scholarly journals A Crisis in Chronic Pain Care: An Ethical Analysis Part Two: Proposed Structure and Function of an Ethics of Pain Medicine

2008 ◽  
Vol 5;11 (10;5) ◽  
pp. 589-595 ◽  
Author(s):  
James Giordano
Keyword(s):  
Virtue Ethics ◽  
Ethical Issues ◽  
Current System ◽  
Moral Agent ◽  
Applied Ethics ◽  
Pain Patient ◽  
Pain Medicine ◽  
Key Words Pain ◽  
And Function ◽  
Pain Care

In this paper, we propose a constructive approach to an ethics of pain medicine that is animated by a core philosophy of medicine as specific and focal to the uniqueness of pain, the pain patient, and the pain clinician. This philosophy of pain medicine 1) defines the nature of pain, 2) recognizes the variability and subjectivity of its expression in the pain patient, 3) acknowledges and explicates the vulnerabilities rendered by pain, 4) describes the inherent characteristics and asymmetries of the patient-clinician relationship, and 5) defines the ends of pain care. That these ends entail the provision of “good” care links the epistemic domains of pain medicine to its anthropologic focus and ethically sound conduct. We posit that an ethics of pain medicine should define the profession and sustain the practice. Facts establish (the need for) certain duties and rules of pain medicine. These emphasize the duty to self and others, and an appreciation for relational asymmetries, and dictates that those who enter the profession of pain medicine should be generally aligned with this set of core practical and ethical affirmations and duties. To maintain contemporary relevance, rules, duties, and moral reasoning must adjust to changing conditions. Applied ethics shape the practice within the infrastructure of core rules and duties of the profession. An applied ethics of pain medicine must be pragmatic, and therefore, cannot rely upon, or be reduced to, a single principle or ethical system. A number of ethical systems (such as the use of principles, utilitarianism, casuistry, feminist/ care orientations) all have relative merit and potential limitations. We argue that the obligation to recognize ethical issues, and utilize knowledge to best reflect appropriate moral values rests upon the clinician as a moral agent, and therefore advocate the relevance and importance of an agent-based virtue ethics, recognizing that virtue ethics cannot stand alone, but must be employed within a larger system of ethical intuition. Yet, if such a structure of normative and applied ethics is to be realized, moral consideration must guide evaluation of the current system of pain care, and provide direction for the development and implementation of therapeutically and ethically integrative pain medicine for the future. Key words: Pain medicine, normative ethics, applied ethics, deontology, virtue ethics, humanities

scholarly journals An Ethical Analysis of Crisis in Chronic Pain Care: Facts, Issues and Problems in Pain Medicine; Part I

2008 ◽  
Vol 4;11 (8;4) ◽  
pp. 483-490
Author(s):  
James Giordano
Keyword(s):  
Chronic Pain ◽  
Ethical Analysis ◽  
Legal Environment ◽  
Pain Medicine ◽  
Key Words Pain ◽  
Ethical Problems ◽  
And Function ◽  
Contemporary Practice ◽  
Pharmacologic Agents ◽  
Pain Care

We posit that in order to realistically, fully, and most positively affect the capability of implementing a more comprehensive paradigm of pain care it is necessary to: 1) recognize the complexity of chronic pain; 2) account for economic factors imposed upon the healthcare system, and 3) enable articulation of any paradigmatic revision within the contemporary medico-legal environment. Three primary ethical problems arise from the interaction(s) of these contingencies — namely 1) the under-treatment of pain, 2) the inappropriate over-utilization of pharmacologic agents and techniques, and 3) tensions and conflicts that develop within the relationships of pain medicine. All can lead to a failure of technically apt and ethically sound pain care. This essay — the first in a 3-part series — employs the method of ethical analysis to approach the circumstances, issues, questions, and problems of contemporary practice of pain medicine, to allow insight(s) to the facts, define the agents involved, appreciate how problems are generated, and develop more thorough evaluation and articulation of potential resolutions. We contend that resolution of these problems must offer practical responses to the circumstances and issues. Such practicality entails affording “good” in ways that are grounded to the facts and realities of situations, and are not merely theoretical or conceptual. Determining the “good” is the work of ethics — as systems and analyses of the moral decisional process. Ethics establishes norms and articulates their use in practice, and we opine that the distinction between the normative and applied is more of a continuum that is dependent upon case and circumstance(s). Given the variety of circumstances in the practice of pain medicine, no single ethical system would be totally adequate, and we believe a discursive approach to be most effective. Subsequent papers in this series will describe the systems, structure, and function of a putative ethical infrastructure of pain medicine, and will attempt to illustrate how these could be articulated within an integrative paradigm of pain care. Key words: Pain medicine, crisis, ethics, philosophy, sociology, humanities, chronic pain

