Telling the truth is one of the most respected virtues in medical history and one of the most emphasized in the code of medical ethics. Health care providers are frequently confronted with the dilemma as to whether or not to tell the truth. This dilemma deepens when both choices are critically vicious: The choice is no longer between “right and right” or “right and wrong,” it is between “wrong and wrong.” In the case presented and (...) discussed in this paper, a research team in Saudi Arabia unintentionally uncovered information regarding misattributed paternity. In such a situation and in the context of a tribal cultural system, what should the team do with this information? This case analysis demonstrates the joint application of ethical resources originating from within and outside the Saudi Arabian context. The article analyses the case based on the moral problems involved, relevant medical application, and the impact of such information in the Saudi tribal and Islamic domains. The most pertinent relevant values and secular debates on similar matters are discussed. Finally, the article aims to provide an Islamic dimension of family, fatherhood, and adultery. (shrink)

This chapter contains sections titled: The Clinical Encounter Medical Paternalism Re‐examined Ethical Frameworks The Temptation to Deceive Different Forms of Deception Communicating Outside Medicine Character, Context, and Care References Further reading.

Health care providers are expected both to relieve pain and to provide anticipatory guidance regarding how much a procedure is going to hurt. Fulfilling those expectations is complicated by the cognitive modulation of pain perception. Warning people to expect pain or setting expectations for pain relief not only influences their subjective experience, but it also alters how nociceptive stimuli are processed throughout the sensory and discriminative pathways in the brain. In light of this, I reconsider the characterization of (...) placebo analgesia as pharmacologically inert and the use of it as deceptive. I show that placebo analgesia exploits the same physical mechanisms as proven analgesics and argue that it should be utilized to relieve pain. Additionally, I describe factors to help identify situations in which clinicians have the obligation to disclose the potential for pain coupled with ways of mitigating the risk of high-intensity pain by setting positive expectations. (shrink)

In this paper, we explore the idea of digital technologies as truth‐bearers in health care and argue that devices like SenseCam, which facilitate reflection and memory recall, have a potentially vital role in healthcare situations when questions of veracity are at stake (e.g., when best interest decisions are being made). We discuss the role of digital technologies as truth‐bearers in the context of nursing people with dementia, as this is one area of health care (...) in which the topic of truth‐telling has been hotly debated. People with dementia have been excluded from research studies and decisions that affect their lives because they are not regarded as truth‐bearers—that is, as being capable of giving truthful accounts of their experiences. Also, considerable research has focused on the ethics of lying to and deceiving people with dementia. Given their increasing prominence in healthcare settings, there has been surprisingly little discussion of what role digital technologies might play in relation to these questions of truth and deception. Drawing on theories from science and technology studies (STS), we explore their possible future role in some of the truth‐making processes of health care. In particular, we discuss the potential value of constraints on use of SenseCam to support the accounts of people with dementia as part of their care. (shrink)

A notable feature of the COVID-19 pandemic is that children are less at risk of becoming infected or, if infected, less likely to become seriously unwell, so ethical discussions have consequently focused on the adult healthcare setting. However, despite a lower risk of children becoming acutely ill with COVID-19, there nevertheless may be significant and potentially sustained effects of COVID-19 on the physical, psychological, and emotional health and well-being of children. Focusing on the context of children’s cancer care, (...) and specifically bone marrow transplant, we describe some of these effects and then address one specific ethical challenge that arises. That is the question of what and how much to tell children whose cancer treatment has been changed because of COVID-19. Drawing on our previous work on the ethical reasons for telling the truth to younger children we link different ethical reasons to the different types of information that could be given to children in this context. We argue that children should be given an explanation of the changes that they will directly experience, including some changes to the process of their actual medical treatment; but not about increased risk associated with these changes, unless they specifically ask for this information. (shrink)

This article aims to identify and describe the ethical dilemmas that are involved in the care of patients with incurable cancer. The data were collected in semistructured focused interviews with 32 patients, 13 nurses and 13 doctors from two central hospitals and four community health centres. The interviews were tape-recorded and transcribed verbatim. Interpretation was based on the method of content analysis. Ethical dilemmas occurred at the time of diagnosis, in connection with telling the truth, in (...) providing information, in the treatment of pain, and in decision-making situations concerning active treatment. Dilemmas of active treatment concerned chemotherapy, intravenous infusions, blood transfusions and antibiotics. There were also problems in relationships between nursing staff and next of kin, as well as a lack of co-operation between nurses and doctors. (shrink)

