(1/153) Ethical issues among Finnish occupational physicians and nurses.
A postal survey was conducted among 200 Finnish occupational physicians and nurses on their ethical values and problems. Both groups considered 'expertise' and 'confidentiality' as the most important core values of occupational health services (OHS) corresponding with newly published national ethical guidelines for occupational physicians and nurses in Finland. Nearly all respondents had encountered ethically problematic situations in their work, but ethical problems with gene testing in the near future were not considered likely to occur. Only 41% of the nurses and 36% of the physicians had received some training in the ethics of OHS, and 76% of all respondents never used available ethical guidelines. According to the results, even if ethics play a vital role in OHS, the ability to critically evaluate one's own performance seems quite limited. This creates a need for further training and more practicable national guidelines. (+info)
(2/153) From a philosopher's perspective, how should animal scientists meet the challenge of contentious issues?
This article reviews how professional ethics can be useful in helping animal scientists meet new responsibilities. The transition to a postindustrial period in animal production signals a shift in the nature of contentious issues that animal producers face. Whereas farm income was once the most controversial issue in animal production, producers and animal scientists now face complex risk issues that have overlapping constituencies. Animal scientists need to develop a professional ethic that will stress open and active debate on these issues. Discussion of these issues must take place in the animal science classroom. The new professional ethic should be based on core values required for scientific research. However, departments and professional societies must develop institutions that will permit the values and methods of rationality and truth seeking to be applied in areas where measurement and experimental method are unlikely to resolve disputes, (i.e., to controversial issues that require public discussion and debate). Several specific proposals for such institution building are discussed. (+info)
(3/153) Ethics instruction at schools of public health in the United States. Association of Schools of Public Health Education Committee.
OBJECTIVES: A survey of US schools of public health was undertaken in 1996 and 1997 to obtain a general picture of public health ethics curricula. METHODS: An explanatory letter with a list of questions for discussion was sent to the deans of the accredited US schools of public health. The deans were asked that at least 1 individual at their school who "is most knowledgeable about ethics curricula" review the list of questions and complete an ethics survey contact form. RESULTS: Ethics instruction was required for all students at only 1 (4%) of the 24 schools surveyed, while 7 schools required ethics instruction for some students. Two of the schools had no ethics courses. Ethics instruction was required for all MPH students at 9 (38%) of the schools and for all doctoral students at 4 (17%) of the schools. Most of the schools (19 of 24, or 79%) offered short courses, seminar series, or invited lectures on ethical topics, and 23 (96%) included lectures on ethics topics in other courses such as health law. CONCLUSIONS: Training programs at US schools of public health vary greatly in how much attention is given to ethics instruction. Model curricula in public health ethics should be developed to help fill this gap. (+info)
(4/153) League tables, institutional success and professional ethics.
League tables are just one example of the growing importance of "institutional success" in the health service. What are the implications of attaching importance to institutional success, and what impact might this have on professional ethics? This paper considers these issues and argues that public policy processes which centre on institutional performance, and which co-opt professional loyalties to this end, shift the balance between person-centred and impersonal standpoints in health care (from the former and towards the latter). There is no attempt to make a global ethical appraisal of this putative shift but rather to raise a matter of concern for those committed to a person-centred conception of professional ethics. (+info)
(5/153) Ethical review of regulatory toxicology guidelines involving experiments on animals: the example of endocrine disrupters.
