Volume 25, Issue 2, February 2025, Page 23-25.

Volume 24, Issue 12, December 2024, Page 48-51.

Volume 25, Issue 2, February 2025, Page 145-148.

Volume 24, Issue 7, July 2024, Page 127-128.

Men who are victimized in their intimate different-sex (DS) and same-sex (SS) relationships often report not having information to help them escape their abusive situations. To overcome this lack of information, public awareness campaigns have been created. But thus far, there is no clear understanding of how these campaigns reflect theoretical principles central to improve message effectiveness and avoid undesired negative effects. This study aims to review the content of intimate partner violence (IPV) pictorial campaigns focusing on victimized men in (...) DS and SS relationships. Specifically, it aims to understand the campaigns’ global characteristics and if their content represents constructs from different theoretical models. Online search engines were used to extract pictorial campaigns in English, Spanish, and Portuguese, released up until 2019. They must have had to be promoted by a formal organization, and were coded according to a theoretically grounded taxonomy, using thematic analysis. Our results indicate that out of the 57 campaigns collected, most were aimed at men without specifying the relationship they were in (i.e., DS or SS) ( n = 22, 39%) and intended to change attitudes, beliefs, and behaviors about IPV (in line with the Theory of Planned Behavior) ( n = 47, 82%). Additionally, four campaigns adequately integrated fear appeal constructs of the Extended Parallel Processing Model ( n = 4, 7%), while 41 campaigns highlighted dissonant states in line with the Elaboration Likelihood Model ( n = 41, 72%). Following the Transtheoretical Model, most campaigns targeted victims in the Maintenance stage ( n = 52, 92%). The campaigns under analysis may prove useful for some victimized men, mostly presenting messages designed to elicit a beneficial attitude and behavior change. Our analysis highlights different limitations as well, such as the lack of information on susceptibility to IPV ( n = 13, 23%) and the effectiveness of the recommended responses that the campaigns provide ( n = 20, 38%), which may interfere with adequate fear appeal processing. Additionally, presenting more diverse victims may be beneficial, along with social norms change information regarding gender roles, violence, and help-seeking. This may guide the development of improved and tailored campaigns to better facilitate help-seeking in victimized men that mostly avoid undesired negative effects on the viewer. (shrink)

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to (...) 68,000. The median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals (...) in the U.S., and in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very (...) positive perceptions of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

Volume 24, Issue 12, December 2024, Page 51-53.

Volume 24, Issue 12, December 2024, Page 71-73.

In most children’s hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers (...) and physicians about clinical dilemmas. Then, as a case-study, we describe the different venues that have developed at one children’s hospital to address ethical issues. At our hospital, there are nine different venues in which ethical issues are regularly and explicitly addressed. They are ethics committee meetings, Nursing Ethics Forum, ethics Brown Bag workshops, PICU ethics rounds, Grand Rounds, NICU Comprehensive Care Rounds, Palliative Care Team case conferences, multidisciplinary consults in Fetal Health Center, and ethics consultations. In our hospital, ethics consults account for only a tiny percentage of ethics discussions. We suspect that most hospitals have multiple and varied venues for ethics discussions. We hope this case study will stimulate research in other hospitals analyzing the various ways in which ethicists and ethics committees can build an ethical environment in hospitals. Such research might suggest that ethicists need to develop a different set of “core competencies” than the ones that are needed to do ethics consultations. Instead, they should focus on their skills in creating multiple “moral spaces” in which regular and ongoing discussion of ethical issues would take place. A successful ethicist would empower everyone in the hospital to speak up about the values that they believe are central to respectful, collaborative practice and patient care. Such a role is closer to what the first hospital philosophers set out to do than in the role of the typical hospital ethics consultant today. (shrink)

In Turkey, city hospitals play a significant role in the provision of healthcare services. This survey looked at the level of satisfaction with various hospitals. In the study, social media was one of the tools. The hospitals' websites were used to compile satisfaction ratings. After that, content analysis was used to look at the hospitals' indicators for technological, communicative, and physical quality. The study considered hospitals with 1200 beds or greater as a sampling factor in (...) hospital selection. Hospitals are classified with the designation "Hospital" in objectives of information security and ethics. Encoding was carried out like Hos1, Hos2, Hos3, etc. for every hospital. The results of this article, which are considered significant research findings, are believed to had an important effect on improving hospital service requirements. Additionally, improvements can be made in health service delivery in line with the opinions of stakeholders. Additionally, the importance of patient satisfaction in terms of health tourism was emphasized. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important (...) higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

