This book explores the controversial relationship between physicians and the pharmaceutical industry, identifies the ethical tensions and controversies, and proposes numerous reforms both for medicine's own professional integrity and for effective public regulation of the industry.

Background: Recently, a singular survey titled “Measure of Moral Distress—Healthcare Professionals,” which addresses shortcomings of previous instruments, has been validated. Aim: To determine how moral distress affects nurses and physicians differently across the various wards of a community hospital. Participant and research context: We distributed a self-administered, validated survey titled “Measure of Moral Distress—Healthcare Professionals” to all nurses and physicians in the medical/surgical ward, telemetry ward, intensive care units, and emergency rooms of a community hospital. Findings: A total of 101 (...) surveys were included in the study. The mean Measure of Moral Distress—Healthcare Professionals score for all respondents was 143.0 (standard deviation = 79.8). The mean Measure of Moral Distress—Healthcare Professionals score was 1.75 greater for nurses than for physicians (92.5 vs 161.5, p <.001), and nurses were 2.52 times more likely to consider leaving their position due to moral distress (68% vs 27%). The mean Measure of Moral Distress—Healthcare Professionals score for moral distress was least prevalent in the medical/surgical ward (92.5, SD = 38.2) and highest in the telemetry ward (197.7, SD = 83.6). The intensive care unit ward had a mean Measure of Moral Distress—Healthcare Professionals score mildly greater than the emergency room. Ethical considerations: No participant identifying information or information connecting a survey response to an individual was collected. This study was approved by the Raritan Bay Medical Center’s Institutional Review Board. Discussion: This study provides insight into the level of moral distress in the community hospital setting. Telemetry nurses experience significantly more than nurses in other wards. Telemetry nurses typically manage patients sicker than medical/surgical wards, however do not have the resources of the critical care units. This scenario presents challenges for telemetry nurses and may explain their elevated moral distress. Conclusion: In community hospitals, telemetry nurses experience a considerably greater amount of moral distress compared to their colleagues in other wards. As measured by the Measure of Moral Distress—Healthcare Professionals questionnaire, moral distress continues to be higher among nurses compared to physicians. (shrink)

This book looks to establish worldwide technical and ethical standards of engineering as an occupation. The author is the most senior thinker in this field and has spent much of his career developing this thesis.

Traditional accounts of legal ethics put lawyers in a difficult position. They require lawyers to take on surprisingly high risks of wrongdoing when they navigate the narrow passage between differing demands of legal ethics. And this occurs even if we accept the standard conception of legal ethics on its own terms while disregarding possible clashes with external norms. According to the standard conception of lawyers’ ethical responsibilities, lawyers should “zealously” advocate for their clients—further their clients’ interests right up to the (...) limits of the law. Under this view, a lawyer might violate ethical obligations to their client if they decline to take effective, legally permissible steps out of moral squeamishness or because they’re inclined to be generous with adversaries. But these same traditional views take lawyers to be ethically obligated to not violate the law. On the standard conception, lawyers must approach that line for their clients, but not cross it. And both a lawyer’s duties to the client and their duties to obey the law are treated as moral obligations. According to standard accounts of professional ethics, when a lawyer falls short of these duties, it is a moral failing. -/- Navigating these two requirements—finding the line but not crossing it—seems to require a very high level of clarity about both the law and the legally relevant facts. And that clarity may be difficult to achieve in ordinary legal practice. Real life involves uncertainty about the law and legally relevant facts, often with too little time to resolve it. But the structure of lawyers’ obligations means that when they face uncertainty, they may not be able to use one approach that’s common in day-to-day life: avoid a questionable activity just in case it’s morally wrong and opt for an alternative that’s clearly morally permissible. For a lawyer, there may not be an alternative that is clearly morally permissible. Instead, this avoidance strategy would often mean a lawyer either errs in the direction of violating an obligation to a client or errs in the direction of violating obligations to the law. If standard accounts of lawyers’ ethical obligations are correct, then we are asking lawyers to assume an unusually high risk of moral wrongdoing. And it may be unfair to lawyers to expect them to take this on. In other areas, our legal system provides standards for what it takes to move from one way of handling an ambiguous circumstance to another—“proof beyond a reasonable doubt” or a “preponderance of the evidence,” for example. These are messy and imperfect. But lawyers are left with even less guidance—the equivalent of telling a jury to “be sure to get it right” and saying very little about what to do when it’s unclear what “right” involves. (shrink)

