Questions about the dignity of the human person give rise to
many of the most central and hotly disputed topics in bioethics. In
A Defense of Dignity: Creating Life, Destroying Life, and
Protecting ...the Rights of Conscience , Christopher Kaczor
investigates whether each human being has intrinsic dignity and
whether the very concept of "dignity" has a useful place in
contemporary ethical debates. Kaczor explores a broad range of
issues addressed in contemporary bioethics, including whether there
is a duty of "procreative beneficence," the ethics of ectopic
pregnancy, and the possibility of "rescuing" human embryos with
human wombs or artificial wombs. A Defense of Dignity also
treats issues relevant to the end of life, including
physician-assisted suicide, provision of food and water to patients
in a persistent vegetative state, and how to proceed with organ
donation following death. Finally, what are the duties and
prerogatives of health care professionals who refuse in conscience
to take part in activities that they regard as degrading to human
dignity? Should they be forced to do what they consider to be
violations of the patient's well being, or does patient autonomy
always trump the conscience of a health care professional? Grounded
in the Catholic intellectual and moral tradition, A Defense of
Dignity argues that all human beings from the beginning to the
end of their lives should be treated with respect and considers how
this belief should be applied in controversial cases.
Objective
To describe health‐care personnel's (HCP's) perceptions of the ethical climate at their workplace in paediatric oncology.
Methods
A cross‐sectional survey was conducted using the Swedish ...version of the shortened Hospital Ethical Climate Survey (HECS‐S). HCP at all six paediatric oncology centres (POCs) in Sweden were invited to participate. Analysis included descriptive statistics, the Mann‐Whitney U test (differences between groups) and Spearman's rank correlation. Informed consent was assumed when the respondents returned the survey.
Results
A high response rate was achieved as 278 HCP answered the questionnaire. Medical doctors perceived the ethical climate to be more positive than registered nurses and nursing assistants. At the POC with the significantly lowest values concerning immediate manager, no significant correlation with the other items was found. At the POC with the poorest ethical climate, HCP also had the lowest perception of the possibility of practicing ethically good care.
Conclusions
Differences between centres and professional groups have been demonstrated. A negative perception of the immediate manager does not necessarily mean that the ethical climate is poor, but the manager's ability to provide the conditions for an open dialogue within the health‐care team is key to achieving an ethical climate.
Background
Many hospitalized adults do not have the capacity to make their own health care decisions and thus require a surrogate decision-maker. While the ethical standard suggests that decisions ...should focus on a patient’s preferences, our study explores the principles that surrogates consider most important when making decisions for older hospitalized patients.
Objectives
We sought to determine how frequently surrogate decision-makers prioritized patient preferences in decision-making and what factors may predict their doing so.
Design and Participants
We performed a secondary data analysis of a study conducted at three local hospitals that surveyed surrogate decision-makers for hospitalized patients 65 years of age and older.
Main Measures
Surrogates rated the importance of 16 decision-making principles and selected the one that was most important. We divided the surrogates into two groups: those who prioritized patient preferences and those who prioritized patient well-being. We analyzed the two groups for differences in knowledge of patient preferences, presence of advance directives, and psychological outcomes.
Key Results
A total of 362 surrogates rated an average of six principles as being extremely important in decision-making; 77.8% of surrogates selected a patient well-being principle as the most important, whereas only 21.1% selected a patient preferences principle. Advance directives were more common to the
patient preferences
group than the
patient well-being
group (61.3% vs. 44.9%; 95% CI: 1.01–3.18;
p
= 0.04), whereas having conversations with the patient about their health care preferences was not a significant predictor of surrogate group identity (81.3% vs. 67.4%; 95% CI: 0.39–1.14;
p
= 0.14). We found no differences between the two groups regarding surrogate anxiety, depression, or decisional conflict.
Conclusions
While surrogates considered many factors, they focused more often on patient well-being than on patient preferences, in contravention of our current ethical framework. Surrogates more commonly prioritized patient preferences if they had advance directives available to them.
Biomedical research is increasingly globalized with ever more research conducted in low and middle-income countries. This trend raises a host of ethical concerns and critiques. While community ...engagement (CE) has been proposed as an ethically important practice for global biomedical research, there is no agreement about what these practices contribute to the ethics of research, or when they are needed.
In this paper, we propose an ethical framework for CE. The framework is grounded in the insight that relationships between the researcher and the community extend beyond the normal bounds of the researcher-research participant encounter and are the foundation of meaningful engagement. These relationships create an essential "human infrastructure" - a web of relationships between researchers and the stakeholder community-i.e., the diverse stakeholders who have interests in the conduct and/or outcomes of the research. Through these relationships, researchers are able to address three core ethical responsibilities: (1) identifying and managing non-obvious risks and benefits; (2) expanding respect beyond the individual to the stakeholder community; and (3) building legitimacy for the research project.