Lying is a common phenomenon amongst human beings. It seems to play a role in making social interactions run more smoothly. Too much honesty can be regarded as impolite or downright rude. Remarkably, lying is not a common phenomenon amongst normally intelligent human beings who are on the autism spectrum. They appear to be ‘attractively morally innocent’ and seem to have an above average moral conscientious objection against deception. In this paper, the behavior of persons with autism with regard to (...) deception and truthfulness will be discussed in the light of two different ethical theories, illustrated by fragments from autobiographies of persons with autism. A systemizing ‘Kantian’ and an empathizing ‘ethics of care’ perspective reveal insights on high-functioning autism, truthfulness and moral behavior. Both perspectives are problematic from the point of view of a moral agent with autism. High-functioning persons with autism are, generally speaking, strong systemizes and weak empathizers. Particularly, they lack ‘cognitive empathy’ which would allow them to understand the position of the other person. Instead, some tend to invent a set of rules that makes their behavior compatible with the expectations of others. From a Kantian point of view, the autistic tendency to always tell the truth appears praiseworthy and should not be changed, though it creates problems in the social life of persons with autism. From a care ethics perspective, on the other hand, a way should be found to allow the high-functioning persons with autism to respect the feelings and needs of other persons as sometimes overruling the duty of truthfulness. We suggest this may even entail ‘morally educating’ children and adolescents with autism to become socially skilled empathic ‘liars’. (shrink)

The truth about health care policy lies between two exaggerated views: a market view in which individuals purchase their own health care from profit maximizing health-care firms and a control view in which costs are controlled by regulations limiting which treatments health insurance will pay for. This essay suggests a way to avoid on the one hand the suffering, unfairness, and abandonment of solidarity entailed by the market view and, on the other (...) hand, to diminish the inflexibility and inefficiency of the control view. It suggests that the way to mitigate these problems is to recognize the malleability of motivation and the range of factors, in addition to financial incentives, that may influence the behavior of patients and especially physicians. (shrink)

Objectives—To investigate the incidence and solution of ethical dilemmas in a palliative care unit.Design—Health care workers recorded daily all dilemmas in caring for each patient.Setting—Palliative care unit of National Taiwan University Hospital in Taiwan.Patients—Two hundred and forty-six consecutive patients with terminal cancer during 1997-8.Main measurement—Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and (...) others.Results—The type and frequency of ethical dilemmas encountered were: place of care ; truth-telling ; hydration and nutrition ; therapeutic strategy , and use of medication . Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care , truth-telling and therapeutic strategy . Problems of truth-telling occurred in nearly half of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients .Conclusions—The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care. (shrink)

This study describes the ways in which professionals in two contexts of health care: general practice and homeopathic consultations, respond to patients' affective expressions of a trouble or a problem. The focus is on the turns of professionals that display understanding, compassion or agreement with the patient's account. Different types of affiliative turns are described and their consequences for the following interaction are scrutinized in relation to the institutional task of solving the patients' health-related problems. It (...) is shown that in both contexts, affiliation is oriented to as working towards closing the sequence of troubles-telling and serves to shift back to problem-solving activity, whilst in homeopathy, it may also serve as a means to problem-solving and thus help to complete the institutional task at hand. Some implications of these observations for professional—client interaction will be described. To conclude, the role of emotion in institutional interaction will also be discussed. (shrink)

An incisive examination of bioethics and American healthcare, and their profound affects on American culture over the last sixty years, from two eminent scholars. An eye-opening look at the inevitable moral choices that come along with tremendous medical progress, Everybody Wants to Go to Heaven but Nobody Wants to Die is a primer for all Americans to talk more honestly about health care. Beginning in the 1950s when doctors still paid house calls but regularly withheld the truth (...) from their patients, Amy Gutmann and Jonathan D. Moreno explore an unprecedented revolution in health care and explain the problem with America’s wanting everything that medical science has to offer without debating its merits and its limits. The result: Americans today pay far more for health care while having among the lowest life expectancies and highest infant mortality of any affluent nation. Gutmann and Moreno—“incisive, influential, and pragmatic thinkers” (Arthur Caplan)—demonstrate that the stakes have never been higher for prolonging and improving life. From health care reform and death-with-dignity to child vaccinations and gene editing, they explain how bioethics came to dominate the national spotlight, leading and responding to a revolution in doctor-patient relations, a burgeoning world of organ transplants, and new reproductive technologies that benefit millions but create a host of legal and ethical challenges. With striking examples, the authors show how breakthroughs in cancer research, infectious disease, and drug development provide Americans with exciting new alternatives, yet often painful choices. They address head-on the most fundamental challenges in American health care: Why do we pay so much for health care while still lacking universal coverage? How can medical studies adequately protect individuals who volunteer for them? What’s fair when it comes to allocating organs for transplants in truly life-and-death situations? A lucid and provocative blend of history and public policy, this urgent work exposes the American paradox of wanting to have it all without paying the price. (shrink)