scholarly journals Pain Assessment: Subjectivity, Objectivity, and the Use of Neurotechnology Part One: Practical and Ethical Issues

2010 ◽  
Vol 4;13 (4;7) ◽  
pp. 305-315 ◽  
Author(s):  
James Giordano
Keyword(s):  
Pain Assessment ◽  
Subjective Experience ◽  
Ethical Issues ◽  
Social Issues ◽  
Clinical Care ◽  
Pain Syndrome ◽  
Objective Evaluation ◽  
Pain Patient ◽  
Key Words Pain ◽  
The Right

The pain clinician is confronted with the formidable task of objectifying the subjective phenomenon of pain so as to determine the right treatments for both the pain syndrome and the patient in whom the pathology is expressed. However, the experience of pain — and its expression — remains enigmatic. Can currently available evaluative tools, questionnaires, and scales actually provide adequately objective information about the experiential dimensions of pain? Can, or will, current and future iterations of biotechnology — whether used singularly or in combination (with other technologies as well as observational-behavioral methods) — afford objective validation of pain? And what of the clinical, ethical, legal and social issues that arise in and from the use — and potential misuse — of these approaches? Subsequent trajectories of clinical care depend upon the findings gained through the use of these techniques and their inappropriate employment – or misinterpretation of the results they provide — can lead to misdiagnoses and incorrect treatment. This essay is the first of a two-part series that explicates how the intellectual tasks of knowing about pain and the assessment of its experience and expression in the pain patient are constituent to the moral responsibility of pain medicine. Herein, we discuss the problem of pain and its expression, and those methods, techniques, and technologies available to bridge the gap between subjective experience and objective evaluation. We address how these assessment approaches are fundamental to apprehend both pain as an objective, neurological event, and its impact upon the subjective experience, existence, and expectations of the person in pain. In this way, we argue that the right use of technology — together with inter-subjectivity, compassion, and insight — can sustain the good of pain care as both a therapeutic and moral enterprise. Key words: pain, assessment, neurotechnology, biotechnology, neuroethics, medicine

scholarly journals Digital Media Ethics

2017 ◽  
Author(s):  
Charles Ess
Keyword(s):  
Digital Media ◽  
Hate Speech ◽  
Ethical Issues ◽  
Moral Agent ◽  
Applied Ethics ◽  
Developed Countries ◽  
Media Ethics ◽  
Everyday Lives ◽  
Computing Technologies ◽  
The People

