Ethical challenges and responses in harm reduction research: promoting applied communitarian ethics. 0000044602 00000 n 88 0 obj <> endobj We want dedicated and engaged people. 2008. Public policy ensuring the equal and fair provision of educational services can help in building social cohesion and rectifying inequalities. ‘Those who were in the situation try to take a few minutes, then and there, in order to go through what happened.’ Participants did not mention prospective or structural meetings in which ethical challenges are discussed pro-actively. Is this right?’ Others said that basically it is all ‘ethical reflections’: ‘I think all we do is ethical reflections, that is essentially what our job is.’ In these citations, participants seemed to perceive questioning whether you are doing the right thing as a way of dealing with ethical challenges. The four generational groups examined in the survey are Traditionalists, Baby Boomers, Generation X workers (Gen Xers), and Millenials or Generation Y workers (Gen Yers). Working … However, ethical challenges are also discussed in informal meetings or small gatherings during the day: ‘We discuss these kinds of issues in small groups, in the back room.’. Another participant presupposed that it will become easier when justifications for the use of coercion are more often discussed. Responses to epidemics, emergencies and disasters raise many ethical issues for the people involved, including public health specialists and policy makers. These interviews took place prior to the start of a two-year subproject on the implementation and evaluation of ethics reflection groups in mental health care, focusing on the use of coercion. Every business needs to be aware of the anti-discrimination laws and regulations that exist to protect employees from unjust treatment. Finally, limited evidence of whether coercive measures are ‘helpful’ or ‘effective’ increases the need for moral deliberation [7–11]. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Other teams experienced less constructive ways of dealing with disagreement, for example by means of privatizing existing disagreements, or criticizing persons or teams instead of opinions or viewpoints. Just as some societies tend to venerate multiple gods, practice polygamy, and do not consume some animals because they are considered sacred, Western beliefs, for example, have a different perspective of perceiving the world. An open analysis of how health care professionals in mental health care actually experience and deal with ethical challenges related to coercion resulted in a rich harvest, both theoretically and practically. Finally, it can stimulate reflection about what kind of ‘dealing with ethical challenges’ should get covered by ethics support services, and what kind of ‘dealing with ethical challenges’ can get supported via more implicit support mechanisms within regular clinical practice [32]. * … Quite often, participants mentioned that they arrange an ad-hoc meeting when experiencing an actual ethical challenge. Participants stressed the need for understanding the use of coercion. 1. (IV) Interestingly, participants themselves gave three possible reasons for how ethical challenges emerged or became more difficult to deal with. Loyalty dilemmas were somehow related to dealing with disagreement, but in a slightly different way. An expanded sourcebook. Dealing with ethical challenges is then seen as something you usually do on your own, without having a dialogue with others. Ethical dilemmas are problems which arise when an action breaks multiple ethical codes. This happened when he was working at another workplace in another hospital. The findings of this focus group study seem to indicate that dealing with ethical challenges is an important and quite often a burdensome part of working in mental health care which requires more, and a more appropriate, attention. Ethics in Clicinal Practice – an Interprofessional Approach. Ethical Challenges and Dilemmas in Organizations A Case Study Approach The business of the modern world, for better or worse, is business. 0000044844 00000 n We can envision a dealing-with continuum with on the one hand ‘recognizing’ or ‘mentioning’ an ethical challenge, and on the other, a structured moral case deliberation in which the participants step by step go through the processes of systematically analysing and reasoning together with a trained ethics facilitator. Cite this article. They mentioned that they lack a clear understanding of what ‘ethical’ exactly means. However, this does not immediately imply that these health care professionals are also uncertain or disagree about whether using forced medication in this particular situation is morally right or good. BM, MHH & RP work respectively as Associate Professor of Clinical Ethics, Postdoc-researcher and Professor-researcher at the Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. 0 Both a limitation and strength of this study is that we, purposely, did not define beforehand what we meant by ‘an ethical challenge’ and ‘dealing with.’ We just asked and looked at what kind of stories came up in order to see how health care professionals, through their stories, implicitly or explicitly define what they consider to be ‘an ethical challenge’ and ‘dealing with.’ This resulted in a rich and varied harvest on what participants understood as ‘ethical challenges’ and ‘dealing with.’ We did not explicitly help the participants in increasing the clarity and consistency of the use of these concepts during the focus group interviews. Oxford: Oxford University Press; 2004. 