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Ethical conflicts reported by registered nurse/certified diabetes educators: a replication¶ The purpose of this study was to identify types of ethical conflicts reported by certified diabetes educators who are also registered nurses (RN/CDEs) and to examine their relationship with demographic, educational and practice setting variables. This study is a replication of an earlier pilot study. Ethical conflicts expressed by RN/CDEs in active practice in New York and Pennsylvania were analysed according to four themes. Disagreement with medical practice was by far the most dominant clinical context for the conflicts (61%), as it had been in the pilot study (75%). Participants believed that 32% of the ethical conflicts were resolved. Ethics committees and consultants were very rarely used. Of the relationships between the kinds of conflicts and their resolution, and demographic, educational and practice setting variables of the participants, only kind of position was significantly (P

The purpose of this study was to identify the types of ethical conflict reported by certified registered rehabilitation nurses (CRRNs) and their relationship to demographic, educational, and practice-setting variables. Ethical conflicts expressed by CRRNs in active practice in Maryland, Virginia, and the District of Columbia were analyzed according to four themes. Disagreements about medical or institutional practice, patients' rights, and payment issues were the most frequent practice contexts for ethical conflicts, reflecting these nurses' considerable underlying concerns about resource allocation in rehabilitation practice. Participants believed that 60% of the ethical conflicts were resolved, frequently through discussions with other team members and patients' family members. Ethics committees and consultants were used infrequently. There were no statistically significant relationships between the kinds of conflicts or their resolution and the participants' demographic, educational, and practice-setting variables.

Objectives. To analyse the ethical implications of informing patients about their do-not-resuscitate status (DNR). Design. Questionnaire. Setting. Nationwide, 6 months after the publication of guidelines on DNR in 1994. Subjects. A 10% random sample of the members of the Swedish Cardiac Society, 104 physicians and 196 nurses. Main outcome measures. To what extent are patients, physicians and nurses involved in decisions about DNR, and how should the ethical conflict involved in informing patients about their DNR status be described and analysed? Results. Of 73% responding, 84% of the physicians and 8% of the nurses had made a DNR decision. The decision was regarded as ethically right and well timed and it was discussed with 33% of the competent patients. Half of the respondents believed that DNR orders should be discussed with the competent patient, but still only one third of the patients are involved. The ethical conflict is analysed using the principles of autonomy and nonmaleficence as value premises. Conclusions. Many physicians are still reluctant to find out what the patient wants. Being ignorant they risk harming the patient. It is recommended that information about DNR status should be given incrementally and that the attitudes of the old and chronically ill in-hospital patients are studied. Do they want to be informed, and if so, how and when do they want it to be done?

Smoking is a preventable health risk to smokers as well as to nonsmokers who are exposed to tobacco smoke (Eriksson, LaMaistre, & Newell, 1988; Healthy People 2000, 1991; Peto, 1994), and costs related to the use of tobacco are substantial (Hocking, Grain, & Gordon, 1994). It is therefore not surprising that far-reaching measures have been suggested to protect individuals against the dangers of smoking (Leppo & Verio, 1986; Roemer, 1993), frequently with strong opposition from the tobacco industry (Editorial, 1994; Stanton & Begay, 1994).

‘Why do we need codes of ethics or codes of conduct today?’ International Federation for Information Processing (IFIP) member societies, organizations like the Council of Europe, and distinguished experts have already explained it sufficiently. Their reasons, as well as the process of reflection inside IFIP, are reviewed in this book.

In the field of new reproductive technologies ethical controversy has followed close on the heels of scientific discovery. When Robert Edwards and Patrick Steptoe published, in Nature in 1969, the first account of the fertilization of a human egg outside the body, the Archbishop of Liverpool immediately condemned the experiments as ‘morally wrong’ and Baroness Summerskill, the social reformer, supported them as a morally uncontroversial mode for overcoming infertility ([9], p. 88). The ethical debate on new reproductive technologies has continued ever since and shows little signs of abating. This raises questions not only about the morality of particular reproductive technologies themselves but also about the nature of ethics and about the central philosophical and practical role recently attributed to the idea of consensus.

