Ethics committees in health care institutions in the New York City metropolitan region: a report of two nursing surveys

Two surveys were conducted independently to ascertain whether health care institutions in the New York City metropolitan region currently have ethics committees and to gather information related to their functioning and use by nurses. Comparable findings in the overlapping samples suggest that approximately one-third of surveyed institutions do not have interdisciplinary ethics committees. Where the committees do exist, they may not be adequate to address nurses' ethical concerns.     

Why the professional-client ethic is inadequate in mental health care

Patients who are subject to compulsory care constitute a substantial proportion of the work-load of mental health professionals, particularly psychiatric nurses. This article examines the traditional 'beneficence-autonomy' approach to ethics in compulsory psychiatric care and evaluates it against the reality of daily practice. Risk to the public has always been an important but often unacknowledged consideration. Inequalities exist among ethnic and socio-economic groups and there is a lack of agreement on what constitutes mental disorder. Two major changes in compulsory psychiatric care--community orders and care for patients with untreatable severe personality disorders--further challenge the traditional ethical approach. There are also important human rights implications. The simple patient-health professional relationship no longer provides an adequate framework for mental health professionals on which to base their ethical decisions. The public and organizations may have different perspectives and their interests are becoming increasingly important. Mental health professionals, particularly psychiatric nurses, may face ethical dilemmas because of these different perspectives.     

Biomedical ethics committees

As a consequence of rapidly increasing and complex ethical dilemmas in medicine, health care institutions are responding by forming biomedical ethics committees. In this article, the authors review the origins, functions, and potential drawbacks of these committees and also make suggestions on starting these committees.     

The therapeutic dimension of research about spirituality: Particularities of cancer,mental health and infertility

Healthcare is moving from a biomedical paradigm into a holistic paradigm, which includes all dimensions and needs of patients and families. Health conditions may trigger a spiritual journey for believers or non‐believers bringing to light the nature of the human being and its vulnerable condition. Healthcare professionals are full participants in this life and health scenario and have an unquestionable duty related to the provision of spiritual care, on the basis of legislation, ethical codes, and on research evidence. Researchers are seizing better and broader knowledge about spirituality in healthcare, and research about this phenomenon is growing internationally. But, spirituality is considered complex, an area of intimacy and deep subjective meaning. These factors may raise some ethical concerns when submitting research projects to the ethics committees. In this paper, the authors share their experience in research about spirituality in the beginning of life issues/infertility and with adults with severe health conditions, and describe participants’ perspectives on research engagement.     

Identification of core ethical topics for interprofessional education in the intensive care unit: a thematic analysis

ABSTRACT

Medical educators have not identified effective approaches for interprofessional ethics education of clinicians who work in intensive care units (ICUs), in spite of the fact that ICUs have a high incidence of ethical conflicts. As a first step in designing an interprofessional ethics education initiative tailored to the needs of ICU team members, we interviewed 12 professionals from the medical and surgical ICUs of a tertiary care academic medical center to understand what they know about medical ethics. Respondents were interviewed between November 2016 and February 2017. We used the ‘think aloud’ approach and realist thematic analysis of the sessions to evaluate the extent and content of interprofessional team members’ knowledge of medical ethics. We found wide variation in their knowledge of and facility in applying the principles and concepts of biomedical ethics and ways of resolving ethical conflicts. Ethics education tailored to these areas will help equip critical care professionals with the necessary knowledge and skills to discuss and address ethical conflicts encountered in the ICU. Preventive ethics rounds are one approach for providing real-time, embedded interprofessional ethics education in the clinical setting.     

Abortion in modern health care: Considering the issues for health‐care professionals

This paper explores the challenging and contentious issue of abortion and its ethical, legal and political significance regarding public health. It is intended as an educational guide for health‐care professionals. A comprehensive search strategy of international health, law and political source materials was undertaken in order to benchmark from international approaches to abortion. Test cases illustrate the application of legislation, ethical, political and cultural issues surrounding abortion. Abortion is a complex contemporary issue where balancing the well‐being of both the mother and the unborn has prompted considerable international discourse. The right to life of the woman and the unborn continues to lie in tension. Ambiguity surrounds the concept of personhood, and the inception of human life prevails across many International jurisdictions. Health‐care professionals must be well informed in order to respond safely and appropriately to a diverse range of clinical scenarios in which decisions regarding abortion are required. Research and evidence of test cases will better inform how abortion issues evolve and are managed. Ultimately, the abortion debate requires a balance between legislation and clinical governance.     

