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At least 19 recordsLinked to original sources

PubMed1996

Designing ethicists.

In the United States, disturbing concerns pertaining to both how putative bioethicists are perceived and the potential for the abuse of their power in connection with these perceptions compel close examination. This paper addresses these caveats by examining two fundamental and interrelated components in the image-construction of the ethicist: definitional and contextual. Definitional features reveal that perceptions and images of the ethicist are especially subject to distortion due to a lack of clarity as to the nature and qualifications of the ethicist. Furthermore, the clinical, professional, political, academic, and linguistic contexts in which these ethicists are engaged are contexts of disquieting degrees of power. I argue that the lack of definitional clarity as to what constitutes an ethicist combined with the above volatile contexts together set the stage for the abuse of power on the part of ethicists. Throughout, I question the extent of self-critical analyses among ethicists, and, in view of these components in image-construction and their relationship to power, I challenge the degree of integrity within the field. In conclusion, I propose some areas for further investigation.

Bioethical Issues↗

PubMed1993

The influence of philosophical versus theological education on the moral development of clinical medical ethicists.

PURPOSE: Because of the increasing involvement of clinical medical ethicists in patient care and the resultant controversy over the appropriate background, training, and certification of clinical ethicists, this study was designed to investigate whether different educational backgrounds (philosophical versus theological) affected the moral reasoning of clinical ethicists and their orientations toward justice or care. METHOD: From 1987 through 1990, extensive oral interviews were conducted with 50 clinical medical ethicists (26 philosophers and 24 theologians) who were at 32 medical centers in 14 states from all sections of the United States. The interviews were used to gather selected demographic characteristics about the ethicists (age, gender, and educational background) as well as to determine the ethicists' scores for stages of moral reasoning and for moral orientation. Polyserial correlations and multivariant analyses were then performed between the demographic characteristics and the data on moral reasoning and moral orientation. RESULTS: The philosophers and theologians were found not to be significantly different (p > .05) in their moral reasoning skills in terms of either moral stage score or weighted average score. Similarly, the philosophers and theologians were found not to be significantly different in their moral orientations toward justice or care in terms of recognition, predominance, or alignment. No significant relationship was found between age or gender and moral reasoning or moral orientation. CONCLUSION: Based on the results of this study, it appears that clinical medical ethicists, whether philosophers or theologians, are a fairly homogeneous group with regard to their moral development, in terms of both their stages of moral reasoning and their moral orientations toward justice and care.

Adult↗

PubMed1993

A comparison of the moral reasoning of physicians and clinical medical ethicists.

BACKGROUND: Because of the increasing controversy over who should provide ethics consultations, this study investigated differences in the moral reasoning and moral orientations of physicians and clinical ethicists. METHOD: From 1987 through 1990, extensive interviews were conducted with 39 physicians and 50 clinical medical ethicists (26 philosophers and 24 theologians) who were at 32 medical centers in 14 states from all sections of the United States. The interviews were used to gather selected demographic characteristics (age, gender, and profession--physician or ethicist) for the 89 individuals as well as to determine their scores for moral reasoning and moral orientation. Polyserial correlations and multivariant analyses were then performed between the demographic characteristics and the data on moral reasoning and moral orientation. RESULTS: The physicians consistently scored lower than the clinical ethicists in their moral reasoning skills in terms of both moral stage score (p < .01) and weighted average score (p < .01). However, the physicians were found not to be significantly different (p < .05) from the clinical ethicists in their moral orientations toward justice or care in terms of recognition, predominance, or alignment. No significant relationship was found between age and moral orientation. A significant relationship was found between age and stage of moral reasoning, with the older individuals scoring higher. No significant relationship was found between gender and stage of moral reasoning. A significant relationship was found between gender and moral orientation: the women were more likely to recognize elements of care in moral dilemmas and the men more likely to recognize elements of justice. CONCLUSION: This study provides initial evidence that clinical medical ethicists, whether philosophers or theologians, may be better skilled than physicians to do ethicists consultations. To the extent that higher levels of moral reasoning correlate with superior skills in performing clinical ethics consultations, this study shows the value of bringing philosophers and theologians into the clinical setting.