ObjectivePhysical and mental well-being are threatened by climate change. Since hospitals in high-income countries contribute significantly to climate change through their greenhouse gas (GHG) emissions, the medical ethics imperative of ‘do no harm’ imposes a responsibility on hospitals to decarbonise. We investigated hospital stakeholders’ perceptions of hospitals’ GHG emissions sources and the sense of responsibility for reducing GHG emissions in a hospital.MethodsWe conducted 29 semistructured qualitative expert interviews at one of Germany’s largest hospitals, Heidelberg University Hospital. (...) Five patients, 12 clinical and 12 administrative employees on different levels were selected using purposive maximum variation sampling. Interviews were transcribed verbatim and analysed using the framework approach.ResultsConcerning GHG emissions, hospital stakeholders perceived energy and waste as most relevant emission sources followed by mobility. Climate change mitigation in general was considered as important. However, in their role as patients or employees, hospital stakeholders felt less responsible for climate change mitigation. They saw providing best possible medical care to be the top priority in hospitals and were often concerned that patients’ health could be jeopardised by climate change mitigation measures.ConclusionPerceptions of most important emission sources did not coincide with those in literature, highlighting the need to inform stakeholders, for instance, about pharmaceuticals as important emission source. A frequently perceived conflict between reducing emissions and providing high-quality medical care could be eased, if reducing emissions would not only be justified as a contribution to mitigation, but also as a contribution to preventing ill health—a basic principle of medical ethics. (shrink)

Some nurses are responding rebelliously to the changing healthcare landscape by challenging the status quo and deviating from suboptimal practices, professional norms, and organizational rules. While some view rebel nurse leadership as challenging traditional structures to improve patient care, others see it as disruptive and harmful. These diverging opinions create dilemmas for nurses and nurse managers in daily practice. To understand the context, dilemmas, and interactions in rebel nurse leadership, we conducted a multiple case study in two Dutch hospitals. (...) We delved into the mundane practices to expand the concept of leadership‐as‐practice. By shadowing rebel nurse practices, we identified three typical leadership practices which present the most common “lived” experiences and dilemmas of nurses and nurse managers. Overall, we noticed that deviating acts were more often quick fixes rather than sustainable changes. Our research points to what is needed to change the status quo in a sustainable manner. To change unworkable practices, nurses need to share their experienced dilemmas with their managers. In addition, nurse managers must build relationships with other nurses, value different perspectives, and support experimenting to promote collective learning. (shrink)

BackgroundTo help inform the development of more accessible, acceptable, and effective ethics consultation (EC) training programs, we conducted an EC training needs assessment, exploring ethics practitioners’ opinions on: the relative importance of various EC practitioner competencies; the potential market for EC training (that is, how many individuals would benefit and how much individuals and hospitals would be willing to pay); and the preferred content, format, and characteristics of EC training.MethodsAs part of a multipart study, we surveyed “best informants” who (...) self-identified as the person most actively involved in EC or healthcare ethics in a random sample of 600 U.S. general hospitals, stratified for bed size.ResultsThe competency that was ranked most important for a lead or solo ethics consultant was knowledge of ethics, while common sense was ranked least important. The median estimated number of individuals at each hospital who would benefit from EC training was six at the basic level, three at the advanced level, and two for EC management training. In 19.1 percent of hospitals, respondents thought their hospital would not be willing to pay anything for EC training within the next two years. Respondents thought potential trainees would be likely to participate in EC training on multiple different topics. Opinions varied widely on preferred formats. Most respondents thought it very important to be able to interact with instructors and with other trainees, practice EC skills, receive a certificate for completing EC training, and complete EC training during work hours.ConclusionsThese findings provide U.S. population data that may be useful to healthcare educators and bioethics leaders in their efforts to develop EC training programs and products that match trainees’ preferences and needs. (shrink)

BackgroundEthics is the science of moral and ethical rules recognised in human life and attempts to verify what is morally right and wrong. Healthcare ethics is seen as an integrated part of the daily activities of health facilities. Healthcare professionals’ standardisation and uniformity in healthcare ethics are urgent and basic requirements. Therefore, this study aimed to assess the practice of the code of ethics and associated factors among health professionals in Central Gondar Zone public hospitals, Northwest Ethiopia, 2021.MethodsA facility-based (...) cross-sectional study design with a mixed method was conducted on 631 health professionals from Central Gondar Zone public hospitals. For the quantitative part, pre-tested self-administered questionnaires were used, and for the qualitative part, key informant interviews with a semi-structured questionnaire were used. Variables with a p value of < 0.2 in binary logistic regression entered into a multivariable logistic regression, then p value < 0.05 and AOR were used to declare statistically significant variables in quantitative data. A thematic content analysis was used for qualitative data analysis.ResultsThis study revealed that only 286 health professionals had good practice of the code of ethics. Good ethical knowledge, favourable attitude, and satisfaction of health professionals with their jobs were significantly associated with the practice of health care ethics.ConclusionsHealth professionals' overall level of practice of health care ethics in the Central Gondar Zone public hospitals was poor. This necessitates practical training, ongoing follow-up, availing of necessary medical equipment, a smooth working environment, and modification of the recognition system for health professionals. (shrink)

