Chapter 1 Who this book is for and who it is not for1 There are already too many books offering solutions to the problems of the health service. ...

What are the moral challenges that confront doctors as they manage healthcare institutions? How do we build trust in medical organisations? How do we conceptualize moral action? Based on accounts given by senior doctors from organisations throughout the UK, this book discusses the issues medical leaders find most troubling and identifies the moral tensions they face. Moral Leadership in Medicine examines in detail how doctors protect patients' interests, implement morally controversial change, manage colleagues in difficulty and (...) rebuild trust after serious medical harm. The book discusses how leaders develop moral narratives to make sense of these situations, how they behave while balancing conflicting moral goals and how they influence those around them to do the right thing in difficult circumstances. Based on empirical ethical analysis, this volume is essential reading for clinicians in leadership roles and students and academics in the fields of healthcare management, medical law and healthcare ethics"--Provided by publisher. (shrink)

There are few industries in which decisions are so intently scrutinized by millions of Canadians as the healthcare industry. Each and every day important decisions concerning the funding and delivery of healthcare are made away from the clinic and in the offices of administrators and policy makers. This book is designed to assist the current and future healthcare administrator to render effective and ethical decisions. Health administration ethics functions as a bridge between business ethics and clinical ethics. (...) This book forges the essential link between the foundational concepts of ethics theories, principles, and codes and the science of decision making. It takes a case study approach and introduces a new, user-friendly decision-making model. There is currently no Canadian textbook designed to guide administration decisions within the Canadian healthcare system, making this textbook unique in the market. (shrink)

Background: In Hospital Emergency Department and Emergency Medical Services professionals experience situations in which they face difficulties or barriers to know patient’s advance directives and implement them. Objectives: To analyse the barriers, facilitators, and ethical conflicts perceived by health professionals derived from the management of advance directives in emergency services. Research design, participants, and context: This is a qualitative phenomenological study conducted with purposive sampling including a population of nursing and medical professionals linked to Hospital Emergency (...) Department and Emergency Medical Services. Three focus groups were formed, totalling 24 participants. We performed an inductive-type thematic discourse analysis. Ethical considerations: This study was approved by ethical committees of Ethical Commitee of Clínic Hospital (Barcelona) and Comittee of Emergency Medical Services (Barcelona). The participants received information about the purpose of the study. Patients’ anonymity and willingness to participate in the study were guaranteed. Findings: There were four types of barriers that hindered the proper management of patients’ advance directives in Hospital Emergency Department and Emergency Medical Services: personal and professional, family members, organisational and structural, and those derived from the health system. These barriers caused ethical conflicts and hindered professionals’ decision-making. Discussion: These results are in line with those of previous studies and indicate that factors such as gender, professional category, and years of experience, in addition to professionals’ beliefs and the opinions of colleagues and family members, can also influence the professionals’ final decisions. Conclusion: The different strategies described in this study can contribute to the development of health policies and action protocols to help reduce both the barriers that hinder the correct management and implementation of advance directives and the ethical conflicts generated. (shrink)

Wenn digitale Technologien wie künstliche Intelligenz, Blockchain und Robotik auf die Medizin treffen, entstehen zwangsläufig ethische Fragestellungen. Diese lassen sich nicht ohne Weiteres mit medizinisch-technologischen, rechtlichen oder ökonomischen Argumenten allein beantworten. Neue Themenfelder wie die sich wandelnde Rolle der Patienten, die neue Verantwortung von Ärzten und Pflegenden, neue digitale Möglichkeiten in der Medizin, Smart Hospitals im Klinikalltag, die gesellschaftliche Legitimität eines möglichen dritten Datengesundheitsmarktes, eine zukunftsfeste Ausbildungslandschaft für den Gesundheits-/Medizinbereich sowie die Grenzen der digitalen Forschung bedürfen einer kritischen und gleichzeitig (...) thematisch breiten Auseinandersetzung mit ethischen Aspekten in der digitalen Gesundheitswirtschaft und Medizin. (shrink)

This book equips readers with a sound understanding of the value-base of mental health care and provides them with the skills and knowledge to demystify complex values in decision-making in order to reach outcomes which are focused on the needs of service users. Engaging case examples and exercises link theory and practice throughout.

This book addresses the moral, social and political problems emerging from the practice of healing and caring, biomedical research and the provision of health care services. The primary aim of many professional bioethicists is, of late, to solve as efficiently as possible, the problems encountered by health care providers and scientists in clinical, laboratory and administrative settings. Seen from the viewpoint of applied philosophy, however, this is a dangerous tendency if the grounds for the suggested solutions (...) are not properly examined. Even choices which are harmless and seem to involve no immoralities can be indirectly hazardous if those making choices appeal to dubious ethical principles or inaccurate data. This is why this book is dedicated to the examination of the reasons that people can and should have for their health care related decisions as well as to the formulation of good solutions to difficult problems. It covers criterial in life and death decisions, voluntary euthanasia and medical paternalism, wrongful medical authoritarianism, health education, preventive medicine and the welfare of the population, AIDS, discrimination and legal restrictions, and health care policy-making. (shrink)

This textbook looks at how different world faiths approach ethics in health and social care, and how their faith informs their practice. Equipping practitioners with the information they need, it will help them to be more reflective regarding spirituality, ethics and their provision of care.