Background: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. Objective: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators’ selection and use of published texts and film. Methodology: This study employed discourse analysis. Participants and research context: A total (...) of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. Findings: The desire to understand others and how to care compassionately characterised educators’ choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those ‘deserving’ often understood as the suffering person doing enough to help themselves. Discussion: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). Conclusion: To feel cared about people need to feel ‘visible’ as though they matter. Nurses need to be alert to problems that may arise if their ‘moral vision’ is influenced by ideas of desert and how much the patient is doing to help himself or herself. (shrink)

Careful critical analysis is central to reigning in untutored desires to claim the current canons of political correctness, social assumptions, or personal intuitions as moral truth or as necessarily reliable indicators of appropriate choice. This outlook is particularly essential in medicine since its conceptual and moral convictions are not merely theoretical but are applied directly (often irretrievably) to persons. The growing cleft between traditional Christianity and the methodological atheism of contemporary bioethics colors the very contours of how one appreciates public (...) deliberation regarding morality and medicine. It shapes what is judged acceptable social debate and appropriate moral discussion, proper institutional goals and objectives of public policy. As the authors in this issue of Christian Bioethics reflect, while there exist family resemblances among various accounts of medical professionalism, claims that medicine is governed by uniquely true and universal secular moral obligations is implausible, especially given how far contemporary medical practice has drifted from traditional Christian understandings. Christian witness and traditionally Christian bioethics are central elements of a distinctly Christian practice of medicine. (shrink)

Volume 19, Issue 11, November 2019, Page 87-89.

Review of British Medical Association handbook on human rights and doctors.

Over the past decades the mortality rate in the United States has decreased and life expectancy has increased. Yet a number of recent studies have drawn Americans attention to the fact that racial and ethnic disparities persist in health care. It is clear that the U.S. health care system is not only flawed for many reasons including basic injustices, but may be the cause of both injury and death for members of racial and ethnic minorities.In 2002, an Institute of Medicine (...) report requested by Congress listed more than 100 studies documenting a wide range of disparities in the United States health care system. This report found that people belonging to racial and ethnic minorities often receive lower quality of health care than do people of European descent, even when their medical insurance coverage and income levels are the same as that of the latter. (shrink)

Existing literature indicates that the moral complexities of teachers’ daily routine have not been searched enough. Robust knowledge on the way teachers apply ethics in their classrooms and schools is also limited. The purpose of this paper is to challenge teachers’ honesty and ethical judgment, as it explores teachers’ lying as a response to critical incidents in schools. Mixed methodology has been used to analyze data from 524 Primary and Secondary teachers. The results indicate that only half of the participants (...) choose to use little conventional lies [“white” lies] in critical situations. They choose to do so for “good reasons”, to protect their students or to cover for colleagues. The study contributes to existing research on ethical knowledge and sensitivity and the moral dimensions of teaching and stresses the practical need for continuous training on ethical sensitivity and the attainment of ethical knowledge when coping with critical incidents and arising dilemmas. (shrink)