Heathcare spending, which was almost 13% of the gross national product last year, is estimated to jump to 14% in 1992. For the first time, hosital expenditures are projected to exceed $300 biilion, representing over 38% of the nation's total healthcare bill. In an effort to reduce federal and state budget deficits and to stimulate institutional cost containment, Medicare and Medicaid officials are becoming even more parsimonious in negotitation reimbursement levels.

Background‘The Clinical Ethics Advisory Group’ (CEAG) is the clinical ethics support body for Newcastle upon Tyne Hospitals National Health Service Foundation Trust. A significant change in CEAG’s way of working occurred over the past 5 years as a result of Court decisions, increasing public expectations and an increase in CEAG’s paediatric case flow.PurposeReview historical data: (a) as a useful benchmark to look for the early impact of significant service changes and (b) to seek possible reference (‘sentinel’) cases for use (...) with a posited practical (casuistic) case-based reasoning model.MethodsAudit of the minutes of the first 22 years’ meetings was undertaken by the two chairs of CEAG over that period of time.Results223 matters discussed: 86 Trust policy issues; 117 clinical cases (84 adult (32 urgent), 33 child (8 urgent)); 12 CEAG procedural issues and 8 UK Clinical Ethics Network ‘round robin’ cases. The range of topic areas was wide. A broad range of ethical structures were deployed, principlism predominated. Quality was subjectively assessed by each reviewer, but different methods were used. This proved highly concordant between the two reviewers. 47% (105/223) of discussions were ‘excellent’ (*A4C4–A4C4) and 70% (156.5/223) ‘good’ or better (*A4C4–A3C3). By meeting the criteria of ‘excellent’ and ‘prospective’, 92/223 (41%) of matters were deemed potentially suitable as sentinel cases.ConclusionsThe audit provides a rich vein of information. There is demand for CEAG’s services, workload is becoming more complex. Formal funding for such services seems justified. (shrink)

BackgroundThe principles of informed consent, confidentiality and privacy are often neglected during patient care in developing countries. We assessed the degree to which doctors in Lahore adhere to these principles during outpatient consultations.Material & MethodThe study was conducted at medical out-patient departments (OPDs) of two tertiary care hospitals (one public and one private hospital) of Lahore, selected using multi-stage sampling. 93 patients were selected from each hospital. Doctors' adherence to the principles of informed consent, privacy and confidentiality was observed (...) through client flow analysis performed by trained personnel. Overall patient perception was also assessed regarding these practices and was compared with the assessment made by our data collectors.ResultsSome degree of informed consent was obtained from only 9.7% patients in the public hospital and 47.8% in the private hospital. 81.4% of patients in the public hospital and 88.4% in the private hospital were accorded at least some degree of privacy. Complete informational confidentiality was maintained only in 10.8% and 35.5% of cases in public & private hospitals respectively. Informed consent and confidentiality were better practiced in the private compared to the public hospital (two-sample t-test > 2, p value < 0.05). There was marked disparity between the patients' perspective of these ethical practices and the assessment of our trained data collectors.ConclusionObservance of medical ethics is inadequate in hospitals of Lahore. Doctors should be imparted formal training in medical ethics and national legislation on medical ethics is needed. Patients should be made aware of their rights to medical ethics. (shrink)

Background: The COVID-19 pandemic severely strained the already unprepared Italian healthcare system. This had repercussions on healthcare workers, stemming, in particular, from a lack of clear guidelines, adequate protective equipment, and professional preparedness. Such conditions were especially prevalent in Northern Italy.Objectives: This study aimed to examine COVID-19-related professional and psychoemotional stress among nurses and doctors in two hospitals in Northern Italy, along with the worst critical incidents affecting healthcare personnel. A parallel objective was to elicit healthcare professionals' opinions about (...) what changes are needed in the healthcare system's operations, as well as about the relational/emotional skills that are needed to better manage relationships with patients in emergency situations.Participants: Snowball sampling was used to recruit participants and yielded 17 hospital professionals: six nurses and 11 doctors. Three of these professionals worked in intensive care and the others in different wards. All had close contact with COVID-19 patients.Methods: The study employed a qualitative research design, using in-depth interviews of ~60 min each that were conducted via Skype video calls. The interviews were recorded and transcribed, then analysed. The qualitative analysis employed mixed methods to identify the most relevant and recursive themes from the interviews.Results: Four fundamental themes emerged from our analysis of the interview texts: disorganisation and psychoemotional stress; urgency and critical incidents; everything surreal; and disruptions in empathetic relationships with patients.Conclusions: Through our analysis of the interview narratives, we found that systematic and in-depth psychological training is needed to prepare professionals for altered relationships with patients in emergencies; use of exceptional medical equipment; elaboration of new bioethical models suitable for disasters and pandemics; and engagement with the themes of death and dying. (shrink)

