Poor conditions of detention compromise ethical standards. (1/18)

The ethical standards of police surgeons are being compromised by conflict between obligations to their paymasters, the police authorities, and their responsibilities to their patients, when these patients are prisoners detained in unacceptable conditions and where even minimum standards of medical care and management are difficult to deliver.  (+info)

Whistleblowing in academic medicine. (2/18)

Although medical centres have established boards, special committees, and offices for the review and redress of breaches in ethical behaviour, these mechanisms repeatedly prove themselves ineffective in addressing research misconduct within the institutions of academic medicine. As the authors see it, institutional design: (1) systematically ignores serious ethical problems, (2) makes whistleblowers into institutional enemies and punishes them, and (3) thereby fails to provide an ethical environment. The authors present and discuss cases of academic medicine failing to address unethical behaviour in academic science and, thereby, illustrate the scope and seriousness of the problem. The Olivieri/Apotex affair is just another instance of academic medicine's dereliction in a case of scientific fraud and misconduct. Instead of vigorously supporting their faculty member in her efforts to honestly communicate her findings and to protect patients from the risks associated with the use of the study drug, the University of Toronto collaborated with the Apotex company's "stalling tactics," closed down Dr Olivieri's laboratory, harassed her, and ultimately dismissed her. The authors argue that the incentives for addressing problematic behaviour have to be revised in order to effect a change in the current pattern of response that occurs in academic medicine. An externally imposed realignment of incentives could convert the perception of the whistleblower, from their present caste as the enemy within, into a new position, as valued friend of the institution. The authors explain how such a correction could encourage appropriate reactions to scientific misconduct from academic medicine.  (+info)

Supporting whistleblowers in academic medicine: training and respecting the courage of professional conscience. (3/18)

Conflicts between the ethical values of an organisation and the ethical values of the employees of that organisation can often lead to conflict. When the ethical values of the employee are considerably higher than those of the organisation the potential for catastrophic results is enormous. In recent years several high profile cases have exposed organisations with ethical weaknesses. Academic medical institutions have exhibited such weaknesses and when exposed their employees have almost invariably been vindicated by objective inquiry. The mechanisms that work to produce such low ethical standards in what should be exemplary organisations are well documented and have been highlighted recently. The contribution of elements of medical training in eroding ethical standards of medical students have also been emphasised recently and strategies proposed to reduce or reverse this process. The ability to rapidly change the ethical and professional culture of graduate medical trainees may help to deal with some of the perceived problems of declining ethical standards in academic medicine.  (+info)

The Olivieri debacle: where were the heroes of bioethics? (4/18)

All Canadian bioethicists need to reflect on the meaning and value of their work, to see more clearly how the ethics of bioethics is being undermined from within. In the case involving Dr Olivieri, the Hospital for Sick Children, the University of Toronto, and Apotex Inc, there were countless opportunities for bioethical heroism. And yet, no bioethics heroes emerged from this case. Much has been written about the hospital's and the university's failures in this case. But what about the deafening silence from the Canadian bioethics community? Given the duty of bioethicists to "speak truth to power", this silence is troubling. To date, nothing has been written about the silence. This article is intended as a partial remedy. As well, the article pays tribute to heretofore unsung heroes among Dr Olivieri's research colleagues.  (+info)

Practical virtue ethics: healthcare whistleblowing and portable digital technology. (5/18)

Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers' agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical "coalfaces". Virtue ethics, emphasising techniques promoting an agent's character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing. The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety.Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development.  (+info)

Parents' champions vs. vested interests: who do parents believe about MMR? A qualitative study. (6/18)

BACKGROUND: Despite the Government acting quickly to reassure parents about MMR safety following the publication of the 1998 paper by Wakefield and colleagues, MMR uptake declined. One of the reasons suggested for this decline is a loss of public trust in politicians and health professionals. The purpose of this analysis was to examine parents' views on the role the media, politicians and health professionals have played in providing credible evidence about MMR safety. METHODS: A qualitative focus group study conducted with parents living in Central Scotland. Eighteen focus groups were conducted with 72 parents (64 mothers and 8 fathers) between November 2002 and March 2003. Purposive sampling was used to ensure maximum variation among parents. RESULTS: In the period after the MMR controversy, parents found it difficult to know who to trust to offer balanced and accurate information. The general consensus was that politicians were untrustworthy in matters of health. The motives of primary health care providers were suspected by some parents, who saw them as having a range of vested interests (including financial incentives). Among the sources of evidence seen by some parents as more credible were other parents, and Andrew Wakefield who was viewed as an important whistle-blower and champion of ordinary parents. CONCLUSION: The provision of accurate information is only one aspect of helping parents make immunisation decisions. Establishing and maintaining trust in the information provided is also important. The MMR controversy may provide useful lessons for health professionals about trust and credibility that may be generalisable to future health controversies.  (+info)

Presentation and outcome of clinical poor performance in one health district over a 5-year period: 2002-2007. (7/18)


Physician impairment: is recovery feasible? (8/18)

BACKGROUND: Physician impairment is a serious public health issue affecting not only physicians, but also their families, colleagues, and patients. Physician impairment is used most often to refer to substance use disorders, which involve both substance abuse and substance dependence and/or addiction. OBJECTIVE: This article aims to describe the problem of physician impairment within the context of substance use disorders. The concept of recovery and several strategies for effective recovery are explored. DISCUSSION: Experts now define impairment as an enduring condition that if left untreated is not amenable to remission and cure. In terms of functional capacity, impairment renders the physician unable to provide competent medical services, with serious flaws in professional judgment. Herein, we define the scope of the problem, consider several theories to explain the reason physicians may be prone to develop substance use disorders, discuss diagnosis and reporting, as well as treatment and prognosis, and identify several relapse prevention strategies. CONCLUSION: Physician impairment is a real and significant public health concern; however, recovery is feasible and the data support favorable odds of recovery and a return to clinical practice among those seeking appropriate treatment, counseling, and relapse prevention strategies.  (+info)