Professionalism in the age of computerised medical records.
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Electronic medical records have the potential to improve clinical care and to provide answers to important research questions. Research using existing medical records has provided important knowledge about the effectiveness and risks of widely-used medications. However, electronic medical records also raise ethical dilemmas regarding informed consent and confidentiality. Breaches of confidentiality with electronic records can be more severe than breaches with paper records. Furthermore, computerised health information raises new ethical dilemmas regarding direct advertisements of new drugs to patients, the impact of email on the doctor-patient relationship and the quality of outsourced radiology readings. Resolving these dilemmas may require new regulations and laws. In the interim, society will need to rely on physicians' professionalism to minimise the risks of electronic medical records and to ensure that the benefits outweigh the risks. (+info)
Holiday review. Duty of care to the undiagnosed patient: ethical imperative, or just a load of Hogwarts?
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With the restoration of You-Know-Who to full corporeal form, the practice of the dark arts may lead to multitudes being charmed, befuddled and confounded. At present, muggle ethics dictate that aid may be rendered in a life-or limb-threatening situation, but the margins are blurred when neither is at stake. Muggle and wizard healers, fearful of being labelled ambulance chasers, may shy away from approaching those who remain blissfully unaware of their illnesses. We describe 4 case studies in which we intervened as muggle healers, to salutary effect. The afflicted were healed or helped, without bringing the weight of the Ministries of Magic or Magical Healing upon us. We advocate a spirit of cooperation between muggle and magical folk, mindful of the strengths that the healing arts from each community have to offer. As long as the intent is beneficent, healers or even the wizard or muggle on the street may intervene and render aid to the afflicted. (+info)
Best Practice Guidelines on Publication Ethics: a publisher's perspective.
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These Best Practice Guidelines on Publication Ethics describe Blackwell Publishing's position on the major ethical principles of academic publishing and review factors that may foster ethical behavior or create problems. The aims are to encourage discussion, to initiate changes where they are needed, and to provide practical guidance, in the form of Best Practice statements, to inform these changes. Blackwell Publishing recommends that editors adapt and adopt the suggestions outlined to best fit the needs of their own particular publishing environment. (+info)
Ethics in oncology: consulting for the investment industry.
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As Ethics Committee Chair, I am pleased to introduce the first in an ongoing series of ethics vignettes. These columns, which are based on true-to-life situations that arise in oncology research and practice, are intended to identify and explore important ethical issues and provide commentary that is specific to oncology. Please look for them periodically in both the Journal of Clinical Oncology and the Journal of Oncology Practice. The idea for publishing vignettes evolved through the joint efforts of the Ethics Committee and the Board of Directors. Rather than adopt a single set of ethical principles that applies vaguely to any situation and well to none, the Committee and the Board preferred to tackle ethical dilemmas individually, specifically, and directly. Because the Ethics Committee thought the ethical and legal implications of physician interactions with the investment industry were so important and timely, it chose to address this topic in both a position article, which was previously published in the January 20, 2007, issue of the Journal of Clinical Oncology (J Clin Oncol 25:338-340, 2007) and in its first vignette column. The Ethics Committee hopes this column will be the first of several that ASCO members will find helpful as they grapple with the many ethical issues that arise in daily practice in the field of oncology. Because these columns are intended to address the concerns of ASCO members, the Committee welcomes suggestions for future topics at [email protected]. Martin D. Abeloff, MD, Chair, Ethics Committee. (+info)
Professional ethics in occupational health--Western European perspectives.
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In this paper, the foundations of professional ethics in occupational health care is described and discussed. After an introduction reminding of the global developments of world economy, communications and trade and reference to cultural and social developments, reference is given the four basic ethical criteria of biomedical ethics of beneficence ("doing good"), non-malfeasance (avoidance of harm), autonomy (integrity) and Justice/Equity-The "Appletown consensus" of 1989. These criteria provide the basis for current thinking and practice in health professions of Western Europe. The principles of ethical analysis, as currently practiced is described using a practical case scenario drawn from experience of challenging tasks for Occupational Health Services in Western Europe. Specific challenges to professional ethics are discussed-the growth of knowledge in subjects and academic disciplines relevant to occupational health and the multiple loyalties of occupational health professionals. The principles of ethical codes and their implementation are touched on. In conclusion, the universality of professional ethical principles of bioethics-including occupational health-is discussed in observing global inter-cultural commonalities and convergence on ethical criteria of central importance. Emphatic recommendation is given to continue inter-cultural exchanges with a view to improve understanding of impact of contextual and cultural factors on ethics in professional occupational health practice. (+info)
Ethical challenges related to elder care. High level decision-makers' experiences.
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BACKGROUND: Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. METHODS: A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. RESULTS: Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. CONCLUSION: Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet. (+info)
Do-not-resuscitate decision: the attitudes of medical and non-medical students.
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OBJECTIVES: To study the attitudes of both medical and non-medical students towards the do-not-resuscitate (DNR) decision in a university in Hong Kong, and the factors affecting their attitudes. METHODS: A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of participants on cardiopulmonary resuscitation in various situations and case scenarios, experience of death and dying, prior knowledge of DNR and basic demographic data were evaluated. RESULTS: A total of 766 students participated in the study. There were statistically significant differences in their DNR decisions in various situations between medical and non-medical students, clinical and preclinical students, and between students who had previously experienced death and dying and those who had not. A prior knowledge of DNR significantly affected DNR decision, although 66.4% of non-medical students and 18.7% of medical students had never heard of DNR. 74% of participants from both medical and non-medical fields considered the patient's own wish as the most important factor that the healthcare team should consider when making DNR decisions. Family wishes might not be decisive on the choice of DNR. CONCLUSIONS: Students in medical and non-medical fields held different views on DNR. A majority of participants considered the patient's own wish as most important in DNR decisions. Family wishes were considered less important than the patient's own wishes. (+info)
Legal and ethical considerations in processing patient-identifiable data without patient consent: lessons learnt from developing a disease register.
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The legal requirements and justifications for collecting patient-identifiable data without patient consent were examined. The impetus for this arose from legal and ethical issues raised during the development of a population-based disease register. Numerous commentaries and case studies have been discussing the impact of the Data Protection Act 1998 (DPA1998) and Caldicott principles of good practice on the uses of personal data. But uncertainty still remains about the legal requirements for processing patient-identifiable data without patient consent for research purposes. This is largely owing to ignorance, or misunderstandings of the implications of the common law duty of confidentiality and section 60 of the Health and Social Care Act 2001. The common law duty of confidentiality states that patient-identifiable data should not be provided to third parties, regardless of compliance with the DPA1998. It is an obligation derived from case law, and is open to interpretation. Compliance with section 60 ensures that collection of patient-identifiable data without patient consent is lawful despite the duty of confidentiality. Fears regarding the duty of confidentiality have resulted in a common misconception that section 60 must be complied with. Although this is not the case, section 60 support does provide the most secure basis in law for collecting such data. Using our own experience in developing a disease register as a backdrop, this article will clarify the procedures, risks and potential costs of applying for section 60 support. (+info)