This anthology will be appropriate for administrative ethics classes and professional thinking in public administration at both the masters and doctoral levels. It is a collection of administrative ethics articles published in journals of the American Society for Public Administration (ASPA) from 1941 (the earliest publication) through 1983 (the year that the first ASPA Code of Ethics was established). The articles are organized by themes of enduring importance to the field in order to provide graduate students with ready (...) access to the classic works on ethics in public administration. Reading this collection will enhance student’s knowledge and skills to think and act ethically and contribute to their ability to view current practices in light of traditional perspectives. The ASPA Classics volume serves to bridge the practice of public policy and administration with the empirical research base that has accrued and the models for practice that may be deduced from the research. (shrink)

In the context of the ever-increasing political problematization of migration in Europe, agencies charged with migrant administration create diverse categories of difference to distinguish between the 'deserving migrant' and the illegal one: They assess the detainability or the credibility of asylum seekers, the danger posed by Islamic organizations, and make situational decisions that determine whether migration or labour law applies to individual agricultural workers. In this book, each chapter analyses how organizational interpretations 'in service of' the common good shape (...) bureaucratic practices. Together, these ethnographic analyses reveal how migration policies in different European countries take shape in administrative practice."--Back cover. (shrink)

In the article, we analyse ethical and moral issues of public administration in region of Eastern Slovakia through some cases of the last years. We focused on self-governing regions, namely the Košice and Prešov self-governing regions. We identified two fundamental situations where failures on the side of public administrators occur: selection processes for vacant positions, be it directly in public administration or institutions that fall under its domain, and public procurement with regard to the acquisition of (...) goods and services. The year 2009 was the year of elections to self-governing regions which is why a great number of negative cases dealt with the election campaign. Further, we stated that negative cases dealt with failures of bodies of self-governing regions from both the legal (breaking the law) and moral viewpoint. By claiming that public administrators failed morally, we meant breaking moral norms and rules. Contradictions, which were identified (from the ethical viewpoint), predominantly result from the conflict between public and private interests. In many cases, private interests of public administrators are preferred at the expense of public interests. And it is exactly this preference (a conflict of interests) that is sensitively perceived by the public. (shrink)

Beyond Clinical Dehumanisation Toward the Other offers a rare and intimate portrayal of the moral process of a mental health clinician that interrogates the intractable problem of systemic dehumanization in community mental health care, and looks to the notion of 'wonder,' and the visionary relational ethics of Emmanuel Levinas, for a possible cure. This book is an ethical primer for mental health professionals, researchers, educators, advocates and service users working to re-imagine and heal a broken (...) system by challenging the underpinnings of entrenched dehumanization and standing with those they "serve". (shrink)

In the current U.S. context, we are facing a Constitutional crisis with frequent government shutdowns and new policy debates surrounding immigration, climate change, budgeting practices, and the balance of power. With competing interests, unclear policy, and inconsistent leadership directives, the question becomes: How do contemporary bureaucrats make sense of this ethically turbulent environment? This collection provides a lens for viewing administrative decision-making and behavior from a Constitutional basis, as contemporary bureaucrats attempt to navigate uncharted territory. Ethics for Contemporary Bureaucrats is (...) organized around three constitutional values: freedom, property, and social equity. These themes are based on emerging trends in public administration and balanced with traditional ethical models. Each chapter provides an overview of a contemporary ethical issue, identifies key actors, institutions, legal and legislative policy, and offers normative and practical recommendations to address the challenges the issue poses. Rooted in a respected and time-tested intellectual history, this volume speaks to bureaucrats in a modern era of governance. It is ideally suited to educate students, scholars, and public servants on Constitutional values and legal precedent as a basis for ethics in the public sector. (shrink)

In recent years there has been increased recognition of the global burden of mental disorders, which in turn has led to the expansion of preventive initiatives at the community and population levels. The application of such public health approaches to mental health raises a number of important ethical questions. The aim of this collection is to address these newly emerging issues, with special attention to the principle of prevention and the distinctive ethical challenges in mental (...) class='Hi'>health. The collection brings together an interdisciplinary group of experts in bioethics, mental health, public health, and global health. (shrink)

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client?

The concept of community is increasingly the focus of political argument in Britain, the United States and elsewhere around the world. The sense people have of belonging to coummunities provides a powerful motivation which continues to affecct the political and social face of the world. Recently, debate about the relationship between individuals and their communities has become central to the making of both, American and European social policy. In the United Kingdom this is especially apparent in the area of (...) class='Hi'>health care, where ideas of community have informed recent legislation concerning community care, community health trusts and the Children Act among others. This volume explores the focus of interest in community and the emerging theoretical oppostion between communitarianism and liberalism, as well as the practical, theoretical and ethical issues relating to community in the health care professions, including a discussion of the health service as Civil Association, an analysis of liberal and communitarian views on the allocaiton of health care resources, an exploration of the use of genetic information and an examination of health care decision making for incapacitated elderly patients. (shrink)

This book uses the analogy of three mountains on the horizon that must be traveled in order to explore ethics in relation to student affairs. It contends there are three major approaches to ethics that represent three major approaches to the moral life: (1) principles-based; (2) case-based; and (3) virtues-based. In order to facilitate a person's experiences in using these approaches, an overview is presented, with an assessment of the strengths and weaknesses of the approaches. The chapters refer to (...) an extended case encapsulating the events of a real situation. Chapter One discusses several major approaches to ethics and student affairs administration. Chapter Two presents a single case in depth. In Chapter Three, a summary of major principles-based approaches to ethics is presented. Chapter Four explains the case-based approach to ethics, and how the guiding rules emerge from the facts of the case itself. Another approach to ethics, the virtues-based approach is discussed in Chapter Five. In the virtues-based approach a person asks "What would be correct for me to do in light of my moral character?" The book concludes with Chapter Six, which presents ethics of responsibility as one way to synthesize the various approaches to ethics. The ethics of responsibility draws on the three ethics methods previously discussed, the expressive-collaborative approach, and the contributions of feminism. This information is presented to help people identify which approaches to ethics reflect their personal values, and to articulate the reasons behind this affinity. (Contains 128 references.) (JDM). (shrink)

Coercive Care: The Ethics of Choice in Health and Medicine asks probing and challenging questions regarding the use of coercion in health care and social services. This book combines philosophical analysis with comparative studies of social policy and law in a large number of industrialized countries and proposes an ideal of judicial security on a global scale.

