Deontological Codes Research Articles

Professional deontology and medical practice in prisons.

To study the knowledge on professional deontology amongst doctors in prisons. Descriptive, transversal and multi-centre study. Labour, collegiate, social, demographic and deontological variables were collected. A descriptive analysis of the variables was performed. A bivariate analysis was made by binary logistic regression models, attending to the odds ratio, and assuming a 95% confidence interval. Data was processed by SPSS v.20 software. 118 doctors replied. 68 men (57.6%), with an average age of 51 years (50-53). 100 know about the Deontology Committee (84.7%), but just 77 (65.3%) know its functions properly. 42 (35.6%) know about the existence of the Deontological Code, and 37 (31.3%) have read and apply it. Those who made a correct definition of deontology do find more deontological issues in their daily work [23(46.9%) vs. 18(26.1%); OR: 2.506; IC95%: 1.153-5.451; p=0.020] and would denounce a colleague more often to the Medical Association [40(81.6%) vs. 42 (60.9%); OR: 2.857; IC95%: 1.197-6.819; p=0.018]. Older ones know more about the deontology commissions' functions [54(73%) vs. 23(52.3%); OR: 2.465; IC95%: 1.127-5.394; p=0.024] and have already denounced situations to the Medical Association [27(36.5% vs. 5(11.4%); OR: 4.481; IC95%: 1.577-12.733; p=0.005], but think that a different Care Ethics Committee is unnecessary [57(77%) vs. 42(95.5%); OR: 0.160; IC95%: 0.035- 0.729; p=0.018]. Prison doctors know little about what professional deontology really is. This knowledge increases with age in the profession and is associated with an increased perception of deontological issues in daily practice.

Conflict of interest and professional ethics

In general terms, we can face a conflict of interest every time that we have to deal with competing goals and responsibilities. In a more specific sense, however, such a conflict is understood as a situation where a personal self-interest could unduly interfere with professional responsibilities. This situation appears particularly blameworthy, when public interest and protection of fundamental individual rights are involved. According to the Italian Code of medical deontology, conflict of interest is in itself a condition that a physician may well happen to experience and not ipso facto a violation of legal or moral rules. As a condition, it entails the necessity to make decisions which should always comply with an unquestionable priority: the best interest of the patient must always come first and professional behaviour can never be conditioned by improper benefits of economic or other nature. Full disclosure is required, whenever conflicts of interest may impinge upon the diagnostic or therapeutic prescriptions or the possible relationships with industries and institutions [1]. It is also worth observing that a physician is very often an employee. The employer's and the patient's interest may not coincide and this can generate a conflict of loyalties. The distinction between external and internal goods, proposed by the philosopher Alasdair MacIntyre, helps clarify this ethical challenge. By external goods, we understand those goods, such as money, power and fame, that can be achieved as a result of the practice, but are not a component of its standard of excellence and tend to be enjoyed exactly as a private property. Internal goods, on the contrary, correspond to the very fundamental goals and essence of the practice and tend to be a good for all those, who are involved in it [2]. In the present “market society”, physicians are frequently faced with possible conflicts of interest in their prescriptions, but paediatricians are particularly vulnerable when they must decide how their patients should be fed. In the case of breast-feeding, the standard on which the internal good of excellence relies has been already set in the WHO's International Code of 1981: «Health workers should encourage and protect breast-feeding» and «no financial or material inducements» should be offered «to health workers or members of their families» nor accepted by them to promote the use of other products beyond their real need [3].

Neuroethics are more than the bioethics of neuroscience.

