Ethical Guidance Research Articles

Prioritise research on vaccines for pregnant and breastfeeding women

Prioritise research on vaccines for pregnant and breastfeeding women

Critical Thinking Skills: Developing a Course to Guide our World toward Ethical Decision-Making

Many people would have us believe that teaching critical thinking skills is not possible, but that these are skills we are born with, or not. This is simply not true. Understanding that making good decisions is something that must be taught, because young people in our current culture are engulfed in worldwide societies that purport little ethical or moral guidance. Due to the dearth of good role modeling for character, the important skill of critical thinking must be addressed in our churches, our schools, and our homes. We cannot leave this important skill to social media and peers and have the expectation that our young people will understand how to become good, moral citizens of our world.

Ethical Leadership as a Predictor of Work Deviance Among Public Sector Workers in Administrative Offices in the Cape Coast Metropolis, Ghana: A Structural Equation Modelling Approach

The study focused on ethical leadership and work behaviours of public sector workers in administrative offices in Ghana. The quantitative cross-sectional survey was adopted to survey all public sector workers in active service. Ninety-two respondents were recruited online for the study. Data for the study were gathered using adapted ethical leadership and work deviance scales. Data collected were analyzed inferentially using the structural equation modelling (SEM) approach. The study revealed that people orientation (b=.222, p=.000), fairness (b=.351, p=.000), concern for sustainability (b=.432, p=.000), and ethical guidance (b=-.287, p=.000) significantly predicted work deviance. The study concluded that a high ethical leadership style could either maximize or minimize the likelihood of deviant work behaviour at the workplace. It is recommended that public sector leaders should first identify the root cause of work deviance in the workplaces within the Metropolis and put measures such as positive rewards, effective supervision, and infusion of ethical programmes into the workplace culture to minimize work deviance among administrative officers.

"It's Almost as if Stakeholder Engagement is the Annoying 'Have-to-do'…": Can Ethics Review Help Address the "3 Ts" of Tokenism, Toxicity, and Tailoring in Stakeholder Engagement?

Ethics guidance recommends that researchers engage stakeholders and that RECs review research for such engagement. The ethics review process may present a unique opportunity to support stakeholder engagement practices for HIV prevention studies. We conducted 28 interviews with experts from 12 countries to explore this issue, and analyzed the data using Thematic Analysis. We found that the value of engagement and review processes was strongly endorsed. However, we identified 3 major thematic complexities, namely: “Tokenism” where processes risk being “tick-box”; “Toxicity”, where practices may inadvertently have negative consequences; and “Tailoring”, where processes need careful variation in intensity. We make recommendations for how these “Ts” can be addressed during the review process to help contribute to thoughtful review of meaningful stakeholder engagement in research.

An Ethics Checklist for Digital Health Research in Psychiatry: Viewpoint.

BackgroundPsychiatry has long needed a better and more scalable way to capture the dynamics of behavior and its disturbances, quantitatively across multiple data channels, at high temporal resolution in real time. By combining 24/7 data—on location, movement, email and text communications, and social media—with brain scans, genetics, genomics, neuropsychological batteries, and clinical interviews, researchers will have an unprecedented amount of objective, individual-level data. Analyzing these data with ever-evolving artificial intelligence could one day include bringing interventions to patients where they are in the real world in a convenient, efficient, effective, and timely way. Yet, the road to this innovative future is fraught with ethical dilemmas as well as ethical, legal, and social implications (ELSI).ObjectiveThe goal of the Ethics Checklist is to promote careful design and execution of research. It is not meant to mandate particular research designs; indeed, at this early stage and without consensus guidance, there are a range of reasonable choices researchers may make. However, the checklist is meant to make those ethical choices explicit, and to require researchers to give reasons for their decisions related to ELSI issues. The Ethics Checklist is primarily focused on procedural safeguards, such as consulting with experts outside the research group and documenting standard operating procedures for clearly actionable data (eg, expressed suicidality) within written research protocols.MethodsWe explored the ELSI of digital health research in psychiatry, with a particular focus on what we label “deep phenotyping” psychiatric research, which combines the potential for virtually boundless data collection and increasingly sophisticated techniques to analyze those data. We convened an interdisciplinary expert stakeholder workshop in May 2020, and this checklist emerges out of that dialogue.ResultsConsistent with recent ELSI analyses, we find that existing ethical guidance and legal regulations are not sufficient for deep phenotyping research in psychiatry. At present, there are regulatory gaps, inconsistencies across research teams in ethics protocols, and a lack of consensus among institutional review boards on when and how deep phenotyping research should proceed. We thus developed a new instrument, an Ethics Checklist for Digital Health Research in Psychiatry (“the Ethics Checklist”). The Ethics Checklist is composed of 20 key questions, subdivided into 6 interrelated domains: (1) informed consent; (2) equity, diversity, and access; (3) privacy and partnerships; (4) regulation and law; (5) return of results; and (6) duty to warn and duty to report.ConclusionsDeep phenotyping research offers a vision for vastly more effective care for people with, or at risk for, psychiatric disease. The potential perils en route to realizing this vision are significant; however, and researchers must be willing to address the questions in the Ethics Checklist before embarking on each leg of the journey.

