How physician executives and clinicians perceive ethical issues in Saudi Arabian hospitals.
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OBJECTIVES: To compare the perceptions of physician executives and clinicians regarding ethical issues in Saudi Arabian hospitals and the attributes that might lead to the existence of these ethical issues. DESIGN: Self-completion questionnaire administered from February to July 1997. SETTING: Different health regions in the Kingdom of Saudi Arabia. PARTICIPANTS: Random sample of 457 physicians (317 clinicians and 140 physician executives) from several hospitals in various regions across the kingdom. RESULTS: There were statistically significant differences in the perceptions of physician executives and clinicians regarding the existence of various ethical issues in their hospitals. The vast majority of physician executives did not perceive that seven of the eight issues addressed by the study were ethical concerns in their hospitals. However, the majority of the clinicians perceived that six of the same eight issues were ethical considerations in their hospitals. Statistically significant differences in the perceptions of physician executives and clinicians were observed in only three out of eight attributes that might possibly lead to the existence of ethical issues. The most significant attribute that was perceived to result in ethical issues was that of hospitals having a multinational staff. CONCLUSION: The study calls for the formulation of a code of ethics that will address specifically the physicians who work in the kingdom of Saudi Arabia. As a more immediate initiative, it is recommended that seminars and workshops be conducted to provide physicians with an opportunity to discuss the ethical dilemmas they face in their medical practice. (+info)
Pathologies of power: rethinking health and human rights.
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The field of health and human rights has grown quickly, but its boundaries have yet to be traced. Fifty-one years after the Universal Declaration of Human Rights, consensus regarding the most promising directions for the future is lacking; however, outcome-oriented assessments lead us to question approaches that rely solely on recourse to formal legal and civil rights. Similarly unpromising are approaches that rely overmuch on appeals to governments: careful study reveals that state power has been responsible for most human rights violations and that most violations are embedded in "structural violence"--social and economic inequities that determine who will be at risk for assaults and who will be shielded. This article advances an agenda for research and action grounded in the struggle for social and economic rights, an agenda suited to public health and medicine, whose central contributions to future progress in human rights will be linked to the equitable distribution of the fruits of scientific advancement. Such an approach is in keeping with the Universal Declaration but runs counter to several of the reigning ideologies of public health, including those favoring efficacy over equity. (+info)
Arguments for zero tolerance of sexual contact between doctors and patients.
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Some doctors do enter into sexual relationships with patients. These relationships can be damaging to the patient involved. One response available to both individual doctors and to disciplinary bodies is to prohibit sexual contact between doctors and patients ("zero tolerance"). This paper considers five ways of arguing for a zero tolerance policy. The first rests on an empirical claim that such contact is almost always harmful to the patient involved. The second is based on a "principles" approach while the third originates in "virtues" ethics. The fourth argues that zero tolerance is an "a priori" truth. These four attempt to establish that the behaviour is always wrong and ought, therefore, to be prohibited. The fifth argument is counterfactual. It claims a policy that allowed sexual contact would have unacceptable consequences. Given the responsibility of regulatory bodies to protect the public, zero tolerance is a natural policy to develop. (+info)
An ethical paradox: the effect of unethical conduct on medical students' values.
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OBJECTIVE: To report the ethical development of medical students across four years of education at one medical school. DESIGN AND SETTING: A questionnaire was distributed to all four classes at the Wake Forest University School of Medicine during the Spring of 1996. PARTICIPANTS: Three hundred and three students provided demographic information as well as information concerning their ethical development both as current medical students and future interns. MAIN MEASUREMENTS: Results were analyzed using cross-tabulations, correlations, and analysis of variance. RESULTS: Results suggested that the observation of and participation in unethical conduct may have disparaging effects on medical students' codes of ethics with 35% of the total sample (24% of first years rising to 55% of fourth years) stating that derogatory comments made by residents/attendings, either in the patient's presence or absence, were "sometimes" or "often" appropriate. However, approximately 70% of the sample contended that their personal code of ethics had not changed since beginning medical school and would not change as a resident. CONCLUSIONS: Results may represent an internal struggle that detracts from the medical school experience, both as a person and as a doctor. Our goal as educators is to alter the educational environment so that acceptance of such behaviour is not considered part of becoming a physician. (+info)
Proceedings of the International Symposium on Torture and the Medical Profession.
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... The main topic of this publication is the involvement of professional medical doctors in the course of torture in, generally speaking, the following ways: 1. Medical scientific knowledge and experience is used in the design of the methods and techniques of torture, for example pharmacological torture; 2. Doctors teach the torturers/perpetrators regarding the practical application of these methods; 3. Doctors actively participate in carrying out torture and in executions in relation to the death penalty; 4. Doctors are present -- "passive" -- during the implementation of torture (in more than sixty per cent of cases) for example monitoring the clinical condition of the victim in order to prevent death; are present when the death sentence is carried out, and then write out death certificates. Many of these are later shown by forensic documentation to be false.... This supplement is based on an international symposium, Torture and the Medical Profession, which was held at the University of Tromso in June 1990.... (+info)
Perceptions of Canadian dental faculty and students about appropriate penalties for academic dishonesty.
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The purpose of this investigation was to a) compare the opinions of Canadian faculty and students as regards to what they felt was an appropriate penalty for particular academic offenses and b) to analyze the results and create a jurisprudence grid to serve as a guideline for appropriate disciplinary action. Two hundred questionnaires were distributed to the ten dental colleges in Canada. Each college was asked to have ten faculty and ten students complete the survey. A response rate of 100 percent was achieved for students and 92 percent for faculty. The questionnaire required respondents to select what they felt were appropriate penalties for a list of fifteen academic offenses and to render judgment on three specific cases. Statistical analysis of survey responses led to the following conclusions: 1) students gave equal or more lenient penalties than faculty for the same offense; 2) extenuating circumstances introduced via case presentations altered penalty choice only slightly; and 3) offenses could be grouped to correspond with appropriate penalties, thereby establishing a jurisprudence grid that may serve as a guideline for adjudication committees. (+info)
A necessary inhumanity?
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It is argued that the phrase "Necessary Inhumanity" more accurately describes the alienation required of doctors in some circumstances, than do modern sanitised coinages such as 'clinical detachment.' 'Detachment' and 'objectivity' imply separation, not engagement: creating distance not only from patients, but from the self: the process may well be required, but where it becomes too extreme or prolonged, it can damage everybody, including patients, family members, doctors themselves, and wider society. An awareness of the history of health care in the context of our society might assist self reflection--might help keep initiates in touch with the culture they have been induced to leave and might help them remain humane despite the bruising process of training. (+info)