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An approach to ethical issues

Eugene Bereza

in Palliative Medicine: A case-based manual

This chapter presents a case study to illustrate the desired skills, attitudes, and knowledge required to deal with ethical issues. It describes a four-step approach to appreciating and resolving ... More

This chapter presents a case study to illustrate the desired skills, attitudes, and knowledge required to deal with ethical issues. It describes a four-step approach to appreciating and resolving ethical issues in clinical care that involves identifying the ethical dilemmas; gathering all of the pertinent information; analyzing the information in the context of the dilemma; and prioritizing recommendations and articulate supporting argumentation.Less

Mentoring and Collaboration

Adil E. Shamoo and David B. Resnik

in Responsible Conduct of Research

Mentoring and collaboration are cornerstones of modern science, but they also raise some ethical problems and dilemmas. This chapter explores a variety of issues related to mentoring and ... More

Mentoring and collaboration are cornerstones of modern science, but they also raise some ethical problems and dilemmas. This chapter explores a variety of issues related to mentoring and collaboration. It discusses some of the moral dimensions of mentoring and collaboration, such as proper training, setting examples, trust, accountability, and collegiality. It also considers some reasons why collaborations sometimes fail in research and addresses policies designed to promote collaboration and effective mentoring. The chapter also discusses leadership in mentoring, collaboration, and other professional relationships in science.Less

Implications for the Interpretation of Research Findings

Robert Rosenthal and Ralph L. Rosnow

in Artifacts in Behavioral Research: Robert Rosenthal and Ralph L. Rosnow's Classic Books

This chapter presents an ethical dilemma when societal and scientific imperatives collide. It also covers the threat to the robustness of generalizations and the threat to inferred causality.

Ethical Dilemmas in Therapy Withdrawal

Katrina A. Bramstedt

in Supportive Care in Heart Failure

This chapter explores the concept of therapy withdrawal on heart failure and offers guidance for the resolution of ethical dilemmas that can occur in such situations. It introduces burdens, benefits, ... More

This chapter explores the concept of therapy withdrawal on heart failure and offers guidance for the resolution of ethical dilemmas that can occur in such situations. It introduces burdens, benefits, and futility. It also deals with the patient's treatment preferences. It then covers surrogate decision-making and the termination of implantable interventions, specifically the termination of pacemaker, defibrillators, ventricular assist devices, and total artificial heart. All therapies, whether implantable or not, should be regularly evaluated to ascertain their burdens and the patient's capacity to benefit from them. Patients with decision-making capacity should be routinely invited to comment on their quality of life, as well as their health-care goals. When advance directive documentation exists, it should be reviewed by the health-care team and decision-making surrogates. All treatment decisions should reflect the burdens, benefits, and values of the patient or the patient's best interests when discrete values are unknown.Less

Introduction

David S. Wendler

in The Ethics of Pediatric Research

The first chapter begins with an example of an important series of pediatric research studies, the studies that led to the development of vaccines for rotavirus. This example illustrates the dilemma ... More

The first chapter begins with an example of an important series of pediatric research studies, the studies that led to the development of vaccines for rotavirus. This example illustrates the dilemma posed by pediatric research between protecting individual children and improving pediatric medical care. The chapter then explains the importance and prevalence of pediatric research and ends with a summary of the argument that we have an interest in contributing to valuable projects. This interest suggests that “nonbeneficial” pediatric research can be justified when it involves the participating children contributing to a valuable project to help others.Less

The Roles and Ethical Dilemmas for Military Medical Care Workers

Victor W. Sidel and Barry S. Levy

in War and Public Health

This chapter describes the roles and ethical dilemmas for military medical care workers, including obligations to enhance military strength versus obligations to meet the needs of individual military ... More

This chapter describes the roles and ethical dilemmas for military medical care workers, including obligations to enhance military strength versus obligations to meet the needs of individual military personnel, the ability to override the patient's wishes for “the patient's benefit,” obligations of medical care workers to serve those in need of care, blurring combatant and noncombatant roles, and enhancing the ability of medical care workers to serve as moral agents.Less

Rewards, Challenges, and Ethical Dilemmas in Undertaking Community Asset Assessments

MELVIN DELGADO and DENISE HUMM-DELGADO

in Asset Assessments and Community Social Work Practice

Community asset assessments are a distinctive form of community-based participatory research, with all of its rewards and challenges. This form of research, as the reader will see, has its share of ... More

Community asset assessments are a distinctive form of community-based participatory research, with all of its rewards and challenges. This form of research, as the reader will see, has its share of tension areas that are natural points for the ethical dilemmas that are quite familiar to most social work practitioners. These dilemmas are partly tied to the tensions inherent in practicing in communities, as well as the tensions related to being “outsider” researchers. There is little question that community asset assessments have tremendous potential for helping community social workers carry out initiatives that reinforce key antioppression aspects of our mission and Code of Ethics. These rewards, so to speak, are limitless and so, unfortunately, are the challenges. This chapter highlights some of the most obvious and significant rewards and challenges. Local circumstances wield considerable influence on the rewards and challenges of community asset assessments. The reader, as a result, may well have additional examples of both that have been dictated by what is happening in their respective communities.Less

Punishment, Revenge, and Organizational Injustice

Sandra L. Bloom and Brian Farragher

in Destroying Sanctuary: The Crisis in Human Service Delivery Systems

The notion that “punishment works” is simply taken for granted as true, part of our existing mental model for dealing with other people. Here this chapter asks whether punishment actually is ... More

The notion that “punishment works” is simply taken for granted as true, part of our existing mental model for dealing with other people. Here this chapter asks whether punishment actually is effective and under what conditions. In chronically stressed organizations, as leaders become more authoritarian and their efforts to correct problems are ineffective, leaders are likely to become increasingly punitive in an effort to exert control. But organizational practices that are perceived as unjust evoke a very human desire for vengeance. As in the case of the chronically stressed individual, shame, guilt, anger and a desire for justice can combine with unfortunate consequences for individuals and for the organization. When this is happening the organization may become both socially irresponsible and ethically compromised. The chapter explores what happens when good people do bad things, including when otherwise decent people stand around and watch unjust behavior and do nothing.Less

Conflicts of culture and accountability: managing ethical dilemmas and problems in community practice

Banks Sarah

in Managing community practice: Principles, policies and programmes

All managers face difficult choices — relating, for example, to conflicts of interest between various stakeholders; political imperatives; resource allocation or staff management decisions. This ... More

All managers face difficult choices — relating, for example, to conflicts of interest between various stakeholders; political imperatives; resource allocation or staff management decisions. This chapter explores some of the ethical conflicts and dilemmas that arise for managers of community practice. It uses two case studies relating to regeneration and mental health work to illustrate how managers conceptualise and handle ethical dilemmas and demonstrates how their practice embodies certain core values or principles.Less

Personal and professional ethical dilemmas in the context of developing teacher leaders in Australia

Allie Clemans, John Loughran, and Amanda Berry

in Exploring the dynamics of personal, professional and interprofessional ethics

The chapter explores some interesting ethical issues faced by educational academics in developing the professional practice of teacher leaders through a three year government funded leading ... More

The chapter explores some interesting ethical issues faced by educational academics in developing the professional practice of teacher leaders through a three year government funded leading professional learning (LPL) programme in Australia. The programme was initiated to develop teacher leaders in public schools and was conceptualized around a core set of principles designed to illustrate that teachers and their professional knowledge were highly valued. As the project was funded by the State Education system, negotiations between the representatives of the bureaucracy and academics around programme intent and delivery presented significant ethical issues and tensions which inevitably cut across the ethos of program design and implementation. Ultimately, these influenced the programme and impacted the outcomes anticipated for the development of the teacher leaders’ professional practice. Sadly, they may also have diluted the opportunities for support that these teacher leaders needed to confront their own ethical dilemmas in their workplace settings.Less

Ethical issues

Derek Doyle, David Jeffrey, and Kenneth Calman

in Palliative Care in the Home

Caring for terminally ill patients is often framed by ethical issues that arise at all stages of the palliative care period and are an integral part of medical and nursing decision making. Ethical ... More

Caring for terminally ill patients is often framed by ethical issues that arise at all stages of the palliative care period and are an integral part of medical and nursing decision making. Ethical dilemmas provide no easy solution but good communication between the professional health care providers, the patients, and the families can provide the best outcome for the patient. This chapter focuses on the ethical issues encountered by primary care teams providing palliative care at home, the most primary of which is good communication. Good communication plays a vital role in determining the decisions and wishes of the patient and family and maintains a trusting relationship between the professional and the patient. The second ethical issue is informed consent, which reflects the respect for the autonomy of the patient. It means respect for the decision of the patient before administering medical interventions. Another issue prevalent in palliative care is confidentiality, wherein professionals are expected not to divulge information without the explicit consent of the patient. Compassion, which is often ignored by professionals, should be encouraged, as it reflects the emotional aspects of caring and may help to foster a trusting relationship between patients and professionals. Advanced directives and living wills also form part of the ethical issues. General practitioners are often in the best position to discuss wills with the patients and their families. The last, yet most ethically arresting issue, is the withdrawal of feeding and fluids and euthanasia. Both should be reviewed and undertaken within the views of the family and the patient.Less

The ethical basis for making decisions

R.J. DUNLOP and J.M. HOCKLEY

in Hospital-based Palliative Care Teams: The Hospital/Hospice Interface

Decisions about care at the end of life are very difficult. It is often distressing looking after terminally ill patients and their families. This makes decisions about withholding or withdrawing ... More

Decisions about care at the end of life are very difficult. It is often distressing looking after terminally ill patients and their families. This makes decisions about withholding or withdrawing life-prolonging treatment even more emotive. This chapter briefly outlines the basis of such ethical principles, including ideas on exploring what the patient understands about future treatment and how to present treatment options. It also considers some of the major ethical dilemmas within the context of hospital palliative care, including euthanasia and living wills. Palliative care teams are often called on to support the staff. Team members need to have a clear understanding of the ethical basis for making decisions.Less

Consultation and Ethics

Lynn Milgram Mayer

in Consultation Theory and Practice: A Handbook for School Social Workers

Although the NASW Code of Ethics clearly articulates the mission of the profession and its core values of service, social justice, dignity and worth of the person, importance of human relationships, ... More

Although the NASW Code of Ethics clearly articulates the mission of the profession and its core values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence, school social work consultants are not immune to ethical dilemmas. In fact, they might actually be in a position to feel more challenged than their colleagues in other social service settings due to the complexities of working in an educational host environment. This chapter discusses ethical dilemmas faced by school social work consultants, including privacy of minors, confidentiality, informed consent, and conflicts of interest. Ethical dilemmas are then examined in the context of the school setting and the school situation. Finally, ethical dilemmas are examined from the perspective of consequential theory, principles theory, and virtue ethics.Less

Ethical structures and issues

Antonie Vos

in The Philosophy of John Duns Scotus

This chapter explores the works of John Duns Scotus related to ethics. It presents the bare challenge of Scotian ethical dilemma and interprets the key words of Scotus's ethical terminology with a ... More

This chapter explores the works of John Duns Scotus related to ethics. It presents the bare challenge of Scotian ethical dilemma and interprets the key words of Scotus's ethical terminology with a view to his language of argumentation in ethics. The chapter discusses the essentials of his philosophy of love, proposes solutions to the Quintonian and Harrisian fallacies, and also considers the Scotian solution of the problem of dispensation from law and the structure of virtue.Less

Introduction

Mike W. Martin

in Meaningful Work: Rethinking Professional Ethics

The expression “professional ethics” can mean three things: de facto morality, justified morality, and moral inquiry. Professional ethics consists entirely of the moral requirements attached to a ... More

The expression “professional ethics” can mean three things: de facto morality, justified morality, and moral inquiry. Professional ethics consists entirely of the moral requirements attached to a profession and imposed on all its members, together with the ethical dilemmas created when the requirements conflict or are too vague to provide guidance. This dominant perspective is called the consensus paradigm, which the present book argues is implausible and constricting. The consensus paradigm neglects how personal moral commitments and ideals motivate, sustain, and guide professionals in their work. In exploring personal commitments, this book introduces narrative case studies and also includes portrayals of professionals in works of fiction. Case studies are ubiquitous in studying professional ethics, but almost invariably they consist of episodic (time-slice) dilemmas about how to act when confronted with conflicting obligations. A diachronic perspective reveals the importance of caring relationships, meaningful work, voluntary service, burnout, self-betrayal, balancing family with other commitments, and other topics examined in this book.Less

Preamble

Michael Jackson

in Wherewithal of Life: Ethics, Migration, and the Question of Well-Being

Fieldwork among Sierra Leoneans in London: existential and ethical dilemmas of leaving one’s homeland to seek a better life abroad; the meaning of mobility, metamorphosis and mutation in human life; ... More

Fieldwork among Sierra Leoneans in London: existential and ethical dilemmas of leaving one’s homeland to seek a better life abroad; the meaning of mobility, metamorphosis and mutation in human life; a phenomenological approach to migration; the question of “life itself”; tensions between the legal, moral, and ethical dimensions of the migrant experience; ethics and intersubjectivity in Ricoeur, Levinas, and Sartre; “ordinary ethics” in recent anthropological writing; ethics in Kuranko storytelling.Less

Decision Making

Wendy Johnston

in Palliative Care in Amyotrophic Lateral Sclerosis: From diagnosis to bereavement, 2nd Edn

This chapter discusses the decision-making integral to ALS patients and their families. Diagnosis and the quality of life have steadily improved for ALS patients with the advent of improved ... More

This chapter discusses the decision-making integral to ALS patients and their families. Diagnosis and the quality of life have steadily improved for ALS patients with the advent of improved nutrition, respiratory support, and the riluzole. However, amidst these developments, treatments face certain limitations and the daunting task of making decisions on accepting or forgoing life-sustaining therapies will inevitably be made. These decisions include requests for assisted suicide or euthanasia, and advance care planning. In the course of decision-making, several factors affecting decisions and their implementation such as the social and spiritual context of each individual, the family, the medical community including financial resources often come into play. The cognitive deficits and the depression of ALS patients also affect decision-making related to end-of-the-life care. Discussion of end-of-life issues is often combined with ethical dilemmas and difficult choices where conflict is never distant resulting to avoidance of clinicians to openly discuss advance life planning however, open discussion of end-of-life issues is integral as it helps ALS patients and their families to achieve quality life and to prepare for the inevitable end. Informing and guiding patients and their families in the decision-making process to a peaceful death should be integral to medical practice.Less