Forensic patients, treating psychiatrist and the Mental Health Review Tribunal – An ethical question?

2019 ◽  
Vol 27 (5) ◽  
pp. 441-443
Author(s):  
Rajesh Maheshwari ◽  
Yvonne Skinner

Objective: In inpatient forensic settings, a psychiatrist is expected to wear ‘Two Hats’, as a treating physician and as an expert to provide risk assessments and expert advice to the judicial authorities for leave and release decisions. Although dual roles have long been accepted as an inevitable part of independent forensic practice, there are additional ethical challenges for the treating psychiatrist to provide an expert opinion. This paper examines the specific ethical ambiguities for a treating psychiatrist at the interface of legal process related to leave and release decisions in the treatment of forensic patients. Conclusions: While respect for justice is the prevailing ethical paradigm for court-related forensic work, the medical paradigm should remain the key ethical framework for psychiatrists in treatment settings. Thus, psychiatrist should be aware of possible adverse consequences in acting as forensic experts for their patients. A conscientious adherence to clinical facts and awareness of the ‘Two Hats’ ethical pitfall can serve as important reference points in framing the psychiatric evidence in the decision-making process and safeguard treating psychiatrist’s role.

2021 ◽  
pp. 875697282110377
Author(s):  
Mehrdad Sarhadi ◽  
Sogand Hasanzadeh

Ethical aspects of stakeholder behavior can have a wide range of implications for other areas of project management. This research critically reviewed project ethics under the philosophical paradigm change from modernism to late modernism, which led to a flexible and realizable ethical framework based on Levinasian and Nietzschean moral psychologies. A qualitative approach was adopted through a multiple-case study to confront the theoretical framework with the empirical world, evaluate its authenticity, and obtain a better understanding of its challenges. Research results showed that stakeholders’ unconscious desire for existential meaning can provide considerable potential for dealing with ethical challenges.


Author(s):  
Susan McHugh

In countless ways, plants have been in literature from the start. They literally provide surfaces and tools of inscription, as well as figuratively inspire a diverse body of writing that ranges from documenting changing social and ecological conditions to probing the limits of the human imagination. The dependence of human along with all other life on vegetal bodies assures their omnipresence in literatures across all periods and cultures, positioning them as ready reference points for metaphors, similes, and other creative devices. As comestibles, landscape features, home décor, and of course paper, plants appear in the pages of virtually every literary text. But depictions of botanical life in action often prove portentous, particularly when they remind readers that plants move in mysterious ways. At the frontiers of ancient and medieval European settlements, the plant communities of forests served as vital sources of material and imaginative sustenance. Consequently, early modern literature registers widespread deforestation of these alluring and dangerous borderlands as threats to economic and social along with ecological flourishing, a pattern repeated through the literatures of settler colonialism. Although appearing in the earliest of literatures, appreciation for the ways in which plants inscribe stories of their own lives remains a minor theme, although with accelerating climate change an increasingly urgent one. Myths and legends of hybrid plant-men, trees of life, and man-eating plants are among the many sources informing key challenges to representing plants in modern and contemporary literature, most obviously in popular genre fictions like mystery, horror, and science fiction (sf). Further enlightening these developments are studies that reveal how botanical writing emerges as a site of struggle from the early modern period, deeply entrenched in attempts to systematize and regulate species in tandem with other differences. The scientific triumph of the Linnaean “sexual system” bears a mixed legacy in feminist plant writing, complicated further by Black, Indigenous, and People of Color (BIPOC) writers’ creative engagements with the unevenly felt consequences of professionalized plant science. Empowered by critical plant studies, an interdisciplinary formation that rises to the ethical challenges of emergent scientific affirmations of vegetal sentience, literature and literary criticism are reexamining these histories and modeling alternatives. In the early 21st century with less than a fraction of 1 percent of the remaining old growth under conservation protection worldwide, plants appear as never before in fragile and contested communal terrains, overshadowed by people and other animals, all of whose existence depends on ongoing botanical adaptation.