This paper is sadly opportune. The general public is angry and bewildered if not hurt by the variety of strikes which are brought more or less forcibly to their attention. People used to understand what lay behind a strike - a demand for more pay, better conditions - but today a political element often intrudes, and it is this that worries those who ask themselves whether this or that dispute is either lawful or morally acceptable. Professor Dworkin, a lawyer, first (...) sets out the legal issues surrounding strikes and then advances the ethical arguments, closely relating them to the legal framework. The most interesting part of the paper, however, may well be that devoted to the moral obligation of example, in particular the example to be set by members of the medical profession and by all those caring for the sick. As public attitudes to industrial disputes `become dulled and quiescent' it is absolutely necessary that there should be a reappraisal of the moral standards of the past which coincide with a respect for the law. In the last century the term `anomie' was used to describe a `society which has shaken off its former restraints such as religion, respect for law and order and a definite moral code as to what is right and wrong'. We are living in that sort of society today, and one need not be a professional `ethicist' to recognize the signs, and hopefully, to work for the return of `ethical' values. (shrink)

As one of the most massive and successful business sectors, the pharmaceutical industry is a potent force for good in the community, yet its behaviour is frequently questioned: could it serve society at large better than it has done in the recent past? Its own internal ethics, both in business and science, may need a careful reappraisal, as may the extent to which the law - administrative, civil and criminal - succeeds in guiding (and where neccessary contraining) it. The rules (...) of behavior that may be considered to apply to today's pharmaceutical industry have emerged over a very long period and the process goes on. Even the immensely detailed standards for quality, safety and efficacy laid down in drug law and regulation during the second half of the twentieth century have their limitations as tools for ensuring that the public interest is well served. In particular, national and regional regulatory agencies are heavily dependent on industrial data for their decision-making, their standards and competence vary, and even the existing network of agencies does not cover the entire world. What is more there are many areas of law and regulation affecting the industry, concerning for example the pricing of medicines, the conduct of clinical studies, the health protection of workers and concern for the environment. In some fields it is indeed hardly possible to maintain standards through regulation. Professor N.M. Graham Dukes, a physician and lawyer with long term experience in industrial research management, academic study and international drug policy, provides here a powerfully documented analysis into the way this industry thinks, acts, and is viewed, and examines the current trends pointing to change. *Provides a balanced picture of the current role of the pharmaceutical industry in society *Includes indices of conventions, laws, and regulations; as well as judicial and disciplinary cases *This is the only book addressing the legal implications of big pharma activities and ethical standards. (shrink)

The goal of this book is to help the reader gain knowledge on ethical and legal issues in the field of student affairs and develop competency to follow the profession’s principles and standards of conduct. The significance of the book is due to its focus on the practical value of ethics and legal issues and its aim to address the knowledge, skills, and dispositions required of student affairs educators to develop and maintain integrity in their life and work as (...) described by the ACPA/NASPA. The text offers readers a number of major unique features: It offers multiple ethical decision-making models to guide student affairs educators in their ethical decision-making process. It proposes that ethics is not an individual but an organizational responsibility. It offers that ethical decision making is a professional skill that can be practiced and applied in student affairs educators’ day-to-day practice. It presents the reader with the most current legal issues in student affairs and higher education. Finally, it reflects three themes: integration of ACPA/NASPA competency areas; development of professional identity; and application of knowledge and theory to practice. The book is critical and timely. A book that focuses on ethical and legal issues in student affairs is needed for faculty in preparation programs, new professionals navigating their identity as student affairs educators, and a resource for mid- and senior-level professionals facilitating ongoing professional development. The book begins to address what it means to have a professional identity, which is ground in the shared ethical and legal values espoused within the profession and academia. Each chapter uniquely contributes to the complexity embedded in the study of ethics and how that is applied to practice. Additionally, the volume is a balance of procedural knowledge, case illustrations, and guided practice exercises to facilitate the reader’s ability to translate the theory and research discussed into professional decision making and application. (shrink)

This interdisciplinary collection presents valuable discourse and reflection on the nature of a good death. Bringing together a leading judge and other legal scholars, philosophers, social scientists, practitioners and parents who present varying accounts of a good death, the chapters draw from personal experience as well as policy, practice and academic analysis.Covering themes such as patients' rights to determine their own good death, considering their best interests when communication becomes difficult and the role and responsibilities of health professionals, the (...) book outlines how ethical healthcare might be achieved when dealing with assisted suicide by organizations and how end of life services in general might be improved. It will be of interest to students and academics working the area of medical law and ethics as well as health professionals and policy-makers. (shrink)

In this book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: what is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Daniels' theory has implications for national and global health policy: can we meet health needs fairly in ageing societies? Or protect health (...) in the workplace while respecting individual liberty? Or meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? Just Health: Meeting Health Needs Fairly explores the many ways that social justice is good for the health of populations in developed and developing countries. (shrink)