Florida is currently collecting data on the “costs of uncompensated care for aliens who are not lawfully present in the U.S.” (Statutes of Florida, 2023). The Florida data collection law, enacted in 2023, is part of aggressive anti-immigrant legislation. Hospitals accepting Medicaid must inquire about patients’ immigration status and submit de-identified reports. In August 2024, the Governor of Texas signed an Executive Order comparable to the Florida statute. Although presented as a data-collection measure, the legal requirements have far-reaching consequences. (...) The potential adverse impacts on immigrants’ health pose bioethical concerns. Immigration-related inquiries create barriers to healthcare access and advance care planning, exacerbating healthcare disparities and presenting ethical concerns. This article examines the effects on immigrants and the resulting ethical challenges, including respect for persons, beneficence, non-maleficence, and justice. The article proposes recommendations for mitigating these challenges, including community outreach, patient education, policy development, in-service education, and advocacy. While the legal requirements apply specifically to Florida and Texas, the ethical issues have nationwide relevance. (shrink)

Social analysis of transplant organ demand often focuses on either small-scale (familial) tyrannies of the gift or large-scale (global) markets. Media accounts of the scandalous in transplant medicine stress the latter, a homogeneous model of flows of biovalue down gradients of economic and social capital. This article examines particular globalizations of tissue demand organized as much around claims of social similarity as gradients of social difference. To engage apparent ‘diasporic’ networks of organ purchase — Non-Resident Indians traveling to India and (...) Overseas Chinese to China — I elaborate a concept of bodily supplementarity. Supplementarity in this account is the ability of an individual or population to secure longevity through the mobilization or acquisition of the organic form of others. Diasporic tissue circuits are analyzed in the context of ‘experiments’ in supplementarity that proliferate with the transformation of the molecular conditions for supplementarity. The emergence of powerful immunosuppressants renders the scale of tissue recruitment flexible and contingent, and allows clinics to develop alternatives to brain death. These circuits emerge as situations that reorder the relation of the familial and the global in transplantation, in the service not only of migrant supplementarity but also efforts to reimagine the challenges of emigrant belonging within particular configurations of racialized life and its government. (shrink)

ZusammenfassungDie Einführung der kostenkalkulierten und landesweit einheitlich bepreisten DRGs hat die Möglichkeiten gewinnorientierter Krankenhausträger, ehemals kommunale, defizitäre Krankenhäuser in die Gewinnzone zu führen, erschwert. Diese reagieren darauf mit dem Einsatz bisher nicht gekannter Werkzeuge wie beispielsweise der Steuerung von Patientenströmen, Anreizsystemen, Gründung von Privatkliniken sowie erlösorientierten Therapien und Abrechnungen. Mittlerweile bedienen sich auch andere Trägergruppen dieser Instrumente, so dass sich die Frage stellt, ob angesichts der Wettbewerbssituation nicht gewinnorientierte Träger eines besonderen wirtschaftlichen Schutzes bedürfen, damit die bisher im Krankenhaus gültigen (...) ethischen Prinzipien auch weiterhin Anwendung finden können. (shrink)

Healthcare professionals encounter many moral challenges in their daily clinical practice. However, there have been few studies on the subject matter in Tanzania. This study aims to provide an account of moral challenges faced by healthcare professionals in Tanzanian hospitals, their understanding of clinical ethics, and the ethics education they have received. Many participants reported receiving some kind of ethics training through formal education and on-the-job training. Some participants understood ethics in healthcare settings as adherence to established laws, regulations, (...) guidelines, procedures, norms, and rules essential in clinical practice. Analysis of the data identified four themes of moral challenges. These challenges are related to 1) decision-making and communication in clinical practice, 2) scarcity of medical resources and prioritization in clinical practice, 3) withdrawal of curative treatment, and 4) conflicts between professional judgment, religious convictions and adherence to alternative treatments. Based on the findings, we suggest a context-sensitive form of clinical ethics training to prepare healthcare professionals to recognize and address these moral challenges. (shrink)