Ethical Problems In Clinical Practice Research Articles

Perspectives of physicians who work in public hospitals about ethical problems in medical practice

The recognition of ethical problems in medical practice and the potential harmful effects that they may have on patients, underscores the importance of the ethical training of professionals as well as the development of Ethics Committees in Healthcare institutions. However, there is a paucity of national studies about the type of problems faced by professionals and the role of Ethics Committees in hospitals. To explore the perception about ethical problems in clinical practice of Chilean physicians of different specialties of two public teaching hospitals. Physicians of both sexes and different specialties working in two teaching hospitals of Metropolitan Santiago, were invited to participate in focus groups of seven to eight participants. They discussed the ethical problems faced during their clinical practice. A content analysis based on the Grounded Theory was performed with the obtained information. Different types of ethical problems could be distinguished according to their content and the actors involved. The data obtained shows that the ethical dimension is present in the daily work of physicians. The evolution of the narrative throughout the interviews corroborated the importance of installing ethical issues and culture in the working routine of health care professionals. Human resources and an adequate institutional environment are required to promote the discussion about ethical issues such as the relationship between physicians and patient, the role of teaching in health care and institutional decisions.

Nurses Who Assume the Role of Advocate for Older Hospitalized Patients: A Qualitative Study.

IntroductionPatient advocacy, acting on behalf of patients’ unmet needs, is fundamental to nursing, and the perception of the need for advocacy motivated this study. Nurses experience moral discomfort, which results from a divergent view regarding medical or caregivers’ decisions about patients’ clinical proceedings, in which patients’ involvement in making those decisions is either doubtful or absent.ObjectivesThe aim of this study is to assess the need for advocacy and explore the perspectives of nurses engaged in the care of older patients.MethodsThe methodological orientation is that of a qualitative design, by using a purposive and criterion sampling. The sample was of 14 nurses of a ward of general medicine. Focus group as collecting data tool was used, followed by a thematic analysis.ResultsNurses demonstrated a high level of moral sensitivity to ethical problems in clinical practice and on occasions, the courage to bring the problem to the physicians or patients’ family’s attention, or help patients develop self-determination. However, it is difficult to advocate because of insufficient communication between professionals, insufficient knowledge of ethics, and the emotional burden it places on nurses which results in emotional resignation in the face of interprofessional teams’ lack of consideration of nurses’ opinions.ConclusionThis research highlighted nurses’ need for advocacy to promote patients’ rights, wishes, and values. It is essential for nurses to be aware of their level of moral sensitivity and develop a strategy to regain courage to engage in advocacy. Therefore, ethics education and interprofessional ethical leadership is desired, which inspires healthcare professionals’ work and allows the foundations of an ethical decisionmaking process to be laid through patients and their families’ active involvement.

Effects of using standardized patients on nursing students’ moral skills

Nurses and nursing students increasingly confront ethical problems in clinical practice. Moral sensitivity, moral reasoning, and ethical decision-making are therefore important skills throughout the nursing profession. Innovative teaching methods as part of the ethics training of nursing students help them acquire these fundamental skills. This study investigated the effects and potential benefits of using standardized patients in ethics education on nursing baccalaureate students' moral sensitivity, moral reasoning, and ethical decision-making by comparing this method with in-class case analyses. This is a quasi-experimental study. The sample comprised 89 students in Hacettepe University's Faculty of Nursing. Following lectures describing the theoretical components of ethics, students were randomly assigned to two working groups, one using standardized patients and the other using in-class case analyses. Data were collected using the Moral Sensitivity Questionnaire, Rest's Defining Issues Test, and the Nursing Dilemma Test. All data were analysed using IBM SPSS Statistics Version 23. Ethical approval and official permission were obtained. All participating students completed informed consent forms. According to the results, the moral sensitivity of students in the standardized patient group significantly improved over time compared to those in the case analysis group, while the mean scores of students in both groups for moral reasoning and ethical decision-making were not statistically significant. Based on our results, we recommend the use of both standardized patients and case analysis as appropriate teaching methods in ethics education.

Consulted ethical problems of clinical nursing practice: perspective of faculty members in Japan