Dear Sir, Evolutionary changes in the knowledge society and the rapid increase of scientific and technological information have outlined new territories and dilemmas for health professionals. New challenges and new demands need to be faced so as to make balanced decisions that privilege the wellbeing and the rights of individuals and their priorities as patients. The Hippocratic Oath and other deontological codes have contributed, from the global historical perspective, to the regulation of these actions. However, many of these precepts have been overtaken by new questions and ethical dilemmas. Bioethics was originally created as a survival strategy that allows the preservation of the rights of the individuals and their ecosystems in the face of uncontrolled technical growth and technological development based on supply and demand. That is why Bioethics has positioned itself as a contemporary, valid regulatory axis in health and medicine.[1] In neurosciences, punctual paradigms of knowledge, which also require more specialized attention, are introduced. The enormous display of scientific information in this area, technological development and its Translational impact have surpassed both our capacity to regulate and the dimension of the decisions centered on the wellbeing of the patient. That is why civil society and a meeting of journalists and science advocates proposed the concept of neuroethics before the scientific community did. Beyond the use or the fashion of the prefix neuro, which some authors consider eroded and unreasonably abused, the international community of bioethicians dedicated to neurosciences has identified a process that is supported by both branches: (i) Solid education in bioethical knowledge and (ii) Knowledge as an expert in the area of neurosciences. That is why we pose the question of the pertinence and validity of the concept of neuroethics as an entity that represents a more integral and global vision than a bioethics of neurosciences.[3,4] International consensus identifies two fundamental meanings in this innovative perspective of the discipline: On the one hand, Ethics in Neuroscience, which refers to the analysis of all the ethical implications that arise in the creation of knowledge, research, technological development, and clinical practice (Neurology, Neurosurgery, Psychiatry), according to a specific sociocultural context. And on the other hand, there is the Neuroscience of Ethics, which refers to the study of the neural basis for ethical behavior, free will, moral conscience and behavior based on values and precepts. In consequence, neuroethics supposes a dual and bi-directional concept with an axis that connects a great number of topics that need to be considered through the lens of humanistic thought and not only through hard scientific data.[5] The editorial proposal described by Faria[2] analyzes the certainty that the Hippocratic Oath does not cover all the branches of knowledge in current neurosciences and proposes an ethics of Neuroscience. However, the reach of disciplinary ethics covers only marginal aspects of the field of Bioethics within the enormous area of scientific and technological knowledge that is Neuroscience. That is why we must emphasize the relevance of strengthening ethical education in the training of human resources for health. Although the scientific community has worked to refine its educational processes and their pragmatic application that preserves the principles and values of neuroethics, there is suspicion based on the fact that ethical decisions must obey to the educational profile of the medical-scientific individual, to his or her internal and moral will, and not to a legal precept. Neuroethics must appeal to the moral conscience of individuals about what is right and wrong in the area of Neuroscience, and not necessarily to a legal assertion. It seems that the concept of Neuroethics is here to stay, in the expectation that it can be conformed by specialized personnel who are honorable scientific leaders, to serve as a guide to decision-making in ethical dilemmas in the neurosciences, all of this under the premise of maintaining and conserving the rights of the individual and the rights of the patient from a humanistic perspective.

El rechazo en las transfusiones de sangre y hemoderivados: criterios éticos, deontológicos y médico-legales

The refusal of a blood transfusion and blood products is a specific situation of the patient's right to refuse a treatment and is based on the principle of autonomy, exercised through consent. When a vital treatment is refused, it can cause disappointment and doubts to the professional.This article reviews the ethical principles, the Deontological Code and the medico-legal issues concerning the refusal of treatment, and proposes general and specific recommendations. The aim of these recommendations is to guide the conduct of the physicians who must respect the patient's rights and act with legal certainty.

Geoethics: Master’s Students Knowledge and Perception of Its Importance

In the 1990s, the field of geoethics started its development, associated with a set of ethical principles that regulate the profession of geologists in their relationship with society and with nature. Given the importance of this field, but also its youth, 36 higher education students attending a Master’s of Geology course were surveyed (20 were from an educational branch and 16 were from a scientific branch). The questionnaire applied to them aimed to achieve the following goals: (a) to identify the knowledge of the respondents about this new field and to verify their position about the inclusion of geoethics in the curriculum, (b) to understand how they consider the importance of geological knowledge in political decisions and (c) to investigate possible differences in the thinking of the respondents, given the specificities of their educational branches. The study concluded that the field of geoethics is unknown to the majority of the respondents. However, the recognition of its importance was also verified, after getting familiar with the definition of the concept, as well as the need for its inclusion in formal education. The respondents also considered relevant the creation of a deontological code that could provide geologists with ethical guidance. They also considered that geology should influence political decisions, but they did not consistently recognise the limits of its influence, which seems to reveal the need of a deeper understanding of the specific nature of geological knowledge when compared with other sciences. Almost all the results were similar in both groups, but the students from the educational branch offered more elaborate answers about the issues present in the questionnaire.