Adult↗

PubMedDate not supplied

Professional liability (malpractice) coverage of humanist scholars functioning as clinical medical ethicists.

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way the function as clinical ethicists.

Consultants↗

PubMed1991

A study of the foundations of ethical decision making of clinical medical ethicists.

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values.

Adult↗

PubMed1992

The problem of the impaired clinical ethicist.

Because clinical ethicists wield considerable power and influence in matters affecting institutions, clinicians, and patients, they should be accountable to those who employ them, rely on them, or are affected by their judgment. At a minimum, clinical ethicists have a duty not to be impaired, and the doctrine of corporate liability obliges institutions to ensure that neither they nor their patients are exposed to the risks the impaired clinical ethicist creates. Although their roles are still evolving and professional standards have yet to be established, a close look at what clinical ethicists do and what they say they do suggests the forms impairment may take and what the health community might do about it.

Decision Making↗

PubMed1994

Ethicists and health care reform: an indecent proposal?

The Clinton Administration stated that the list of values and moral principles generated by the Ethics group reflects "fundamental national beliefs about community, equality, and liberty" and that "these convictions anchor health reform in shared moral traditions." However, these statements are difficult to justify. There is not a moral consensus in America that would justify through-going health care reform. In such a context of pluralism, ethicists should seek to move society in the direction of solidarity. The participation of ethicists on the Clinton Task Force was valuable because it showed that health reform is an exercise in social ethics, disseminated the work of ethicists to the entire Task Force, and expanded the experience of the ethicists involved. It may also have accelerated the moral transformation of Americans, which is needed before radical reform can take place.

Advisory Committees↗

PubMed2004

Clinical education of ethicists: the role of a clinical ethics fellowship.

BACKGROUND: Although clinical ethicists are becoming more prevalent in healthcare settings, their required training and education have not been clearly delineated. Most agree that training and education are important, but their nature and delivery remain topics of debate. One option is through completion of a clinical ethics fellowship. METHOD: In this paper, the first four fellows to complete a newly developed fellowship program discuss their experiences. They describe the goals, structure, participants and activities of the fellowship. They identify key elements for succeeding as a clinical ethicist and sustaining a clinical ethics program. They critically reflect upon the challenges faced in the program. RESULTS: The one-year fellowship provided real-time clinical opportunities that helped them to develop the necessary knowledge and skills, gain insight into the role and scope of practice of clinical ethicists and hone valuable character traits. CONCLUSION: The fellowship enabled each of the fellows to assume confidently and competently a position as a clinical ethicist upon completion.

Bioethics↗

PubMedDate not supplied

Should a hospital ethicist have clinical experience?

As the federal government, accrediting agencies, and board-certifying organizations pay closer attention to hospitals' handling of ethical issues, the need increases for trained medical ethicists. The role of such persons should be one of an inside aide, not an outside expert. Although persons from disciplines other than medicine may have differing ideas about life-and-death issues, their perspectives can be of great help to physicians. The more medicine grapples with complex ethical issues, the greater the need for interdisciplinary cooperation. The kind of strategy most appropriate for the institutional ethicist's work is not one of abstract philosophizing but rather one that focuses on concrete cases and the development of decision-making strategies. If ethicists help physicians develop the conceptual tools to think through practical cases, then physicians will be better equipped to make defensible ethical decisions. In addition to providing consultive services, staff ethicists could serve on policy-making committees. They also could help physicians and nurses explain to patients' families the reasons for certain decisions or policies.

Clinical Competence↗

PubMed2006

Attitudes of patients, healthcare professionals and ethicists towards embryonic stem cell research and donation of gametes and embryos in Germany.