ObjectivesTo research the influence of stress factors on the development and circuit of voice disorders in their relation to anxiety and depressive spectrum.AimsTo analyze the extent to which the anxiety and depressive disorders are spreading among the patients with voice dysfunctions, to determine the variety of factors for psychological traumatic experience, and to distinguish the variety of anxiety and depressive disorders.MethodsThe Hospital Anxiety and Depression Scale (HADS), the projective psychological tests.ResultsPreliminary HADS screening was conducted among 180 patients. More than half of the patients (57.5%) had high risk of anxiety and depressive disorders. 55 patients (44 women, 13 men, age of 18–70) with voice disorders and the positive results of screening were included to the study. Patients underwent a complete otolaryngologic examination and were grouped into organic voice pathology (34.5%) and non-organic voice pathology (65.5%). In accordance with ICD-10, anxiety and depressive disorders were diagnosed in 48 (87%) patients. In most cases the phoniatric pathology developed in chronic stress conditions. The prevailed chronic stress factors that provoked both anxiety-depressive spectrum disorders and voice pathology were inability to reach pre-set social goal (65.4%), ethical conflict (18.2%) and lack of external control factors (16.4%). Professional factor was also important as 38.2% of the group claimed heavy voice load at work.ConclusionChronic stress factors play significant provoking role in the development of voice and anxiety-depressive spectrum disorders, which should be taken into account to design diagnostic and therapeutic tactics for patients with voice pathology.

Legal rules establish basic duties akin to the floor for acceptable behavior, whereas ethical codes represent aspirational standards for best practice. For school counselors, fulfilling both legal requirements and ethical principles may pose challenges that warrant careful consideration. This article outlines a legal/ethical conflict in the case of Woodlock v. Orange Ulster B.O.C.E.S. (2006/2008), in which the school counselor followed the ethical precept of advocacy but did so in a way that collided with legal protections.

This chapter examines the use of the title of the American TV programme thirtysomething as a name for a particular service-class fraction — the new petite bourgeoisie. It is concerned with the way the characters in the series both reflect and promote the distinction of this social group. A major focus is upon their characteristic ‘investment orientation to life’ — what Rose (1991) has termed ‘the enterprising self’ — and how the series acts as a vehicle for its promulgation. The TV programme is investigated in an attempt to discover which aspects have facilitated its title being appropriated, and how it can now be applied to people who do not necessarily resemble those depicted in the show. It is not our intention to celebrate or to pan the programme itself, rather we wish to concentrate upon it as the locus for the discussion of certain key socio-cultural shifts. In particular we will focus on several contemporary issues of consumption and lifestyle.

There is far-reaching consent in the literature that public and consensual agreements on the basics of the different aspects of medical ethics are inalienable before the instigation of any innovative transplant procedure. In the case of a certain method and/or of an individual patient, however, the ultimate ethical evaluation can most likely never be entirely complete before this application. Ethical evaluation depends on the actual criteria used, the present knowledge regarding the risk--benefit--balance as well as on the ethical evaluation of the patient's and his family's own feelings and expectations which are not entirely conscious. In relation to the so-called "fundamental and constant ethical guidelines" and under a psychological perspective potential, ethical conflict constellations are presented which have to be dealt with in the process of ethical and psychological evaluation before living organ transplantation.

This paper describes the experience of one New York court in extending its uses of microcomputers beyond the records management functions initially contemplated, to encompass substantive applications serving the judiciary in an advisory role. The applications described include a rule-based expert system in case disposition, and a system for the detection of ethical conflicts in the selection of assigned counsel. These substantive applications are seen to significantly extend the utility of the standard database functions typically encountered.

In a previous article (see ibid., February, 1996), the author discussed the difference between common morality and role morality and the dilemmas, especially for young graduate engineers, that can arise when these are in conflict. This article looks at how a company should respond to the potential whistleblower.

This article is the second in a two-part study on common-sense ethics. In Part 1 (October 1991 JONA), the authors presented preparatory steps for the nurse administrator to consider in the management of diverse ethical issues. In Part 2, the authors delineate proactive steps to facilitate the resolution of administrative problems with economic, social, and ethical dimensions. They apply the model to the problem of the nursing shortage. Although no guarantees are assured in following the steps, decision making may be facilitated during the ethical conflict.

This article illustrates the problems of lawyers in maintaining their ethical and legal responsibilities when such maintenance is difficult or impossible, a situation which will be defined as “normally deviant” within the armed forces. This analysis centers upon several distinct issues: (1) Professional and ethical conflict in the application of legal advice, (2) The construction of legal “normality” in situations which are chronically “deviant,” (3) “Normal law” in deviant situations versus “deviant law” in normal situations, and (4) The personal conflicts Army lawyers must resolve in order to maintain their professional status which is both soldierly and legal in character. The conclusions suggest that the Army lawyer is “deviantly normal” within usual Army channels and “normally deviant” in the professional restrictions his/her role imposes upon the definition and application of Army social control. The conclusions also suggest that the organizational and professional conflicts inherent with such a fin...