Medical error disclosure: from the therapeutic alliance to risk management: the vision of the new Italian code of medical ethics.

BackgroundThe Italian code of medical deontology recently approved stipulates that physicians have the duty to inform the patient of each unwanted event and its causes, and to identify, report and evaluate adverse events and errors. Thus the obligation to supply information continues to widen, in some way extending beyond the doctor-patient relationship to become an essential tool for improving the quality of professional services.DiscussionThe new deontological precepts intersect two areas in which the figure of the physician is paramount. On the one hand is the need for maximum integrity towards the patient, in the name of the doctor’s own, and the other’s (the patient’s) dignity and liberty; on the other is the physician’s developing role in the strategies of the health system to achieve efficacy, quality, reliability and efficiency, to reduce errors and adverse events and to manage clinical risk.SummaryIn Italy, due to guidelines issued by the Ministry of Health and to the new code of medical deontology, the role of physicians becomes a part of a complex strategy of risk management based on a system focused approach in which increasing transparency regarding adverse outcomes and full disclosure of health- related negative events represent a key factor.

La responsabilidad contable en las crisis económicas: cuestiones éticas

La calidad de la información contable reviste una extraordinaria importancia para el buen funcionamiento de las empresas y del sistema económico en su conjunto. Es por ello que su ejercicio está reservado a profesionales, es decir personas científicamente cualificadas, sometidas a un estricto código deontológico y orientadas en su actividad al bien público. El olvido o menosprecio del componente ético, imprescindible en el ejercicio de la profesión contable, así como de su naturaleza de servicio público da lugar a formas de contabilidad creativa muy nocivas para el buen funcionamiento de la economía. En el presente artículo se analiza la naturaleza científica de la contabilidad, su utilidad pública y el indispensable componente ético que implica su ejercicio, así como la responsabilidad que el mal uso de esta ciencia ha tenido en los escándalos financieros y en la gran crisis económica de principios del s.XXI.

The evolution of the Italian Code of Medical Deontology: a historical-epistemological perspective

The Italian Code of Medical Deontology is a set of self-discipline rules prefixed by the medical profession, that are mandatory for the members of the medical registers, who must conform to these rules. The history of the Italian Code of Medical Deontology dates back to the beginning of the twentieth century. In 1903 it appeared in the form of a "Code of Ethics and Deontology" and was prepared by the Board of the Medical Register of Sassari (Sardinia). This Board inserted the principles inspiring the correct practice of the medical profession in an articulated and self-normative system, also foreseeing disciplinary measures. About ten years later, in 1912, the Medical Register of Turin (Piedmont) elaborated a Code which constituted the basis for a subsequent elaboration leading to a Unified Code of Medical Ethics (1924). After World War II the idea prevailed in Italy that the codes of medical deontology should undergo periodical review, updating and dissemination, and the new 1947 text (Turin) was for the first time amply diffused among Italian physicians. The next national code dates back to 1958, and twenty years later a revision was published. In the 1989 Code new topics appeared, including organ transplantation, artificial in vitro insemination and the role of police doctors; these and other issues were later developed in the 1995, 1998 and 2006 versions of the Code. The last available edition of the Italian Code of Medical Deontology is that of May 2014.

