease raises different clinical ethics issues compared with thyroid oncology. Within thyroid oncology, each type of thyroid cancer raises unique and distinct clinical ethics issues and dilemmas. For example, the clinical ethics dilemmas that present in hereditary medullary thyroid cancer surrounding genetic screening are not the same as in thyroid cancers that are not familial or do not yet have defined germline genetic markers. The dilemmas associated with poorly differentiated and aggressive thyroid cancers (such as anaplastic thyroid cancer) and raising end-of-life issues such as code status, existential suffering, and palliative care are not the same that present in well-differentiated thyroid cancers that respond well to treatment. In many cases, there is clinical disagreement over what constitutes beneficent care for patients. Additionally, new clinical ethics dilemmas are resulting from drug shortages (e.g., recombinant human thyrotropin), medical isotope shortages (e.g., I), as well as nuclear disasters where priority-setting guidelines for distributing potassium iodide are not in place or not identified. Despite the prevalence of clinical ethics dilemmas in thyroid disease, clinical ethics guidelines specific to the thyroid disease context have been notably absent. Clinical ethics expertise can provide morally sound frameworks for (i) the nuances and complexities of diagnosis and treatment, and (ii) allocation of resources in situations where the demand is greater than the supply. The field of thyroidology comprises both clinical ethics and research ethics issues; in both arenas, complex professional ethics and research integrity dilemmas may arise as funding for basic research shrinks, investigators move from clinical to corporate cultures, and competition for funding increases. Conflicts of interest are often poorly understood, which can range from financial to interprofessional conflicts of interest. The clinical and professional ethics guidelines presented here are intended to provide clear guidance about specific, yet common, ethics dilemmas and questions that arise in this unique subspecialty. These guidelines mainly address two groups of ethics dilemmas that are typically encountered by thyroidologists: clinical ethics dilemmas—those that arise in the patient care setting; and professional ethics dilemmas— those that revolve around disclosure of conflicts of interest and professional integrity. These guidelines also provide clear guidance on research ethics issues, such as when innovative therapy becomes ‘‘research,’’ the role of an institutional review board, as well as publication and data-sharing integrity issues. Finally, as enormous changes begin to take effect consequent to The Affordable Care Act (www.healthcare.gov/law/ index.html), thyroid practitioners find themselves in a new clinical landscape involving numerous resource allocation decisions. As aggressive, non-iodine-avid thyroid cancer continues to rise in incidence, more questions about end-oflife care, palliative care, or clinical trial candidacy have arisen. We offer these guidelines in recognition of this unique subspecialty that confronts wide clinical and research diversity.

The best clinical medicine, Plato tells us, is practiced when the scientific and technical aspects of care are placed in the context of a personal and professional relationship in which the physician strives to win the patient's support and trust1. In this regard, the professional and ethical values described by Plato and those expected of contemporary physicians are remarkably similar. Both are based on a medical relationship with the patient in which the physician's core ethical and professional values are the foundation of good clinical care.

Thousands of health professionals who share common interests enroll in associations by their own choices. In China medical associations are academic organizations classified by specialty, and membership is voluntary. Medical associations are not trade guilds, nor are they family or religious groups or professional societies. Each has its own constitution. They include the China Medical Association (CME), Chinese Academy of Preventive Medicine, Traditional Chinese Medicine Association, Chinese Nursing Association, Chinese Pharmaceutical Association, and Chinese Association of Combined Chinese Traditional and Western Medicine. Some were founded nearly 100 years ago, such as the China Medical Association, founded in 1915; the Chinese Pharmaceutical Association; and the Chinese Nurses' Association (now the Chinese Nursing Association), founded in 1909. Other early modern organizations were Doctoring, founded in 1897 in Shanghai; the Shanghai Chief Association of Medicine (1906); and the China Medical Research Institution (1904).[1] Medical associations in China are expected to establish professional standards (both technical and ethical) to guarantee individual or public health, to disseminate knowledge of new medical advances and techniques, and to spread medical ethics. Each association is expected to protect its members' interests as well. Members are expected to contribute their membership responsibilities and enjoy corresponding privileges. They are given opportunities to carry forward medical science by publishing their new findings and exchanging their ideas in the association's academic forum or journals, and receive the latest medical information to promote individual academic ability and moral values as well. Medical associations in China are thus both academic organizations designed to spread medical knowledge and organizations that cultivate medical ethics. Contemporary medical associations are the product of modern science and technology, but they have ancestors in China's long history. The earliest medical association, Yititang Association of Benevolent Doctors, was founded in 1568 during the Ming Dynasty by Xu Chunpu, the emperor's physician.[2] The tenet of the association was to practice medicine as a humane art and to promote medical professional values, its main tasks were to discuss medical skills and promote professional competence. Its members--forty-six physicians from various provinces who were living in Beijing at that time--were expected to adhere to twenty-two precepts: sincerity, good sense, self-restraint, prudence, reason, high morale, self-improvement, teaching, being good at pulse feeling, careful prescription, cautiousness, sympathy, self-respect, abiding the law of nature, devotion, avoidance of avarice, pity for the poor, self-fulfillment, understanding, wisdom, and not participating in abuse. Although it set out an ideal academic attitude, methods, and key points in pursuing and promoting professional values, the Yititang Association of Benevolent Doctors ultimately had little impact on later medical associations. The main ideas of medical ethics in China are to cherish life and fulfill one's medical duties accordingly. Medical associations are expected to disseminate bioethical values. The 1980s began what might be described as an ethical Renaissance in China. Academic exchange in ethics among medical associations at all levels took place frequently. International and national experts were invited to give lectures, and seminars were held to disseminate theories of medical ethics and achievements in bioethics. Thousands of medical professionals in teaching and research have communicated ideas with each other, published their papers and accomplishments in a variety of journals, such as Medicine and Philosophy and launched a new national publication, Chinese Medical Ethics. In 1988 the China Medical Association established the Chinese Association of Medical Ethics, which unites medical science and medical humanism structurally and serves to support and disseminate research in medical ethics and bioethics. …

Here Comes the Sun: Medical Professionalism and the Implications of the Sunshine Act for Gastroenterology Practice