In a small geographical area a study was undertaken to determine the ethical conflicts experienced by mental health workers related to their clinical interventions. An Ethical Conflict Questionnaire, a 20-item, self-report attitude measure, was sent to all mental health workers in a tri-city area. A multivariate analysis of variance of the 164 returned questionnaires indicated that sex, years of clinical experience, and occupation (psychologist, psychiatrist, psychiatric social worker, psychiatric nurse, and a combined group of mostly vocational rehabilitation counselors and mental health therapy aides) significantly affect reported ethical conflict.

Much have been written about marketing ethics. Virtually no published research, however, has examined what factors are related to the ethical conflict of salespeople. Such research is important because it could have direct implications for the management of sales personnel. This paper presents the results of an exploratory study that examined selected correlates of salespeople's ethical conflict. Implications for practitioners and academic are also provided.

The relationship between personal and professional ethics is examined from the standpoint of the public librarian. Librarians' personal attitudes and the service philosophy implicit in public librarianship often suggest contradictory responses to information or service requests which are personally offensive to the librarian, resulting in ethical dilemmas. Examples of such dilemmas are given: reasons for their occurrence and different opinions regarding ethical behavior are discussed. This type of conflict is itself neither good nor bad, but must be acknowledged by librarians and dealt with by the profession. Existing ethics of service guidelines are reviewed, and recommendations for resolving ethical conflict are offered.

This paper presents the responses of 118 executives to a mail survey which examined their views of business ethics and various business practices. In addition to identifying various sources of ethical conflict, current business practices are also examined with respect to how ethical or unethical each is believed to be. Results are also presented which outline executive responses to four ethical business situations. Overall conclusions to the study are outlined, as well as future research needs.

It is obvious that people experience ethical conflicts, and that many of these conflicts occur at work. We do not yet know empirically whether or how these experiences affect productivity. A person experiencing an ethical conflict will, at a minimum, be distracted. It seems likely that the incident will have a negative impact on his or her job performance. The kinds or degree of impact ethical conflicts have on productivity have not yet been determined scientifically. The purpose of this paper is to encourage empirical investigation of the phenomena of the experience of ethical conflict at work and the impact these kinds of incidents have on job performance.

Seventy-two randomly selected American Mental Health Counselor Association members completed a mailed questionnaire containing four ethical conflict vignettes in written analogue form. Two levels of pressure (high and low) and legal guideline clarity (clear and unclear) were incorporated into the descriptions of the conflict situations. Participants indicated the likelihood of each of five Likert-scaled response options designed specifically for the conflict situation in question. These options corresponded to five decision styles postulated by Janis and Mann (1977) (unconflicted adherence, unconflicted change, defensive avoidance, hypervigilance, and vigilance). The 2 × 2 analyses of variance with repeated measures of these likelihood responses revealed significant main effects for pressure and for legal guideline clarity for responses to conflict and significant interaction effects (pressure × clarity). In general, pressure tended to increase unconflicted change and hypervigilance and to decrease unconflicted adherence. Clarity of legal guidelines had few effects on decision responses. Consistent with Janis and Mann's theory, results showed that decision making was affected negatively by pressure but that participants relied little on legal guidelines in making responses to ethical conflict dilemmas.

This survey was an attempt to identify which ethical decisions are most frequently encountered and are most difficult to make for practicing physical therapists. A questionnaire that described 30 situations with an ethical dimension was sent to 450 American Physical Therapy Association members practicing in New England. A total of 187 (41.5%) usable questionnaires was returned. Issues raised by items were designated as primary, secondary, or nonpriority. Seven primary and 11 secondary ethical issues were identified. In brief, these issues involve the decision about which patients should be treated, what obligations are entailed by that decision, who should pay for treatment, and what duties derive from the physical therapist's relationship; with other health professionals, including physicians. Some of these decisions are more frequent in certain types of employment facilities than in others. Sources of ethical conflict and the role of the professional organization in defining moral values for the profession are discussed in this paper, and implications for education are presented.