BackgroundThere are several studies that have targeted student nurses, but few have clarified the details pertaining to the specific ethical problems in clinical practice with the viewpoint of the nursing faculty. This study was to investigate the ethical problems in clinical practice reported by student nurses to Japanese nursing faculty members for the purpose of improving ethics education in clinical practice.MethodThe subjects comprised 705 nursing faculty members (we sent three questionnaires to one university) who managed clinical practice education at 235 Japanese nursing universities. We performed a simple tabulation of the four items shown in the study design. 1) the details of student nurse consultations regarding ethics in clinical practice (involving the students themselves, nurses, care workers, clinical instructors, and nursing faculty members); 2) the methods of ethics education in clinical practice; 3) the difficulties experienced by the nursing faculty members who received the consultations; and 4) the relationship between clinical practice and lectures on ethics. Furthermore, the analysis was based on the idea of ethical principles, respect for persons, beneficence, and justice.ResultsThe response rate was 28% (198 questionnaires). The nursing faculty members were consulted for various problems by student nurses. The details of these consultations were characterized by the principles of respect for patient by nurses, the principles of benevolence by faculty and clinical instructors, and the principle of justice pertaining to evaluations. The results indicate that there is an awareness among the nursing faculty regarding the necessity of some sort of ethics education at clinical settings. Moreover, based on the nature of the contents of the consultations regarding the hospital and staff, it was evident that the nursing faculty struggled in providing responses. More than half of subjects exhibited an awareness of the relationship between the classroom lectures on ethics and clinical practice.ConclusionThe results suggest the need for analyzing the ethical viewpoints of student nurses, prior learning, and collaboration with related courses as part of ethics education in clinical practice.

Application research of Four Topics method in the clinical ethics training of standardized resident training

Due to the insufficient education of medical ethics and tending to medical moral education, the residents lack the ability to make ethical decisions. Therefore, we applied Four Topics method in the clinical ethics training of residents. The clinical ethics training was divided into three stages, and each stage had different training content and objectives. Dongyang People's Hospital adopted the form of lectures and panel discussions. During the group discussion, the group leader was in charge of case preparation, which came from clinical practice, and then all members applied the Four Topics method to analyze and discuss the ethical conflicts, and make the ethical decision. Through this process, residents' ability to solve ethical problems in clinical practice was enhanced. Key words: Four topics method; Clinical ethics; Ethical decision; Standardized resident training

Nursing students' experiences of ethical issues in clinical practice: A New Zealand study

Nursing students experience ethical problems in clinical practice in a different way from registered nurses. In order to develop ethical reasoning and competence in nursing students, nurse educators must recognise the unique issues students face. This research described the occurrence of ethical issues in clinical practice for 373 undergraduate nursing students who responded to a national questionnaire investigating the frequency of pre-determined ethical issues and the corresponding level of distress. Over two thirds of respondents experienced breaches of a patient's right to confidentiality, privacy, dignity or respect and 87% experienced unsafe working conditions. The most distressing issues were those that compromised patient safety, including unsafe healthcare practices, working conditions and suspected abuse or neglect. Themes that emerged from an open-ended question included lack of support and supervision, bullying and end of life issues. This research found the frequency at which ethical issues are experienced was highest in year three participants. However, the overall distress levels were lower for the majority of issues for those participants in the later part of their degree. Recommendations from this research include developing ethics education around the main concerns that students face in order to enhance students' understanding, resilience and ability to respond appropriately.

Jack of all trades, master of none? Challenges facing junior academic researchers in bioethics

The rise of a ‘new’ empirical bioethics, which aims to ground normative judgments in ‘real-world’ data relating to different ethical problems in the biomedical sciences, has been well-documented in recent years. – 7 Indeed, the journal Clinical Ethics was established as a valuable forum for the dissemination of research that embraced an empirical approach to the exploration of ethical problems in clinical practice. For postgraduates who see themselves as engaging in bioethics research, these developments present both a real opportunity to adopt a broad range of disciplinary perspectives in exploring their chosen topic, and a series of challenges in producing rigorous and respected work that might lead to an established academic career. The breadth of the field called ‘bioethics’ is well-suited to postgraduate research. At this level, researchers have a great degree of freedom to draw on different theoretical and methodological traditions in developing projects that address new problems in different ways. Indeed, one might say that this freedom to explore and experiment with different perspectives is what makes undertaking a PhD so special. However, this process of experimentation is also conducive to producing identity crises. When asked to describe the work that we do, we might respond by saying, for example, that it has a social scientific, a philosophical, a legal and a psychiatric component. When asked how these components integrate, or when called to account on the basis of the quality of our research by supervisors, reviewers or examiners, we have an uneasy sense that everything might unravel around us, our projects amounting to less than the sum of their parts.

Clinical Ethics Committees

This article describes a recent development in the way in which ethical problems in clinical practice are being dealt with. The development of a network of Clinical Ethics Committees (CECs) across the UK is described, and the rationale for their emergence is explored. With the aid of a case example, two of the main methods available to CECs for analysis of cases referred to them are illustrated. A contrast is drawn between psychological and 'medical ethical' responses to the case example.

The Bioethics of Business: Rethinking the Relationship between Bioethics Consultants and Corporate Clients

What in the hell's happened to you George? said when saw him. His right arm was bandaged to the shoulder, the crook of his left arm looked like overdone bacon, his lips were blistered, his nose was shiny with grease and swollen out of shape and his right ear was red and thickened. They want me to go back to work, he They told me if didn't go back wouldn't get paid. want to see you. (1) George--the central character in William Carlos Williams' story Paid Nurse--is speaking with his Earlier in the day he had been cleaning metal disks by rinsing them in a pail of flammable solvent and placing them in a two hundred degree oven. He knew this was dangerous work, but his boss insisted. George describes the events that followed: I hadn't hardly started when, blup! it happened ... smelt burnt hair and cloth and saw my gloves blazing. His co-workers put out the flames and took him to the nurse. She called the [company] doctor but he didn't come any nearer than six feet from me. That's not very bad, he said. The nurse agreed with the doctor, put tannic acid on George's fight arm, and demanded he go back to work. by the way, she said, don't go to any other doctor. (2) Williams' account of George's mistreatment at the hands of caregivers on the company payroll is instructive for those watching how the pharmaceutical industry is working with bioethicists. Williams does not suggest that the nurse and doctor were greedy people, anxious to render diagnoses favorable to the company in exchange for money. In fact, Williams tells us nothing about the character of the caregivers; instead, he focuses our attention on the way financial incentives color medical judgment and constrain behavior. Paid Nurse shows us how the financial arrangements of caregiving shape the care given. Is the advice bioethicists give to the drug and medical device industries also shaped by the way bioethicists are paid? Clearly, bioethicists are not naive about the way money, can influence scholarly work and medical advice--witness the large bioethical literature on conflicts of interest and the efforts of bioethicists to structure their consulting relationships to minimize the role of money in shaping their recommendations. Examples of the latter include: the use of disclosure, complex schemes for funding ethics advisory boards, and the designation of the money for project support as an unrestricted rather than as funding for work with an agreed-upon deliverable. Unfortunately, none of these arrangements solves the conflict of interest problem. Lacking consensus on what must be disclosed, disclosure can be nothing more than an empty ritual. Innovative funding schemes, such as irrevocable trusts that prevent a company from disbursing the funding depending on how much k likes the bioethicists' advice, are a step in the right direction, (3) but they must be very carefully crafted to efface the potential tensions of serving two masters--of being ethical advisor to the corporation and advocate for the experimental subject. And to a sociologist, the designation of project funding as a gift creates problems of obligation that can be more severe than those written into contracts. (4) Because of the private nature of bioethics consultation, we know very little about how ethicists are selected, what advice is given, what issues are fired, what rationales are raised and discarded, or how interests are balanced. In a few instances, however, bioethicists have offered descriptions of their consulting work in peer-reviewed publications and on the web. Two such cases are particularly interesting. Both involve ethicists supported by funding from the drug company Eli Lilly; the fist involves the ethics of research, the second focuses on ethical problems in clinical practice. In the late 1990s, Eli Lilly faced an ethical problem. The public learned about Lilly's problem via an article in the Wall Street Journal that article described the company's use of homeless alcoholics for Phase trials of new drugs--trials designed to test a new drug's toxicity. …

Book Review: Ethical problems in clinical practice: the ethical reasoning of health care professionals

Book Review: Ethical problems in clinical practice: the ethical reasoning of health care professionals

Ethical problems in clinical practice: the ethical reasoning of health care professionals

Engaging the world - a defence of descriptive ethics the scientific status of qualitative research protective responsibility - a core notion in the ethical reasoning of health-care professionals ethical decision- making and the organization of health-care delivery from description to action.

Analysis of clinical bioethics teaching in pediatric surgery residency

Background/Purpose: Although clinical bioethics teaching (CBT) is not a required component of the essential curriculum for pediatric surgery residency, ethical considerations often accompany surgical decision making for infants and children. This study was designed to quantitate CBT during pediatric surgery residency (PSR) and to determine preferences about formal bioethics instruction. Methods: An 80-item questionnaire was mailed to 140 graduates of accredited PSR in the United States and Canada. Questions included demographic data, experience in CBT during and after PSR, preferred topics and teaching methods, and self-assessed and objective competency in bioethics. Results: The response rate was 78% (n = 109); 72% completed PSR between 1990 and 1995 (mean, 1991). Formal CBT within the curriculum of PSR was reported by 9% of respondents; lecture and consultation with an ethicist were the most frequent teaching methods. Informal CBT was noted by 88% of pediatric surgeons; observation of patient cases with ethical dilemmas was the primary mode of instruction. Quality of life, withholding/withdrawal of care, informed consent, child abuse, and economics ranked highest for most important CBT topics, while euthanasia, clinical research trials, and cultural diversity were given low priority. The preferred teaching methods were case-based discussions and consultation with an ethicist. Although 97% favored additional CBT in all postgraduate training, respondents who completed advanced study in medical ethics ( P < .05), were women ( P < .05), or were members of a hospital ethics committee ( P < .05) were more likely to advocate a standardized bioethics curriculum during PSR. A majority (86%) expressed competency in handling ethical problems in clinical practice, however, 47% gave incorrect responses or were unsure about routine bioethics questions. Conclusions: Formal instruction in clinical bioethics is not included in the curriculum of most residencies in pediatric surgery. Recent graduates of PSR favor case-based and practice-oriented teaching in clinical bioethics.

