scholarly journals The Effect of Hierarchy on Moral Silence in Healthcare: What Can the Holocaust Teach Us?

Conatus ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 21
Author(s):  
Ashley K Fernandes ◽  
DiAnn Ecret
Keyword(s):  
Medical Education ◽  
Nursing Education ◽  
National Socialism ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Clinical Care ◽  
Negative Effects ◽  
Professional Students ◽  
Parallel Features

Physicians, nurses, and healthcare professional students openly (and in many cases, eagerly) participated in the medical atrocities of the Shoah. In this paper, a physician-bioethicist and nurse-bioethicist examine the role of hierarchical power imbalances in medical education, which often occur because trainees are instructed ‘to do so’ by their superiors during medical education and clinical care. We will first examine the nature of medical and nursing education under National Socialism: were there cultural, educational, moral and legal pressures which entrenched professional hierarchies and thereby commanded obedience in the face of an ever-diminishing individual and collective conscience? We will then outline relevant parallel features in modern medical education, including the effects of hierarchy in shaping ethical decision making and conscience formation. We then propose several solutions for the prevention of the negative effects of hierarchical power imbalances in medical education: (1) universal Holocaust education in medical and nursing schools; (2) formative and experiential ethics instruction, which teaches students to ‘speak up’ when ethical issues arise; (3) acceptance of, and adherence to, a personalistic philosophical anthropology in healthcare; (4) support for rigorous conscience protection laws for minority ethical views that respect the role of integrity without compromising patient care.

Death, taxes and uncertainty: Economic motivations in end-of-life decision making

2021 ◽  
pp. 147775092110114
Author(s):  
George Slade Mellgard ◽  
Jacob M Appel
Keyword(s):  
End Of Life ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Third Party ◽  
Ethical Conflicts ◽  
Financial Interests ◽  
End Of Life Decision ◽  
Death Taxes

Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests? Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.

Ethical issues in social marketing

2017 ◽  
Author(s):  
Lynne Eagle ◽  
Stephan Dahl ◽  
David Low
Keyword(s):  
Social Marketing ◽  
Financial Incentives ◽  
Potential Role ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Code Of Ethics ◽  
Ethical Challenges ◽  
Ethical Frameworks

Many social marketers assume that because they are focusing on positive behaviour change they may expect fewer ethical issues arising from their work than conventional, commercial marketing. However, such a view is sadly too simplistic. This chapter focuses on the ethical issues facing social marketing. It argues that social marketers face an even greater potential for ethical issues and gives examples of these by focusing on targeting, stigmatization, victim blaming, coercion, and the use of financial incentives, among others. Recognizing the manifold potential for ethical challenges, and the lack of a decisive manner in which to resolve them easily, it then discusses ethical frameworks which can aid social marketers in formulating a response to potential issues and arriving at a considered decision. The chapter concludes by discussing the potential role of a professional code of ethics, and how this can aid future ethical decision-making.

scholarly journals The role of prison nursing: an integrative review

2021 ◽  
Vol 23 (2) ◽  
pp. 76-85
Author(s):  
A Isaac Caro
Keyword(s):  
Nursing Education ◽  
Ethical Issues ◽  
Prison Population ◽  
Quality Care ◽  
Integrative Review ◽  
Ethical Implications ◽  
Review Period ◽  
Training Need

Objectives: To review the scientific literature on the role of the nurse in Penitentiary Institutions through the study of care training and ethical implications when offering quality care to the prison population. Material and method: An integrative review was carried out in Medline, SciELO and LILACS databases. The MeSH and DeCS terms used were: nurse’s role, nursing, nurse, nursing education, prison, ethics, ethical issues, job satisfaction, enfermeria, penitenciaria, health professionals, nursing care. The types of studies included in this work are literature reviews, and qualitative, quantitative and mixed studies. The CASPe tool was used to assess the methodological quality of selected literature. The review period was October, November and December 2019. Results: A total of 264 articles were obtained, of which 98 were chosen after applying filters corresponding to each database and after discarding duplicate articles. The title and abstract of these articles were read and the established selection criteria were applied, to obtain 18 studies. Finally, after critical reading, 15 articles were selected for this work. Discussion: The role of the prison nurse is generally unknown. Nursing undergraduate training in this area is limited, exposing a specific training need, which may help these professionals to deal with ethical issues that they may find in their practice, as well as to improve the quality of care for the prison population.

Ethical Issues in Treating Pain and Addiction (DRAFT)

2018 ◽  
Author(s):  
Christopher J. Spevak
Keyword(s):  
Ethical Decision Making ◽  
Ethical Issues ◽  
Human Subjects ◽  
Clinical Care ◽  
Hippocratic Oath ◽  
Treatment Programs ◽  
Ethical Challenges ◽  
Faith Based ◽  
History Of ◽  
History Of Medical Ethics

In addressing the ethical issues that arise in treating both pain and addiction, the author of this chapter has organized his presentation around: the history of medical ethics; theories and definitions; and the ethical challenges to providing clinical care. The theoretical underpinnings to ethical decision-making are important to providing the best possible outcome, and their evolution is described, from the Hippocratic Oath to current human subjects’ protection rules for clinical trials. The tension between patient autonomy and the physician’s obligation to protect is as high as that seen in parenthood, but commonly with even less control of the individuals involved. A framework is provided for examining clinical cases that aids in addressing such topics as treatment disagreement, confidentiality, informed consent, abandonment, pregnancy, and biases that may be seen with categorical treatment programs (e.g., abstinence-based, faith-based). A text box is added giving additional resources on the topics discussed.

Medical ethics in peacetime and wartime: the case for a better understanding

2013 ◽  
Vol 95 (889) ◽  
pp. 189-213 ◽  
Author(s):  
Vivienne Nathanson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Workers ◽  
Armed Conflict ◽  
Ethical Decision Making ◽  
Clinical Care ◽  
Clinical Intervention ◽  
Care Workers ◽  
The Common

AbstractHealth-care workers face ethical dilemmas in their decision-making in every clinical intervention they make. In times of armed conflict the decisions may be different, and the circumstances can combine to raise ethical tensions. This article looks at the tensions in peacetime and in times of armed conflict and examines the types of cases that doctors and other health-care workers will face. It also discusses the common ethical decision-making framework and the role of communication within both clinical care and ethical analysis.

Role of the Independent Donor Advocacy Team in Ethical Decision Making

2005 ◽  
Vol 15 (3) ◽  
pp. 298-302 ◽  
Author(s):  
Dianne LaPointe Rudow ◽  
Robert S. Brown
Keyword(s):  
New York ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
New York State ◽  
Direct Result ◽  
Donor Liver Transplantation ◽  
Living Liver Donors ◽  
Living Liver Donation ◽  
Liver Donors

Adult living donor liver transplantation has developed as a direct result of the critical shortage of deceased donors. Recent regulations passed by New York State require transplant programs to appoint an Independent Donor Advocacy Team to evaluate, educate, and consent to all potential living liver donors. Ethical issues surround the composition of the team, who appoints them, and the role the team plays in the process. Critics of living liver donation have questioned issues surrounding motivation and the ability of donors to provide true informed consent during a time of family crisis. This article will address issues surrounding the controversies and discuss how using the team can effectively evaluate and educate potential living liver donors and improve practice to ensure safety of living donors.

scholarly journals Spirituality Training as an Essential Element of Person-Centered Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 132-132
Author(s):  
Raya Kheirbek
Keyword(s):  
Spiritual Care ◽  
Cultural Sensitivity ◽  
Ethical Issues ◽  
Clinical Care ◽  
Critical Role ◽  
Essential Element ◽  
Spiritual Needs ◽  
Consensus Definition ◽  
Sensitivity Assessment

Abstract Palliative Medicine, built on the biopsychosocial-spiritual model of care, has long recognized the critical role of spirituality in the care of patients with complex, serious, and chronic illnesses. We conducted focus groups to arrive at a consensus definition of “spiritual care.” Additionally, we collected and compared frameworks and models that recognize that providers cannot be made compassionate simply through the imposition of rules; methods were needed to achieve behavior change. The created curricula covered the definitions of spiritual care, self-awareness, cultural sensitivity, assessment, and skills. As part of ongoing curriculum development processes, training included evaluation tools to accompany competency standards. Results demonstrated improvements in self- reported abilities to (a) establish appropriate boundaries with patients; (b) apply the concept of compassionate presence to clinical care; (c) understand the role of spirituality in professional life; (d) identify ethical issues in inter-professional spiritual care. Clinicians need to address patients’ spiritual needs.

Identifying and Addressing Ethical Issues with Use of Electronic Health Records

2018 ◽  
Vol 23 (1) ◽  
Author(s):  
Susan McBride ◽  
Mari Tietze ◽  
Catherine Robichaux ◽  
Liz Stokes ◽  
Eileen Weber
Keyword(s):  
Decision Making ◽  
Electronic Health Records ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Clinical Care ◽  
The United States ◽  
Unintended Consequences ◽  
Health Records ◽  
Electronic Health

With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, the United States, as of 2017, has achieved 95% saturation with electronic health records as a means to document healthcare delivery in acute care hospitals and guide clinical decision making. Evidence is mounting that EHRs are resulting in unintended consequences with patient safety implications. Clinical teams confront usability challenges that can present ethical issues requiring ethical decision-making models to support clinicians in appropriate action on behalf of safe, effective clinical care. The purpose of this article is to identify and address ethical issues raised by nurses in use of electronic health records. We provide a case scenario with application of the Four Component Model and describe a study of nurse experiences with the EHR. The nursing Code of Ethics, Nursing Scope and Standards, and Legal Implications are reviewed, and we conclude with recommendations and a call to action.

Confronting the grey zone after severe brain injury

2019 ◽  
Vol 3 (6) ◽  
pp. 707-711 ◽  
Author(s):  
Andrew Peterson ◽  
Adrian M. Owen
Keyword(s):  
Brain Injury ◽  
Ethical Issues ◽  
Vegetative State ◽  
Clinical Care ◽  
Grey Zone ◽  
Severe Brain Injury ◽  
New Methods ◽  
Legal Decision Making ◽  
Technological Developments ◽  
The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

Can trust become a factor of economic growth? Dynamic changes in the level of trust of Russian youth

2020 ◽  
pp. 92-107 ◽  
Author(s):  
A. I. Bakhtigaraeva ◽  
A. A. Stavinskaya
Keyword(s):  
Institutional Environment ◽  
Negative Effects ◽  
Dynamic Changes ◽  
Generalized Trust ◽  
Level Of Education ◽  
Advantages And Disadvantages ◽  
The Future ◽  
Analysis Of Dynamics

The article considers the role of trust in the economy, the mechanisms of its accumulation and the possibility of using it as one of the growth factors in the future. The advantages and disadvantages of measuring the level of generalized trust using two alternative questions — about trusting people in general and trusting strangers — are analyzed. The results of the analysis of dynamics of the level of generalized trust among Russian youth, obtained within the study of the Institute for National Projects in 10 regions of Russia, are presented. It is shown that there are no significant changes in trust in people in general during the study at university. At the same time, the level of trust in strangers falls, which can negatively affect the level of trust in the country as a whole, and as a result have negative effects on the development of the economy in the future. Possible causes of the observed trends and the role of universities are discussed. Also the question about the connection between the level of education and generalized trust in countries with different quality of the institutional environment is raised.

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