Institutional ethics committees: a survey of children's hospitals

Institutional ethics committees first gained national prominence after the 1976 Karen Ann Quinlin decision by the New Jersey Supreme Court. However, it wasn't until the Federal Government promulgated the Baby Doe regulations in 1983 that significant movement occurred toward implementing such committees. Currently, statistics show that the number of ethics committees are increasing in health care institutions across the country. However, the majority of studies have focused on adult institutions. The membership of ethics committees and the objectives under which the committees function are usually addressed by the studies. Very little attention has been given to the nursing representation on the institutional ethics committee and the unique role played by nurses in the deliberation of ethical decision-making. It is the intent of this research to shed some light on the availability and functions of ethics committees within children's hospitals. Attention has also been given to the nurses' involvement on such committees. Additionally, the study takes a separate look at nursing ethics committees, their function within an institution, and the availability of ethics education for nurses. The study offers information not previously acknowledged in past studies of ethics committees. The study also opens up to consideration the unique concerns of nurses and their roles in ethical decision-making.     

Ethical values in health care: an Indian-Swedish co-operation

The aim of this report is to present an example of a multidisciplinary Indian-Swedish co-operation on ethics in health care. It is based on a conference held in Asia Plateau, Panchgani, Maharasthra, India in 1998. The emphasis is on ethical values that are important for consumers of health care and professionals, and also for different cultures in developed and developing countries. The importance of human dignity is stressed. Sixteen recommendations are given in an appendix.     

A tale of two studies: research governance issues arising from two ethnographic investigations into the organisation of health and social care

In a number of countries throughout the world attention is being paid to the ways in which health and social care research is undertaken and regulated. In the United Kingdom, new research governance frameworks are intended to promote improvement in research quality. This paper draws on our experiences of seeking research ethics committee approval for two investigations with the same research design, in order to address four governance issues: consistency within and between ethics committees; the assessment of vulnerable individuals regarding their suitability to participate in studies; the relationship between ethics and access; and ethics committee understanding of qualitative research.     

A comparison between the ethics of justice and the ethics of care

The parameters of the problem within which the principal aim of the present article will be addressed can be described as follows. When making ethical decisions there are different perspectives that health care professionals may use. This may lead to conflict and insufficient co-operation between the members of the health team. Two of these perspectives are the ethics of justice and the ethics of care. The ethics of justice constitutes an ethical perspective in terms of which ethical decisions are made on the basis of universal principles and rules, and in an impartial and verifiable manner with a view to ensuring the fair and equitable treatment of all people. The ethics of care, on the other hand, constitutes an ethical approach in terms of which involvement, harmonious relations and the needs of others play an important part in ethical decision-making in each ethical situation. To seek some sort of way of avoiding conflict and promoting a mutual understanding about ethical decisions in the health team, there is a need to examine the ethics of justice and ethics of care. In order to understand the ethics of justice and ethics of care, the purpose of this article is to compare the two ethical perspectives. It is argued that the ethics of justice and the ethics of care represent opposite poles. If the members of the health team were to use only one of these two perspectives in their ethical decision-making, certain ethical dilemmas would almost certainly remain unresolved. Both the fair and equitable treatment of all people (from the ethics of justice) and the holistic, contextual and need-centred nature of such treatment (from the ethics of care), ought therefore to be retained in the integrated application of the ethics of justice and the ethics of care.     

Developing ethical competence in health care organizations

Increased work complexity and financial strain in the health care sector have led to higher demands on staff to handle ethical issues. These demands can elicit stress reactions, that is, moral distress. One way to support professionals in handling ethical dilemmas is education and training in ethics. This article reports on a controlled prospective study evaluating a structured education and training program in ethics concerning its effects on moral distress. The results show that the participants were positive about the training program. Moral distress did not change significantly. This could be interpreted as competence development, with no effects on moral distress. Alternatively, the result could be attributed to shortcomings of the training program, or that it was too short, or it could be due to the evaluation instrument used. Organizational factors such as management involvement are also crucial. There is a need to design and evaluate ethics competence programs concerning their efficacy.     

Hospital ethics committees: is it time to expand our access to managed care organizations?

Hospital ethics committees provide important services to their institutions, often including review of clinical cases for which an ethical issue or dilemma has been recognized.Traditionally, such case reviews or consults by the ethics committee may be called by the patient and/or family and institutional healthcare providers. Recently, managed care organizations have requested an ethics committee case review at a Chicago area institution. This article will explore whether or not the time has come to expand hospital ethics committees access to managed care organizations.     

Nurses' ethical perceptions of health care and of medical clinical research: an audit in a French university teaching hospital

Very few data exist in France on: (1) nurses' knowledge and behaviour concerning ethical decisions in clinical practice; and (2) their knowledge of ethical rules in clinical research. This questionnaire-based audit tried mainly to assess these questions in a large French university teaching hospital. Of the 257 questionnaires distributed to nurses in 23 clinical units of the hospital, 206 were returned (80% response rate). When responding to the vignette describing a clinical situation requiring an ethical decision to be made, most nurses acted as the patient's advocate although they have had no formal training in ethics. Indeed, 66% of nurses responding considered that the patients themselves should be the primary decision makers in situations that relate to their health and medical care. For children or comatose patients, the decision should be left to the relatives according to 72% of the responses. The results indicated that the role of health care professionals in ethical decisions made for a given patient should be marginal. Nurses' knowledge concerning research protocols, particularly their ethical requirements and consequences, is poor at present and information from and communication with doctors should be improved.     