'Trade in Health is a timely reflection on the interface of economics with the ethics and public policy facets of the international movement of patients. Health issues such as these are at the forefront of modern political economy."National" health is increasingly less so. Reisman's previous scholarship in this area is brought to bear in an insightful and eminently readable and engaging fashion. In an area where uncovering the facts is more difficult than "decyphering the Dead Sea Scrolls", (...) such a reflective work on the critical aspects of political economy helps to fill a void in considering whether such trade is likely to be in the interests of patients, nations and the global community. In addition to the rosy picture of healthy and wealthy tourists having a sojourn for medical care during a vacation, Reisman is not afraid to tackle the thorny issues concerning trade in organs, eggs and even death, in this sobering and comprehensive volume. It is a rare skill to bring the luminaries of Smith, Marshall, Mill and Confucius to bear on such a contemporary tale! International travel by patients is at the nexus of a revolution in global health. It is driving and affecting aspects of foreign investment, health worker migration and e-health provision. Reisman skilfully links these foundations of health care, and as such provides critical text for consideration by those seeking to build and strengthen future health systems. Trade in Health is an excellent overview. It provides critical insights for those new to the area as well as new information and challenges for those of us involved for a number of years.' - Richard Smith, Professor of Health Ssytem Economics and Dean of Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK. Once exports and imports meant agriculture and industry. In the global economy and the electronic age, trade is also expanding into the service sector. This timely book closely examines trade in health. It documents the growth of a cross-national service that in the past was mainly consumed at home. Following from his highly successful book Health Tourism, Professor David Reisman offers a comprehensive and searching multidisciplinary account of the way in which medical services, patients, capital and professionals are making up a global healthcare economy that crosses borders. He reflects on their pursuit of lower prices, better quality and a differentiated product, and suggests that public policy is essential if the ethical capital of interdependent societies is not to be eroded by the international market in health and care. Written in a concise and lucid form, this original book will be of great interest to all people interested in the internationalization of health care. Combining theory and empirical evidence from economics, tourism and medical care, scholars involved in health policy and social administration will find much of significance in this authoritative study. (shrink)

Medical assistance in dying (MAiD) in Canada is a complex, novel interprofessional practice governed by stringent legal criteria. Often, patients need assistance navigating the system, and MAiD providers/assessors struggle with the administrative challenges of MAiD. Resultantly, the role of the MAiD care coordinator has emerged across the country as a novel practice dedicated to supporting access to MAiD and ensuring compliance with regulatory requirements. However, variability in the roles and responsibilities of MAiD care coordinators across Canada has highlighted the need (...) for accountability and standardization for this practice. This manuscript constitutes a first attempt to describe this emerging role, through discussion of proposed standards of practice, as well as roles and responsibilities, and ethical duties of this emergent professional practice. We detail the core commitments of MAiD care coordinators to patients, providers/assessors and institutions involved in the MAiD process. We address the core competencies that inform the unique skillset required by MAiD care coordinators to facilitate high-quality care, while highlighting the moral and ethical considerations embedded in this work. To illustrate the complexity of the MAiD care coordinator role, case examples involving ethical dilemmas encountered in practice are included. Finally, a code of ethics is proposed to serve as a guide for appropriate professional practice and conduct. This manuscript is intended to illustrate the importance of transparency and accountability for this new role that provides service to vulnerable patients and families; this is especially critical as the ethical complexity of MAiD is likely to increase with future changes in legislation opening MAiD access to new populations. (shrink)

Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part (...) of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly. (shrink)

Health care services today lack the resources to meet everybody's exspectations. Patients, professional workers and trade unions have legitimate but frequently conflicting claims, and so too have the different interest groups and specialties within medicine. This book provides an account of how resource allocation dilemmas appear to those confronted by them, in the hospital, on health boards and in the community, and it offers a critique of the moral and political arguments most commonly employed in discussing (...) them. (shrink)

The Oxford Handbook of Psychotherapy Ethics explores a whole range of ethical issues in the heterogenous field of psychotherapy. It will be an essential book for psychotherapists in clinical practice and valuable for those professionals providing mental health services beyond psychology and medicine, including counsellors and social workers.

This book argues that contractarianism is well suited as a political morality and explores the implications of deploying it in this way. It promises to revive contractarianism as a viable political theory, breaking it free from its Rawlsian moorings while taking seriously the long-standing objections to it. It's natural to think that the state owes things to its people: physical security, public health and sanitation services, and a functioning judiciary, for example. But is there a theory--a political morality--that (...) can explain why this is so and who the state's people are? This new contractarianism deploys a reversed state of nature thought experiment as the starting point of political theorizing. From this starting point it develops a political morality: a theory of the common ground of the role moralities attached to the various roles within the state. Contractarianism, so understood, can provide a basis for already popular ideas in political theory--such as political and legal liberalism--and overturn conventional wisdom, for example that the state is obligated to secure justice and that animals should have no legal standing. Contractarianism, Role Obligations, and Political Morality will be of interest to scholars and advanced students working in moral and political philosophy. (shrink)

Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff (...) when moral distress was present. The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such (...) models of health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This work provides an overview of traditional and contemporary ethical perspectives and critically examines a range of ethical and moral challenges present in ...