Since the early 2000s, Digital Media Ethics (DME) has emerged as a relatively stable subdomain of applied ethics. DME seeks nothing less than to address the ethical issues evoked by computing technologies and digital media more broadly, such as cameras, mobile and smartphones, GPS navigation systems, biometric health monitoring devices, and, eventually, “the Internet of things,” as these have developed and diffused into more or less every corner of our lives in the (so-called) developed countries. DME can be characterized as demotic—of the people—in three important ways. One, in contrast with specialist domains such as Information and Computing Ethics (ICE), it is intended as an ethics for the rest of us—namely, all of us who use digital media technologies in our everyday lives. Two, these manifold contexts of use dramatically expand the range of ethical issues computing technologies evoke, well beyond the comparatively narrow circle of issues confronting professionals working in ICE. Three, while drawing on the expertise of philosophers and applied ethics, DME likewise relies on the ethical insights and sensibilities of additional communities, including (a), the multiple communities of those whose technical expertise comes into play in the design, development, and deployment of information and communication technology (ICT); and (b), the people and communities who use digital media in their everyday lives. DME further employs both ancient ethical philosophies, such as virtue ethics, and modern frameworks of utilitarianism and deontology, as well as feminist ethics and ethics of care: DME may also take, for example, Confucian and Buddhist approaches, as well as norms and customs from relevant indigenous traditions where appropriate. The global distribution and interconnection of these devices means, finally, that DME must also take on board often profound differences between basic ethical norms, practices, and related assumptions as these shift from culture to culture. What counts as “privacy” or “pornography,” to begin with, varies widely—as do the more fundamental assumptions regarding the nature of the person that we take up as a moral agent and patient, rights-holder, and so on. Of first importance here is how far we emphasize the more individual vis-à-vis the more relational dimensions of selfhood—with the further complication that these emphases appear to be changing locally and globally. Nonetheless, DME can now map out clear approaches to early concerns with privacy, copyright, and pornography that help establish a relatively stable and accepted set of ethical responses and practices. By comparison, violent content (e.g., in games) and violent behavior (cyber-bullying, hate speech) are less well resolved. Nonetheless, as with the somewhat more recent issues of online friendship and citizen journalism, an emerging body of literature and analysis points to initial guidelines and resolutions that may become relatively stable. Such resolutions must be pluralistic, allowing for diverse application and interpretations in different cultural settings, so as to preserve and foster cultural identity and difference. Of course, still more recent issues and challenges are in the earliest stages of analysis and efforts at forging resolutions. Primary issues include “death online” (including suicide web-sites and online memorial sites, evoking questions of censorship, the right to be forgotten, and so on); “Big Data” issues such as pre-emptive policing and “ethical hacking” as counter-responses; and autonomous vehicles and robots, ranging from Lethal Autonomous Weapons to carebots and sexbots. Clearly, not every ethical issue will be quickly or easily resolved. But the emergence of relatively stable and widespread resolutions to the early challenges of privacy, copyright, and pornography, coupled with developing analyses and emerging resolutions vis-à-vis more recent topics, can ground cautious optimism that, in the long run, DME will be able to take up the ethical challenges of digital media in ways reasonably accessible and applicable for the rest of us.

scholarly journals A Crisis in Chronic Pain Care: An Ethical Analysis. Part Three: Toward an Integrative, Multi-disciplinary Pain Medicine Built Around the Needs of the Patient

2008 ◽  
Vol 6;11 (12;6) ◽  
pp. 775-784 ◽  
Author(s):  
James Giordano
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Treatment ◽  
The United States ◽  
High Tech ◽  
Pain Medicine ◽  
Specific Patient ◽  
Key Words Pain ◽  
Medical Needs ◽  
Pain Care

A number of variables have contributed to the current crisis in chronic pain care and are affected by, and affect, the philosophies and politics that influence the socio-economic climate of the American healthcare system. Thus, we posit that managing the crisis in chronic pain care in the United States is contingent upon the development of a multi-focal healthcare paradigm that more thoroughly enables and fortifies research, its translation (in education and practice), and the implementation of, and support for, both the curative and healing approaches in medicine in general, and pain care specifically. These steps necessitate re-examination, if not revision of the health care system and its economics. The ethical imperative to consider and prudently employ cutting-edge diagnostic and therapeutic technologies in pain medicine is obligatory. However, “supply side prudence” is of little value if “demand side accessibility” is lacking. Revisions to health insurance plans advocated by the in-coming administration seek to create uniformity in basic health care services based upon re-assessment of the clinical effectiveness (versus merely cost) of treatments, including those that are “high tech.” These plans attempt to allow every patient a more complete ability to deliberatively work with physicians to access those services and resources that maximize health functioning and goals. But even given these revisions, authentic pain care must take into account the interactive contexts of the painient individual. The biopsychosocial model of chronic pain management may have significant practical and ethical worth in this regard. A system of pain treatment operating from a biopsychosocial perspective necessitates integrative multi-disciplinarity. We propose a tiered, multi-disciplinary paradigm based upon the differing needs of each specific patient. But establishing such a system does not guarantee access, and distribution of these services and resources requires economic support to ensure that capabilities are more broadly available (i.e., supplied), and afforded as needed and wanted (i.e., demanded). Toward this end, we posit the need to focus upon, and more fully integrate 1) education, 2) multi-disciplinary care (including re-vivification of MPCs), 3) policies that allow financial subsidies that afford patients the latitude to access and utilize such expanded resources appropriately to meet identified medical needs, and 4) medico-legal initiatives and statutes that protect and enable patients and physicians. The proposed changes comport with a number of ethical systems in that they support the basic deontic structure of the profession and allow for a richer, more finely grained articulation of clinical and ethical responsibilities within the scope of particular general, specialty, and sub-specialty practices. Key words: Pain medicine, ethics, policy, integrative care, multi-disciplinary pain care