At the time America was discovered, three activities related to Earth Sciences were carried out by the native Indians (Amerindians would be a better term) in what is now the Colombian territory: gold and emerald mining and salt extraction; the first one is recognized as the main motivation for Spaniards to conquer the entire mainland and to oblige Indians to work in gold mines; this servitude, together with the new diseases brought from Europe and the occupation of croplands by cattle (...) and horse raising, caused the reduction of indigenous people in 90%, as it was demonstrated by historians as Colmenares (Historia económica y social de Colombia, 1537–1719. Universidad del Valle, Cali, 1973). This situation motivated Bishop Bartolomé de las Casas to obtain from the Council of Indies to bring of African slaves, who were more resistant than Indians to work in the gold mines. The main argument behind was de las Casas conviction that Indians had a soul and thus should be considered as “true human beings.” This episode, which signified the forceful translation of hundreds of thousands of Africans to America, should deserve a mention in a topic as “Geoethics.”. (shrink)

Teisininko profesijos krizė pasauliniame diskurse yra vertinama kaip trimatė problema, susidedanti iš teisininkų profesijos vertybių kaitos, visuomenės nepasitikėjimo teisininkais ir pačių teisininkų nepasitenkinimo savo profesija. Straipsnyje analizuojama, kaip teisininko profesiją Lietuvoje paveikė politinių ir ekonominių pokyčių procesai, ar profesinėms vertybėms daro įtaką pakitusios teisinių paslaugų rinkos sąlygos, kodėl labai paplitusios teisininkų psichologinės problemos? Lietuva, kaip ir daugelis pokomunistinių šalių, šiuo metu įstojusių į Europos Sąjungą, yra kreivės, parodančios visuomenės pasitikėjimą teisine sistema, gale, t. y. beveik dvigubai žemiau už ES vidurkį. (...) Tyrimai rodo, jog teisinė sistema iš dalies nepateisina pokomunistinių visuomenių šalių gyventojų lūkesčių dėl egzistuojančio atotrūkio tarp pasikeitusios politinės sistemos bei mentaliteto lygmenyje įsitvirtinusių mąstymo ir veikimo modelių. Be to, Lietuvoje dominuojant teisininkų profesinio rungimosi modeliui, didėjant teisinių paslaugų komercializacijai bei praktikuojančių teisininkų konkurencijai, ryškėja profesinių vertybių nuvertėjimo tendencijos, kurias ateityje dar labiau paskatins teisės aktais suteikta galimybė advokatams reklamuotis ir liberalus privačių teisinių paslaugų teikimo reguliavimas. Tyrimai taip pat rodo, kad teisininkai dažniau nei kitų profesijų atstovai kenčia nuo depresijos, priklausomybių ir kitų psichologinę įtampą liudijančių simptomų: nemigos, apetito praradimo ar persivalgymo, nerimo, socialinės atskirties, priešiškumo ar net paranojos, o siekdami numalšinti nerimą ir stresą piktnaudžiauja alkoholiu, vaistais ir narkotikais. Teisininkų psichologinės gerovės tyrimai Lietuvoje yra neabejotinai reikalingi, nes problemą visų pirma reikia pripažinti ir įvertinti jos apimtis, be to, būtina į ją atsižvelgti jau rengiant teisininkus: daugiau dėmesio skirti ne vien specialiosioms kompetencijoms, bet ir emociniam bei socialiniam intelektui ugdyti. (shrink)