10.1177/0969733012452687. Each author presented separately and independently some preliminary topics out of the transcribed interviews. Within these categories some challenges were clearly focused on patient care while some were more focused on cooperation among professionals. The focus group interviews lasted approximately 1,5 to 2 hours each, and were audio-taped and transcribed into 200 pages. Part of During the fall of 2012, two authors (MHH & BM) conducted seven focus groups interviews in seven wards in three mental health care institutions from different clinical fields (acute wards, rehabilitation unit, youth mental health care, geriatric mental health care, outpatient services). For example, one participant described the ethical challenge of whether to give a suicidal patient permission to leave the ward or not. What is it we do then?’. And that maybe could be traded in for a little sentence about intentions that could, yes, explain a little more about why and how’. It seems that dealing with ethical challenges often took place in a rather implicit way. So we don’t really know, and then we believe, and predict that we are at about the same level, but I don’t think we really are. 10.1111/j.1525-1497.2004.21238.x, Gjerberg E, Førde R, Pedersen R, Bollig G: Ethical challenges in the provision of end-of-life care in Norwegian nursing homes.Soc Sci Med 2010,71(4):677–84. At this moment, we distinguish the following six categories of ethical challenges as experienced by health care professionals: a) sincerely asking oneself whether one does the right or good thing; b) not knowing what is the right thing to do; c) being uncertain or in doubt about what is the right or good thing to do; d) disagree about what is morally right or good to do; e) knowing what is right or good to do but not being able or allowed to do that; and f) feeling obligated or forced to do something which you think is morally wrong or bad. We received funding from the Norwegian Directorate of Health (September 2011–February 2015). formal, informal and perceived coercion). Future research should focus on how ethics support services, such as ethics reflection groups or moral case deliberation, can be of help with respect to dealing with ethical challenges and value disagreements in a constructive way. They mentioned that they need a specific kind of support in order to deal with ethical challenges. Weidema F PhD thesis. It takes effort to keep a company ethical, but it's worth it. will be kept confidential. The presence of ethical challenges varied considerably. Patients and relatives are often key stakeholders in the situations that are described as ethical challenges, yet they rarely seem to be involved in the actual dealing with those ethical challenges. Through an initial open reading of the interviews each author presented separately and independently some preliminary topics. MHH and BM executed the focus group interviews. A case book in psychiatric ethics. 1. startxref what ought or should be done), ethical theory (e.g. Radden J: The virtuous psychiatrist: character ethics in psychiatric practice. 0000000016 00000 n Pelto-Piri V, Engström K, Engström I: Staffs’ perceptions of the ethical landscape in psychiatric inpatient care - a qualitative content analysis of ethical diaries.Clinical Ethics 2014, 1:45–52. Interviews with Swedish GPs.Eur J Gen Pract 2001, 7:143–7. Other types of regular meetings are the supervision sessions, or the times where some educational activities are planned. statement and Edited by: Denzin NK, Lincoln YS, Denzin NK, Lincoln YS. All authors read through several drafts of this paper, including the final, in order to scrutinize the findings in the results section and control for haphazard or unbalanced used of citations and representations of the interviews [36]. Finally, the empirical and conceptual understanding of what is and should being conceived as an ethical challenges will be helpful in developing more targeted training and tools for both health care professionals and staff members of clinical ethics support services. In Dialogue at work. When the staff decides that we should all do the same, I think it is important for me to do that, and so we do. As if she/he is saying: if you work here, you should accept the use of coercion. And third, those who have to deal with ethical challenges concerning coercion on a daily basis were often not participants of treatment meetings where views and decisions related to coercion are discussed and explained. In another paper based on these focus group interviews, in which we describe the content of the actual ethical challenges related to the use of coercion, we elaborate more on the values that were at stake within these ethical challenges [22]. Physicians and nurses experience shared suffering. Struggling, they described, is also a sign of being a dedicated professional, of not treating ethical challenges as routine issues. trailer Ethical challenges emerged when health care professionals did not agree due to different viewpoints. As we have written in NAEYC books about professional ethics, when faced with a challenging situation in the workplace, the first thing an early childhood educator needs to do is to determine whether it is an ethical issue. Future empirical and conceptual research is needed in order to further clarify the concept and practice of ‘ethical challenge.’ This research could not only shed a light on the question which challenge is appropriate for which kind of clinical ethics support service but it could also inform us about the training and tools for both health care professionals and staff of ethics support services.

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