Resolution Of Ethical Dilemmas Research Articles

An Online COVID-19 Simulation to Explore Interprofessional Collaboration and Foster Systems Leadership Competencies in Doctor of Nursing Practice Students

Organizational and systems leadership, a competency for doctor of nursing practice students, encompasses the evaluation of care delivery systems, accountable care of populations, and resolution of ethical dilemmas. Faculty created an online simulation in which students developed a management proposal for an impending pandemic. All students agreed or strongly agreed that the simulation increased their skills in systems-based thinking, increased their knowledge of others' roles and responsibilities in addressing health care crises, and enabled them to balance ethical considerations and societal interests. Online simulations are a feasible, cost-effective method to foster systems leadership competency and ethical decision-making in doctoral students.

Resolution of Ethical Dilemmas Using Basic Ethical Principles in Cases of Pregnancy with Severe Symptoms of Coronavirus Disease 2019 Complications

BACKGROUND: Coronavirus disease 2019 (COVID-19) can attack the entire population, but is more aggressive in vulnerable populations such as the elderly, patients with chronic diseases, and pregnant women. For pregnant women, the management of COVID-19 treatment provided must be in line with efforts to reduce maternal mortality. The method of this study was a case report. A pregnant woman aged 40 years who was confirmed with severe COVID-19 symptoms. This patient had severe symptomatic hypoxemia and had a hypercoagulable state. Termination of pregnancy in patients is considered for the sake of fetomaternal safety so that an ethical dilemma arises. For this reason, a joint conference was held to get the best solution for the patient and the fetus. CASE REPORT: Using several basic ethical principles such as beneficence, nonmaleficence, justice, and autonomy, which are supported by the principles of minus malum, double effect, and prima facie, it was decided for the patient to terminate pregnancy to reduce severe symptoms of COVID-19. Termination of pregnancy in pregnant women with confirmed COVID-19 with severe symptoms is still an ethical dilemma that needs to be discussed further. Therefore, ethical considerations in this patient were carried out by reviewing obstetric, pediatric, pulmonology, anesthesia, and internal medicine indications. CONCLUSION: Termination of pregnancy in this patient with confirmed COVID-19 with severe symptoms can be done. Although termination of pregnancy has not completely saved the mother’s condition, this decision has the potential to provide benefits and safety for the patient and the fetus.

COVID-19 underscores the important role of Clinical Ethics Committees in Africa

BackgroundThe COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa.MethodsTwenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses.ResultsKenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: (1) Lack of formal CECs and resolution of ethical dilemmas; (2) Role of CECs during COVID-19; (3) Ethical dilemmas presented to CECs pre-COVID-19; (4) Lack of awareness of CECs; (5) Lack of qualified bioethicists or clinical ethicists; (6) Limited resources to establish CECs; (7) Creating interest in CECs and networking.ConclusionsThis study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services (CESs) in the region. The study results have triggered an idea for the creation of a network of African CECs.

La responsabilità giuridica nella Consulenza Etica in Ambito Sanitario

Scopo del presente contributo è delineare il perimetro entro il quale articolare una riflessione critica relativa alla questione della responsabilità giuridica connessa all’attività di Consulenza Etica in Ambito Sanitario (CEAS). Innanzitutto, saranno illustrate le ragioni per le quali ritenere che, al momento attuale, in Italia, la CEAS resa da un Consulente Etico singolo rappresenti il modello che meglio risponde all’esigenza di garantire un servizio di qualità ai pazienti e agli operatori sanitari. In secondo luogo, saranno analizzati gli elementi in base ai quali possa considerarsi ascrivibile in capo al Consulente Etico una responsabilità giuridica per violazione di una norma civile o penale. Infine, a partire dall’analisi dell’evoluzione giurisprudenziale e degli interventi legislativi di riforma in ambito sanitario, verrà avanzata una proposta in ordine alla disciplina applicabile all’operato del Consulente Etico in caso di danno procurato al paziente. Alla luce di quanto esposto, si tenterà di sostenere come il formale riconoscimento, anche giuridico, della figura del Consulente Etico possa risultare funzionale sia a dare contenuto all’effettivo ruolo svolto dal consulente nel processo di cura, sia a incentivare la stessa diffusione della cultura della CEAS, intesa come processo dialogico che ha lo scopo di contribuire al miglioramento dell’assistenza sanitaria mediante l’individuazione, l’analisi e la risoluzione dei dilemmi etici riconducibili alla pratica clinica.

Resolución 8430 de 1993: ¿Responde a las necesidades actuales de la ética en investigación en salud con seres humanos en Colombia?