Fish has always been adept at revising his position to incorporate what he’s learned from his critics while repaying the favor by assigning them a position they never took. The latter practice naturally helps conceal the borrowings, but as Fish’s position evolves it becomes progressively difficult to determine who is the author of his essays. I am, of course, gratified to see how much Fish has learned from me. It is salutary to find that Fish is finally just a humble (...) historian working with others at “recovering a system of thought and feeling” that will enable us to establish the historical context of Milton’s most probable intentions and realizing, as many historians of literature don’t, that we can only do so by bringing concepts provided by literary theory—form, function, artistic purpose, and so forth—to bear on the mass of historical materials at our disposal.3 It is also gratifying to see that Fish has discovered the law of context and now realizes that there are no local matters. Had he discovered that earlier, we’d have been spared Aunt Tilly and the discussion of Mr. Collins—as well as the general notion extrapolated from those examples that anything a sizable group decides to do will fly since nothing else constraints interpretation. We’d also have been spared the concepts of reading and affective criticism presented in Fish’s early work and the unchecked linguistic hijinks used to sustain those readings. I derive my deepest pleasure, however, from finding that Fish has finally discovered the conflict of interpretations proper and its primacy—“the resistance offered by one interpretively produced shape to the production of another” —though I must sadly abridge this progress report by noting that he finds himself powerless to do anything with this recognition. That is as it must be, for the most interesting thing about Fish’s borrowings is where he stops—and why he has to. Having let me write the first 5 ½ pages of his reply, he suddenly stops taking dictation so that he can simply reassert, in all its abstract glory, his tried-and-true resolution of all interpretive controversy by community interest. Had he read further, he would have discovered that a good deal more emerges if one attempts to preserve and deal with the conflict of interpretations rather than to do away with it. He would even have discovered my epistemology and would have learned the main lesson—that his position is not an alternative to mine but an early moment it contains and sublates in a larger context.Have taught Fish so much, I found myself, instead, poorly repaid by the position he foists upon me. Constantly caught up in an effort to reiterate the dichotomy on which his entire theorizing depends, Fish’s fixed need is to rework all disputes into an opposition between the party of independent fact-disinterested reason and the party of interest so that he might triumphantly resolve all difficulties by once again discovering the simple fact of interests. Lest this strategy hide behind a common misconception, our debate is not a case where distinct frameworks are simply misreading one another, as they must, but one where one framework must deliberately and seriously misread others since it has no other way to sustain itself. If the account Fish gives of my argument is the way things must look from his framework, all that this fact signifies is the paucity of his framework and its inability to achieve even minimal descriptive adequacy. 3. But even here things are a good deal more complex than Fish imagines. For a good statement of the logic and problems of historical interpretation, see Robert Marsh, “Historical Interpretation and the History of Criticism,” in Literary Criticism and Historical Understanding, ed. Philip Damon, pp. 1-24. (shrink)

Auf dem Wege zu einer aufgabenzentrierten Professionstheorie pädagogischen Handeins I. Die Verberuflichung des Erziehens ist historisch weitgehend abgeschlossen. In den modemen Industrie-und Dienstleistungsgesellschaften hat sich ein eigenständiger Sektor der institutionalisierten Erziehung ausdifferenziert, der mittlerweile zu einem der größten Teilsysteme der Gesellschaft geworden ist und immer größere Gruppen der Bevölkerung durch alle Lebensphasen hindurch erfaßt. In diesem Sektor ist eine Vielzahl von Berufen entstanden, zu der die Kindergärtnerin, die Lehrerin, die Sozialpädagogin, die Erziehungsberaterin, die Erwachsenenbildnerin und bald auch die Gerontagogin rechnet. (...) Sie decken ein weites Spektrum von erzieherischen Tätigkeiten ab und sind - gemessen an der Ausbildungsart und -dauer -auf ganz unterschiedlichen Qualifikationsniveaus angesiedelt: von der Erzieherin mit Fach schulausbildung über Fachhochschulabsolventinnen z. B. der Sozialpädagogik, über Lehrer verschiedener Schulstufen mit akademischer oder universitärer Ausbildung bis zu Diplom-Pädagoginnen mit und ohne Promotion. Sie alle erziehen - sei es der Absicht nach, sei es beiläufig oder verschämt. Unerledigt ist die Frage der Professionalisierung des Erziehens. Die Formulie rung und die Institutionalisierung pädagogischer Berufsbilder und ihre Legitimation durch entsprechende Zertifikate stellen keine Garantie für Professionalität dar. Dies gilt jedenfalls dann, wenn unter Professionalisierung nicht nur der historische Prozeß gemeint ist, in dem sich eine Gruppe von Berufen etablieren konnte, sondern auch die Ausbildung einer spezifischen Handlungskompetenz, die von der Struktur der professionellen Handlung erfordert wird. (shrink)

This piece lists, in an evocative way, how the author hopes that psychoanalysis may contribute to liberation.