234 research outputs found
Research on clinical ethics and consultation. Introduction to the theme
Clinical ethics consultation has developed from local pioneer projects into a field of growing interest among both clinicians and ethicists. What is needed are more systematic studies on the ethical challenges faced in clinical practice and problem solving through ethics consultation from interdisciplinary perspectives. The Thematic Issue covers a range of topics and includes five recent studies from various European countries and the USA, focusing on issues such as the ethical difficulties of end of life decisions, experiences with newly developed or well established ethics consultation services, and the expectations of physicians in various clinical fields who are still unfamiliar with clinical ethics consultation. The papers included illustrate the interface between different socio-cultural contexts and their ways of dealing with clinical ethics consultation. They deepen the dialogue on clinical ethics consultation that has emerged at the European and International leve
Therapist-client sex in psychotherapy: attitudes of professionals and students towards ethical arguments
Data suggest that a substantial proportion of psychotherapists engage in therapist-client sex (TCS), violating national and international ethical guidelines. The objective of our study was to find a new and effective starting point for preventive interventions.; Using an online questionnaire, this study explored professionals' attitudes toward aspects of a TCS-case example influencing the tendency to pursue colleagues' TCS, including self-interest and responsibility ascribed to clients.; A total of 421 participants expressed preferences for courses of action and rated given information in a questionnaire. Results indicate that TCS is most often condemned for its inherent carelessness towards clients, its exploitative nature, the abuse of dependency and for counteracting the inherent intention of psychotherapy. Partial responsibility for TCS was attributed to clients by 41.3% of the respondents. Although self-interest related information was rated as an acceptable reason against pursuing TCS, a strong tendency exists to confront an abusive colleague, even at the risk of own disadvantages.; In the detailed discussion ethical arguments against TCS (other than the certainly inflicted, but hardly measurable harm) are elaborated. In particular the incompatibility of TCS with a psychotherapeutic relationship, the responsibility for TCS in the asymmetrical client-therapist relationship and the legitimacy of self-protection are discussed.; Reasoning against TCS can and should be based on explicit, ethical requirements for psychotherapists. Furthermore, integrating the topic in psychotherapists' training is encouraged and a discrete procedure to report a colleague's TCS is requested
"Alter" und "Kosten" -Faktoren beiTherapieentscheiden amLebensende? Eine Analyseinformeller Wissensstrukturenbei Ărzten und Pflegenden1
Zusammenfassung: Die qualitative Interviewstudie analysiert informelle Wissensstrukturen von Pflegenden und Ărzten hinsichtlich der beiden Einflussfaktoren "Alter" und "Kosten" auf Therapieentscheide am Lebensende als Grundlage ethischer Meinungsbildung. Als Auswertungsmaterial dienen spontane Aussagen zu "Alter" und "Kosten", die nicht im Kontext von Fragestellungen zu Ageism oder Rationierung erhoben wurden. Diese Aussagen wurden einer Inhaltsanalyse unterzogen, und zwar anhand von qualitativen und quantitativen Analyseschritten. Die Studie zeigt, dass der Faktor "Alter" wesentlich hĂ€ufiger als Einflussfaktor auf Therapieentscheide am Lebensende genannt wird als der Faktor "Kosten". Zudem gibt es Hinweise auf mögliche Ungleichbehandlung sowie auf Ăberversorgung von Patienten am Lebensende. Die Befunde stĂŒtzen die Annahme, dass Therapieentscheidungen eher auf informellen, nicht-institutionalisierten Prozessen beruhen. Eine stĂ€rker explizite Strukturierung des Prozesses zur Therapieentscheidung könnte die Risiken von Ungleichbehandlung und Ăberversorgung reduzieren und dadurch zu ethisch besser vertretbaren Ergebnisse fĂŒhre
Alter Patient - (k)ein Grund zur Sorge?: Ethische Fragen im Lichte empirischer Daten