Global mental health in a changing world -- Contemporary humanitarianism -- Humanitarian ethics -- Professional and personal challenges in humanitarian work -- Managing ethical challenges in global mental health -- Aspirational guidance : principles of humanitarian assistance -- Operational guidance : IASC guidelines -- Ethical dilemmas : damned if you do and damned if you don't -- Ethically questionable practices -- Safety imperative and self-care -- Values-based ethical framework and core competencies in global mental (...) class='Hi'>health -- Ethical considerations for refugee mental health providers in the United States -- Conclusion and future directions. (shrink)

The traditional organizational boundaries between healthcare, social work, police and other non-profit organizations are fading and being replaced by new relational patterns among a variety of disciplines. Professionals work from their own history, role, values and relationships. It is often unclear who is responsible for what because this new network structure requires rules and procedures to be re-interpreted and re-negotiated. A new moral climate needs to be developed, particularly in the early stages of integrated services. Who should do (...) what, with whom and why? Departing from a relational and hermeneutic perspective, this article shows that professionals in integrated service networks embark upon a moral learning process when starting to work together for the client’s benefit. In this context, instrumental ways of thinking about responsibilities are actually counterproductive. Instead, professionals need to find out who they are in relation to other professionals, what core values they share and what responsibilities derive from these aspects. This article demonstrates moral learning by examining the case of an integrated social service network. The network’s development and implementation were supported by responsive evaluation, enriched by insights of care ethics and hermeneutic ethics. (shrink)

This book provides an interdisciplinary perspective on working with young people, focusing on education, health and social work, and draws on projects and perspectives from the United Kingdom, the United States, Canada and Australia. The volume highlights the ethical challenges and dilemmas as these and other services are integrated and addresses how ethical practices are confronted and shared across disciplines.<BR> The first section looks at professional practice; the second foregrounds children's and young people's voices and is (...) especially concerned with children and young people as co-researchers. Subjects addressed within the text include sex education, health education, custodial care, confidentiality and gaining consent, ethical issues around ICT and researching with vulnerable populations.<BR> The book is intended for both scholars and practitioners. It places examples in clearly articulated theoretical frameworks as well as considering professional principles and practice. (shrink)

The UK Chief Medical Officer’s 2016 Annual Report, Generation Genome, focused on a vision to fully integrate genomics into all aspects of the UK’s National Health Service. This process of integration, which has now already begun, raises a wide range of social and ethical concerns, many of which were discussed in the final Chapter of the report. This paper explores how the UK’s 100,000 Genomes Project —the catalyst for Generation Genome, and for bringing genomics into the NHS—is (...) negotiating these ethical concerns. The UK’s 100 kGP, promoted and delivered by Genomics England Limited, is an innovative venture aiming to sequence 100,000 genomes from NHS patients who have a rare disease, cancer, or an infectious disease. GEL has emphasised the importance of ethical governance and decision-making. However, some sociological critique argues that biomedical/technological organisations presenting themselves as ‘ethical’ entities do not necessarily reflect a space within which moral thinking occurs. Rather, the ‘ethical work’ conducted by organisations is more strategic, relating to the politics of the organisation and the need to build public confidence. We set out to explore whether GEL’s ethical framework was reflective of this critique, and what this tells us more broadly about how genomics is being integrated into the NHS in response to the ethical and social concerns raised in Generation Genome. We do this by drawing on a series of 20 interviews with individuals associated with or working at GEL. (shrink)

Adolescent sexuality is one of the most important reproductive health issues that confronts healthcare professionals with moral dilemmas and legal issues. In this study, we aim to justify the at-risk adolescents’ regulations on access to key reproductive health services (KRHSs) based on principles of Islamic biomedical ethics and jurisprudence. Despite the illegitimacy and prohibition of sexuality for both girls and boys in Islamic communities, in this study, using 5 principles or universal rules of purpose; certainty, no-harm; (...) necessity; and custom, we argue that first, applying these principles in the context of the no-harm principle can provide the best interests of at-risk adolescents; second, it is permissible to provide KRHSs to these adolescents with their own assent, as long as necessary, only with the intention of preventing or reducing harm. In this framework, while preventing harm, it tries to provide the best interests of at-risk adolescent. Thus, the principle of no-harm requires that the government, by designating the responsibility to healthcare professionals, protects at-risk adolescents from harm, and obliges these professionals to choose and implement the option that best suits adolescents’ interests. (shrink)

The legal environment -- Regulation of nursing practice -- Nurses in legal actions -- Standards of care -- Defenses to negligence or malpractice -- Prevention of malpractice -- Nurses as witnesses -- Professional liability insurance -- Accepting or refusing an assignment/patient abandonment -- Delegation to unlicensed assistive personnel -- Patients' rights and responsibilities -- Confidential communication -- Competency and guardianship -- Informed consent -- Refusal of treatment -- Pain control -- Patient teaching and health counseling -- Medication administration (...) -- Clients with AIDS and HIV testing -- Abusive situations -- Reproductive services -- Restraints -- Emergency psychiatric admissions -- Organ and tissue donation and transplantation -- Discharge against medical advice -- The medical record and documentation standards -- Electronic health information and communications -- Interdependent nursing functions: verbal orders and telenursing -- Event reporting and compliance -- Quality and safety in nursing practice -- Forensic issues -- Employer and employee rights -- Contracts -- Corporate liability -- Employment contracts and unionization -- Employment status liability -- Staffing issues and floating -- Americans with Disabilities Act -- Employees with AIDS/HIV infection and exposure to bloodborne pathogens -- Impaired nurses -- Sexual harassment in the workplace -- Violence in the workplace -- Intentional torts -- Environmental health and safety -- Ethical decision making -- Professional boundaries and patient relationships -- Moral courage and patient advocacy -- Social media and online professionalism -- Reporting illegal, unethical, or unsafe conduct -- Maternal versus fetal rights -- Futility of care -- Advance directives and end-of-life decisions -- Assisted suicide. (shrink)

Coercive Care asks probing and challenging questions regarding the use of coercion in health care and the social services. The book combines philosophical analysis with comparative studies of social policy and law in a large number of industrialized countries.

