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Background: Research is urgently needed to understand health care workers' (HCWs') experiences of moral-ethical dilemmas encountered throughout the COVID-19 pandemic, and their associations with organizational perceptions and personal well-being. This research is important to prevent long-term moral and psychological distress and to ensure that workers can optimally provide health services., Objective: Evaluate associations between workplace experiences during COVID-19, moral distress, and the psychological well-being of Canadian HCWs., Method: A total of 1362 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in an online survey. Participants completed measures reflecting moral distress, perceptions of organizational response to the pandemic, burnout, and symptoms of psychological disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD)., Results: Structural equation modelling showed that when organizational predictors were considered together, resource adequacy, positive work life impact, and ethical work environment negatively predicted severity of moral distress, whereas COVID-19 risk perception positively predicted severity of moral distress. Moral distress also significantly and positively predicted symptoms of depression, anxiety, PTSD, and burnout., Conclusions: Our findings highlight an urgent need for HCW organizations to implement strategies designed to prevent long-term moral and psychological distress within the workplace. Ensuring availability of adequate resources, reducing HCW risk of contracting COVID-19, providing organizational support regarding individual priorities, and upholding ethical considerations are crucial to reducing severity of moral distress in HCWs., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

The UK's on-going sex-selective abortion (SSA) controversy remains a major obstacle to the liberalization of national abortion governance, and is an issue broadly attributed to a "cultural" preference for sons among South Asian women. We conceptualize how healthcare professionals "arbitrate" requests for SSA by exploring the tension between its legal status and how requests are encountered by abortion providers. SSA is framed in this article as a legitimate care service that can support providers to meet the diverse reproductive health needs of women to the full extent of the law.

Background : Human Resources for Health are a core building block of a health system, playing a crucial role in improving health outcomes. While the existing literature has examined various forms of corruption that affect the health sector, few articles have examined the role and impact of corruption in the recruitment and promotion of health-workers. Objectives : This study reviews the role of corrupt practices such as nepotism, bribery and sextortion in health-worker recruitment and promotion and their implications for health systems. Methods : The study is based on an interdisciplinary non-systematic review of peer-reviewed journal articles in the public health/medicine and political science literature, complemented with the 'grey' literature such as technical reports and working papers. Results : Political and personal ties, rather than merit are often factors in the recruitment and promotion of health-workers in many countries. This results in the employment or promotion of poorly qualified or unsuitable workers, with negative implications for health outcomes. Conclusion : Corrupt practices in health-worker recruitment and promotion 'set the tone' for other forms of corruption such as absenteeism, embezzlement, theft and bid-rigging to flourish, as those recruited corruptly can collude for nefarious purposes. On the other hand, merit-based recruitment is important for curbing corruption. Corrupt recruitment practices have deleterious effects on health-worker motivation and retention, quality and competency, citizens' trust in health services and health outcomes. Whereas international law and policy such as the United Nations Convention Against Corruption and the WHO Handbook on Monitoring and Evaluation of Human Resources for Health state that recruitment of public officers and health workers respectively should be done in a transparent and accountable manner, more research is needed to inform policies on merit-based recruitment.

Objective: We sought to learn where older veterans seek information about anxiety and coping. Due to increasing use of technology in health care, we also explored benefits and barriers of using technology to teach coping skills., Methods: Twenty veterans (mean age = 69.5 years, SD = 7.3) participated in semi-structured interviews in which we inquired about where they seek information about anxiety. We explored quantitative and qualitative differences for veterans with high versus low anxiety. In follow-up focus groups, we examined opinions about learning coping skills using technology., Results: Though veterans primarily named health care professionals as sources of information about anxiety, online searches and reading books were frequently mentioned. Reported benefits of using technology were convenience and standardized instruction of coping skills. Barriers included lack of interaction and frustration with technology usability., Conclusion: Older veterans use multiple sources, heavily rely on interpersonal sources (e.g., professionals, friends), and employ varied search strategies regarding how to cope with anxiety. Using technology to teach coping skills was generally acceptable to older veterans., Clinical Implications: Health care professionals could guide patients towards credible online and book sources. Providing instruction about using technology may help older adults use technology to learn coping skills.