Children ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 20 ◽  
Author(s):  
Bethan Everson ◽  
Kelly A. Mackintosh ◽  
Melitta A. McNarry ◽  
Charlotte Todd ◽  
Gareth Stratton

Wearable cameras combined with accelerometers have been used to estimate the accuracy of children’s self-report of physical activity, health-related behaviours, and the contexts in which they occur. There were two aims to this study; the first was to validate questions regarding self-reported health and lifestyle behaviours in 9–11-year-old children using the child’s health and activity tool (CHAT), an accelerometer and a wearable camera. Second, the study sought to evaluate ethical challenges associated with taking regular photographs using a wearable camera through interviews with children and their families. Fourteen children wore an autographer and hip-worn triaxial accelerometer for the waking hours of one school and one weekend day. For both of these days, children self-reported their behaviours chronologically and sequentially using the CHAT. Data were examined using limits of agreement and percentage agreement to verify if reference methods aligned with self-reported behaviours. Six parent–child dyads participated in interviews. Seven, five, and nine items demonstrated good, acceptable, and poor validity, respectively. This demonstrates that the accuracy of children’s recall varies according to the behaviour or item being measured. This is the first study to trial the use of wearable cameras in assessing the concurrent validity of children’s physical activity and behaviour recall, as almost all other studies have used parent proxy reports alongside accelerometers. Wearable cameras carry some ethical and technical challenges, which were examined in this study. Parents and children reported that the autographer was burdensome and in a few cases invaded privacy. This study demonstrates the importance of adhering to an ethical framework.


2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Michelle T. Nguyen ◽  
Laurence B. McCullough ◽  
Frank A. Chervenak ◽  
Kathryn J. Shaw ◽  
Dominique Luckey

Abstract Background A fetal diagnosis poses ethical challenges when a woman requests elective cesarean delivery for psychosocial reasons. We address the ethical challenges of counseling such patients. Case presentation A 36-year-old G4P2012 has chosen to continue a pregnancy despite a high likelihood of trisomy 18. At 36.5 weeks she was admitted for preeclampsia with severe features and requested to be delivered by primary cesarean section. Due to the poor prognosis associated with trisomy 18, the patient’s request for cesarean delivery was declined even when her baby changed to breech presentation with Category 2 fetal heart rate (FHT). The patient subsequently experienced a traumatic stillbirth and post-traumatic shock disorder (PTSD). Conclusion The obstetrician’s goal should be to transform the patient’s request into an informed decision. The obstetrician should explain that, while a cesarean could increase the likelihood of a live birth, it will not alter long-term neonatal outcomes and entails net biomedical risk for the current and future pregnancies. The obstetrician should ensure that the patient understands these clinical realities. The obstetrician should support the patient’s decision-making about whether to accept the risks of cesarean delivery for psychosocial benefit. The obstetrician should initiate counseling during prenatal visits to empower the patient with information to meaningfully exercise her autonomy. If the patient makes an informed decision for cesarean delivery, it becomes ethically permissible. Plans regarding intrapartum management and mode of delivery should be documented in case the patient is delivered by a physician who was not involved in prenatal counseling.


2018 ◽  
Vol 63 (5) ◽  
pp. 584-603 ◽  
Author(s):  
Naomi Hossain ◽  
Patta Scott-Villiers

Participatory research studies utilizing qualitative data drawn from large, diverse samples appear increasingly common in the social sciences, particularly in international development. This reflects demand for participatory approaches to researching human well-being at scale, comparative research on globalization and development, and breadth and scale in evidence-based policy making. “Big Qual” studies in international development increasingly combine qualitative with participatory methods and incorporate action research, oral histories, case studies, and visual methods. Apart from their scale (more sites and research participants than conventional “face-to-face” research) and diversity of contexts, these studies broadly share a focus on application, and an epistemological and ideological commitment to hearing and amplifying the voices of research participants and contributing to positive change in their lives. Some ethical challenges of Big Qual research—for example, reuse, storage, and sharing of third party data—have been thoroughly debated. Less is known of how complexities across time, space, and culture may shape researcher relations in large-scale participatory research, biasing results against context-specificity and meaningful local political analysis. Drawing on almost a decade’s experience with large participatory research, this article explores why and how scale, encompassing a complex network of institutions, relationships, contexts, and cultures, affects the ethics of these studies. We propose that Bradbury and Reason’s (2001) five criteria for judging the value and contribution of social inquiry are helpful: (a) the quality of relationships built, (b) the usefulness of the research, (c) its trustworthiness, (d) its relevance to vital issues of human society, and (e) its enduring consequence. Drawn from an action research tradition, these criteria constitute a comprehensive ethical framework particularly applicable to Big Qual participatory work in development studies. Through an empirical application of these criteria, the article highlights emerging ethical challenges facing applied social research in increasingly complex, multiscalar, and globalized contexts.