Implementation of a nurse-led overdose prevention site in a hospital setting: lessons learned from St. Paul\u2019s Hospital, Vancouver, Canada

ObjectivesIn May 2018, St. Paul’s Hospital (SPH) in Vancouver (Canada) opened an outdoor peer-led overdose prevention site (OPS) operated in partnership with Vancouver Coastal Health and RainCity Housing. At the end of 2020, the partnered OPS moved to a new location, which created a gap in service for SPH inpatients and outpatients. To address this gap, which was magnified by the COVID-19 pandemic, SPH opened a nurse-led OPS in February 2021. This paper describes the steps leading to the implementation of the nurse-led OPS, its impact, and lessons learned.MethodsFour steps paved the way for the opening of the OPS: (1) identifying the problem, (2) seeking ethics guidance, (3) adapting policies and practices, and (4) supporting and training staff.ResultsThe OPS is open between 10:00 and 20:00 and staffed by two nurses per shift. It is accessible to all patients including inpatients, patients in the Emergency Department, and patients attending outpatient services. Between February 1, 2021 and October 23, 2021, the OPS recorded 1612 visits for the purpose of injection, for an average weekly visit number of 42. A total of 46 overdoses were recorded in that 9-month period. Thirty-seven (80%) required administration of naloxone and 12 (26%) required a code blue response.ConclusionsDue to the unique nature of our OPS, we learned many important lessons in the process leading to the opening of the site and the months that followed. We conclude the paper with lessons learned grouped into six main categories, namely engagement, communication, access, staff education and support, data collection, and safety.

A new definition for global bioethics: COVID-19, a case study

ABSTRACT A truly global bioethics involves cooperation and collaboration among countries. Most of the articles published in bioethics journals address a problem that exists in one or more countries, but the articles typically do not discuss solutions that require collaboration or cooperation. COVAX is one example of proposed international cooperation related to the current COVID-19. pandemic. Yet it is evident that nations have been proceeding on their own with little, if any collaboration. Despite international research ethics guidance from the World Health Organization (WHO), an article published under WHO auspices violates an ethical principle rejecting “double standards” in the conduct of global research. The COVID pandemic provides an opportunity for countries to learn from the recent lack of international cooperation and employ a multi-national strategy in future global health crises.

The Market in Noninvasive Prenatal Tests and the Message to Consumers: Exploring Responsibility.

The potential for bias in industry-developed information about noninvasive prenatal testing (NIPT), in addition to the lack of regulatory oversight for this type of product, raises questions about clinical communication and adoption. We identify NIPTs marketed globally and analyze their English-language consumer-oriented brochures to determine whether they meet existing policy and ethical guidance from the Nuffield Council on Bioethics on NIPT marketing, how they establish the legitimacy of the test given the lack of regulatory oversight for NIPT, and whether content differs between the brochures from for-profit and nonprofit entities. In many of these brochures, NIPTs are misrepresented as diagnostic tests, claims lack supporting evidence, regulatory bodies that do not evaluate the test itself are referenced, and clinicians are invoked as authorities on specific NIPTs. Our findings substantiate concerns about the extent to which commercial imperatives operating in the absence of market-access regulation could exacerbate problems of misrepresentation and inaccuracy in marketing materials.

Profiling, Privacy, and Protection: Ethical Guidance When Police Are Present at Bedside.

Profiling, Privacy, and Protection: Ethical Guidance When Police Are Present at Bedside.

Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit

BackgroundPeople working in long-term care homes (LTCH) face difficult decisions balancing the risk of infection spread with the hardship imposed on residents by infection control and prevention (ICP) measures. The Dementia Isolation Toolkit (DIT) was developed to address the gap in ethical guidance on how to safely and effectively isolate people living with dementia while supporting their personhood. In this observational study, we report the results of a survey of LTCH staff on barriers and facilitators regarding isolating residents, and the impact of the DIT on staff moral distress.MethodsWe completed an online cross-sectional survey. Participants (n = 207) were staff working on-site in LTCH in Ontario, Canada since March 1, 2020, with direct or indirect experience with the isolation of residents. LTCH staff were recruited through provincial LTCH organizations, social media, and the DIT website. Survey results were summarized, and three groups compared, those: (1) unfamiliar with, (2) familiar with, and (3) users of the DIT.Results61% of respondents identified distress of LTCH staff about the harmful effects of isolation on residents as a major barrier to effective isolation. Facilitators for isolation included delivery of 1:1 activity in the resident’s room (81%) and designating essential caregivers to provide support (67%). Almost all respondents (84%) reported an increase in moral distress. DIT users were less likely to report an impact of moral distress on job satisfaction (odds ratio (OR) 0.41, 95% CI 0.19-0.87) with 48% of users reporting the DIT was helpful in reducing their level of moral distress.ConclusionsIsolation as an ICP measure in LTCH environments creates moral distress among staff which is a barrier to its effectiveness. ICP guidance to LTCH would be strengthened by the inclusion of a dementia-specific ethical framework that addresses how to minimize the harms of isolation on both residents and staff.

The Ethical and Religious Directives for Catholic Health Care Services: Part Five-Issues in Care for the Seriously Ill and Dying-and Promoting their Value in a Secular Culture Seeking Assisted Suicide.

The sixth edition of the United States Conference of Catholic Bishops' (USCCB) Ethical and Religious Directives for Catholic Health Care Services (ERDs) provides ethical guidance for Catholic healthcare professionals and institutions for many moral issues. Presented here is a brief discussion of the main points contained in Part Five, which covers issues in care for the seriously ill and dying patient, and includes a focus on the challenges of promoting the essence of these Directives-without using religious arguments-to a secularized culture clamoring for physician-assisted suicide (PAS).

Operationalising a real-time research ethics approach: supporting ethical mindfulness in agriculture-nutrition-health research in Malawi

BackgroundThere have been notable investments in large multi-partner research programmes across the agriculture-nutrition-health (ANH) nexus. These studies often involve human participants and commonly require research ethics review. These ANH studies are complex and can raise ethical issues that need pre-field work, ethical oversight and also need an embedded process that can identify, characterise and manage ethical issues as the research work develops, as such more embedded and dynamic ethics processes are needed. This work builds on notions of ‘ethics in practice’ by developing an approach to facilitate ethical reflection within large research programmes. This study explores the application of a novel ‘real-time research ethics approach’ (RTREA) and how this can support ethical mindfulness. This involves embedding ethical analysis and decision-making within research implementation, with a continuous dialogue between participants and researchers. The aim is to improve ethical responsiveness and participant experience, which in turn may ethically support adherence and retention. In this case study, a bioethics team (BT) was embedded in a community-based randomised, controlled trial conducted in rural Malawi, titled the ‘Addressing Hidden Hunger with Agronomy’. To identify ethical issues, the researchers conducted ten focus group discussions, fourteen in-depth interviews with key informants, two workshops, observed two sensitisation and three activity meetings conducted by the trial team, and analysed fifteen reports from pre-trial to trial implementation.ResultsThe RTREA facilitated the identification of social and ethical concerns and made researchers aware of participants’ ‘lived research experience’. To address concerns and experiences, the BT worked with researchers to facilitate conversation spaces where social and ethical issues were discussed. Conversation spaces were designed to create partnerships and promote participatory methods to capture trial participants’ (TPs) perspectives and experiences.ConclusionsThe use of RTREA showed the value of real-time and continuous engagement between TPs and researchers. These real-time processes could be embedded to complement traditional ethical guidance and expert opinions. A deeper engagement appeared to support greater operationalising of principles of inclusion, empowerment, and participant autonomy and supported researchers ‘ethical mindfulness’ which in turn may support instrumental outcomes of high recruitment, retention, and adherence levels.

A Code of Digital Ethics: laying the foundation for digital ethics in a science and technology company

The rapid and dynamic nature of digital transformation challenges companies that wish to develop and deploy novel digital technologies. Like other actors faced with this transformation, companies need to find robust ways to ethically guide their innovations and business decisions. Digital ethics has recently featured in a plethora of both practical corporate guidelines and compilations of high-level principles, but there remains a gap concerning the development of sound ethical guidance in specific business contexts. As a multinational science and technology company faced with a broad range of digital ventures and associated ethical challenges, Merck KGaA has laid the foundations for bridging this gap by developing a Code of Digital Ethics (CoDE) tailored for this context. Following a comprehensive analysis of existing digital ethics guidelines, we used a reconstructive social research approach to identify 20 relevant principles and derive a code designed as a multi-purpose tool. Versatility was prioritised by defining non-prescriptive guidelines that are open to different perspectives and thus well-suited for operationalisation for varied business purposes. We also chose a clear nested structure that highlights the relationships between five core and fifteen subsidiary principles as well as the different levels of reference—data and algorithmic systems—to which they apply. The CoDE will serve Merck KGaA and its new Digital Ethics Advisory Panel to guide ethical reflection, evaluation and decision-making across the full spectrum of digital developments encountered and undertaken by the company whilst also offering an opportunity to increase transparency for external partners, and thus trust.

Communication in Healthcare: Global challenges in the 21st Century.

This article explores the communication challenges brought about by the digital revolution in the 21st century for healthcare professionals internationally. It particularly focuses on the use of content-generating and sharing platforms like social media. Globally, healthcare has been irrevocably altered by digital innovation and health professionals deploy an extensive range of social media and web-based tools on a daily basis. However, many healthcare professionals use these platforms in a regulatory vacuum-where there may not be specific legal or ethical guidance-and without an appreciation of the associated risks. Given the special protections afforded to the practitioner-patient relationship, and the importance of a health practitioners' reputation, it is vital that we understand how to traverse the many ethical and legal challenges of the digital interaction. A comprehensive set of recommendations (see "Guidelines for Good Digital Citizenship in the Health Professions" on page 5 ff.) to keep practitioners out of trouble is provided. These hinge on the notion of being a "good person and a good doctor" as a formative maxim for ethical and legal safety. The constituents of publication, and the consequences of falling foul of acceptable publication standards on social media, are specifically discussed. "Publication" involves sharing content with a third party, or a group of people, and social media refers to platforms on which content can be shared with more than one person. Hence, most information that we post on social media can be considered as "published," and as such may attach liability for health professionals who do not use these platforms with requisite care and sufficient forethought.

FORGOTTEN FATHERS IN CHILD HEALTHCARE

Objective: Father involvement is a largely unexplored area in health literature. The purpose of this research was to investigate how pediatric residents and mothers perceive fathers' participation in health monitoring, fathers' self-assessment of their participation in their child’s health monitoring, and to examine mothers and fathers' views on "fatherhood roles." Materials and Methods: Between March and May 2019, a total of 155 individuals, including pediatrics residents (n=45), mothers (n=55) and fathers (n=55) of children admitted to the outpatient clinic of pediatrics participated survey, in Inonu University, Turkey. Results: It was found that 44% of the children had attended with their parents (40% only with their mother, and 16% only with their father), but the perceptions of the residents were not in this direction and residents did not care for the fathers and assigned them to a second role. The questions were asked to mothers and fathers about the role of fathers, adapted using the Role of the Father and it was concluded that giving moral and ethical guidance, showing love and affection, and providing financial care to children were more important for fathers, respectively. Conclusion: As suggested by American Academy of Pediatrics, residents should be aware of the importance of the fathers' participation and include them.