Purpose: A randomized controlled trial was conducted to evaluate the impact of Professional Boundaries for Health Professionals (PBHP) training program on the knowledge, comfort, experience, and ethical decision-making of multidisciplinary practitioners facing client-practitioner boundary dilemmas., Methods: In all, 36 rehabilitation practitioners from an Australian state-wide spinal cord injuries service were assigned to experimental and control groups. The Boundaries in Practice (BIP) Scale measured outcomes at four points: pre, post, 3 months, and 1 year. The control group received the training after 3 months. Nonparametric Friedman's two-way analysis of variance was used to examine the trajectories over time., Results: Analysis was conducted using the data of 10 experimental and 13 control group participants who responded at four data collection points. The experimental group showed significant improvement in knowledge (χ 2  = 10.673, p = 0.014) and comfort (χ 2  = 9.727, p = 0.021) managing professional boundaries post-training. The control group showed no significant change in knowledge or comfort. No significant change was seen in experience across either experimental (χ 2  = 3.609, p = 0.307) or control group (χ 2  = 7.800, p = 0.050). Ethical decision-making improved in the control group (χ 2  = 13.188, p = 0.004) following training, however remained unchanged in the experimental group., Conclusions: The findings do not definitively support this training approach. Ethical decision-making may improve more substantially within the practice context and organizational culture change. Multifaceted approaches are indicated. Implications for Rehabilitation Ethical dilemmas related to boundaries between clients and practitioners are a frequent occurrence in the rehabilitation setting. In a relatively small sample, the current randomized trial provided inconclusive evidence on the benefit of a 1-day needs-oriented training program to improve knowledge, comfort, and ethical decision-making. Randomized trials of education and training for rehabilitation practitioners are fraught with challenges in the clinical environment of the rehabilitation setting. Multifaceted training approaches, management support and training as well as changes to policy and organizational context in the rehabilitation setting may be needed to more holistically address the issues surrounding professional boundaries in the rehabilitation setting.

Background: The communicative encounter has been described as a fundamental element in caring for the patients, and further, in this encounter, the nonverbal body language and the tone of speech are agued to play a crucial role., Aim: This study explores how seriously ill hospitalised patients experience and assign meaning to the health professionals' communication with special attention to the nonverbal body language and tone of speech. The study is part of a larger study exploring how seriously ill patients experience and assign meaning to the sensory impressions in the physical hospital environment as well as to the health professionals' communication., Method: The study is based on qualitative interviews supplemented by observations and applies Paul Ricoeur's phenomenological-hermeneutic theory of interpretation in processing the collected data. We included twelve patients with potentially life-threatening illnesses such as cancer, severe lung, liver and heart disease., Findings: Through analysis and interpretation of the interviews, we identified two themes in the text: (i) Being confirmed, (ii) Being ignored and an inconvenience. The patients experienced that the health professionals' nonverbal communication was imperative for their experience of being confirmed or in contrast, their experience of being ignored and an inconvenience., Conclusion: The health professionals' nonverbal communication proved essential for the seriously ill patients' experience of well-being in the form of positive thoughts and emotions. Consequently, this sensory dimension of the communicative encounter represents a significant ethical element in caring for the patients., (© 2016 Nordic College of Caring Science.)

Learning from events with unwanted outcomes is an important part of workplace based education and providing evidence for medical appraisal and revalidation. It has been suggested that adopting a 'systems approach' could enhance learning and effective change. We believe the following key principles should be understood by all healthcare staff, especially those with a role in developing and delivering educational content for safety and improvement in primary care. When things go wrong, professional accountability involves accepting there has been a problem, apologising if necessary and committing to learn and change. This is easier in a 'Just Culture' where wilful disregard of safe practice is not tolerated but where decisions commensurate with training and experience do not result in blame and punishment. People usually attempt to achieve successful outcomes, but when things go wrong the contribution of hindsight and attribution bias as well as a lack of understanding of conditions and available information (local rationality) can lead to inappropriately blame 'human error'. System complexity makes reduction into component parts difficult; thus attempting to 'find-and-fix' malfunctioning components may not always be a valid approach. Finally, performance variability by staff is often needed to meet demands or cope with resource constraints. We believe understanding these core principles is a necessary precursor to adopting a 'systems approach' that can increase learning and reduce the damaging effects on morale when 'human error' is blamed. This may result in 'human error' becoming the starting point of an investigation and not the endpoint.