Background Hip fracture repair surgery carries a certain mortality risk, yet evidence suggests that orthopedic surgeons often refrain from discussing this issue with patients prior to surgery. Aim This study aims to examine whether orthopedic surgeons raise the issue of one-year post-surgery mortality before hip fracture repair surgery and to explore factors influencing this decision. Method The study employs a cross-sectional design, administering validated digital questionnaires to 150 orthopedic surgeons. Results A minority of orthopedic surgeons reported always informing patients about (...) the risk of mortality in the year following hip fracture surgery. The main reasons for not discussing this risk were a desire to avoid frightening patients, time constraints, and concerns about undermining patient hope. Orthopedic surgeons reported a medium-high level of perceived self-efficacy, with higher self-efficacy associated with a reduced likelihood of discussing one-year mortality risk. Conversely, older age and holding a specialist status in orthopedic surgery were associated with an increased likelihood of discussing this risk with patients. Conclusions These findings suggest a need for interventions to address communication barriers and ensure consistent provision of essential information to patients undergoing hip fracture surgery. Additionally, they highlight the importance of considering individual factors such as self-efficacy, age, and expertise in designing strategies to improve patient-provider communication in orthopedic care settings. Trial registration : The study doesn`t report the results of a health care intervention. (shrink)

The principle of respect for autonomy requires informing patients adequately and appropriately about diagnoses, treatments, and prognoses. However, some clinical cases may cause ethical dilemmas regarding telling the truth. Under the existence especially of certain cultural, social, and religious circumstances, disclosing all the relevant information to all pertinent parties might create harmful effects. Even though the virtue of telling the truth is unquestionable, sometimes de facto conditions compel physicians to act paternalistically to protect the patient/patients from (...) imminent dangers. This article, which aims to study the issue of whether a physician should always tell the truth, analyzes an interesting case that represents the detection of misattributed paternity during pre-transplant tests for a kidney transplant from the son to the father in Turkey, where social, cultural, and religious factors have considerable impact on marital infidelity. After analyzing the concept of telling the truth and its relationship with paternalism and two major ethical theories, consequentialism and deontology, it is concluded that the value of the integrity of life and survival overrides the value of telling the truth. For this reason, in the case of a high possibility of severe and imminent threats, withholding some information is ethically justifiable. (shrink)

A considerable section of the population in India accesses the services of individual private medical practitioners (PMPs) for primary level care. In rural areas, these providers include MBBS doctors, practitioners of alternative systems of medicine, herbalists, indigenous and folk practitioners, compounders and others. This paper describes the profile, knowledge and some practices of the rural doctor in India and then discusses the reasons for lack of equity in health care access in rural areas and possible solutions to (...) the problem. (shrink)

Truth-telling for terminally ill patients is a challenging ethical and social issue for Chinese health care professionals. However, despite the existence of ethical and moral standards for nurses, they frequently encounter moral dilemmas when making decisions about truth-telling to patients with end-stage diseases in China. This article aims to provide ethical strategies for clinical nurses in China regarding truth-telling decisions for terminally ill patients on the basis of their individual autonomy. This article (...) first presents a common case scenario in China and then critically discusses ethical issues related to ethical principles and philosophical theories. The aim is to provide the much needed strategy for truth-telling for nurses who are terminally ill rather than to focus on attitudes toward disclosure. This article focuses on nursing morality, ethics, norms, and philosophy in health care and discusses countermeasures taken by nurses in truth-telling decision-making in combination with Chinese Confucian culture. The analysis identifies key ethical strategies tailored to Chinese nurses’ practices, emphasizing individual autonomy, cultural sensitivity, and family dynamics in truth-telling decisions. The complexity of end-of-life illness requires Chinese nurses to strengthen the communication training needed to deliver bad news, as well as critical and autonomous thinking and good communication skills when implementing patient- and family-centered care, to achieve true delivery of bad news, thereby increasing patient autonomy and promoting more successful collaboration among patients, families, and providers. To improve the quality of care. Chinese nurses should integrate ethical principles with Confucian values to enhance patient-centered communication, respecting autonomy while adapting to cultural nuances in end-of-life care. (shrink)

Medical error is a leading problem of health care in the United States. Each year, more patients die as a result of medical mistakes than are killed by motor vehicle accidents, breast cancer, or AIDS. While most government and regulatory efforts are directed toward reducing and preventing errors, the actions that should follow the injury or death of a patient are still hotly debated. According to Nancy Berlinger, conversations on patient safety are missing several important components: religious (...) voices, traditions, and models. In After Harm, Berlinger draws on sources in theology, ethics, religion, and culture to create a practical and comprehensive approach to addressing the needs of patients, families, and clinicians affected by medical error. She emphasizes the importance of acknowledging fallibility, telling the truth, confronting feelings of guilt and shame, and providing just compensation. After Harm adds important human dimensions to an issue that has profound consequences for patients and health care providers. (shrink)