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The (...) objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the (...) goals of the nursing profession, CERN sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Objective:The purpose of this study was to describe the current situation of moral distress and to explore its influencing factors among Chinese nurses.Methods:This is an exploratory, descriptive design study. A total of 465 clinical nurses from different departments in three Grade-III, Level-A hospitals in Jinan, Shandong Province, completed the questionnaires, including demographics questionnaire, Chinese version of Moral Distress Scale–Revised, and Job Diagnostic Survey.Ethical considerations:The study was approved by the university ethics board and the local health service (...) director.Results:The total score of Moral Distress Scale–Revised was 36.01 ± 24.02 points. The mean frequency and intensity scores of moral distress were 1.13 ± 0.49 and 1.09 ± 0.58, respectively. The level of moral distress among Chinese clinical nurses was low, and the frequency and intensity of moral distress were on low to moderate level. The level of moral distress experienced by clinical nurses is associated with demographics features and job characteristics, including age, education degree, department, task significance, autonomy, and dealing with others.Conclusion:Our conclusion suggests that hospital and organizational administrations should attach much importance to the moral distress experienced by clinical nurses in China. Further studies should focus on interventions about how to reduce the levels of the frequency and intensity of moral distress among clinical nurses. (shrink)

In Drawing the Line, philosopher Samuel Gorovitz examines the ethical questions that permeate the daily lives of medical professionals: Who should be making life and death decisions? How should scarce medical resources be allocated? What rules should govern the use of fetal tissues in research? Where should we draw the line?The questions are rooted in the author's seven-week observation of events at Boston's Beth Israel hospital. Gorovitz shares with readers an intense, disturbing, and insightful account of operating rooms, intensive (...) care units, surgeons' meetings, and administrative discussions of competition in the health-care market. His unusual look at contemporary health care combines startling reality with the provocative reflections of a highly respected philosopher. Author note: Samuel Gorovitz is Dean of the College of Arts and Sciences and Professor of Philosophy at Syracuse University. He is also the author of the widely hailed Doctors' Dilemmas. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Chair’s Perspective on the Work of the Advisory Committee on Human Radiation ExperimentsRuth Faden (bio)On January 15, 1994, President Clinton created the Advisory Committee on Human Radiation Experiments in response to his concern about the increasing number of reports describing alleged unethical conduct of the U.S. Government, and institutions funded by the government, in the use of, or exposure to, ionizing radiation in human beings at the height of (...) the Cold War. He directed the Committee: (1) to uncover the history of human radiation experiments and intentional environmental releases of radiation; (2) to identify the ethical and scientific standards for evaluating these events; and (3) to make recommendations to ensure that whatever wrongdoing may have occurred in the past will not be repeated.The Committee was composed of 14 members: a citizen representative and 13 experts in bioethics, radiation oncology and biology, epidemiology and statistics, public health, history of science and medicine, nuclear medicine, and law. We reported to a cabinet-level group (the Human Radiation Interagency Working Group) convened by the president, which includes the secretaries of defense, energy, health and human services, and veterans affairs; the attorney general; the administrator of the National Aeronautics and Space Administration; the director of the Central Intelligence Agency; and the director of the Office of Management and Budget.On April 21, 1994, at the end of the first day of our first meeting, President Clinton invited us to the White House to personally communicate his commitment to the process we were about to undertake. He urged us to be fair, thorough, and unafraid to shine the light of truth on this hidden and poorly understood aspect of our nation’s past. Our most important task, he said, was to tell the full story to the American public. [End Page 215] At the same time, we were to examine the present, to determine how the conduct of human research today compares with that of the past, and to assess whether, in light of this inquiry, changes need to be made in the policies of the federal government. Eighteen months later, the Committee’s attempt to tell the story of the past and to report on our inquiry into the present was delivered to the president in a 900-page Final Report (ACHRE 1995) and several supplemental volumes.The Committee’s charge was enormous. We were asked to conduct a massive investigation into events that occurred as much as 50 years ago and that involved the highest reaches of the defense establishment and the medical community. This investigation necessitated an examination of the conduct and policies of six federal agencies and countless agents in the private sector, as well as the location and interpretation of hundreds of thousands of documents, many of which were buried in obscure locations or were still classified.In addition, the Committee was instructed to establish standards for judging, in moral terms, the events that it uncovered. This charge necessitated the confrontation of contentious debates in moral thought and theory about history, relativism, and the significance of context in moral judgment. But our purpose was not to engage in these debates in the abstract. Although the Committee was not expressly charged with considering issues relating to remedies, including financial compensation, we felt obliged to address the type of remedies that we believed the government, as an ethical matter, should provide to subjects of experiments where the circumstances warranted such a response. Thus our deliberations about relativism and moral judgment were tied to concrete recommendations for public policy and were conducted in a public context that included participants from numerous adversarial legal proceedings.In tandem with our reconstruction of the past, we undertook three projects to examine the current state of human radiation experiments. First, we studied how each federal agency that currently conducts or funds research involving human subjects regulates and oversees its research activity. Second, from among the very large number of federally-supported research projects involving human subjects, we randomly selected 125 projects for closer scrutiny. We reviewed all available relevant documentation for each project in order to assess how well it appeared to protect the rights and interests of the participating subjects. Third... (shrink)

From a largely Western phenomenon, the “animal turn” has, in recent years, gone global. Animals and Human Society in Asia: Historical, Cultural and Ethical Perspectives is just such a timely product that testifies to this trend.But why Asia? The editors, in their very helpful overview essay, have from the outset justified the volume's focus on Asia and ensured that this is not simply a matter of lacuna filling. The reasons they set out include: the fact that Asia is the (...) cradle of early human settlement and animal domestication; Asia encompasses an extreme diversity of closely connected ecosystems and human cultures; Asia is the place where the world's major religions originated; and, as in other parts of the world, Asia's use of animals for food and other utilitarian purposes constitutes a prominent feature of its culture. All of these factors, they argue, made Asia a unique lab for the exploration of major developments in human civilization and the complexities of human-animal interactions.Based on these premises, the book is divided into four parts, each concentrating on areas that the editors consider to have paramount significance in world history: Part I, “Hunting and Domestication”; Part II “Animals as Food”; Part III “Animals at War”; and Part IV “Animals in Culture and Religion.” As many good works on animal studies do, the volume adopts a truly cross-disciplinary approach, uniting scholars from disciplines as diverse as archaeology, history, anthropology, art, religion, literature, and cultural studies. It too takes an interregional approach and covers a vast geographical area, stretching from the western edge of Asia in the Levant to Central Asia, where once roamed the horses of the nomadic pastoral tribes, to the other end of Asia, including India, China, and Japan. Temporally impressive as well, the work takes us from the deep history of the Paleolithic period up to the contemporary world, exploring the diverse roles that a wide range of animals—horses, donkeys, camels, elephants, tigers, and so forth—have played in Asia's rich and unique past and present.Strong in archaeology, Part I, “Hunting and Domestication,” responds to the much-called for “deep” or “coevolutionary” history of human-animal relations in recent years. The three chapters discuss, respectively, the roles that proboscideans have played in the diet and culture of early societies in Paleolithic China and beyond; the ways in which animals of all sizes have been increasingly integrated into the diet, daily uses, trade, and warfare in Holocene Negev; and the diversifying roles played by donkeys in the early Bronze Age in Southern Levant as a food source, a means of transport and in ritual sacrifices. Together, they demonstrate, with reference to telling archaeological evidence how the early societies in this region have been highly dependent upon the increasingly sophisticated interactions with and uses of mega-herbivores in the protracted and by no means clear-cut transition from hunting and herding towards the agricultural way of life, affirming the co-existing and co-constituting relations between humans and other animals in the deep past of Asia.The chapters in the section on “Animals at War” equally reveal the crucial roles that animals have played in the military sphere, as either a practical war technology or a show of military power. “Elephants in Mongol History” revisits the thesis of elephant-mounted troops in South and Southeast Asia as a barrier to Mongol expansion. Through its lively account of the pivotal battles in Mongolian history, especially that against India and China, it illustrates with great success the complex interactions between animals (especially elephants, horses, and humans), technology, and the geographical environment, which jointly exercised their influence on the outcome of warfare and degree of success of political rule. Turning away from the dynamic of warfare, the following two chapters explore the biopolitical question of the management of the horse as a bio-resource in the Mamluk Sultanate of Egypt and Syria (1250–1517) and early Ming Dynasty China, respectively. The first one places its focus on the breeding, procurement, and feeding of the horse subjects in question, while the latter concentrates on the human organization of various resources for the upkeep of government horses—a conventional area of study called “horse administration” in the institutional history of the government in China.The last section, “Animals in Culture and Religion,” examines the changing images of apex predators, such as lions and tigers, in Buddhist perceptions from South Asia to East Asia; the cult of the Horse King in late Imperial China; and the significance of animal signs in Mongolian historiography. They represent an established approach in animal studies that seeks to understand different aspects of human culture through symbolic or metaphorical animals. Instead of treating the animals discussed as mere abstractions, which has been a frequent criticism of works that adopt this approach, the relations between the symbolic animals and their prototype in the natural world were attentively explored. The essay on the cult of the Horse King, for example, closely links the wax and wane of the cult since late imperial China with the changing use and subsequent disuse of the actual horses in agriculture, transportation, commerce, and quotidian life. Yet, classic as these essays on symbolic animals are, one does feel slightly unsatiated when coming to the end of this section, which also marks the end of this volume. Having been reminded early in the introductory essay that Asia was “a major site for the emergence of moral teachings and ethical guidance on the treatment of animals” and how this legacy “still affects the lives of billions of humans to this very day,” one feels naturally rather let down that no article in this volume directly addresses this vital ethical dimension, especially since it belongs to a series on “animal ethics.”Indeed, regarding the task of placing either the nonhuman animals or the ethical relations between humans and other animals center stage, the essays in this volume achieve only varying levels of success. Some authors exhibit a more acute awareness of what “animal studies” or “animal ethics” might entail epistemically and methodically and experiment by paying closer attention to the species-specific characteristics, experience, and agency of nonhuman animals in order to cast off the deified anthropocentrism previously ruled in humanist scholarship. However, others have made no such attempt. For example, in Part II of “Animals as Food,” an essay on the production and consumption of milk in contemporary China, albeit alert to the issue of health hazards to consumers, omits any consideration of the subject from the dairy cows’ perspective under the modern intensive farming system. Moreover, otherwise superb research on the tuna-fishing industry in Japan, with its insightful discussion of the nexus between knowledge economies and imperial politics, too passes over any discussion of the fate of the tuna, whether collectively as a group of living organisms containing 15 species or individually as animals with an embodied experience. One does ponder whether these essays would fit better in a volume on the cultural history of food or on the entwining history of knowledge production, economics, and politics, which conventionally position human interests at the center of research.Taken as a whole, this is an impressive volume that directs our attention to the hitherto understudied world of Asia in animal studies. The long durée, with its interdisciplinary and interregional approach, also most powerfully presents a past in Asia that could not have been the same without the participation of animals at every level, from everyday life to the shaping of cultural values, the construction of belief systems, the building of a national identity, and even the rise and fall of regimes. Scholars and students interested in expanding the frontier of our understanding of the world with a more inclusive “we” should find a wealth of interesting subjects on which to build further research. Finally, the volume also presents a fitting occasion for all scholars committed to animal studies to consider the grave challenge confronting the field that arose alongside its growing respectability and rapid expansion: Should it be oriented toward the destabilization of our previously anthropocentric conception of the world? Or should no such perimeter be imposed, as in this volume? The overall breadth and limitations of this volume leave one pondering this issue. (shrink)