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.

Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on fairness accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation.

Professionals' experiences, perceptions, and attitudes may be reflected in the metaphors they use to describe and discuss important professional issues. This qualitative study explored speech-language pathologists' experiences of caseload management through metaphorical analysis. Metaphors provided a lens for reflecting participants' lived experiences and professional knowledge construction. Data was obtained from 16 practising speech-language pathologists during individual work place interviews. Participants included new graduate and experienced speech-language pathologists who were employed in hospital and community settings. Metaphors for caseload management were identified from participants' transcribed narratives, then coded and organized into themes. Participants produced a total of 297 metaphors during professional practice narratives. Thematic analysis indicated that participants used three salient metaphors of sport, measuring scales, and war when they addressed caseload issues. Metaphors of sport, scales, and war reflected speech-language pathologists' concerns about managing clients efficiently, perceived caseload burdens, and the conflict they experienced when resources were inadequate. These metaphors may also represent a continuum in speech-language pathologists' personal and professional responses to caseload demands. Shared metaphors may contribute to the professional socialization of individuals entering a profession and to changing or maintaining workplace culture. Hence, speech-language pathologists need to consider the impact of using metaphors of sport, measuring scales, and war during interactions with clients and colleagues.

Background:   There is growing awareness that cultural background influences health beliefs and practices and can impact on the patient-practitioner encounter. However, in relation to optometry there is little known about the implications of cultural diversity for clinical decision-making and how optometrists address culturally based understandings of health. This pilot study examines how culturally based differences in health practices and beliefs impact on patient-optometrist interactions and how optometrists negotiate and manage these differences., Methods:   Semi-structured interviews were conducted with 10 optometrists. A qualitative analysis was undertaken regarding the optometrists' experiences of cultural diversity and how these impact their decision-making and clinical interactions., Results:   Emergent themes were: 1 Culture can influence and impact on patient-optometrist clinical encounters. 2 Culturally based differences in health practices and beliefs can have a negative impact on clinical encounters. 3 Culturally based differences, beliefs and values (related to eye health) can be difficult to negotiate. 4 Optometrists might benefit from additional training and strategies to deal with culturally based differences in health beliefs and practices., Conclusions:   This pilot study provides data about some of the issues that arise as a result of cultural differences between patients and health care practitioners. The findings from this study contribute to an understanding of the impact of cultural diversity and might assist the development of training and further research in the area., (© 2011 The Authors. Clinical and Experimental Optometry © 2011 Optometrists Association Australia.)

With the escalation of terrorism worldwide in recent years, situations arise in which the perpetration of violence and the defense of human rights come into conflict, creating serious ethical problems. The Geneva Convention provides guidelines for the medical treatment of enemy wounded and sick, as well as prisoners of war. However, there are no comparable provisions for the treatment of terrorists, who can be termed unlawful combatants or unprivileged belligerents. Two cases of severely injured terrorists are presented here to illustrate the dilemmas facing the medical staff that treated them. It is suggested that international legal and bioethical guidelines are required to define the role of the physician and auxiliary medical staff vis a vis injured terrorists. There are extreme situations where the perpetration of violence and the defense of human rights come into conflict, leading to serious ethical and psychological discord. Terrorists, using violence to create fear in order to further their political objectives, might require life-saving medical care if injured during the course of their terror activities.

Many nations in the developing world invest scarce funding into training health workers. When these workers migrate to richer countries, particularly when this migration occurs before the source community can recoup the costs of training, the destination community realizes a net gain in resources by obtaining the workers' skills without having to pay for their training. This effect of health worker migration has frequently been condemned as 'poaching' or a case of theft. I assess the charge that the rich nations of the world poach the resources of the developing world through the active recruitment of migrants. I argue that the charge of poaching is misguided in these cases. The misuse of the term poaching is particularly troubling as it distracts attention away from the many actual moral wrongs taking place through the process of health worker migration and objectifies health workers.

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard.