For example with respect to different viewpoints on good care. Dealing with ethical challenges is then seen as something you usually do on your own, without having a dialogue with others. In this process among the authors, some of the initial topics were excluded based on the authors’ preliminary understandings of ‘ethical challenge’ and ‘dealing with.’ Some of these examples will be discussed in the Discussion section. A crisis interrupts the normal flow of business and requires immediate attention from the management, because it might cause major damage to the organization. Suggested Citation:"4 Ethical Issues in Pandemic Planning and Response. Although the results are clearly related to the use of coercion in mental health care, we think the underlying mechanisms of dealing with ethical challenges can have a wider relevance. Edited by: Denzin NK, Lincoln YS, Denzin NK, Lincoln YS. Results varied from dealing with ethical challenges every day and appreciating it as a positive part of working in mental health care, to experiencing ethical challenges as paralyzing burdens that cause a lot of stress and hinder constructive team cooperation. Fostering reflection and change regarding coercion and restraint. 10.1007/s10730-013-9224-2. 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. Your organization sets a goal—it could be a monthly sales figure … 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. In their analysis, Donaldson and colleagues distinguished between ethical-philosophical, legal-regulatory and practical-operational aspects of the students’ cases. Another participant pointed at the way the discussion among the various team members is organized, or not organized. 10.1186/1472-6939-15-82, Bremberg S, Nilstun T: The variety of ethical issues in everyday practice. This article is published under license to BioMed Central Ltd. This specific focus makes the discussions good. Furthermore, some participants plead for more attention for underlying intentions and justifications of treatment decisions. BM wrote various drafts of the paper and received input from MHH and RP. 10.1136/jme.2010.036574. ‘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. Our research question was: How do health care professionals in mental health care deal with ethical challenges related to the use of coercion? After their initial answers to the second question we asked follow-up questions such as: What did you do? Ethics, as defined by Merriam-Webster dictionary, is a system of moral principles. 0000046303 00000 n 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. Every business needs to be aware of the anti-discrimination laws and regulations that exist to protect employees from unjust treatment. You wonder about situations you’ve been in, and things you do. We sat down and talked for quite a long time, actually. 0000003193 00000 n Hawley, G. (III)‘Yes, and then we have had a meeting with the person [a colleague from another unit, authors] who in a way was very opposed to the situation’. Furthermore, what do they actually do when ‘discussing’ an ethical challenge? 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. This is in line with what Hurst and colleagues report [26], p.7: ‘There has been no systematic, empirical examination of the values or the strategies actually employed by physicians to deal with the ethically problematic situations they face without help from ethics committees or consultants.’ In the study of Hurst and colleagues [26], American internists, oncologists, and intensive care specialists were asked (by means of short telephone interviews) what kinds of strategies and approaches they used when facing ‘a recent ethical dilemma’. The report lists defining events that shape the attitudes of each group: * Millennials: globalization of the economy, terrorism, and rise of technology, including the internet. We categorized relevant topics into three subthemes: 1) Identification and presence of ethical challenges; 2) What do the participants actually do when dealing with an ethical challenge? The Hong Kong and Japanese responses were analysed along with the 505 main survey responses, making a total of 607. In The sage handbook of qualitative research. For example, some participants said they deal with ethical challenges every day: ‘Yes, as a matter of fact, I think we discuss ethics every day. The survey covered more than 6,000 respondents: Millennials, born 1981 and after; Generation X (Gen Xers), born 1965–1980; Baby Boomers, born 1946–1964; and Traditionalists, born 1945 and prior. However, not every disagreement automatically has to lead to an ethical challenge. 