Historico-philosophical consideration on the social role of French doctor: medical anthropology of Pierre-Jean-Georges Cabanis (1757-1808) and the French code of medical deontology

을 수행해야 한다. 의사에게 사회적 역할이 필수적인 이 Doctor’s task cannot be limited to medical practice and research. As a citizen of society, and above all as a professional, doctors should not evade their social responsibilities. This idea was systematically developed and widely diffused throughout Europe by Pierre-Jean-Georges Cabanis (1757-1808). He was not only a doctor, but also a philosopher and a politician who lived at the time of the French Revolution. His philosophy on the nature of medicine and the social role of the doctor is conceptualized in his idea of medical anthropology (science de l’homme, anthropologie). In order to understand why the social role of the doctor was particularly emphasized in and around France, Cabanis’ medical anthropology should be analyzed in depth. His medical anthropology is composed of three major domains: physiology, ethics, and analysis of ideologies. The following ideas of his medical anthropology can be identified in the current articles of the French code of medical deontology. 1) Health and disease being a social problem, a social solution should be sought (1.6, 1.7, 1.10, 2.37, 2.44, 2.50); 2) Medical practice is in principle not a commercial service for profit, but rather a public service supported by the government’s power (1.12, 1.19, 1.21, 2.55, 3.57, 3.67); 3) Doctors should maintain their professional autonomy by establishing and observing the principles of self-regulation (1.1, 1.5, 1.31, 2.50, 5.109, 5.110). Referring to the historical experience of French doctors, the Korean medical community should also enter into a broad and fundamental reflection on the nature of medicine and the social role of the doctor.

¿Hay lugar para el consentimiento informado en los tratamientos de las personas con psicosis?: una reflexión sobre el tratamiento de las psicosis

Informed consent (IC) in Mental Health care is unusual, especially for psychotic patients. However, current legislation, statements of professional associations, patient organizations and deontological codes advocate informed consent and patients' autonomy, also for people with psychosis. Patients and their relatives usually are unaware of the scope, limits and risks of drug treatment and the existence of other approaches. The reasons for the IC’s lack can be found in the peculiarities of these patients, but also on the assumption that psychosis impacts the core of the person, and therefore they are unfit of understanding and consent. Today there are two different ways to receive the patient with psychosis problems: first, the mainstream whose objective is to block the process and reverse psychotic symptoms principally using antipsychotics drugs, and another one, that includes various clinic models, that receive psychotic person with their difficulties, proposing to build a framework of understanding for their experiences. The outcomes don’t reveal superiority for the mainstream model, rather the opposite. When listening to the users, they clearly opt for their autonomy and right to choose, rejecting coercive models. Informed consent is a right that empowers the patients and also a recovery factor for many of them. Its implementation will require significant changes in the training of professionals and in the current Mental Health Care networks.

Ethics of Future Doctors in the Process of Teaching Foreign Language

The article deals with the problem of implementing professional ethics into higher medical education while teaching foreign languages. In professional ethics of doctors encompasses the codes of morality, ethics, deontology and bioethics of major professional issues, providing facts how various professions define, interpret, and enforce ethical behavior. Professional ethics should only be educated in adolescence, in particular, while being a student. Humanity disciplines should be based on the identification of opportunities for education of ethical standards in students. The basic principles of English classes should be the use of individual, pair and group discussions of medical students’ about current professional issues, giving students the opportunity to think, to express their own thoughts and ideas and to focus on the content of cultural expression. During practical lessons the teacher should focus on medical ethics, its relationship with medical practice and modern ethics in general. Future doctors should strictly follow the main principles of medical ethics and confidential approach to patients’ problems, complaints, diagnosis and treatment.

The Problem with Ethics

A minimalist and deontological focus of anthropological ethics, and the current lack of consensus in the field about ethical and methodological rigor, produces conference presentations, monographs, and ethnographic essays of questionable quality. Research that fulfills its IRB‐defined duties is ethically problematic if it reproduces colonial relationships, ignores community input into agenda and risk, offers no real possibility for improving human life, or uses so loose a methodology that it cannot be relied upon to produce scientifically valid data. Finally, the modernist fetish of “knowledge” – assumed in the Code to be a value in itself, detached from human wellbeing – grants legitimacy to research that has little purpose other than to further academics' careers.In the following essay I reflect upon my experience conducting ethnographic research into the underground economies of marginalized youth in Havana, New York, and Hartford. What emerges are four principles, which together suggest a departure from the standard catalogue of deontological AAA Code of Ethics concerns toward greater methodological integrity and a more carefully delineated commitment toward the well‐being of the communities with whom we work. An entirely detached and passive anthropology is not an ethical one, but our moral engagement must be based on a solid foundation of data that are analyzed according to sound principles. Thus, ethnographic practice that is methodologically sloppy is not ethical, even if deontological duties—prescribed by the AAA Code and the IRB—have been scrupulously upheld.

Berichtgeving over slachtoffers

Reporting on victims. Journalism praxis according to Flemish journalists Reporting on victims. Journalism praxis according to Flemish journalists Newspaper reporting of a tragic bus crash in Switzerland (Sierre, 2012) in which 22 Belgian and Dutch primary school children and 6 adults were killed, severely shook society. The printing of the children’s pictures on the front pages of popular newspapers (i.e. photos plucked from Facebook and the internet without the parents’ permission) resulted in the adaptation and extension of the deontological code for Flemish journalists (April 2012). We conducted 30 in-depth interviews with journalists (print and audiovisual reporters) during the winter of 2012 and asked them in what way the adapted code has had an impact on the reporting on victims in the journalistic praxis. A semi-structured interview guide was used, the interviews were recorded, fully transcribed and analyzed. Our results show that permanent attention towards the very practical and daily use of the code is essential as most journalists use it rarely and mostly only after reporting has gone wrong.

Professionalism in mountain tourism and the claims to professional status of the International Mountain Leader

Mountain Guides and International Mountain Leaders (IMLs) have achieved cross-border recognition of their professional awards. This allows them to work internationally and provides a rare example of an established, state-sanctioned and respected professional group operating within the tourism industry. As it grows, this industry is increasingly looking to elements of professionalism to provide education and training programmes with the status and credibility that can sustain both industry development and public confidence. The case for professionalism amongst IMLs is examined through an in-depth study of the French and British award schemes. Despite their very different origins, histories and cultures, both schemes train and assess candidates for the IML award and have been selected here because they are the largest and oldest of their kind. This comparative study's focus on the structural elements of these two schemes allows certain aspects of the IML's claim to professional status to be evaluated. First, a framework outlining the defining features of professionalism is explicated. This framework is then used as an analytical tool to evaluate the degree to which the French and British IML schemes can be considered professional. This study concludes that the international accreditation of standards within the field of Mountain Leading, together with the monopolisation of key practices and bodies of knowledge, have contributed to the professionalisation of this area of tourism. There remains much scope, however, for the profession to develop effective and meaningful deontological codes and disciplinary procedures that can further uphold professional standards.

Acesso dos Pacientes aos seus Processos Clínicos

Until recently, the medical record was seen exclusively as being the property of health institutions and doctors. Its great technical and scientific components, as well as the personal characteristics attributed by each doctor, have been the reasons appointed for that control. However, nowadays throughout the world that paradigm has been changing. In Portugal, since 2007 patients are allowed full and direct access to their medical records. Nevertheless, the Deontological Code of the Portuguese Medical Association (2009) explicitly states that patients' access to their medical records should have a doctor as intermediary and that the records are each physician's intellectual property. Furthermore, several doctors and health institutions, receiving requests from patients to access their medical records, end up requesting the legal opinion of the Commission for access to administrative documents. Each and every time, that opinion goes in line with the notion of full and direct patient access. Sharing medical records with patients seems crucial and inevitable in the current patient-centred care model, having the potential to improve patient empowerment, health literacy, autonomy, self-efficacy and satisfaction with care. With the recent technological developments and the fast dissemination of Personal Health Records, it is foreseeable that a growing number of patients will want to access their medical records. Therefore, promoting awareness on this topic is essential, in order to allow an informed debate between all the stakeholders.