Author(s):  
Frank A. Chervenak ◽  
Laurence B. McCullough

Obstetric clinical practice, innovation, and research should be guided by professional ethics in obstetrics. In this chapter, the authors distinguish professional medical ethics from medical ethics and bioethics. They set out an ethical framework for obstetrics based on the invention of professional medical ethics by two eighteenth-century physician-ethicists, John Gregory (1724–1773) and Thomas Percival (1740–1804). Professional ethics in obstetrics appeals to the ethical principles of beneficence and respect for autonomy and the ethical concept of the fetus as a patient. This framework is deployed to provide ethically justified, practical guidance about two ethical challenges in obstetric practice: the professionally responsible role of nondirective counseling of pregnant women about induced abortion and the professionally responsible role of directive counseling about planned home birth. This framework is also deployed to provide ethically justified, practical guidance about professionally responsible obstetric innovation and research for fetal benefit.


1994 ◽  
Vol 26 (1) ◽  
pp. 28-37
Author(s):  
Robert Hayes ◽  
Alan Langley ◽  
William Greer

2020 ◽  
Vol 48 (9) ◽  
pp. 867-873
Author(s):  
Frank A. Chervenak ◽  
Laurence B. McCullough ◽  
Amos Grünebaum ◽  
Eran Bornstein ◽  
Cihat Sen ◽  
...  

AbstractThe goal of perinatal medicine is to provide professionally responsible clinical management of the conditions and diagnoses of pregnant, fetal, and neonatal patients. The New York Declaration of the International Academy of Perinatal Medicine, “Women and children First – or Last?” was directed toward the ethical challenges of perinatal medicine in middle-income and low-income countries. The global COVID-19 pandemic presents common ethical challenges in all countries, independent of their national wealth. In this paper the World Association of Perinatal Medicine provides ethics-based guidance for professionally responsible advocacy for women and children first during the COVID-19 pandemic. We first present an ethical framework that explains ethical reasoning, clinically relevant ethical principles and professional virtues, and decision making with pregnant patients and parents. We then apply this ethical framework to evidence-based treatment and its improvement, planned home birth, ring-fencing obstetric services, attendance of spouse or partner at birth, and the responsible management of organizational resources. Perinatal physicians should focus on the mission of perinatal medicine to put women and children first and frame-shifting when necessary to put the lives and health of the population of patients served by a hospital first.


2018 ◽  
Author(s):  
Lester Darryl Geneviève ◽  
Andrea Martani ◽  
Tenzin Wangmo ◽  
Daniela Paolotti ◽  
Carl Koppeschaar ◽  
...  

UNSTRUCTURED Advances in information technology are changing public health at an unprecedented rate. Participatory surveillance systems are contributing to public health by actively engaging digital (eg, Web-based) communities of volunteer citizens to report symptoms and other pertinent information on public health threats and also by empowering individuals to promptly respond to them. However, this digital model raises ethical issues on top of those inherent in traditional forms of public health surveillance. Research ethics are undergoing significant changes in the digital era where not only participants’ physical and psychological well-being but also the protection of their sensitive data have to be considered. In this paper, the digital platform of Influenzanet is used as a case study to illustrate those ethical challenges posed to participatory surveillance systems using digital platforms and mobile apps. These ethical challenges include the implementation of electronic consent, the protection of participants’ privacy, the promotion of justice, and the need for interdisciplinary capacity building of research ethics committees. On the basis of our analysis, we propose a framework to regulate and strengthen ethical approaches in the field of digital public health surveillance.


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