By recognizing the social and political context of biomedical research, CE offers a promising solution to many seemingly intractable challenges in global health research; however there are increasing concerns about what makes engagement meaningful. We have responded to those concerns by presenting an ethical framework for CE. This framework reflects our belief that the value of CE is realized through relationships between researchers and stakeholders, thereby advancing three distinct ethical goals. Clarity about the aims of researcher-stakeholder relationships helps to make engagement programs more meaningful, and contributes to greater clarity about when CE should be recommended or required.
Belmont Report principles focus on the well-being of the research subject, yet community-engaged investigators often eschew the role of subject for that of participant. We conducted semistructured ...interviews with 29 community and academic investigators working on 10 community-engaged studies. Interviews elicited perspectives on ethical priorities and ethical challenges. Interviewees drew on the Belmont Report to describe 4 key principles of ethical community-engaged research (embodying ethical action, respecting participants, generalizing beneficence, and negotiating justice). However, novel aspects of the participant role were the source of most ethical challenges. We theorize that the shift in ethical focus from subject to participant will pose new ethical dilemmas for community-engaged investigators and for other constituents interested in increasing community involvement in health research.
Machine learning, artificial intelligence, and other modern statistical methods are providing new opportunities to operationalise previously untapped and rapidly growing sources of data for patient ...benefit. Despite much promising research currently being undertaken, particularly in imaging, the literature as a whole lacks transparency, clear reporting to facilitate replicability, exploration for potential ethical concerns, and clear demonstrations of effectiveness. Among the many reasons why these problems exist, one of the most important (for which we provide a preliminary solution here) is the current lack of best practice guidance specific to machine learning and artificial intelligence. However, we believe that interdisciplinary groups pursuing research and impact projects involving machine learning and artificial intelligence for health would benefit from explicitly addressing a series of questions concerning transparency, reproducibility, ethics, and effectiveness (TREE). The 20 critical questions proposed here provide a framework for research groups to inform the design, conduct, and reporting; for editors and peer reviewers to evaluate contributions to the literature; and for patients, clinicians and policy makers to critically appraise where new findings may deliver patient benefit.
Between 15 and 60% of patients are considered "difficult" by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed "difficult." But the ...prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as a response to problematic interactions related to health care delivery. If there are grounds to reconceive the "difficult" patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.
We build on limited research concerning the mediation processes associated with the relationship between ethical culture and employee outcomes. A multidimensional measure of ethical culture was ...examined for its relationship to overall Person-Organization (P-O) fit and employee response, using a sample of 436 employees from social economy and commercial banks in Spain. In line with previous research involving unidimensional measures, ethical culture was found to relate positively to employee job satisfaction, affective commitment, and intention to stay. New to the literature, ethical culture was also found to be associated positively with employee willingness to recommend the organization to others. These effects were observed even when perceptions of P-O fit were controlled. Importantly, ethical culture was also positively related to overall P-O fit, which in turn, partially mediated the relationship between ethical culture and employee outcomes. Our findings add to studies that focus on the importance of the degree of ethical congruence between the individual employee and the organization. They suggest that ethical culture, with its expected impact on virtuousness and emotional well-being, will positively influence outcomes independently of the degree to which there is a match between employee and organizational values.
Photography and electronic media are indispensable tools for dental education and clinical practice. Although previous research has focused on privacy issues and general strategies to protect patient ...privacy when sharing clinical photographs for educational purposes, there are no published recommendations for developing a functional, privacy‐compliant institutional framework for the capture, storage, transfer, and use of clinical photographs and other electronic media. The aims of this study were to research patient rights relating to electronic media and propose a framework for the use of patient media in education and clinical care. After a review of the relevant literature and consultation with the University of Washington's director of privacy and compliance and assistant attorney general, the researchers developed a privacy‐compliant framework to ensure appropriate capture, storage, transfer, and use of clinical photography and electronic media. A four‐part framework was created to guide the use of patient media that reflects considerations of patient autonomy and privacy, informed consent, capture and storage of media, and its transfer, use, and display. The best practices proposed for capture, storage, transfer, and use of clinical photographs and electronic media adhere to the health care code of ethics (based on patient autonomy, nonmaleficence, beneficence, justice, and veracity), which is most effectively upheld by a practical framework designed to protect patients and limit institutional liability. Educators have the opportunity and duty to convey these principles to students who will become the next generation of dentists, researchers, and educators.
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