Zusammenfassung: Hintergrund: Die vorliegende Arbeit befasst sich mit der Frage, ob und inwiefern das Alter des Patienten bei Therapieentscheidungen eine Rolle spielt. Material und Methoden: Als empirische Grundlage werden aktuelle Daten aus 2Interviewstudien zu ethischen Fragen in der Rettungs- und Intensivmedizin bzw. der Geriatrie herangezogen sowie eine Fragebogenstudie bei AllgemeinĂ€rzten und Internisten (ambulant und stationĂ€r tĂ€tig) in 4 europĂ€ischen LĂ€ndern. Ergebnisse: Demnach besteht Evidenz, dass das Alter des Patienten faktisch durchaus ein wirksamer Faktor bei der Therapieentscheidung bis hin zum Vorenthalten adĂ€quater MaĂnahmen ist. Zu unterscheiden ist dabei zwischen einer Wirksamkeit des Faktors Alter einerseits und der Legitimation, Therapie nach dem Alter des Patienten zuzuteilen oder vorzuenthalten. Ob eine solche Unterscheidung nach Alter ethisch akzeptabel ist, wird international kontrovers beurteilt. Die Daten der Studien werden im Lichte ethischer Argumente diskutiert. Schlussfolgerung: Nach einer Ăbersicht ĂŒber das FĂŒr und Wider der Altersrationierung wird die Schlussfolgerung vertreten, dass die Argumente gegen eine Diskriminierung nach Alter ĂŒberwiegen. Die Arbeit schlieĂt mit (ethischen) Empfehlungen fĂŒr die Praxi
Ethische Kompetenz im Rettungsdienst: Ausbildung professioneller Helfer - Ergebnisse einer Interviewstudie in Basel
Zusammenfassung: Fragestellung: Ziel der Studie war es, die ethischen Dimensionen von Reanimationsentscheidungen im Rettungsdienst zu untersuchen. Methode: Ein qualitatives Studiendesign wurde entwickelt, um ethische Entscheidungskriterien, persönliche Wertvorstellungen und Bedarf an Aus- und Weiterbildung zu erfragen. Mit Rettungsdienstmitarbeitern in Basel wurden 30 strukturierte Interviews gefĂŒhrt und nach der qualitativen Inhaltsanalyse ausgewertet. Ergebnisse: NotĂ€rzte und RettungssanitĂ€ter beziehen eine Vielzahl ethischer Ăberlegungen in ihre Entscheidungen mit ein. Die Mehrheit Ă€uĂerte Interesse an ethischer Schulung oder forderte sogar eine stĂ€rkere Verankerung ethischer Inhalte in Aus- und Weiterbildung. Schlussfolgerung: Konzepte fĂŒr die Vermittlung medizinischer Ethik sollten den BedĂŒrfnissen professioneller Helfer und den besonderen Gegebenheiten des Rettungsdienstes Rechnung trage
The role of patients in European Clinical Ethics Consultation
editorialClinical ethics committees and consultation services have existed in many European countries for over
two decades. Many different modes of operation have emerged, each reflecting a particular health and
socio-political context.
As additional clinical ethics services become established, the role of patients and their relatives is
attracting increased attention. In North America, patient involvement has been theoretically lauded and
recommended by policy, but nevertheless is often neglected in practice.1 In Europe, this issue has not
yet received a great deal of attention, although the importance of listening to the patient's voice has
been recognized for some time.2 Despite this, patients have diverse involvement in European clinical
ethics support. Patients or their relatives can, for example: be members of a clinical ethics committee; be
notified when an ethics consultation is requested; or be involved in ethical deliberation to the same
extent as clinicians.
At the 4th International Conference on Clinical Ethics and Consultation,3 Professor Stella Reiter-Theil
convened an expert panel to discuss: âWhether and how to involve patients and relatives in clinical ethics
supportâ. Panellists from across Europe4 used a case study to engage in a lively and interactive
discussion on the different approaches to patient involvement in clinical ethics consultation.This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014
The role of patients in European Clinical Ethics Consultation
Clinical ethics committees and consultation services have existed in many European countries for over two decades. Many different modes of operation have emerged, each reflecting a particular health and socio-political context. As additional clinical ethics services become established, the role of patients and their relatives is attracting increased attention. In North America, patient involvement has been theoretically lauded and recommended by policy, but nevertheless is often neglected in practice.1 In Europe, this issue has not yet received a great deal of attention, although the importance of listening to the patient's voice has been recognized for some time.2 Despite this, patients have diverse involvement in European clinical ethics support. Patients or their relatives can, for example: be members of a clinical ethics committee; be notified when an ethics consultation is requested; or be involved in ethical deliberation to the same extent as clinicians. At the 4th International Conference on Clinical Ethics and Consultation,3 Professor Stella Reiter-Theil convened an expert panel to discuss: âWhether and how to involve patients and relatives in clinical ethics supportâ. Panellists from across Europe4 used a case study to engage in a lively and interactive discussion on the different approaches to patient involvement in clinical ethics consultation.This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014
Avoiding bias in medical ethical decision-making. Lessons to be learnt from psychology research
When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-makin
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