scholarly journals Diagnosing Inherited Platelet Disorders: Modalities and Consequences

2021 ◽  
Author(s):  
Carlo Zaninetti ◽  
Martina Wolff ◽  
Andreas Greinacher
Keyword(s):  
Hematological Malignancies ◽  
Ethical Issues ◽  
Diagnostic Delay ◽  
Bleeding Tendency ◽  
Platelet Morphology ◽  
Laboratory Characterization ◽  
Platelet Disorders ◽  
And Function ◽  
Generation Sequencing

AbstractInherited platelet disorders (IPDs) are a group of rare conditions featured by reduced circulating platelets and/or impaired platelet function causing variable bleeding tendency. Additional hematological or non hematological features, which can be congenital or acquired, distinctively mark the clinical picture of a subgroup of patients. Recognizing an IPD is challenging, and diagnostic delay or mistakes are frequent. Despite the increasing availability of next-generation sequencing, a careful phenotyping of suspected patients—concerning the general clinical features, platelet morphology, and function—is still demanded. The cornerstones of IPD diagnosis are clinical evaluation, laboratory characterization, and genetic testing. Achieving a diagnosis of IPD is desirable for several reasons, including the possibility of tailored therapeutic strategies and individual follow-up programs. However, detailed investigations can also open complex scenarios raising ethical issues in case of IPDs predisposing to hematological malignancies. This review offers an overview of IPD diagnostic workup, from the interview with the proband to the molecular confirmation of the suspected disorder. The main implications of an IPD diagnosis are also discussed.

scholarly journals Office Procedures in Cosmetic Gynaecology

2021 ◽  
Vol 4 (1) ◽  
pp. 446-454
Author(s):  
Anagnostou N ◽  
Gkrozou F ◽  
Ioannidi L ◽  
Papadimitriou A ◽  
Tsonis O
Keyword(s):  
Body Image ◽  
Side Effects ◽  
Cosmetic Surgery ◽  
Ethical Issues ◽  
Structure And Function ◽  
Female Population ◽  
And Function ◽  
Female Genital Cosmetic Surgery ◽  
Office Procedures ◽  
Female Genital

Female genital cosmetic surgery is a set of multiple procedures focused on improving genital appearance, structure, and function. Sexual dysfunction affects a large proportion of the female population and appears to be associated with distorted genital anatomy although what women perceive as normal varies vastly depending on cultural and social beliefs. Cosmetic gynaecology office procedures are simple, quick, and effective solutions to improve sexual function as well as body image with minimal interventions and minimal side-effects. In this narrative review, we present these widely used minimally invasive aesthetic gynaecology interventions, focusing on their efficacy, and reported complications. Recommendations regarding heath professionals’ approach and ethical issues arising are also discussed.