L’infermiere e la lettera di dimissione integrata quale strumento emergente: principi teorici, deontologici e normativi

[ Nurses and "integrated discharge letter" as emerging tool: theoric, deontologic and normative principles] All health care professionals work within a system of interdependent roles and functions, cooperating to the common goal of patient’s care. Nurses have a fundamental role in this system, their functions including assessing patient’s needs, planning outcomes, implementing interventions and treatments, and preventing complications. Nursing has changed consistently over the years, both in terms of daily practice and legislation. This article examines the evolution of nursing in the Italian health care system as a specific profession among other health care professions. The different theories, developed to help nurses direct their activities, are described. Besides, the evaluation of the deontological code is provided, highlighting differences and similarities with the physicians’ one. Finally, the role of nurses in compiling the “integrated discharge letter” is examined.

Professional ethics: know-how, deontological code and legality

The greatest sensitivity and attention to the geoenvironmental problematic underline the urgency to face some matters with new awareness and responsibility, like the management of the territory, the exploitation of the georesources, the energy problem, and the defense against natural risks. The civil community asks for ready and exhaustive answers. The technical-scientific competence of the geologist, linked with the shared deontological practice with respect to the normative in force, can give trust back to the citizens, and support to the political decisoris, the safety and the raising of our professionalism. The Italian territory is a great economic, social and cultural resource that must be defended and valued through the contribution of geologists. New strategies, spheres of action, and operational tools are needed. The National Council of Geologists in Italy is working in this direction.

Content analysis and assessment of international codes of franchising associations

PurposeThe objective of this paper is to improve the knowledge about ethical content of franchising associations at a worldwide level.Design/methodology/approachTo do this, the authors compared the content of 46 deontological codes of franchising associations from five continents to the standards established in the so‐called C‐40 or model of franchising deontological codes.FindingsResults show that, in general, ethical content included in deontological codes of franchising associations is not very large, requiring progress in improving its structure and content. In any case, according to the contents of their deontological codes, there are two groups of franchising associations worldwide. On the one hand, those taking the archetype of the European Franchise Federation code (30 associations), which show a greater number of ethical issues and have a better structured code than the other group that do not follow the European code (16 associations).Originality/valueAlthough currently the majority of franchisees and franchisors associations' have or are in the process of developing a deontological code, there is little knowledge about “how a good code should be”, “what is the content it must include to perform properly” and if “existing codes of franchise associations are appropriated”. The answer to these questions, given the existing gap in the literature, is the value of this work.

Liberdade de expressão em redes sociais: casos do jornalismo brasileiro

On enlarging the possibilities for interaction and participation of everyone in the production, distribution and consumption digital content on the web, social networks seem to contribute to give effect to and strengthen freedom of information and expression. However its use by journalists has revealed contradictions in the way how journalism is practiced/ conducted today. At the same time on that journalistic organizations seek to regulate the use of networks and social media can question the freedom of expression and communication of its professionals. The subject is controversial and lacks of examination. This article raises pertinent questions to the current conjuncture from the presentation of cases of journalists fired because of statements posted on their profiles on social networks. We reflect on freedom of expression, journalistic ethics and challenges of adaptation of journalists and companies. Analyze such problems implies not only adjust deontological codes and manuals, but, above all, rethink practices, norms and values that have been incorporated into the profession.

Conductas transgresoras en el ámbito académico

IntroductionThis article presents a historical review, from an ethic standpoint, of the national legislation that rules the practice of Medicine in Colombia; ity also refers to the deontological code and the Colombian psychiatric code as well as to the commitment of the Health Faculty of the Universidad del Valle regarding ethical conducts. DevelopmentEthics is introduced as an original innate faculty, resulting from cognitive development and learning while being also a manifestation of underlying biological processes or a result of the interaction of different models. The teaching-learning process is a situation in which teachers and students get together in order to acquire competences that are to be ethically expressed. Empirical studies have shown transgressive forms of behavior in teachers, students and academic administrators throughout the world; in addition, the mass media expose transgressions committed by other social groups such as politicians, financiers, clergymen, researchers, etc. ConclusionsFirstly proposed as a problem-solving strategy is the acceptance of the very existence of transgressions, followed by the conformation of a committee aimed at principle-identification for, subsequently, undertaking eductional and following-up actions, while administering sanctions when necessary. The proposal for adopting problem-solving strategies for the Faculty of Health of the Universidad del Valle is also presented.