The safety assessment of new chemicals (including medicines, pesticides, food additives, and industrial chemicals) relies on the results of animal experiments. Because the safety of those exposed to these products and the welfare of the experimental animals used are considered critically important, both testing requirements and the welfare of experimental animals are controlled by law. In the U.K., projects that propose to use animals for experimental purposes, including for the testing of chemicals, have been controlled by law for over a century, with the most recent legislation (Animals [Scientific Procedures] Act of 1986) requiring a cost/benefit assessment before it may proceed. New regulations introduced in 1998 will require an ethical review process for all projects from April 1999. Such ethical review will have to take account of the toxicity testing methods and schemes that are required by the legislation aimed at protecting human health. Neither national nor international proposals for toxicity testing methods and schemes are generally subjected to ethical review from the point of protecting animal welfare. The international nature of the chemical and pharmaceutical industry means that testing requirements from one of the major national regulatory agencies (USA, EU, or Japan) or the international organizations (Organization for Economic Co-operation and Development [OECD]or the International Conference on Harmonization [ICH]) have an impact on the testing carried out by industrial organizations in all countries. The recent proposals for screening and testing chemicals to identify endocrine disrupters (ED) from the Endocrine Disrupter Screening and Testing Advisory Committee (EDSTAC) of the U.S. Environmental Protection Agency (EPA) are used as an example of the interaction between regulatory proposals and animal welfare issues. The current proposals are the most extravagant in the use of animals. Between 0.6 and 1.2 million animals would be required for each 1000 chemicals tested. The EPA, before incorporating them into regulation, is subjecting the recommendations to further review. This will undoubtedly moderate the number of animals actually used from the worst-case calculation. The variables that have the greatest impact on the number of animals required for testing are the prevalence of ED chemicals in the chemicals to be tested, and the sensitivity and specificity of the testing methods. The modeling demonstrates, for example, that increasing the prevalence from 10 to 50% reduces the number of animals used to detect one ED from 10,000 to 2700. Knowledge of the prevalence of EDs in the chemicals to be tested would allow rational selection of tier one screening based on the sensitivity and specificity of the screening tests. The EDSTAC proposals are difficult to justify from an ethical perspective, as equally effective detection rates may be achieved with fewer animals. National and international regulatory testing proposals should be subjected to formal independent ethical review before they are finalized, with a view to improving animal welfare. (+info)
(6/153) For debate: the virtuous public health physician.
This paper argues that although public health physicians have shown interest in ethical dilemmas relating to specific problems within the specialty, few have addressed the central ethical dilemma in public health, namely the conflict between the rights of the individual and the responsibilities of society for all its members. The paper reviews a number of public health programmes, where different approaches have been taken to this central dilemma. It then examines a number of schools of ethics, in an attempt to resolve the problem. Of these, only virtue ethics, perhaps supported by the insights of feminism and the ethics of care, appear to help with an irreconcilable conflict. The paper then makes an attempt to apply the concept of virtue ethics in public health medicine and to answer the question, 'what would a virtuous public health physician look like?' Finally, it lists some of the consequences of such an approach. (+info)
(7/153) Would you like to know what is wrong with you? On telling the truth to patients with dementia.
OBJECTIVES: To discover what dementia sufferers feel is wrong with them; what they have been told and by whom, and what they wish to know about their illness. BACKGROUND: Ethical guidelines regarding telling truth appear to be equivocal. Declarations of cognitively intact subjects, attitudes of family members and current psychiatric practice all vary, but no previous research has been published concerning what patients with dementia would in fact like to know about their diagnosis and prognosis. DESIGN: Questionnaire study of the patients' opinions. SETTING: Old Age Psychiatry Service in Worcester. PARTICIPANTS: 30 consecutive patients with dementia. RESULTS: The quality of information received has been poor and many patients have no opportunity to discuss their illness with anybody. Despite that almost half of the participants in this study had adequate insight and a majority declared that they would like to know more about their predicament. CONCLUSIONS: Although many patients would like to know the truth, the rights of those who do not want to know should also be respected. Therefore the diagnosis of dementia should not be routinely disclosed but (just as in other disorders) health care professionals should seek to understand their patients' preferences and act appropriately according to their choice. (+info)
(8/153) Death--whose decision? Euthanasia and the terminally ill.
In Australia and Oregon, USA, legislation to permit statutory sanctioned physician-assisted dying was enacted. However, opponents, many of whom held strong religious views, were successful with repeal in Australia. Similar opposition in Oregon was formidable, but ultimately lost in a 60-40% vote reaffirming physician-assisted dying. This paper examines the human dilemma which arises when technological advances in end-of-life medicine conflict with traditional and religious sanctity-of-life values. Society places high value on personal autonomy, particularly in the United States. We compare the potential for inherent contradictions and arbitrary decisions where patient autonomy is either permitted or forbidden. The broader implications for human experience resulting from new legislation in both Australia and Oregon are discussed. We conclude that allowing autonomy for the terminally ill, within circumscribed options, results in fewer ethical contradictions and greater preservation of dignity. (+info)