Ethical Medical Practice Research Articles

Up in the Air — Suspending Ethical Medical Practice

First I will define what I conceive medicine to be. In general terms, it is to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their disease, realizing that in such cases medicine is powerless. — The Hippocratic Corpus Our plane was flying from the East Coast to the West carrying 167 passengers, including my wife, a hospitalist and internist, and me, a neurologist and clinical ethicist. About midflight, a woman in the row behind us reached frantically for the baggage bin over our . . .

Prise en charge sanitaire des mineurs détenus

Several new French regulations have come into effect to regulate the healthcare of juvenile offenders in prison with the creation of French Young Offender Institutions. They complete the French prison healthcare methodological guide. This article presents the new developments in the healthcare of juveniles in prison. It specifies the limitations placed on the healthcare team's interventions on imprisoned juveniles. Promoting an individualized prisoner program, as is done in the school context, outlining parental involvement in this program, and withdrawing from the healthcare methodological guide the tasks that are not within the realm of the physician caring for the minor would be measures to ensure good ethical medical practices in prison. These could be applied to French secure training centers and secure children's homes.

Professionalism and Ethics Education on Relationships and Boundaries: Psychiatric Residents' Training Preferences

Awareness of the privileges and limits of one's role as physician, as well as recognition and respect for the patient as a human being, are central to ethical medical practice. The authors were particularly interested in examining the attitudes and perceived needs of psychiatric residents toward education on professional boundaries and relationships given the heightened current focus on professionalism and ethics. Residents from six psychiatric residencies provided views on professionalism and ethics education on a survey encompassing 10 domains of professionalism. The authors focus on residents' perceived need for education on boundaries in the psychiatrist-patient relationship and in peer-peer and supervisor-trainee interactions. Respondents (N=134) felt that nine relationship and boundary issues arising during training should receive more education: being asked to work with inadequate supervision, resolving conflicts between attendings and trainees, resident health care, adequately caring for patients while adhering to work-hour guidelines, performing work beyond one's competence, mistreatment of residents, sexual/romantic relationships between faculty and trainees, mistreatment of medical students, and sexual/romantic relationships between residents and medical students (p<0.05 in all cases). In addition, 15 relationship and boundary issues arising during clinical practice were felt to warrant more education: responding to impaired colleagues, coping with mistakes in clinical care, reporting mistakes, balancing personal and professional life, resolving conflicts, writing prescriptions for friends or family, allocation of health care resources, providing medical advice to friends and family, physicians' social responsibilities, interacting with families, medicine as a profession, gender bias, being asked to falsify clinical information, accepting gifts from patients, and personal relationships with patients (p<0.05 in all cases). The authors found a perceived need for more education for psychiatric residents for the majority of topics pertaining to boundaries and relationships. Residents who reported encountering ethical dilemmas more frequently wanted more education on these topics.

Enhancing medical ethics instruction with a classroom response system

Context and setting The objectives of medical ethics education are to familiarise doctors with the concepts and principles of medical ethics in medical practice and, more importantly, to allow them to develop analytical skills for resolving ethical issues in medicine. In Taiwan, postgraduate Year 1 residents (PGY1) are required to receive at least 8 hours of training in medical ethics. In China Medical University Hospital (CMUH), a classroom response system (CRS) was used to assist the delivery of instruction in medical ethics and to facilitate discussion among residents. Why the idea was necessary The ability to make decisions in circumstances of medical ethical dilemma is developed through social communication. In the classroom context, however, the majority of students are reluctant to voice their opinions because they are shy, lack confidence in their answers, or are distracted. Only a small portion of students are actively involved in discussion. CMUH used CRS in medical ethics courses for PGY1 residents to encourage their participation in classroom discussion. What was done In these medical ethics education sessions, the instructor explained the concepts and principles of medical ethics. This was followed by CRS-assisted case discussions. These cases were presented and shown on a screen along with possible decisions and the ethical principles that were applied, and students selected their choices by clicking with their CRS remote controls. The instructor was able to conduct immediate descriptive analyses of student responses and show them on the screen. Both the instructor and students were able to see the response patterns and students could compare their own responses with those of the class. The instructor was able to select different students to explain why and how they had made their decisions. This allowed the class to learn about the making of different decisions for the same case and enabled the instructor to coach the group on which decisions conformed to medical ethics. Such social constructive processes allowed for opportunities, through CRS, to help students develop their ability to make decisions in circumstances of medical ethical dilemma. In October 2007, 25 PGY1 residents (19 males, six females) at CMUH received CRS-assisted medical ethics instruction. A questionnaire was administered at the end of the instruction to collect their responses to the course. Evaluation of results and impact We found that 84% of participants agreed that the course improved their critical thinking ability, 80% agreed that the course was helpful for resolving medical ethics issues they might encounter in the future, and 72% agreed that CRS helped to enhance their learning motivation, improve the instructor−student relationship and encourage communication among students. In summary, CRS-assisted medical ethics education provided students with a channel for deep-level thinking and discussion and helped them to gain confidence in applying the concepts and principles of medical ethics to medical practice.

Do we need ethics in medical practice?

Do we need ethics in medical practice?

The prevention of hemorrhagic stroke. A review of the rational and ethical principles of clinical trials on unruptured intracranial aneurysms and arteriovenous malformations.

There is currently no evidence that preventive treatment of unruptured aneurysms or AVMs is beneficial and randomized trials have been proposed to address this clinical uncertainty. Participation in a trial may necessitate a shift of point of view compared to a certain habitual clinical mentality. A review of the ethical and rational principles governing the design and realization of a trial may help integrate clinical research into expert clinical practices. The treatment of unruptured aneurysms and AVMs remains controversial, and data from observational studies cannot provide a normative basis for clinical decisions. Prevention targets healthy individuals and hence has an obligation of results. There is no opposition between the search for objective facts using scientific methods and the ethics of medical practice since a good practice cannot forbid physicians the means to define what could be beneficial to patients. Perhaps the most difficult task is to recognize the uncertainty that is crucial to allow resorting to trial methodology. The reasoning that is used in research and analysis differs from the casuistic methods typical of clinical work, but clinical judgement remains the dominant factor that decides both who enters the trial and to whom the results of the trial will apply. Randomization is still perceived as a difficult and strange method to integrate into normal practice, but in the face of uncertainty it assures the best chances for the best outcome to each participant. Some tension exists between scientific methods and normal practice, but they need to coexist if we are to progress at the same time we care for patients.

Changing ethics in medical practice: a Thai perspective

The pace of social change in Thailand has seen the rise of various medical services and a global clientele. Currently, medical tourism and cosmetic surgery have an important role in medical practice here. A growing medical market offers a range of services at competitive rates and high levels of efficiency. This essay provides an overview of medical practices in Thailand and their effect on ordinary people.

Informed Consent: Is it Sacrosanct?

Following Alder Hey and the earlier and much more extreme practices at Nuremberg, legislation has been developed governing the practice of medical ethics and research involving human participants more generally. In the medical context, relevant legislation includes GMC guidance, which states that disclosure of identifiable patient information without consent, for research purposes, is not acceptable unless it is justified in the public interest. There is a presumption, in other words, in favour of the view that patient consent ought to be obtained before any piece of research is conducted. The Data Protection Act, furthermore, requires informed consent to be given before any use of identifiable personal data is made for any purpose. Moreover, ensuring that the informed consent of participants is gained is common practice on most research ethics committees. I argue, in this paper, that applying the principle of ‘informed consent’ too mechanistically in the research ethics context risks undermining the very principle it is designed to support – the principle of autonomy. This issue has been much discussed in medical ethics but not so much, so far, in the research ethics context. It will be argued that a more discerning and a less rigid and mechanistic approach, applied by research ethics committees, may help ensure that ethical issues are properly considered.

Medical ethics in surgical wards: knowledge, attitude and practice of surgical team members in Karachi

A survey was undertaken to assess the knowledge, attitude and practice of medical ethics among surgical residents and interns in three teaching hospitals of Karachi, Pakistan. 101 out of 120 completed responses were included in the study. Fifty-one respondents had heard about the Code of Ethics formulated by the Pakistan Medical and Dental Council. Forty-four had read the code. Seven had no knowledge about it. Forty-seven reported taking consent for procedures. Forty-two respondents gave correct answers on questions of confidentiality and knowledge of law pertaining to trauma victims. Only 11 reported having been taught ethics as students. Four did not feel the need of its teaching at an undergraduate level. Doctors graduating within the last 10 years gave fewer correct answers than those graduating earlier. Knowledge of medical ethics and its application on the surgical floors is extremely poor. The survey results support the view that medical ethics should be part of the undergraduate medical curriculum.

Pedagogy for Medical Ethics in Practice: A Reasonable Approach for Health Care Practitioners

Francis H. Rohlf is an associate professor in the Department of Philosophy and Religious Studies, Mount Aloysius College, Cresson, Pennsylvania. Rosemary J. Bertocci is an associate professor in the Department of Philosophy and Religious Studies, Saint Francis University, Loretto, Pennsylvania. Correspondence should be addressed to: Francis H. Rohlf, PhD 3204 Ben Franklin Highway Ebensburg, PA 15931 Voice: 814-749-6177 E-mail:[email protected]

Major issues relating to end‐of‐life care

PurposeEthical, legal and medical progress has been made in end‐of‐life care, addressing crucial issues in the application of principles to clinical cases. However, despite the progress, there are still unresolved issues concerning the scope and effectiveness of personal decision making and the proper use of last resort measures in terminal care. An analysis of the progress discloses both the advances and the problems still confronting patients and their families. From this perspective, one gains a better understanding of the reality of terminal care and areas that call for reform.Design/methodology/approachA historical analysis reveals the interrelation between moral and legal reasoning and their differences. It also discloses developments in the moral and legal realms that recognize rights of the patient with regard to treatment decisions. A critique of ethical and legal reasoning and medical practice pin‐points the salient problems.FindingsThere are still problems in the application of legal and ethical principles to specific cases. These problems are complicated by poor physician‐patient communication, the ineffective use of advance directives and the impact of the market economy on comprehensive palliative care. These call for reform to protect personal rights and dignity at the end of life.Originality/valueA historical approach, too often lacking, promotes insight into the complexities of end‐of‐life care. An analysis flowing from such a perspective pin‐points not only the advances in ethical, legal and medical practice but also the flaws and inconsistencies that call for a more realistic approach in reasoning and practice.

Viewpoint: The ideal qualities of a good consultant: Who does the cap fit?

The ideal qualities of a good Consultant defy definition, and a full description of one is difficult to completely proffer. Such a description, would also depend on which ‘Camp' or ‘School' you belong to. To a junior doctor, a good Consultant is easily accessible, approachable, friendly, with the patience of a Saint, and the sense of humour of an undergraduate. However, I consider the most important quality to be ‘availability' or ‘presence' - at least on the end of a phone! Tolerance, empathy and understanding are the other basic ideal qualities of a good Consultant. As regards health-care delivery, the good Consultant should have a passionate concern to maintain basic standards of Patient Care. He or she should want his or her colleagues to adopt the same standard and approach towards their Government patients, as they would to their Private patients. The good Consultant never writes “I have given the patient a supply of my formula for asthma“ or denies access to simple tests like fundoscopy nor audiogram. Yes, the Consultant can still change his or her characteristics to fit the “ideal”, if there are more significant negative attributes when you complete reading through this viewpoint on Ethics of Medical Practice. Sahel Med. J. Vol.6(2) 2003: 29-32

Privacy of patients' information in hospital lifts: observational study

Respect for the confidentiality of patients' information is a basic principle of ethical and effective medical practice. It ensures individual patients' privacy, and, more broadly, it upholds public perception of...

An ‘Extra Legible Illustration' of the Christian Faith: Medicine, medical ethics and missionaries in the Arabian Gulf1

This article presents a view of missionary medicine in the Gulf and the ethical issues missionary medical practices evoked. It shows that, as both physicians and missionaries, and seeing themselves as an 'extra legible illustration' of the Christian faith (Paul Harrison, Doctor in Arabia, New York, John Day Co., 1940, 23-4), the missionary physicians gave selflessly to provide the best medical care possible according to their individual abilities and given the environment in which they worked. At the same time, they experimented, took risks that were sometimes unnecessary and were forced to make ethical choices that challenged their Christian moral compass. Furthermore, given the remoteness of their stations, they were absolved from professional oversight and second-guessing by patients who had nowhere else to turn. Drawing on this paradox of self-sacrifice and self-service, of Christian benevolence and imperial posturing, the article considers to what extent the mission was an exercise in altruism or imperialism.

When the treatment goal is not cure: are cancer patients equipped to make informed decisions?

Informed decision making now is considered the underpinning of ethical medical practice. We aimed to determine the extent to which patients with incurable cancer are adequately informed of their prognosis and treatment options and encouraged to participate in treatment decisions. One hundred eighteen cancer patients with incurable disease presenting for an initial consultation with one of nine oncologists at two Sydney tertiary referral hospitals participated in the study. Consultations were recorded on audiotape to permit a content analysis of doctor-patient interactions. We devised a coding system to assess disclosure of information and to evaluate doctor encouragement of patient participation in treatment decision making. Patient recall, satisfaction, anxiety, and perceptions of the decision-making process were assessed to determine the effects of informed decision making on patient outcomes. Most patients were informed about the aim of anticancer treatment (84.7%), that their disease was incurable (74.6%), and about life expectancy (57.6%). An alternative to anticancer treatments was presented to 44.1%, 36.4% were informed about how anticancer treatment would affect quality of life, and 29.7% were offered a management choice. Oncologists checked patient understanding in only 10.2% of consultations. Although greater information disclosure did not seem to elevate anxiety levels, greater patient participation in the decision-making process was associated with increased anxiety levels (P =.0005), which persisted over a 2-week time span. Most patients were well informed, but important gaps remain, especially concerning information about prognosis and alternatives to anticancer treatment. These gaps invite the question concerning whether patients are led toward anticancer treatment.

The American Medical Ethics Revolution: How the AMA's Code of Ethics Has Transformed Physicians' Relationships to Patients, Professionals and Society (review)

Whether the Code of Ethics adopted by the fledgling American Medical Association in 1847, and its several successors, have in fact "transformed physicians' relationships," as the subtitle of this book claims, remains a point for debate. However, the book itself leaves little question that investigation and contemplation of the Code provide a strong stimulus for creative thought and conversation. Based on the example of the many and varied arguments displayed here, perhaps it would even be fair to say that discussion of the Code has the potential to transform the debates of contemporary biomedical ethics. This is an exceptionally good book, not because its contributors' conclusions are unassailable, but precisely because together they raise the right questions and keep the debates open and active. More than many other books about the ethics of medical practice and of health care generally, this one engenders the desire to know more, to think harder and in new ways about lingering conflicts and the assumptions that underlie them.

Money, Consent, and Exploitation in Research

(2001). Money, Consent, and Exploitation in Research. The American Journal of Bioethics: Vol. 1, No. 2, pp. 62-63.

Seven legal barriers to end-of-life care: myths, realities, and grains of truth.

The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) End-of-Life Care Consensus Panel was convened in 1997 to identify clinical, ethical, and policy problems in end-of-life care, to analyze critically the available evidence and guidelines, and to offer consensus recommendations on how to improve care of the dying. Topic selection and content presentation were carefully debated to maximize the project's focus on providing practical clinical and other guidance to clinicians who are not specialists in palliative care. This statement examines current legal myths, realities, and grains of truth in end-of-life care. The Consensus Panel comprises 13 medical and bioethics experts, clinicians, and educators in care at the end of life selected by the Ethics and Human Rights Committee, College leadership, and the Center for Ethics and Professionalism at the ACP-ASIM. A literature review including a MEDLINE search of articles from 1970-1998 and review of end-of-life care literature and organizational bibliographies was conducted. Unpublished sources were also identified by participants, as was anecdotal clinical experience. The draft statement was debated by panel members over a series of 3 to 4 meetings. For this statement, the initial draft and subsequent revised drafts were discussed in 1998-1999. The statement then underwent external peer review and revision before panel approval and the journal peer review process. Legal myths about end-of-life care can undermine good care and ethical medical practice. In addition, at times ethics, clinical judgment, and the law conflict. Patients (or families) and physicians can find themselves considering clinical actions that are ethically appropriate, but raise legal concerns. The 7 major legal myths regarding end-of-life care are: (1) forgoing life-sustaining treatment for patients without decision-making capacity requires evidence that this was the patient's actual wish; (2) withholding or withdrawing of artificial fluids and nutrition from terminally ill or permanently unconscious patients is illegal; (3) risk management personnel must be consulted before life-sustaining medical treatment may be terminated; (4) advance directives must comply with specific forms, are not transferable between states, and govern all future treatment decisions; oral advance directives are unenforceable; (5) if a physician prescribes or administers high doses of medication to relieve pain or other discomfort in a terminally ill patient, resulting in death, he/she will be criminally prosecuted; (6) when a terminally ill patient's suffering is overwhelming despite palliative care, and he/she requests a hastened death, there are no legally permissible options to ease suffering; and (7) the 1997 Supreme Court decisions outlawed physician-assisted suicide. Many legal barriers to end-of-life care are more mythical than real, but sometimes there is a grain of truth. Physicians must know the law of the state in which they practice. JAMA. 2000;284:2495-2501.

The myth of informed consent.

Informed consent is an integral element of ethical medical practice. However, unlike gastrointestinal endoscopy, the consent process is not standardized. Moreover, informed consent is often viewed as a legal necessity rather than as an expression of patients' autonomy. Elevating informed consent to its rightful place can enhance doctor-patient relationship.

Narrative and knowledge development in medical ethics.

The role of individual life accounts has been promoted--largely through what has come to be described as narrative ethics-as important to the practice of medical ethics for a number of...