Verifying compliance with ethical principles of health research legitimizes it in society and allows the resolution of ethical dilemmas that emerge from new research concerns and methods. Resolution 8430 of 1993 is one of the main ethical guidelines that governs health research on human beings in Colombia. Considering that the resolution has not been revised or updated since its promulgation, it becomes necessary to evaluate its currency and sufficiency to address the potential ethical dilemmas in the existing country’s health research. Some gaps, contradictions and aspects that require a deep review are detailed in this paper, assuming a wide conception of health research areas and methods. After discussing the main weaknesses and inaccuracies, some alternative are proposed, so that the resolution can answer to the actual needs in health research with human beings.

Effective Resolution of Ethical Dilemmas in Social Enterprise Organizations: A Moral Philosophy and Public Management Approach

Public service ethics can provide social enterprise organizations (SEOs) with a means of complementing business ethics. Many public service ethics scholars recognize that internal and external ethics sources combine to create stronger ethical guidelines for public servants. This study argues that the classical deontological and teleological debate can provide a useful understanding of ethics as well. Combining the internal/external spectrum with the deontological/teleological spectrum of ethical sources to create four categories for understanding sources of ethical resolutions, this study uses ethnomethodology to find that SEO managers expend fewer resources resolving ethical dilemmas when they reference ethical sources from multiple categories. The study finds that SEO managers who have access to multiple sources of ethics develop more confidence in potential resolutions, and are thus able to dedicate more resources to achieving mission-oriented outcomes.

Ethical dilemmas and tricky decisions: A global perspective of coaching supervisors’ practices in coach ethical decision-making

This paper examines ethical dilemmas and tricky decision-making among coaching supervisors internationally. Supervisors were selected for the first study in this wider project due to the pivotal role they play in coaching practice and the resolution of ethical dilemmas. The research reveals that ethical decision-making is an under-developed area of research given coaching’s growth as an intervention. The study argues that coaching needs to develop an alternative perspective on coach confidentiality, with greater consideration to the circumstances when ‘confidentiality’ can be broken, greater use of contracting and improved coach and coach supervisor training in ethics, ethical sensitivity and ethical decision-making.

Association between perceived level of autonomy and perceived behavioural control over resolving ethical dilemmas: A large N cross-sectional survey of Canadian civil servants

Inspired by the theory of planned behaviour (Ajzen 1991), this study examines the relationship between the perceived level of autonomy among civil servants and their perceived behavioural control over the resolution process of work-related ethical dilemmas. To this end, we used a subset of the data from the 2008 Statistics Canada Public Service Employee Survey (PSES). This cross-sectional survey was conducted between November 3 and December 12, 2008. Approximately 170,000 employees responded to the survey, representing 66 percent of the 258,000 employees invited to participate. In summary, the perceived level of autonomy index is positively associated with the perceived behavioural control over the resolution of ethical dilemmas, as was theoretically expected.

Students' responses to scenarios depicting ethical dilemmas: a study of pharmacy and medical students in New Zealand

One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond...

Emerging Practices of Counseling and Psychotherapy in China: Ethical Dilemmas in Dual Relationships

A qualitative study was conducted with 48 Chinese counselors and psychotherapists who were interviewed in 2006 and an independent sample of 50 participants who responded to a survey in 2014. This study aims to explore how the new emerging expansion of mental health practice is related to issues and challenges of dual role relationship and how the well-engrained values and social characteristics of Chinese culture influences perceptions and resolution of ethical dilemmas. The participants identified similar dual relationships in 2006 and 2014: (a) Incidental boundary crossings, a sexual or romantic relationship, a dual social relationship, and a professional dual relationship were the most frequently reported types of dual relationships encountered by Chinese practitioners, and (b) the socioeconomic and cultural context and the development trajectory of counseling and psychotherapy in China play a significant role in shaping practitioners’ behaviors. The comparison of the data in 2006 and 2014 indicated that practitioners in psychotherapy and counseling have an improved awareness and understanding of ethical issues, evidenced by the decreasing cases of romantic and sexual relationships and increasing cases of social dual relationships influenced by the interrelatedness of traditional Chinese culture.

I don't know why I called you.

This case study details a request from a patient family member who calls our service without an articulated ethical dilemma. The issue that arose involved the conflict between continuing further medical interventions versus transitioning to supportive or palliative care and transferring the patient home. Beyond the resolution of the ethical dilemma, this narrative illustrates an approach to ethics consultation that seeks practical resolution of ethical dilemmas in alignment with patient goals and values. Importantly, the family's suffering is addressed through a relationship driven, humanistic approach that incorporates elements of compassion, empathy and dialog.