Every successful health care system should be based on some general humanistic ideals. However, the nationally organized health care systems of most European countries usually suffer from a deficiency in common ethical values based on universal human principles. When transitional societies, such as that of Bosnia-Herzegovina are concerned, health care organizational models are even more dysfunctional. The sources of a dysfunction in medical care system of Bosnia-Herzegovina are manifold and mutually controversial, including a (...) lack of shared principles, an inappropriate involvement of politicians in medical care and practice, administrative difficulties arising from superficial communication systems, as well as economic limits concerned with the financing of health care. The deficiency of a moral culture of medicine, which is correlated to a general collapse of morality is also responsible for many problems affecting various aspects of life including medical care. Hence, medical ethics from a virtue perspective is becoming an important ingredient of any improvement deigned to provide better-quality medical care.The aim of this paper is to underline the influence of humanism on the organization of health care systems and the ethics of medical interrelations in the society of Bosnia-Herzegovina. It is not intended to diagnose or resolve the problems, but to analyze them. It is also a critique of specific socio-political-economic influences on this health care system, inquiring if well-educated individuals in the virtues, which are involved in medical practice and education, would counteract them.In conclusion, humanism creates a universal ethical structure, which is based on human values such as fidelity, trust, benevolence, intellectual honesty, courage, compassion and truthfulness. These values should represent the standard around which medical care is organized. Since the health care system in Bosnia-Herzegovina is not entirely founded upon humanistic ideals, addressing the socio-political-economic conditions that constantly undermine those values is a prerequisite for any much-needed improvements of the medical care. (shrink)

This article will argue that the church is the mystic body of Christ that believers must guard from purveyors bend on twisting the truth. There is no doubt that the Catholic social teaching on medical and moral matters has proven to be pertinent and applicable to the ever-changing circumstances of health care and its delivery. In response to today’s challenges, these same moral principles of Catholic teaching provide the rationale and direction for the community of faith. In (...) times of coronavirus characterized by falsehoods, the truth is a virtue the church must strive for: “… If you abide in My word, you are My disciples indeed. And you shall know the truth, and the truth shall make you free.”(John 8: 31-32). The truth is Christ; it is Christological. Christians must understand the clash of worldviews that is changing the face of Zimbabwean society. A worldview is simply the sum total of our beliefs about the world; Christianity is a worldview that directs our daily decisions and actions. Worldviews affect the way we think. A worldview is a well-reasoned framework of beliefs and convictions that gives a true and unified perspective on the meaning of human existence. To paraphrase from the book of First Samuel (16: 7) – to see as God sees and not how the world sees. Beliefs are not simple propositions held inside us which drive our outward behaviour in predictable ways, they are more of acts of commitment than anything else. There is no doubt that the future of Catholicism lies in the hands of the church’s leadership and the believing Christians. Catholics look to their faith leaders for guidance on big decisions as regards COVID-19 issues. Conspiracy theories around COVID-19 deny that the COVID-19 pandemic is a biological virus. Catholics require direction from the Pope down to the episcopal leadership to chart the way forward. A worldview not only impacts how one understands and makes sense of the world but also influences how one expresses oneself in the world. The constellation of personal values, beliefs, assumptions, attitudes, and ideas that make up our worldview have an effect on our understanding of reality. Coronavirus has caused uncertainty among believers and confusion as to how to cope with the complex problems that arise in COVID-19 related issues. This article will aver that the nature of drawing the contours of catholicity regarding the biblical foundations of the health falls in the hands of orthodox Catholic teachings. (shrink)

This article interrogates twelve step practice within Alcoholics Anonymous from the perspective of Foucault’s later work on governance, truth-telling and subjectivity. Recent critical studies of addiction tend to view self-help cultures like that of AA and related twelve step programs as integral parts of contemporary power/knowledge complexes, and thus as agents of the modern “will to knowledge” that Foucault often engages with. In line with the widespread Foucauldian critique of governmentality, addiction self-help culture is thus conceived as one (...) that primarily reproduces abstract, neoliberal norms on health and subjectivity. The argument put forward in this article aims to upset this framework attending to a number of features of twelve step practice that, arguably, bear striking resemblances to Foucault’s later discussions of ethics, care of self and truth-telling. In this, it is suggested that a close study of AA practices, might interrupt assumptions about contemporary addiction discourse and its relationship to issues of truth and power often reproduced in Foucauldian critiques. (shrink)