Due to the Embryo Protection Act, creation of supernumerary embryos, as well as egg and embryo donation, is prohibited in Germany. Human stem cell research is regulated through the Act on stem cells that came into force in 2002. A cross-sectional survey of 101 IVF couples (n=202) in two fertility centres, and representative samples of healthcare professionals and ethicists (n=879), was carried out, and their attitudes towards embryonic stem cell research and donation of gametes and embryos compared. A clear majority of IVF couples favoured legalization of egg and embryo donation and embryonic stem cell research for various purposes. The willingness of couples to donate was related to purpose and to other independent influences. The majority of physicians voted for legalization of embryonic stem cell production from surplus embryos. Most human geneticists and obstetricians approved egg, but not embryo, donation to other couples. Ethicists and midwives were opposed to every kind of donation and research on surplus embryos. The IVF couples surveyed have positive attitudes towards donation and research using surplus embryos, whereas the healthcare professionals and ethicists are predominantly sceptical about most research activities destroying human embryos. This difference should be considered carefully in legal and ethical discussions on reprogenetics.

Attitude of Health Personnel↗

PubMed2004

Medical ethicists, human curiosities, and the new media midway.

Medical ethicists have assumed a role in justifying public voyeurism of human "curiosities." This role has precedent in how scientists and natural philosophers once legitimized the marketing of museums of "human curiosities." At the beginning of the twentieth century, physicians dissociated themselves from entrepreneurial displays of persons with anomalies, and such commercial exhibits went into decline. Today, news media, principally on television, promote news features about persons that closely resemble the nineteenth century exhibits of human curiosities. Reporters solicit medical ethicists for soundbites to affirm the newsworthiness and propriety of public voyeurism of these medical stories. Ethicists' soundbites are usually ambiguous or self-evident and rarely enable viewers to morally engage the issues. The precedent of early twentieth century physicians disengaging from such exploitive public shows is a useful example for medical ethics.

Abnormalities, Severe Teratoid↗

PubMed1992

Which opinion should a clinical ethicist give: personal viewpoint or professional consensus?

When clinical ethicists are called upon to give a recommendation regarding patient care, they may be faced with a dilemma of their own. If their own personal opinion is not widely shared, the ethicist will have three options. These include: (1) giving their own opinion; (2) giving the widely shared opinion; and (3) giving both opinions, leaving the physician to select which opinion to accept. The intentions of this article are to evaluate strengths and weaknesses of these three alternatives and to suggest that ethics consultants recognize and deal with this issue. Two cases are presented to explore the limitations of each option. The author suggests that when the views of ethics consultants differ from the consensus view, the consultant should give the consensus view, their own dissenting view and the arguments in support of each position.

Codes of Ethics↗

PubMed2000

Applied ethics: what kind of ethics and what kind of ethicist?

Types of ethics are classified as more or less holistic in three respects. Current forms of applied ethics (among them reflective equilibrium) are criticized for being reductionist rather than holistic. It is claimed that applied ethics ought to be of a holistic kind. Two examples (tracing of hereditary cancer and active euthanasia) are used for maintaining that a reductionist ethic is of limited use for solving practical moral problems. Some possible roles of the ethicist are discussed. It is maintained that the ethicist ought to be a life philosopher mapping the moral landscape or a personal mentor rather than being a policeman or an ethics engineer.

Ethical Theory↗

PubMed1992

Baby marrow: ethicists and privacy.

A family had a child in large part to use its marrow in the hopes of saving the life of an older child afflicted with leukaemia. Public response from medical ethicists was negative. This paper argues that what the family did was not clearly wrong and that the ethicists should not have made public pronouncements calling the morals of the family into question.

Adolescent↗

PubMed2003

What the clinician taught the ethicist: clinical contributions to ethical concerns.