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried (...) out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed. (shrink)

Battle lines have been drawn over involuntary treatment. On one side, there are those who oppose involuntary psychiatric treatments under any condition. Activists who take up this cause often don't acknowledge that psychiatric symptoms can render people dangerous to themselves or others. They also don't allow for the idea that the civil rights of an individual may be at odds with the heartbreak of a caring family. On the other side are groups pushing for increased use of involuntary treatment. These (...) proponents are quick to point out that people with psychiatric illnesses often don't recognize that they are ill, which (from their perspective) makes the discussion of civil rights moot. They may gloss over the sometimes dangerous side effects of psychiatric medications, and they often don't admit that patients, even after their symptoms have abated, are sometimes unhappy that treatment was inflicted upon them. In Committed, psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy--all within the context of civil rights-- Miller and Hanson illuminate the personal consequences of this controversial practice through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it. The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions--mental health court, crisis intervention training, and pretrial diversion--that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public. (shrink)

This new edition of Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals thoroughly updates the highly regarded and groundbreaking first edition, offering the contemporary reader clinical wisdom and ethical guidance for challenging times. As with its predecessor, the second edition features commentaries by leaders in psychiatric ethics, plus two foundational chapters on ethics and professionalism in the field of mental health. These commentaries and introductory chapters provide an overview of essential ethical principles (...) and concepts, the professional obligations of the mental health clinician, common ethical tensions found in practice, ethical aspects of caring for special populations, and ethical issues in professional training and research. The introductory chapters are followed by case-oriented questions and answers on core concepts and topics in clinical care, medical research, and interactions with colleagues and trainees. Topics explored in-depth include authorship, disclosure, and ethical peer review for scientific publications; assisted suicide and euthanasia; professional voyeurism versus patient privacy online and on social media; the appropriate process for reporting an impaired colleague; and problems of burnout, work-life balance, and professional well-being. Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals poses and plumbs critically important ethical dilemmas in a compelling, down-to-earth way for today's practitioners and learners. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Institute of Medicine’s Report on Non-Heart-Beating Organ TransplantationRoger Herdman (bio), Tom L. Beauchamp (bio), and John T. Potts Jr. (bio)In December 1997, the Institute of Medicine (IOM) released a report on medical and ethical issues in the procurement of non-heart-beating organ donors. This report had been requested in May 1997 by the Department of Health and Human Services (DHHS). We will here describe the genesis (...) of the IOM report, the medical and moral concerns that led the DHHS to sponsor it, the process of producing it, and its conclusions. The analyses, findings, and recommendations of the report are also reviewed, in particular the central issues that led to suggestions for policy changes.Transplantation BackgroundAs a first step, some background in the relevant aspects of organ transplantation will prove useful. For the purposes of this analysis, “transplantation” involves the transfer of cells, tissues, or solid organs from one human to another to replace the structure or function of comparable body components that, through injury or disease, are defective or of inadequate function. The IOM report deals with solid organs, primarily kidneys and livers, whose blood supply is reconnected in the organ recipient, in contrast to cells, like bone marrow, and tissues, like corneas. A variety of donor types exists for organ transplantation, each with particular medical and scientific conditions.Living donors are healthy (and usually genetically related) individuals who volunteer to provide either a whole, paired organ such as a kidney or a section of an organ such as a liver. Cadaver donors are individuals who have died and from whom a full array of organs can be taken. “Heart-beating” cadaver donors are individuals who have suffered “brain death,” that is, irreversible cessation of function of the whole brain including the brain stem; and “non-heart-beating” donors (NHBDs) are individuals who are ill or injured, but not “brain dead,” and who have suffered cardiopulmonary death, that is, irreversible cessation of cardiac and respiratory function. NHBDs can be “controlled,” which means that [End Page 83] they can be sustained by artificial life support systems until a medical and family decision is made to terminate futile life support. This can be done at a scheduled time and in a controlled manner, and organs can then be recovered for transplantation. NHBDs can also be “uncontrolled,” which means that their hearts and breathing have stopped through disease or injury at an unexpected time or in an uncontrolled manner, and they cannot be resuscitated; the organs of some individuals of this description can be recovered for transplantation. The IOM report focused on both controlled and uncontrolled NHBDs and on problems specific to them.The questions that were asked and addressed in the IOM report became current and salient beginning in 1992 with the establishment of the University of Pittsburgh “Policy for the Management of Terminally Ill Patients Who May Become Organ Donors After Death.” This policy addressed controlled NHBDs and the ethical questions raised by their use; much of the discussion was reported in the June 1993 special issue of the Kennedy Institute of Ethics Journal. Public notice and anxiety about some of these concerns were sharpened and refocused by national and local media allegations of improper treatment of donors at the Cleveland Clinic in 1997, specifically premature—i.e., antemortem—recovery of organs and administration of drugs that allegedly might hasten donor death.The DHHS Request for StudyIt is not surprising that several federal actions would be taken in response to these events. Some, such as the results of a transplantation task force, remain largely internal to DHHS at this writing. Others are public, such as the IOM study of the NHBD situation. In May 1997, the DHHS initiated contacts with the IOM with the goal of exploring federal concerns about the medical and ethical treatment of NHBDs, in particular the allegations directed at the Cleveland Clinic.The DHHS response should be understood in at least three contexts. First, living donors and uncontrolled NHBDs were essentially the only donor types in the early days of transplantation in the United States. The technologies, ethics, and social acceptance of controlling and terminating life support for... (shrink)