Every successful health care system should be based on some general humanistic ideals. However, the nationally organized health care systems of most European countries usually suffer from a deficiency in common ethical values based on universal human principles. When transitional societies, such as that of Bosnia-Herzegovina are concerned, health care organizational models are even more dysfunctional. The sources of a dysfunction in medical care system of Bosnia-Herzegovina are manifold and mutually controversial, including a (...) lack of shared principles, an inappropriate involvement of politicians in medical care and practice, administrative difficulties arising from superficial communication systems, as well as economic limits concerned with the financing of health care. The deficiency of a moral culture of medicine, which is correlated to a general collapse of morality is also responsible for many problems affecting various aspects of life including medical care. Hence, medical ethics from a virtue perspective is becoming an important ingredient of any improvement deigned to provide better-quality medical care. The aim of this paper is to underline the influence of humanism on the organization of health care systems and the ethics of medical interrelations in the society of Bosnia-Herzegovina. It is not intended to diagnose or resolve the problems, but to analyze them. It is also a critique of specific socio-political-economic influences on this health care system, inquiring if well-educated individuals in the virtues, which are involved in medical practice and education, would counteract them. In conclusion, humanism creates a universal ethical structure, which is based on human values such as fidelity, trust, benevolence, intellectual honesty, courage, compassion and truthfulness. These values should represent the standard around which medical care is organized. Since the health care system in Bosnia-Herzegovina is not entirely founded upon humanistic ideals, addressing the socio-political-economic conditions that constantly undermine those values is a prerequisite for any much-needed improvements of the medical care. (shrink)

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 health care professionals should seek to understand their patients' preferences and act appropriately according to their choice. (shrink)

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities. We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the (...) United Kingdom and the state of Oregon in the US. The approaches used can be divided into those centered on outlining principles versus those that define practices. In order to establish the main lessons from their experiences we consider the process each country used, criteria to judge the success of these efforts, which approaches seem to have met these criteria, and using their successes and failures as a guide, how to proceed in setting priorities. We demonstrate that there is little evidence that establishment of a values framework for priority setting has had any effect on health policy, nor is there evidence that priority setting exercises have led to the envisaged ideal of an open and participatory public involvement in decision making. (shrink)

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on (...) health care resources. Therefore, the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well. (shrink)

A remarkable surge in efforts to assess the quality of life of patients has occurred in recent years in medical research. Philosophical discussions of these developments have focused, on the one hand, on epistemological reservations about the plausibility of measuring quality of life and, on the other hand, on moral and ethical qualms about the meaning of life conveyed in such assessments. Whilst providing an important note of caution, such critiques fail to recognise two basic principles of quality of life (...) in medical research. Firstly it is intended to provide understanding about groups and categories of patients rather than individuals. Secondly the purpose of such research is to produce generalisations about the relative costs and benefits of specific health care interventions rather than absolute judgements regarding the quality of life of patients per se. Selecting a good quality of life measure for a clinical trial requires balancing criteria such as validity with practical feasibility. Such measures will play an increasingly central role in providing research evidence to improve health care. (shrink)

This paper addresses three factors that have contributed to shifts in decision making in health care. First, the notion of patient autonomy, which has changed due to the rise of patient-centred approaches in contemporary health care and the re-conceptualization of the physician-patient relationship. Second, the understanding of patient autonomy has broadened to better engage patient participation. Third, the need to develop cross-cultural health care ethics. Our paper shows that the shift in the West from (...) the individual to the relational self indicates an important change in the understanding of autonomy through the lens of culture. Practices that recognize the notion of the relational self allow for a more balanced view of autonomy and a richer conception of moral agency. (shrink)

The use of opaque, uninterpretable artificial intelligence systems in health care can be medically beneficial, but it is often viewed as potentially morally problematic on account of this opacity—because the systems are black boxes. Alex John London has recently argued that opacity is not generally problematic, given that many standard therapies are explanatorily opaque and that we can rely on statistical validation of the systems in deciding whether to implement them. But is statistical validation sufficient to justify implementation (...) of these AI systems in health care, or is it merely one of the necessary criteria? I argue that accountability, which holds an important role in preserving the patient‐physician trust that allows the institution of medicine to function, contributes further to an account of AI system justification. Hence, I endorse the vanishing accountability principle: accountability in medicine, in addition to statistical validation, must be preserved. AI systems that introduce problematic gaps in accountability should not be implemented. (shrink)

Health Care Ethics Health care ethics is the field of applied ethics that is concerned with the vast array of moral decision-making situations that arise in the practice of medicine in addition to the procedures and the policies that are designed to guide such practice. Of all of the aspects of the human body, and … Continue reading Health Care Ethics →.

In the majority of academic institutions nursing and medical students receive a traditional education, the content of which tends to be specific to their future roles as health care professionals. In essence, each curriculum design is independent of each course. Over the last decade, however, interest has been accumulating in relation to interprofessional and multiprofessional learning at student level. With the view that learning together during their student training would not only encourage and strengthen future collaboration in practice (...) settings but also enhance patient care, the University of Dundee decided to run a pilot study to explore shared teaching in ethics between medical and nursing students. This article presents a report on the reasons for selecting health care ethics as a precursor for shared teaching, the educational tool used for the sessions, and the results of student and facilitator evaluation of the short course. Overall, despite problems such as poor attendance by some students, and facilitation and timetable difficulties, most of the feedback from students and facilitators has been positive. In essence the ‘idea’ has gone from strength to strength and there are now three levels of shared teaching in ethics between nursing and medical students, with plans to include further sessions with students from other disciplines. Within the text, ‘health care ethics’ will be referred to as ‘ethics’; nursing students/nurses encompasses midwifery students/midwives. (shrink)

Background: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care. Objective: The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke. Research design: Qualitative study based on (...) individual interviews utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Findings: The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. Discussion: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first. Conclusion: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge. (shrink)

This analysis examines the practice of care providers in residential aged care lying to residents with dementia. Qualitative data were collected through multiple methods. Data here represents perceptions from registered and enrolled nurses, personal care assistants, and allied health professionals from five residential aged care facilities located in Queensland, Australia. Care providers in residential aged care facilities lie to residents with dementia. Lying is conceptualized as therapeutic whereby the care provider’s intent is (...) to eliminate harm and also control behaviour. Care providers of residents with dementia in RACFs need guidance around lying. An ethical framework cognisant of an ethical theory of good and ethical theory of right supplemented by a theory of virtue is proposed. A complimentary four stage communication strategy that promotes truth telling as a first option while also recommending the lie as a suitable strategy is also promoted. (shrink)

Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on (...) equity and the distribution of resources in health care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community interms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services. (shrink)

The ethics of telling stories about other people become questionable as soon as humans learn to talk. But the stakes get higher when health care professionals tell stories about those whom they serve. But for all the problems that come with such stories, I do not believe it is either practical or desirable for bioethicists to attempt to legislate an end to this storytelling. What we need instead is narrative nuance. We need to understand how to tell (...) respectful stories in which the patients are fully acknowledged fellow participants, not one‐dimensional objects of a knowing gaze. The problem is not narration itself but a particular version of narrational privilege, and getting rid of that would have benefits far beyond practices of writing case studies. In this essay, I first offer four considerations that I have found either omitted or underemphasized in discussions of the ethics of telling stories about patients. I then sketch a model of medical storytelling that might be the basis for shifting the ethical question from whether to how. (shrink)

Mistakes can be made in both personal and official accounts of past events: lies can be told. Stories about the past have many functions besides truth-telling: but we still care deeply that our sense of what happened should be accurate. The possibility of error in memory and in history implies a commonsense realism about the past. Truth in memory is a problem because, coupled with our desires to find out what really happened, we recognize that (...) our individual and collective access to past events may be indirect. This chapter sketches some approaches, from across the disciplines, to such problems about authority over the past. I open up recent lines of research on autobiographical memory which should be more accessible in the humanities and social sciences. Psychological work on constructive remembering should not be seen as sceptically challenging the very possibility of everyday authority over our own past, but as identifying specific forms of fallibility. I argue that the study of historical and social processes is an integral part of the cognitive sciences of memory, not a humanistic curiosity. (shrink)

Should blood be bought and sold is in crude terms the question asked and answered by Richard Titmuss in his recent book The Gift Relationship. Dr Raymond Plant, a lecturer in philosophy at Manchester University, analyses Titmuss' arguments in a paper which we are printing in two parts. Titmuss has taken the provision of blood as his example of the gift relationship--and by extension that of health care generally. Dr Plant considers in turn each of Titmuss' arguments that (...) blood should not be a marketable commodity, the moral objections to which seem to be the erosion of freedom and of truth telling, the separation of society through the cash nexus, and its converse that the provision of health care is a means for the integration of society. Dr Plant also examines the views of other commentators on the Titmuss' theory of the value of a 'free' blood transfusion service and other medical care as a means of integration in society, and ends with his promise that in the second part of his paper he will examine Titmuss' principles not in terms of the market but rather as related to the principle of social justice. (shrink)

Providing health care in the most cost-effective way has become a priority in recent years. This book tackles the important issue of the potential conflict between economic expediency and the welfare of individual patients. Contributors examine different attitudes to this complex problem, along with a variety of legal and historical perspectives. The book addresses particular aspects of health care, such as medical expert systems, general practice, medical education, and clinical decision-making where the direct involvement of (...) doctors in allocating scarce and expensive resources is perhaps most obvious. (shrink)

In recent years, the rights of patients have assumed a more pivotal role in international discussion. Stricter laws on the protection of patients place greater priority on the perspective and the status of patients. The purpose of this study is to emphasize ethical aspects in communication, the role of patient advocates as contacts for the concerns and suggestions of patients, and how many problems of ethics disappear when communication is highlighted. We reviewed 680 documented cases of consultation in a 10-year (...) period of patient advocates’ activity at a big German university hospital with 1,300 beds. On the basis of this extensive material, the article will focus on the intersection of the advocate’s work with the problems of patients in hospitals. Deficits in the level of communication between health care professionals and patients were frequently uncovered. Patients primarily complain about the lack of dialogue and empathy. Middle-aged patients consulted the patients’ advocate disproportionately more often. Measured against this baseline, the group of 65 and older complained less frequently. Besides complaints the advocate was asked in more than one-third of all cases for information about medical matters, hospital regulations or administrative problems. Patients obviously see the advocate as a well-connected and ideally unbiased contact person for uncertainties concerning their malady or a potential stay in hospital. Those seeking help often set hope in the information given by the voluntary patient representative. It should be highly recommended for every German hospital to establish the position of a patient advocate. Furthermore, patients can profit from regular exchange between the advocate and the Ethics Committee, also, to help ensure that their rights are taken into account and implemented in an ethically desirable context. (shrink)

‘I’ll tell you what suits me best if you don’t mind me saying’: ‘lay participation’ in health‐careIncreasing ‘lay participation’ in healthcare has become a popular notion in recent years and is generally considered to be a good thing in both nursing and wider policy circles. Yet despite the widespread acceptance of this overall idea, there is a dearth of theorising in this area. This has resulted in a lack of conceptual clarity which has not only hamstrung the development of (...) empirical work in the field, but has also led to a tendency by both nurses and policy‐makers to assume that greater ‘lay participation’ in health will lead to a concomitant increase in lay power vis‐à‐vis health professionals. The data presented in this paper indicate that this is, at best, an over‐simplistic assumption and, at worst, an erroneous one. Drawing on sociological theories of the division of labour, I suggest that one way in which we might begin to clarify our thinking in this area is by differentiating between the ‘role’ and ‘task’ components of ‘lay participation’. I illustrate my argument with reference to two separate ethnographic studies undertaken between 1994 and 1998 in which participation at the level of the individual was examined. (shrink)

This article explores Dietrich Bonhoeffer’s writings on truth telling with reference to the problem of medical error in the US, the UK, and other developed nations, with particular attention to physicians’ resistance to disclosing their own mistakes to injured patients and their families. The brief essay ‘What Is Meant by “Telling the Truth”?’ and its historical context — Bonhoeffer’s imprisonment and interrogation in 1943 — is proposed as a text for medical ethicists and others seeking (...) to overcome the barrier of the ‘hidden curriculum’ within the culture of medicine, which encourages medical students and physicians to conceal their errors and to fear disclosure. (shrink)

Concepts and Cases in Nursing Ethics maps the ethical landscape of contemporary nursing. The book is the product of a collaboration between philosopher-ethicist Michael Yeo, nurse-ethicist Anne Moorhouse, and six representatives of various areas of professional nursing. It thus combines philosophical and ethical analysis with nursing knowledge and experience in a manner that is both understandable and relevant. The book is organized around six main concepts in nursing ethics: beneficence, autonomy, confidentiality, truth-telling, justice, and integrity. A chapter is (...) devoted to the elucidation of each of these concepts. In each chapter, historical background and conceptual analysis are supplemented by case studies that exemplify issues and show how the concept applies in nursing practice. In this new edition, the materials in each chapter have been updated to reflect recent developments in nursing and more generally in health care. In addition, a totally new chapter on ethical theory has been added. Complete with bibliographies and study questions for further analysis of cases, this book is ideally suited for textbook use. It will help both practitioners and students to deal better with the clinical problems and issues that are encountered in the field. However, it's simple prose and clear exposition of complex issues will make Concepts and Cases in Nursing Ethics attractive to anyone concerned about health care. (shrink)

Health-care provider liability has again taken center stage in American political debate, but with an ironic twist. In the seventies, physicians wanted tort reform, but they measured such reform solely by a reduction in both the risk of being sued and the size of any judgment a plaintiff could win. Malpractice reforms in many states in the seventies therefore capped damages, reduced contingency awards to lawyers, and restricted other tort rules to limit plaintiff success. Today physicians are conflicted. (...) They want an increase in liability exposure — not for themselves, but for managed care plans. We have therefore ended up with a series of overlapping debates, with the same debaters taking contradictory positions. Should managed care organizations—until now protected by ERISA preemption from liability—be liable? Physicians say yes. But should physicians be protected from the threat of suit, which they argue acts as an in terrorem device that drives disclosure of medical errors into hiding? (shrink)

This article aims to examine critically the ‘cultural incompatibility’ argument, which asserts that disclosure of cancer-related information to patients is incompatible with Turkey’s cultural context. For this purpose, a brief overview of the approach to truth-telling in Turkey will first be provided, followed by the claims of two different Turkish authors on the issue and a critical analysis of their approach. It will be contended that this argument has actually been formulated with paternalistic concerns and it may be (...) playing an important role in shaping the approach of Turkish health care professionals to the issue. The article will then examine, in the light of study findings and case reports from Turkey, the concept of patient autonomy as it applies to truth-telling issues. It will be concluded that truth-telling can be compatible with Turkey’s cultural context, provided that health care professionals place more emphasis on good communication with their patients. (shrink)