Legal ethics

2018 ◽  
Author(s):  
Richard Tur
Keyword(s):  
Conflict Of Interest ◽  
Ethical Issues ◽  
Applied Ethics ◽  
Legal Ethics ◽  
Role Morality ◽  
The Third ◽  
Integral Element ◽  
Principles And Standards ◽  
Set Up

Legal ethics can be considered from at least three related viewpoints. First, as ‘professional ethics’, it is a corpus of rules, principles and standards, often embodied in a written code and disseminated, applied and enforced by appropriate governing bodies as a guide to the professional conduct of lawyers. Legal professions set up specific institutions and officers to monitor and assist practitioners and to accumulate experience and expertise in applying detailed provisions in morally complex situations. For some commentators this is primarily regulation or administration and not ethics at all, but for others it is ethics in action or ‘applied ethics’. ‘Applied ethics’ is the second aspect of legal ethics, distinguished from ethics in general by the focus on ethical issues in the context of legal practice, including confidentiality, conflict of interest or acting for a morally disreputable client. Interesting though such questions may be in themselves, some writers do not acknowledge that they are truly questions of ethics, because the duties and privileges of specialist functional groups generally and lawyers in particular are not universalizable. For others, including some feminist ethicists, the ‘agent as such’ does not exist and we all encounter moral difficulties and problems, if we encounter them at all, only in the context of some specific relationship or role, for example in the role of a lawyer. Legal ethics thus requires an analysis of role morality. The third aspect of legal ethics is as an integral element in general philosophical and legal education.

7. Contraception, Abortion, and Pregnancy

2020 ◽  
pp. 320-411
Author(s):  
Jonathan Herring
Keyword(s):  
Pregnant Women ◽  
Criminal Law ◽  
Teenage Pregnancy ◽  
Legal Status ◽  
Ethical Issues ◽  
Tort Liability ◽  
Unborn Child ◽  
The Law ◽  
And Function ◽  
Legal Interventions

This chapter examines the legal and ethical aspects of contraception, abortion, and pregnancy. Topics discussed include the use and function of contraception; the availability of contraception; teenage pregnancy rates; tort liability and contraception; ethical issues concerning contraception; the law on abortion; the legal status of the foetus; abortion ethics; and controversial abortions. A major current issue is the extent to which, if at all, the criminal law should be involved in the law of abortion. The chapter also considers arguments on legal interventions for pregnant women; for example, imprisoning a drug-using mother to ensure that her unborn child does not suffer from the consequences of her drug use.

scholarly journals Virtue ethics: an approach to moral dilemmas in nursing

Curationis ◽  
2005 ◽  
Vol 28 (3) ◽  
Author(s):  
E Arries
Keyword(s):  
Decision Making ◽  
Virtue Ethics ◽  
Moral Agent ◽  
Moral Dilemma ◽  
Moral Dilemmas ◽  
Moral Decision Making ◽  
Whistle Blowing ◽  
Moral Principles ◽  
Principles Of Justice ◽  
The One

Nurses are increasingly confronted with situations of moral difficulty, such as not to feed terminally ill patients, whistle blowing, or participation in termination of pregnancy. Most of these moral dilemmas are often analyzed using the principle-based approach which applies the four moral principles of justice, autonomy, beneficence, and nonmalificence. In some instances, consequentialism is considered, but these frameworks have their limitations. Their limitations has to do with a consideration for the interpersonal nature of clinical nursing practice on the one hand, and is not always clear on how to judge which consequences are best on the other hand. When principles are in conflict it is not always easy to decide which principle should dominate. Furthermore, these frameworks do not take into account the importance of the interpersonal and emotional element of human experience. On the contrary, decision making about moral issues in healthcare demands that nurses exercise rational control over emotions. This clearly focuses the attention on the nurse as moral agent and in particular their character. In this article I argue that virtue ethics as an approach, which focus of the character of a person, might provide a more holistic analysis of moral dilemmas in nursing and might facilitate more flexible and creative solutions when combined with other theories of moral decision-making. Advancing this argument, firstly, I provide the central features of virtue ethics. Secondly I describe a story in which a moral dilemma is evident. Lastly I apply virtue ethics as an approach to this moral dilemma and in particular focusing on the virtues inherent in the nurse as moral agent in the story.

Ethical issues in the substance abusing pain patient

2014 ◽  
pp. 399-407
Author(s):  
Ike Eriator ◽  
Lori Hill Marshall ◽  
Donald Penzien
Keyword(s):  
Ethical Issues ◽  
Pain Patient ◽  
Substance Abusing
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