Violence against trainees: urgent ethical challenges for medical educators and academic leaders in perinatal medicine

2020 ◽  
Vol 48 (7) ◽  
pp. 728-732
Author(s):  
Rodrigo Ayala-Yáñez ◽  
Regina Ruíz-López ◽  
Laurence B. McCullough ◽  
Frank A. Chervenak
Keyword(s):  
Professional Ethics ◽  
Ethical Framework ◽  
Personal Safety ◽  
Ethical Challenges ◽  
Web Searches ◽  
Perinatal Medicine ◽  
Ethical Obligation ◽  
Academic Leaders ◽  
Critical Appraisal Tool ◽  
Medical Educators

AbstractObjectivesViolence against medical trainees confronts medical educators and academic leaders in perinatal medicine with urgent ethical challenges. Despite their evident importance, these ethical challenges have not received sufficient attention. The purpose of this paper is to provide an ethical framework to respond to these ethical challenges.MethodsWe used an existing critical appraisal tool to conduct a scholarly review, to identify publications on the ethical challenges of violence against trainees. We conducted web searches to identify reports of violence against trainees in Mexico. Drawing on professional ethics in perinatal medicine, we describe an ethical framework that is unique in the literature on violence against trainees in its appeal to the professional virtue of self-sacrifice and its justified limits.ResultsOur search identified no previous publications that address the ethical challenges of violence against trainees. We identified reports of violence and their limitations. The ethical framework is based on the professional virtue of self-sacrifice in professional ethics in perinatal medicine. This virtue creates the ethical obligation of trainees to accept reasonable risks of life and health but not unreasonable risks. Society has the ethical obligation to protect trainees from these unreasonable risks. Medical educators should protect personal safety. Academic leaders should develop and implement policies to provide such protection. Institutions of government should provide effective law enforcement and fair trials of those accused of violence against trainees. International societies should promulgate ethics statements that can be applied to violence against trainees. By protecting trainees, medical educators and academic leaders in perinatology will also protect pregnant, fetal, and neonatal patients.ConclusionsThis paper is the first to provide an ethical framework, based on the professional virtue of self-sacrifice and its justified limits, to guide medical educators and academic leaders in perinatal medicine who confront ethical challenges of violence against their trainees.

Professional Ethics in Obstetric Practice, Innovation, and Research

2021 ◽  
pp. 197-211
Author(s):  
Frank A. Chervenak ◽  
Laurence B. McCullough
Keyword(s):  
Medical Ethics ◽  
Professional Ethics ◽  
Home Birth ◽  
Ethical Framework ◽  
Ethical Challenges ◽  
Obstetric Practice ◽  
Ethical Concept ◽  
Practical Guidance ◽  
Planned Home Birth

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.

scholarly journals Professionally responsible advocacy for women and children first during the COVID-19 pandemic: guidance from World Association of Perinatal Medicine and International Academy of Perinatal Medicine

2020 ◽  
Vol 48 (9) ◽  
pp. 867-873
Author(s):  
Frank A. Chervenak ◽  
Laurence B. McCullough ◽  
Amos Grünebaum ◽  
Eran Bornstein ◽  
Cihat Sen ◽  
...  
Keyword(s):  
New York ◽  
Low Income ◽  
Ethical Framework ◽  
Low Income Countries ◽  
Ethical Challenges ◽  
Perinatal Medicine ◽  
World Association ◽  
Women And Children ◽  
Children First ◽  
International Academy

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.

A Qualitative Analysis of Unethical Behaviors in Projects: Insight From Moral Psychology

2021 ◽  
pp. 875697282110377
Author(s):  
Mehrdad Sarhadi ◽  
Sogand Hasanzadeh
Keyword(s):  
Ethical Framework ◽  
Paradigm Change ◽  
Ethical Challenges ◽  
Late Modernism ◽  
Wide Range ◽  
Unethical Behaviors ◽  
Multiple Case ◽  
Stakeholder Behavior ◽  
Unconscious Desire

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.

scholarly journals Can Wearable Cameras be Used to Validate School-Aged Children’s Lifestyle Behaviours?

Children ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 20 ◽  
Author(s):  
Bethan Everson ◽  
Kelly A. Mackintosh ◽  
Melitta A. McNarry ◽  
Charlotte Todd ◽  
Gareth Stratton
Keyword(s):  
Physical Activity ◽  
Self Report ◽  
Ethical Framework ◽  
Ethical Challenges ◽  
Lifestyle Behaviours ◽  
Wearable Camera ◽  
Parents And Children ◽  
Wearable Cameras ◽  
Health Related ◽  
Almost All

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.

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
Keyword(s):  
Reference Points ◽  
Ethical Framework ◽  
Expert Advice ◽  
Ethical Question ◽  
Ethical Challenges ◽  
Dual Roles ◽  
Forensic Patients ◽  
Forensic Practice ◽  
Medical Paradigm ◽  
Health Review

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.

School Psychologists and Ethical Challenges

2017 ◽  
Vol 34 (1) ◽  
pp. 48-61
Author(s):  
Maryanne Kapoulitsas ◽  
Tim Corcoran
Keyword(s):  
School Psychologists ◽  
Education System ◽  
Policy Development ◽  
Professional Ethics ◽  
Ethical Challenges ◽  
Ethical Practice ◽  
System A ◽  
State Education ◽  
Future Direction ◽  
Secondary State

This research explored how psychologists working in the Victorian secondary state school system construct meaning around ethical practice. The specific aims of the research were to examine psychologists understanding of ethics in practice within schools and to explore challenges they faced regarding professional ethics when working in the education system. A qualitative design was adopted to explore the topic. Five psychologists working in the Victorian state education system were interviewed, and the data were analysed using thematic analysis. Two themes presented from the transcripts: legalities and ethics and varied peer support. The psychologists reported having to confront often and repeated ethical challenges, but despite this, positioned themselves as ethical practitioners. Ethical practice was portrayed as a complex construct that is always socially and politically embedded. Subsequently, discussion on the topic should extend beyond the sole practitioner. The research provides future direction for policy development and workplace procedures, including access to professional supervision.

An ethical framework for counseling about mode of delivery for desired psychosocial benefit in pregnancies complicated by severe fetal anomalies

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Michelle T. Nguyen ◽  
Laurence B. McCullough ◽  
Frank A. Chervenak ◽  
Kathryn J. Shaw ◽  
Dominique Luckey
Keyword(s):  
Cesarean Delivery ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Traumatic Shock ◽  
Informed Decision ◽  
Trisomy 18 ◽  
Ethical Framework ◽  
Ethical Challenges ◽  
Fetal Diagnosis ◽  
Elective Cesarean

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.

The Oxford Handbook of Professional Economic Ethics

2014 ◽  
Keyword(s):  
Social Welfare ◽  
Professional Ethics ◽  
Institutional Design ◽  
Ethical Reasoning ◽  
Code Of Conduct ◽  
Policy Formation ◽  
Ethical Challenges ◽  
Economic Ethics ◽  
Economic Practice ◽  
Economics Profession

For more than a century, the economics profession has extended its reach to encompass policy formation and institutional design while largely ignoring the ethical challenges that attend the profession’s influence over the lives of others. Economists have proved to be disinterested in ethics, which, embracing emotivism, they often treat as a matter of preference, and hostile to professional economic ethics, which they incorrectly equate with a code of conduct that would be at best ineffectual and at worst disruptive to good economic practice. But good ethical reasoning is not reducible to mere tastes, and professional ethics is not reducible to a code. Instead, professional economic ethics refers to a new field of investigation—a tradition of sustained inquiry into the irrepressible ethical entailments of academic and applied economic practice. The risks and costs of establishing the field are real, but a profession that purports to enhance social welfare cannot avoid them.

Ethical and Methodological Issues in Large Qualitative Participatory Studies

2018 ◽  
Vol 63 (5) ◽  
pp. 584-603 ◽  
Author(s):  
Naomi Hossain ◽  
Patta Scott-Villiers
Keyword(s):  
Action Research ◽  
International Development ◽  
Participatory Research ◽  
Large Scale ◽  
Well Being ◽  
Ethical Framework ◽  
Human Society ◽  
Ethical Challenges ◽  
Research Participants ◽  
Time Space

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.

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