Ethical behaviours in clinical practice among Mexican health care workers

The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer to as ;dimensions of ethical practice'. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional-patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study's participants would help to improve quality of care.     

What to do when the end is near: ethical issues in home health care nursing

As managed care shortens the length of hospital stays, home settings for the practice of nursing will become increasingly important. In spite of community health nursing's long tradition of family-centered care delivered in the home, many discussions of the nurse/patient relationship in the medical ethics literature assume the hospital setting for the practice of nursing and seem to neglect the impact of family and significant others for the nurse/patient relationship. Through a case-based analysis, this article highlights the special ethical and legal issues encountered in caring for patients who are dying at home. This analysis demonstrates that traditional frameworks for the nurse/patient relationship are inadequate for capturing the richness of the relationship the home health care nurse has with both patient and family. By developing a new framework for the nurse/patient/family relationship that (a) recognizes the patient's decision-making authority and autonomy, (b) allows the exercise of the nurse's moral rights, and (c) recognizes the patient's relationships to significant others, the authors attempt to resolve some challenging legal and ethical questions concerning who should be allowed to decide what to do when the end is near. The discussion details the implications of this framework for nursing assessment in the home care setting.     

Health care,ethics, and information technologies

This essay explores how ethics, computing, and health care intersect in medical informatics. It discusses the power technology places in the hands of health care professionals and the ethical problems they may encounter as a result of that power.     

An integrated approach to ethical decision-making in the health team

When making ethical decisions there are different perspectives that health care professionals may use. This may lead to conflict and insufficient co-operation between the members of the health team. Two of these perspectives are the ethics of justice and the ethics of care. In a bid to gain a better understanding of the nature of ethical decision-making in the health team, a comparison was drawn between the ethics of justice and the ethics of care. The investigation into and comparison between the ethics of justice and the ethics of care revealed that the deficiencies in each of the two perspectives in isolation, in fact, necessitate the application of a combination of both perspectives. The aim of the article is to describe how the members of the health team can, in an integrated manner, apply both the ethics of justice and the ethics of care in their ethical decision-making. The central argument of the article is based on the following premises: (1) the inadequacy of the ethics of justice and the ethics of care in isolation necessitates that both these perspectives be applied; (2) the application of both these perspectives again requires an extended rationality and discourse and (3) discourse, in its turn, requires that the emphasis falls on a specific telos and that the participants in the discourse be endowed with certain virtues in order to abide by the rules of discourse.     

The ethics of care: role obligations and moderate partiality in health care

This article contends that an ethics of care has a particular moral ontology that makes it suitable to argue for the normative significance of relational responsibilities within professional health care. This ontology is relational. It means that moral choices always have to account for the web of relationships, the relational networks and responsibilities that are an essential part of particular moral circumstances. Given this ontology, the article investigates the conditions for health care professionals to be partial and to act on the basis of particular responsibilities to their patients. We will argue that priorities could be partial in three ways: first, because there may be exceptional circumstances that allow for giving priority to one patient over another; second, because the integrity of the patient and a health care worker may be connected in special ways; and, finally, even if impartiality is essential, the institutional basis of health care must always give ample space for an ethically qualified individual and personal care for patients. Even if difficult priorities may be necessary, the conditions of institutional health care should always seek to create the prerequisites for nurses and doctors to administer proper care.     

The changing focus of health care ethics: implications for health care professionals

Contemporary health care ethics has become preoccupied with the issue of people's rights to and in health care (eg the rights to informed consent, confidentiality, quality of life, death with dignity, etc). There is no question that this preoccupation has achieved some morally significant and beneficial outcomes in health care domains. Nevertheless, it is evident that health care ethics has not achieved its most basic task, namely, to promote and protect the genuine wellbeing and welfare interests of those who are among the most vulnerable people in society and whose health status is at risk. A key contention of this paper is that if health professionals are going to be able to meet future moral challenges posed by the complex question of human health, then the nature, aims, purpose, significance, and modus operandi of contemporary health th care ethics needs to be revisited, re-visioned, and revitalised.     

Researching lived experience in health care: significance for care ethics

The aim of this article is to demonstrate the usefulness of qualitative research for studying the ethics of care, bringing to light the lived experience of health care recipients, together with the importance of methods that allow reconstruction of the processes underlying this lived experience. Lived experiences of families being approached for organ donation, parents facing the imminent death of their child and patients being treated using stem cell transplantation are used to illustrate how ethical principles are differentiated, modified or contradicted by the narrative context of persons concerned. The integration of empirical data into ethics will help caregivers in their ethical decision making and may enrich care ethics as a narrative and interpretative field.