Ethical dilemmas arise when physical therapists encounter conflicts between loyalty to their patients and loyalty to their employers. This type of ethical conflict is called "the dilemma of the double agent." If physical therapists perceive themselves as agents of their patients, their employment may be threatened. If physical therapists perceive themselves as agents of their employers, their patients may suffer physical or psychological harm. The double-agent dilemma is illustrated in this article by a hypothetical case study derived from sports physical therapy. Three ethical theories--egoism, utilitarianism, and formalism--are used to analyze the conflict and formulate solutions. A second conflict also is raised between patient autonomy and medical paternalism. As physical therapists become more autonomous, they will assume increased responsibility. Inherent in this increased responsibility is the obligation to recognize and confront ethical dilemmas in physical therapy practice. Resolving ethical dilemmas is difficult, but use of ethical theories can help in the systematic examination of basic assumptions and principles. This article introduces therapists to three ethical theories and presents a model for ethical decision making.

The practice of occupational medicine has been portrayed as being fraught with ethical conflict and yet this problem has received little systematic study. A question and case study survey of a randomly selected cohort of members of the American Occupational Medical Association has been performed to examine the extent and nature of this problem in occupational medicine practice in the United States. The results indicate a strong reliance on traditional medical role models in responding to ethical conflict but with significant underlying tension between more deontological physician-patient approaches and more teleological public health approaches. These results have significant implications for the synthesis of bioethical theories based on a perceived complementarity of ethical reality, as well as suggesting important improvements in future occupational medicine training.

Due to the unique nature of the neonatal intensive care unit (NICU) and its moral distress, this study aimed to investigate moral distress in the NICU. This cross-sectional study was conducted on 234 physicians and nurses working in the neonatal wards of eight hospitals. The Corley’s Moral Distress Scale was used to collect data. Findings showed that 25 of the participants were physicians and 209 were nurses. The intensity and frequency of distress among physicians and nurses were assessed as moderate. The mean intensity and frequency of moral distress among nurses and physicians were 48.3%, 41.5% and 46.46%, 15.62% respectively. The results showed that the mean intensity and frequency of distress were higher, however not significantly, among nurses. The intensity and frequency of moral distress had a statistically significant and direct correlation with the intention to leave and the number of staff in each working shift among the nurses. Moral distress in the NICU practitioners was moderate, so addressing this issue and trying to alleviate it was important. Identifying the causes behind moral distress can help adopt appropriate measures to prevent and reduce them.

Ideal medical care depends to an important degree on the physician's being an advocate of the patient.1 , 2 In fact, however, we physicians have long been double agents, serving other interests as well; and now, as medical-care rationing begins, we face the unpleasant prospect of representing the conflicting interests of the patient and society. How should we respond? In conventional practice, to cite a few examples, the physician may be forced to wear two hats and be thrown into mild ethical conflict when requested by an insurance company to judge the ability of one of his elderly patients to drive an . . .

Since most of the research necessary for the safety evaluation of chemicals requires the killing of laboratory animals, toxicologists are faced with an ethical conflict between their professional duties and the interests of the animals. In the past, the protection of consumers against chemical injury was considered to be of the greatest importance, and society approved of all efforts to detect even the slightest hazards from man-made and environmental chemicals. In recent years, toxicologists have become aware of their ethical responsibilities not only for the safety of the human population but also for the welfare of the animals. They have begun to review the classical toxicological procedures critically and now require that the maximum amount of relevant information is obtained from the smallest number of laboratory animals. Toxicologists have also become aware of the alternative methods that permit the investigation of toxicological responses in unicellular organisms and cell cultures. The problem of testing chemicals for irritant properties on skin and mucous membranes is an excellent example of how concern for animals has generated a range of original and imaginative research leading not only to a reduction in the use of animals but also to a more efficient and scientific approach to an important health problem.

In a recent article, Laura S. Brown, adopting an argument made years ago by Eugene Waith about Fletcherian tragicomedy and adapting it to Restoration tragicomedy, argues that these plays too subordinate thematics to aesthetics, that they emphasize formal patterning to the virtual "renunciation of meaning."'" This formal pattern in both "unified" and "divided" plots, Brown asserts, is that of "'intrigue," the successful conclusion of which is all that really interests the audience. The two plots of the more interesting divided plays remain thematically "disjunctive," but the plays please nevertheless because of the formal symmetry of the intrigue plots. Such plays are marked by "the absence of actual ethical conflict," and all thematic issues simply "dissolve into the pleasing pattern of intrigue" (75-76). I should like here to disagree with Professor Brown. It seems to me that her interpretation is based on insufficient reference (she considers only a handful of plays), a faulty model, and a failure to read dialectically. Let us examine the corpus of Restoration tragicomedies, proceeding from unified to divided plays and concluding with the best of the lot-and Brown's prime example, in which she finds no thematic coherence-John Dryden's Marriage A-la-Mode.