Nursing and the resolution of ethical dilemmas.


 Inherent to Nursing Care, ethical dimension includes having to decide about the dilemmas that arise in practice. Experience shows that generally we do not have a reference and then sufficient training to judge the ethical quality of our decisions and actions, reason why, in this article some methods are introduced that will facilitate this ethical analysis when faced with a conflict or dilemma that warrants it.

Empirical and theory-driven investigations of the Canadian Code of Ethics for Psychologists.

This article summarizes empirical and theoretical research focusing on the structure and content of the Canadian Code of Ethics for Psychologists (Canadian Psychological Association [CPA], 1986, 1991, 2000). Functional grammar and content analyses show that, compared to other codes, the CPA code is written in a way that is empowering for the decision-maker. Moreover, it is more likely than other codes of ethics to provide a rationale for ethical behaviour. Preliminary support for the hierarchical organisation of the ethical principles of the CPA code exists but more research is needed to determine if the hierarchy leads to more consistent decision-making in the resolution of ethical dilemmas. Recommendations for future research directions are outlined. Keywords: CPA code, ethical principles, ethics, Canadian Psychological Association Resume Cet article resume les recherches empiriques et theoriques portant sur la structure et la teneur du Code canathen de deontologie professionnelle des psychologues (Societe canathenne de psychologie [SCP], 1986, 1991, 2000). Des analyses de grammaire fonctionnelle et du contenu revelent que, en comparaison d'autres codes de deontologie, celui de la SCP est redige de facon a habiliter le decideur. En outre, plus que d'autres codes, il est susceptible de fournir un fondement au comportement ethique. Il existe deja un appui a l'organisation hierarchisee des principes de deontologie du Code de la SCP, mais il faudra d'autres etudes pour determiner si une telle hierarchisation mene a une plus grande uniformite dans les decisions relatives a la solution de dilemmes ethiques. Sont mises de l'avant des recommandations quant a l'orientation de futures etudes. Mots-cles : code de la SCP, principes de deontologie, ethique, Societe canathenne de psychologie. Although the development of the original version of the Canadian Code of Ethics for Psychologists (CCEP, CPA, 1986; 1991; 2000) was based, to a considerable extent, on empirically derived information (Sinclair, Poizner, Gilmour-Barrett, & Randall, 1987), research on the code itself has been relative sparse. The goal of this article is to review the research that has been conducted on the various versions of the CCEP, to generate recommendations about the way in which research findings could inform future revisions of the code and to point toward unanswered questions that could be empirically investigated. The Original Empirical Basis of the CCEP As Sinclair et al. (1987) pointed out, the CCEP was originally designed to reflect the collective wisdom of Canadian psychologists. As such, original development work commenced with the creation of 37 vignettes representing hypothetical ethical dilemmas. The dilemmas were based on issues stressed in the code of ethics of the American Psychological Association (APA, 1977). Moreover, these dilemmas were designed to reflect pertinent issues in psychological practice, situations involving conflict between ethical principles as well as innovative but untested approaches. Psychologists with expertise in research and teaching assisted with the development of vignettes relating to areas outside professional practice (C. Sinclair, personal communication, June 23, 1998). Each vignette was followed by six questions that were designed to elicit self-accepted ethical principles (e.g., is your choice of action? Why? What would be the minimal circumstance you can conceive in this situation that would lead to a different choice of action? What would that action be? Why?). Invitations to participate were extended to 400 psychologists. While most of them were selected at random, a significant portion was invited because they were known to have a special interest in ethics (C. Sinclair, personal communication, June 23, 1998). Of those who were invited, 125 agreed to participate and were each sent two or four hypothetical dilemmas. In all, 59 responses were received. …

The Impact of Ethical Orientation and Gender on Final Year Undergraduate Auditing Students' Ethical Judgments

This study considers the possibility of auditing students' ethical judgment being affected by two factors, namely ethical orientation and gender. While tests revealed that more idealistic students judged some unethical situations more strictly than did less idealistic students, overall no significant relationship was found between ethical orientation and ethical judgment. The study also reported no significant relationship between gender and ethical judgment. Furthermore, males were as likely as females to be classified as high idealists. Overall, the findings from the current study inform auditing educators that discriminating among students on the basis of ethical orientation and gender may not assist in stimulating students' discussion and resolution of ethical dilemmas.

Teaching Ethics To Undergraduates: An Examination Of Contextual Approaches

Our purpose was to advance the current academic discussion on how to most effectively teach managerial ethics at the undergraduate level. We argued that undergraduate ethics education should be comprehensive, multi-dimensional and woven into the fabric of each student’s experience. In particular, we hypothesized that the inclusion of service-learning experiences and a rigorous honor system would lead to better identification and resolution of ethical dilemmas. A survey of 304 undergraduates from four colleges and universities yielded modest support for our hypotheses. In conclusion, we discuss possible explanations for the results and avenues for future studies.

751 Quality of Life as a Decision Criterion on Health Care (Ethical Ponderation)

The “Quality of Life”, although to be a subjective concept, is frequently used as criterion in the resolution of problems of the clinical practice, nominated in situations of ethical dilemmas in pediatric intensive care units, being able to take the orientation directions that do not dignify the human being. One of the aims of this research is to perceive as “Quality of Life” criterion is used in the resolution of ethical dilemmas in the clinical practice, having for purpose that the health professionals became aware on the use of this criterion and the potential effects of its use in the clinical practice. 152 nurses, attending post-graduation courses in the Oporto High School of Nursing had been inquired about the professional situations where they have been collated with decisions based on the “quality of life” and about the appreciation of the ethical questions raised by these decisions. After content analysis was verified that the told situations are centered in diverse areas as surgical and therapeutic decisions, do not reanimate orders, institution of measures of life advanced support, decisions on internment/ discharge and the nursing care plan, among others, and excites questions that are related to bioethical principles: autonomy, justice, beneficence, nonharming, human being dignity and respect, among others, and still with attitudes morally improper as the excessive therapy and the lack of attention to the rights of the sick people. The predominance of its occurrence seems to do itself with the situations of intensive and end of life care.

Dilemmas in Surgery: Medical Ethics Education in Surgery Rotation

Mount Sinai School of Medicine, New York, NYMount Sinai School of Medicine provides its studentswith a 4-year curriculum in medical ethics that ishorizontally and vertically integrated into the educa-tional program. In the first 2 years, as part of the Artsand Science of Medicine (ASM) course (ASM 1 andASM 2), students participate in 6 ethics modules, thefirst 5 of which are designed to provide them withan understanding of the basic concepts of medicalethics. Sessions focus on professionalism, fiduciaryresponsibility, truth telling and informed consent,autonomy, surrogate decision making, justice, andresearch ethics. Through readings, minilectures, pan-els, sample cases, and small group discussions, thesessions provide students with the vocabulary andunderstanding to enable them to navigate the ethicalissues of clinical practice. The final module of thesecond year presents students with a model of clin-ical moral reasoning to be used in the resolution ofethical dilemmas.

Ethics Education, Television, and Invisible Nurses

Televised medical dramas often fail to include the nursing role in resolution of ethical dilemmas. Since the nursing role is portrayed inaccurately, excerpts from these dramas should not be include...

Incorporating Cultural Issues in Education for Ethical Practice

The population of most non-dominant ethnic groups in the USA is growing dramatically. Faculty members are challenged to develop curricula that adequately prepare our future nurses. An increased focus on clinical ethics has resulted from the use of sophisticated technology, changes in health care financing, an increasing elderly population and the shift of care from inpatient to outpatient settings. Nurses frequently face situations demanding resolution of ethical dilemmas involving cultural differences. Nursing curricula must include content on both ethics and cultural sensitivity. Active student participation is an important element providing a foundation for ethical practice. A proposed educational format was introduced with graduating baccalaureate students. In a pilot study, curricular content on cultural sensitivity and ethical practice was taught in separate modules. Students were then asked to identify and problem solve an ethical dilemma involving patients and professional caregivers from vastly different cultures. Course faculty members provided discussion questions to guide the students' thinking.

Ethical dilemma and resolution: a case scenario

This article illustrates an ethical dilemma that I faced while treating an 86-year-old woman at her home. The ethical dilemma was caused due to several factors such as the expectations of the client (client/consumer rights), organisational expectations (employer, governmental and payer-source regulations) and my own personal values (one's moral philosophies, perceived social responsibilities, sense of professional duty) and how they all interact with each other. The case is a classic example of a seemingly simple yet frequent dilemma encountered by occupational and physical therapists in the United States serving clients who are covered by Medicare (the government's health insurance) for home health. The article is aimed at highlighting the various ethical principles involved in clinical decision-making, and it suggests methods for resolution of ethical dilemmas. Although the article is based against the backdrop of the US health care system, students and health care practitioners globally can relate to it.