This chapter examines truthfulness, or veracity, in the context of health care services within prisons, jails, and detention facilities in the United States. Mainstream discussions of bioethics often highlight the general importance of veracity within the patient-provider relationship, including providers’ obligations and constraints with respect to telling the truth to their patients, and, to a lesser extent, patients’ responsibilities and concerns regarding truthful reporting to their providers. However, a great deal of this literature largely overlooks how (...) structural barriers to health care impact the functions of veracity in the provision of health care—including racist and sexist biases in clinical judgment, inadequate staffing, infrastructure, and accessibility in medical facilities, and institutionally specific constraints. Through an analysis of Assata Shakur’s political autobiography, this chapter focuses on such structural barriers to health care in carceral facilities with a focus on the institutionally specific constraints that arise through the punitive aims of carceral facilities. By focusing on the intersection between punishment and health, this chapter argues that bioethicists and clinicians alike would be better equipped to analyze structural barriers to health care that exist both within and beyond prison walls through a nonideal approach. (shrink)

The purpose of this article is to consider an answer to the question whether Searle’s idea of sentence in a literary text is still relevant. Understanding literary utterances as specific speech acts, pretended illocutions, is inherent in the process of considering the sentence in a literary text in broader terms. Accordingly, it appears necessary to outline it. Reference to other ideas formulated both in the theory of literature as a speech act [R. Ohmann, S. Levin] as well as in logic, (...) ontology and the theory of literature [J. Pelc, H. Markiewicz, R. Ingarden] will render it possible to adequately place and assess Searle’s theory. Confronting Searle’s theory with the order in a literary work (the relation between the text and the literary work, the status of the presented world, the issue of reference and fiction) will in turn render it possible to determine how empirically adequate Searle’s theory is. (shrink)

There are three main categories of rationale for withholding information or telling lies: if overwhelming harm can only be averted through deceit; complete triviality such that it is irrelevant whether the truth is told; a duty to protect the interests of others. Public health authorities are frequently having to form judgements about the public interest, whether to release information or issue warnings. In June 1992, routine surveillance detected patulin levels (a known carcinogen) in samples of apple juice (...) exceeding safety threshold. Remedial actions were promptly taken and it was planned to subsequently publish the information in the routine way. However, the media portrayed the handling of the problem as a conspiracy and there was a short term reduction in juice sales. In October 1995, the UK Committee on Safety of Medicines issued a warning about certain brands of the contraceptive pill, based on the interim results of three unpublished studies. The increased risk of thromboembolism was small, but the resulting scare led to an increase in unwanted pregnancies. The handling of the B.S.E. crisis in the U.K. also led to accusations of incompetence or conspiracy. Public health authorities have to handle uncertainty and frequently have to form judgements for public safety on the basis of evidence of poor quantity and quality. Their task is not helped by the sometimes conflicting agenda of scientists and media. The public also have differing perceptions and interpretations of risk. The series of scares and crises are having a detrimental effect on public confidence in public health authorities. (shrink)

How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this (...) article we analyze Juth’s argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for. (shrink)

Many of the demands being voiced for a "humanizing" of health care center on the public's concern that they have some say In determining what happens to the individual in health care institutions. The essays in this volume address fundamental questions of conflicts of rights and autonomy as they affect four selected, controversial areas in health care ethics: the Limits of Professional Autonomy, Refusing! Withdrawing from Treatment, Electing "Heroic" Measures, and Advancing Reproductive Technology. Each (...) of the topics is addressed in such a way that it includes an examination of the locus of responsibility for ethical decision making. The topics are not intended to exhaustively review those areas of health care provision where conflicts of rights might be said to be an issue. Rather they constitute an examination of the difficulties so often encountered in these specific contexts that we hope will illuminate similar conflicts in other problem areas by raising the level of the reader's moral awareness. Many books in bioethics appeal only to a limited audience in spite of the fact that their subject matter is of deep personal concern to everyone. In part, this is true because they are frequently written from the perspective of a single discipline or a single profession. As a result, one is often left with the impression that such a book views the philosophical, historical, and! or theological problems as essentially indifferent to clinical, legal, and! or policy-making problems. (shrink)

A collection of essays that cover a range of topics of relevance to health care professionals. The book is intended to fill a gap between introductory texts on medical ethics and in-depth specialized books. It shows the importance of combining philosophical and ethical discussion.

Definition of the problem Interprofessional learning of nursing trainees and medical students offers numerous opportunities for future cooperation aiming to provide high-quality care for patients. Arguments Expert panels, therefore, demand early integration of interprofessional teaching and learning structures in order to be able to achieve effective and sustainable improvements in practice. In Germany, interprofessional learning formats are increasingly used in undergraduate education of the two professions in selected—compulsory and optional—themes and courses. Conclusion So far, the field of (...) class='Hi'>health care ethics has scarcely been taken into consideration. The article examines the situation of interprofessional ethics teaching in Germany and highlights its opportunities and limitations against the background of a pilot project. (shrink)