BACKGROUND: Clinical ethics is often assumed to be a one-way relationship in which ethicists consider the appropriate guidelines for clinical practice and research. This unfortunately ignores the important ways clinical practice informs bioethical thinking. MATERIAL/METHODS: This paper considers the relation between clinical and ethical practice through a consideration of whether there are conditions in which Physician Assisted Suicide, or other forms of euthanasia, serve as an ethically accepted response to chronic illness. At one scale it reviews publicly available data on deaths attributed to euthanasia practitioner Jack Kevorkian to consider the medical rationale of those deaths. At another scale, the 'mercy killing' by Canadian farmer Robert Latimer of his daughter is employed as a case study of surrogate decision making. RESULTS: A clinical review of the more than seventy cases attributed to Jack Kevorkian from 1990-98 reveals a client base that did not fit publicly or clinically accepted parameters within which euthanasia is generally understood. Few if any of the patients were near the end stage of a chronic progressive disease. Most were able to travel independently. Palliative care was in some cases problematic. The case of Latimer emphasizes the importance of social as well as medical care in cases of chronic illness, and the importance of palliative care as an alternative to CONCLUSIONS: Clinical ethics is of necessity a two-way street, one in which ethical paradigms influence practitioners and researchers whose expertise, in turn, necessarily educates the non-clinical ethicist.

Bioethical Issues↗

PubMed2003

Evidence-based medicine: why clinical ethicists should be concerned.

Evidence-based medicine purports to be the integration of three prongs; best research evidence, clinical expertise, and patient values and preferences. Controversy still surrounds the application of evidence-based medicine and undoubtedly controversy will persist in the treatment of specific diseases, thus allowing for some flexibility in decision-making. Yet, the idea that variation is expensive has gained wide acceptance and variation can best be controlled through rigid systems. So given the financial constraints facing healthcare organizations, as well as pressure from such august organizations like the Institute of Medicine to implement evidence-based medicine, flexibility in decision-making may ultimately become the exception rather than the rule. Certainly, in the short-term, the advantages of a rigid system, notably its cost advantage, overwhelm the advantages of a more naturally adaptive system--and so where possible evidence-based medicine will probably be implemented within a rigid context. Rigidity in system design will affect the activities of clinical ethics. To be effective in such a system, clinical ethicists will need an understanding of the system within which they practice including its values, goals, operations, and tools. This is a knowledge area which few in this field currently have and which they may not wish to acquire. But, if clinical ethicists expect to have credibility in responding to these changes, they must understand the values, goals, processes and outcomes of the system in place and be able to advocate for greater flexibility and greater attention to patient values and preferences even within a rigid mechanical system.

Decision Making↗

PubMed1999

Perspectives of new reproductive and diagnostic techniques among biologists and physicians, social scientists and ethicists.

The introduction and acceptance of new techniques in the field of reproductive medicine and antenatal genetic diagnosis is a complicated process in which biomedical professionals, and also social scientists and ethicists, play an important role. In this study the attitudes, expectancies and opinions of a panel of biological and medical professionals working in the field of this new technology are compared with those of a panel of concerned social scientists, psychologists, ethicists and leading members of patient groups. Various aspects of the new techniques are investigated: the present and future feasibility, the potential importance, the ethical evaluation and the social acceptance. The social-ethical panel appears to be much more reluctant regarding the importance, ethical values and social acceptability of new techniques than the biomedical panel, in particular, for preimplantation genetic diagnosis and fetal cell sorting large differences exist.

Attitude of Health Personnel↗

PubMed1995

The bioethics tabloids: how professional ethicists have fallen for the myth of tertiary transmitted heterosexual AIDS.

The hysteria and misconceptions about AIDS which are fostered and held by the popular press have been accepted uncritically by many bioethicists, who have not bothered to explore popular empirical claims in sufficient depth. As a result, and because ethicists attempt to sell moral problems in a manner not much different from the way the popular press attempt to sell newspapers, artificial dilemmas have been produced in professional journals. We concentrate on just one popular misconception about AIDS--that the heterosexual incidence of the syndrome is widespread--and show how bioethicists' unreflective acceptance of this myth has led them to make conceptual and practical errors.

Acquired Immunodeficiency Syndrome↗