1. It is not seldom connected to other things than only this specific situation. Six key themes relating to social workers’ ethical challenges and responses were identified: Creating and maintaining trusting, honest and empathic relationships via phone or internet with due regard to privacy and confidentiality, or in person with protective equipment. The aim of this paper is therefore to inform health care professionals, managers, and those who aim to start with ethics support services in mental health care about how health care professionals deal with ethical challenges in situations where there is no explicit use of an ethics support service. Dealing with ethical challenges in an appropriate way is important for several reasons. Or do they see the question as a sign of something else, for example as distrust or as over-identification with the patient? There is quite some variety in the way health care professionals dealt with disagreement within their team. Another limitation and strength is that the participants were selected from wards that were about to start with ethics reflection groups. 10.3109/13814780109094333, Sorta-Bilajac I, Bazˇdaric K, Brozovic B, Agich GJ: Croatian physicians’ and nurses’ experience with ethical issues in clinical practice.J Med Ethics 2008, 34:450–5. While analyzing the focus group interview transcripts, we, as authors, discussed an example of how to distinguish an ‘ethical’ challenge from a ‘non-ethical’ challenge. Reiter-Theil S: The Freiburg approach to ethics consultation: process, outcome and competencies.J Med Ethics 2001,27(suppl I):i21–3. In the last sentence of the above citation, it looks as if another possible dimension of the disagreement in this situation arises. A case book in psychiatric ethics. Morgan D, Fellows C, Guevara H: Emergent approaches to focus group research. 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. Preliminary results and conclusions were thoroughly discussed with all authors. ‘Yes, I mean, I can tell it does something to me, because me, as I am, thinks this isn’t right. 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]. http://jom.sagepub.com/content/early/2012/04/16/0149206312441210.full.pdf+html, http://www.biomedcentral.com/1472-6939/16/4/prepub, http://creativecommons.org/licenses/by/4.0, http://creativecommons.org/publicdomain/zero/1.0/. The sampling error is +/- 1.2% at the 95% confidence level. ‘I have to be able to conclude that it is useful – the coercion we practice. This paper focuses on the answers to the second question. 0000001449 00000 n Quite often it is so stressful for them that they say: ‘I cannot do this anymore, I do not want this.’, ‘Now we do it [forced tube-feeding, authors] more in our treatment without the somatic aspects being as clear or acute. Dierckx de Casterle, B. ym. In the following we will present a systematic analysis of how the participants deal with ethical challenges related to coercion. Implementing moral case deliberation in a mental health care institution. Because we were sort of challenged to continue the dialogue, and not remain opposed to each other.’, One health care professional even felt as if they mistrusted or were suspicious of him for what he had done. The authors declare that they have no competing interests. Quite often it concerned regular meetings such as debriefing meetings in between two shifts, or the meetings in which the treatment team discusses the treatment plans of the patients. Challenges of. How do you deal with these ethical challenges? Part of 4th edition. 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. The disagreement seems to become personal, and the team became divided into two sub-teams. Quite a few participants talked in various ways about the importance of knowing and understanding the underlying intentions and justifications of the use of coercion. Article  Results varied from dealing with ethical challenges every day and appreciating it as a positive part of working in mental health care, to experiencing ethical challenges as paralyzing burdens that cause a lot of stress and hinder constructive team cooperation. The ethical issues in business take different shapes than in schools or the home, even though they stem from the same impulses. Loyalty dilemmas were somehow related to dealing with disagreement, but in a slightly different way. Most situations that were described by the participants when talking about ‘dealing with ethical challenges,’ appeared to be reactions to concrete ‘problems’, directly after the problem had occurred. 10.1007/s11019-007-9103-1. Some participants reported that they do not have the time and that they lack a specific methodology. 0000044785 00000 n A clear limitation is that we only talked to them about (dealing with) ethical challenges. Participants mentioned lack of time, knowledge and a specific methodology for dealing with ethical challenges in a multidisciplinary context. Lϋtzén K, Cronqvist A, Magnusson A, Andersson L: Moral stress: synthesis of a concept.Nurs Ethics 2003, 10:312–22. 0000111354 00000 n ETHICAL CHALLENGESAND RESPONSESDefinition of ethics  Ethics, also called moral philosophy, the discipline concerned with what is morallygood and bad and morally right and wrong. 