“Webside” healthcare from medical interns' perspective: Telemedicine implementation and need for training

BACKGROUND:Telemedicine involves the use of electronic communication and technology to remotely deliver clinical services to patients. With the increase in the adoption of telemedicine in healthcare delivery, “webside healthcare” is becoming the virtual analog of bedside care. The Ministry of Health in Saudi Arabia has recently established the use of telemedicine, including social media (SM) and medical applications (Apps) to enhance the quality and accessibility of healthcare services to patients and healthcare providers. In the present study, we evaluated medical interns' perception of the use of telemedicine, SM, and medical Apps in patient care, their awareness of related guidelines to find out if targeted training is needed.MATERIALS AND METHODS:A qualitative study recruited and interviewed, through semi-structured key informant (KI) interviews and focus group discussions (FGD), a total of 24 male and female medical interns. The Interns were purposefully sampled from all Saudi Arabia's 5 main geographical regions until data saturation was observed. The transcripts of five KI interviews and 6 FGDs done were thematically analyzed and are presented as themes and subthemes.RESULTS:Medical interns discussed the advantages and disadvantages related to telemedicine, SM, and medical Apps in healthcare services. Overall, interviewees appreciated the role telemedicine, SM, and medical Apps play in the healthcare and for such particular specialties as family medicine and (tele-) psychiatry. However, the interns believed that training on the technical operational aspects of different telemedicine modalities with an emphasis on targeted education for related ethical and legal regulating guidelines was vital.CONCLUSION:Most interviewed medical interns had a positive perception of telemedicine and were willing to use it in their daily clinical practice. However, there were some challenges to its successful implementation such as prompt training on its proper use and clear ethical and legal guidance.

Providing health care in politically charged contexts: a qualitative study about experiences during a public collective hunger strike of asylum seekers in Germany

ABSTRACT Purpose Role expectations of physicians providing health care for hunger strikers have been discussed in the context of prisons and detention centres. Ethical guidance for physicians in these situations is codified in the Declaration of Malta. In the last years, new forms of collective, public hunger strikes of asylum seekers have occurred. We have aimed at reconstructing the experiences of health-care personnel involved in one of such cases. Methods Semi-structured interviews with nine participants (physicians and paramedics) that had been involved in a public collective hunger strike of asylum seekers in Germany were conducted. Results We identified three health-care provider groups: voluntary physicians, emergency service providers and medical consultants for the authorities. Role conflicts arising from multiple loyalty situations with obligations towards different stakeholders (e.g., strikers, employers, authorities) were perceived as the greatest challenge especially for voluntary doctor and emergency service provider participants. Such conflicts culminated in feeling instrumentalized for political goals. Conclusion The results illustrate that professional challenges in the health care during a public collective hunger strike differ in various aspects from those described in the literature on custodial settings. We recommend expanding and adapting the medico-ethical guidance.

Approaches to ethics in the Laozi (Lao‐Tzu)

AbstractThis paper will look at five major approaches to interpreting “ethics” in theLaozi. There is a good deal of controversy over what type of ethics might be promoted in theLaoziand additional discussions of whether or not any the text includes ethical concerns at all. We begin with a basic introduction todao道 (way) and certain patterns of thinking in theLaozibefore moving on to a sketch ofziran自然 or “self‐so” andwuwei無為 or “nonaction.” The first approach finds an account of ethics already within these two concepts. The second sees Confucian virtues along with sincerity, simplicity, purity, and genuineness as ethical guides. Looking to the underpinnings of these reading, the third approach findsdaoitself as moral, and any action in accordance withdaois deemed ethical. However, likedao, being ethical in this manner is considered ineffable. The fourth type of interpretation argues that theLaoziis critical of ethics itself. Finally, we look at how the model of the “sage” can be related to “ethics” or “êthos” in a broad sense. In the short conclusion general agreements that pervade all five approaches will be outlined. These include resisting standardization of ethics and an implicit understanding of human nature as “okay.”

Ethical leadership and program to reduce unethical behaviour among public employees

ABSTRACT Ethical leadership has been considered the central source of ethical guidance for employees in the workplace. Our study tested the effects of ethical leadership on unethical behaviour of public employees through ethics programsbased on social learning theory and reinforcement theory. Using survey data obtained from U.S. federal agencies, we found that ethical leadership reduced unethical behaviour among public employees. Furthermore, the use of ethics programs mediated the positive relationship between ethical leadership and the ethical behaviour of public employees. These results indicated the importance of ethical leadership and effective ethics programs in reducing unethical behaviour by public employees.

Virtual Visitation and Microethical Decision-making in the Intensive Care Unit During COVID-19.

Virtual Visitation and Microethical Decision-making in the Intensive Care Unit During COVID-19.