Ethics of treatment and research in psychiatry.

Most of the publications in the year under review have centered around dilemmas, particularly ethical problems in clinical practice. It has not, however, been a period of systematic theoretical work. In this review, a range of dilemmas which arise in clinical practice are discussed.

Establishing a Nursing Bioethics Committee

Nursing must keep pace with the technological revolution and radical new treatment modalities of patient care, many of which cause ethical dilemmas. To address the unique ethical concerns of staff nurses and managers, the authors discuss the development, implementation, and evaluation of a Nursing Bioethics Committee. The findings of a questionnaire measuring staff nurses' perceptions of the degree of difficulty and frequency of ethical problems in clinical practice are described. The benefits of the committee are presented from the perspective of staff nurses and nurse executives.

Ethics in behaviour therapy: historical aspects and current status.

Ethical problems in clinical practice arise when clinicians confront competing value systems. Historically, behaviour therapy has been criticized because of alleged special ethical, moral and legal problems. These problems are no greater or smaller than in other forms of psychotherapeutic practice. But they can differ in emphasis. This article describes partial responses to selected ethical dilemmas facing general psychotherapy, and outlines relatively novel issues raised by certain features of behavior therapy practice.

Ethical Problems in Clinical Practice: The Limits of Paternalism in Emergency Care

A forty-year-old man who had been stabbed in the chest was brought to the emergency room of a metropolitan hospital by the police. He was bleeding and his blood pressure was low. A physician applied manual pressure to the wound and administered fluid intravenously to restore blood volume. When the pressure was released to allow a surgeon to inspect the wound, bleeding immediately resumed, and pressure was reapplied. The patient was told that an artery had been cut and that he needed an immediate, potentially life-saving operation to tie the bleeding vessel and to determine whether there was a more serious, underlying injury. To everyone's surprise, the patient would not consent to the operation. Holding up his left hand to show three flexed and immobile fingers, he said that ten years earlier he had agreed, against his better judgment, to an operation on his hand. Now the hand was useless. He did not be-

Ethical Problems in Clinical Practice: A Hostile Patient: Fighting Ire with Ire

But, of course, neither perinatologists nor philosophers will ever satisfactorily answer such a question. Its importance lies not in its being answered, but in its being asked. Perinatologists, as physicians, are called to improve the quality of newborn life and enable its potential to flourish. They are not called to be either saviors of every threatened life or workers of miracles as wondrous as birth itself.

Ethical Problems in Clinical Practice: Critical Illness: The Limits of Autonomy

MI r. D, a previously healthy sixtysix-year-old black man, came to a university hospital emergency room with his wife and described a three-day history of sore throat, muscle aches, fevers, chills, cough, sputum production, and blood in his urine. The patient was acutely ill with a high fever, shortness of breath, and a limited attention span. A chest X ray demonstrated a generalized pneumonia in both lungs. The clinical impression was that Mr. D was critically ill, that the cause of his lung disease was obscure, and that a low platelet count and blood in the urine were ominous signs. He was treated aggressively with three antibiotics in an effort to cure his pneumonia. The next day his condition worsened. After reviewing the available clinical and laboratory data, the physicians caring for this man recommended that two uncomfortable but relatively routine diagnostic procedures be performed: a bronchial brushing to obtain a small sample of lung tissue to determine the cause of the pneumonia and a bone marrow examination to determine whether an infection or cancer was invading the bone marrow. The patient refused these diagnostic procedures. Separately, and together, the intern, resident, attending physician, and chaplain explained that 'these diagnostic tests were necessary to help the physicians formulate rational treatment plans. Mr. D became angry and agitated by this prolonged pressure, and subsequently began refusing even routine blood tests and X rays. A psychiatrist who evaluated Mr. D concluded that although he was obviously ill and had a degree of mental impairment manifested by poor memory, he was not mentally incompetent. The psychiatrist thought that the patient understood the severity of his illness and the reasons the physicians were recommending certain tests, but that he was still making a rational choice in refusing the tests. The patient's condition deteriorated further and twenty-four hours later he appeared near death. I was the attending physician, and it was my opinion that the only treatment left was to place Mr. D on a respirator as a stopgap measure that might sustain him for another day or two, during which time the antibiotics and antituberculosis drugs might become effective. Mr. D refused. The physicians expressed considerable disagreement on whether Mr. D was sufficiently rational to refuse a potentially life-saving treatment. In an effort to resolve this controversy, I spent two forty-five-minute periods at his bedside and explained as clearly as I could the reasons for our recommendations. I said that if he survived this crisis he would be able to return to a normal life and