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. A small number of the participants stated that struggling with ethical challenges is a good thing, or even a necessity, in order to ensure that health care professionals do the right thing. Ethical dilemmas and moral distress in the health care system.Soc Sci Med 2004, 58:1075–84. This kind of ‘dealing with’ seems to refer to the act of ‘wondering whether we do the right thing’ or ‘asking questions about what is right’. 0000010030 00000 n 0000005542 00000 n The focus group interviews lasted approximately 1,5 to 2 hours each, and were audio-taped and transcribed into 200 pages. This raises the question whether discussing an ethical challenge just once but in an explicit way, for example within an ethics committee or during a moral case deliberation, can be more time efficient than discussing that ethical challenge informally and implicitly on several occasions. ‘We are professionals, but we haven’t used a guide, or a method to do it.’ ‘So in a way we need guidance. Did you use a specific method? Some participants talked about a dilemma between holding on to one’s own personal view, and at the same time acknowledging that it is important that a team responds in the same way to patients. She referred to the fact that those who have to work with coercion on the shop floor on a daily basis (e.g. The article emphasised the importance of an organisation’s Vision and Mission statements in helping to foster an overall ethical climate. Research from Kellermans et al. Donaldson and colleagues [40] asked medical students to write down a case which according to the students had an ethical interest. Ethical challenges and responses in harm reduction research: promoting applied communitarian ethics. 10.1136/jme.2003.005835, Lillemoen L, Pedersen R: Ethical challenges and how to develop ethics support in primary health care.Nurs Ethics 2013,20(1):96–108. At the same time, most participants reported that they do not use a specific method. Some participants described facing ethical challenges as a dramatic and exhausting experience when the decision that has to be made involves a certain risk. Situation ethics response to the right to life-the most loving thing in any circumstance. We want dedicated and engaged people. Most of them focus mainly on dealing with ethical challenges within the pre-structured context of an ethics support service, such as moral case deliberation or ethics rounds [13–16, 28, 29]. Those who operate under this leadership paradigm share an appreciation for ethics and the three (3) Cs – circumstances, challenges… ‘Some said they attempt to find a balance between the legal and the ethical. 0000000016 00000 n Miles M, Huberman AM: Qualitative data analysis. For example, if a … The participants (in total 65), consisted of various health care professionals such as: nurses, nursing assistants, social workers, psychiatrist, psychologists, physicians, team leaders and management. ‘So, what is it we should emphasize, should we in a way emphasize safety and the risk principle, or should we in a way emphasize the being-able-to-grow principle and autonomy so the patient can actually have a chance at self-development. Can you justify? Participants stressed the need for understanding the use of coercion. 88 0 obj <> endobj One physician, however, spoke favourably of bringing a case to an ethics committee. I don’t want to. All authors redefined initial topics into some main topics. Ethical challenges emerged when health care professionals did not agree due to different viewpoints. Many ethical challenges were related to situations in which there was disagreement or conflict. In one situation, the fact that a health care professional asked for clarification and reasons was interpreted by the chief physician as ‘identification with patients’ or as ‘protesting.’, Unit leader: ‘Then there is nagging to those who make the decisions, like the chief physician, saying: Can you be more clear about your rationale? 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. … 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. 0000004366 00000 n 0000002028 00000 n What do you expect from the ethics reflection groups? Box 1130, Blindern, NO-0318, Oslo, Norway. What is it we do then?’. They mentioned that they need a specific kind of support in order to deal with ethical challenges. These results are also found in other papers [40–43]. They were able to present a broad variety of rich descriptions of situations in which they experienced either small or big ethical challenges [22]. This was especially the case when disagreement or having different viewpoints on what was right to do, resulted in not only criticizing the coercive measure itself, but also the team as such. He thought it could be exciting to explore differences in ethical thinking and welcomed discussing them. Gen Pract 2001, 7:143–7 there are many times that many are unsure about of social., can even be dangerous at work’ it seems that dealing with challenges. In this section we will elaborate more on these experiences in the workplace, the result could catastrophic... 505 main survey responses, making a total of 607, Höglund,. 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