Enjeux ethiques de la psychiatrie sous contrainte [Ethical issues in psychiatry under coercion].

Psychiatry is now subject to two apparently contradictory movements. On the one hand, the need to respect the autonomy and rights of patients is reinforced and coercive measures are strictly defined and limited. On the other hand, security concerns in our society leads to prosecution of psychiatric disorders, especially when accompanied by behavioral problems or criminal acts. In these situations of compulsory treatment or care provided in prisons, a number of dilemmas emerge. The place of the healthcare professional in treatments ordered by the Justice and problems related to administrative detention are discussed in more detail.

Dilemmas in Military Medical Ethics: A Call for Conceptual Clarity

Article

Researching from within: external and internal ethical engagement

This article examines the superficial and deep ethical and moral dilemmas confronting ‘insider’ researchers which we term external and internal ethical engagement. External ethical engagement refers to the traditional, easily identifiable ethical issues that insider researchers attend to by submitting their application for ethical approval to their institution’s internal review board. Internal ethical engagement relates to the deeper level ethical and moral dilemmas that insider researchers have to deal with once ‘in the field’ linked to on-going personal and professional relationships with participants, insider knowledge, conflicting professional and researcher roles, and anonymity. By reviewing the literature in this area and drawing on the authors’ experiences of undertaking interpretive studies at institutions where they were members of staff, we explore these concepts and examine the implications for insider researchers. Keywords: insider research; ethics; professional relationships; anonymity; access

Between the lines: Konrad Wolf's 'Mama, ich lebe' and the dilemmas of betrayal

The article offers a close reading of Konrad Wolf’s anti-fascist Second World War film 'Mama, ich lebe' (DEFA, 1977). 'Mama, ich lebe', like all East German films about the Nazi past, deals with the re-founding of post-war Germany. Unlike the usual approach which focused on political redemption of the past crimes, Wolf’s approach explores rupture and failure of political agency as the pre-condition for a new beginning. The rupture is effected by the defection of four Wehrmacht soldiers who decide to cooperate with the Soviet enemy. Their betrayal of the national collective is ethically motivated and arises from their responsibility for the Soviet ‘other’. Its radicalness opens up a moment of utopian freedom and conciliation for the traitors. Yet the back side of betrayal is insecurity and confliction with regard to their role and roots. While the four meet their role as traitors with self-deception about their ambivalent position, they are eventually forced to acknowledge their position as one of self-defeat. Their ‘ethical betrayal’ (Parikh 2009) does therefore not lead to utopian fulfilment but to the traitors’ expiatory sacrifice as the only form of accountability and self-justification. In Wolf’s film antifascism as a tale of political redemption is thus revised and becomes a tale of necessary individual atonement.

Ethical and professional conduct of medical students: review of current assessment measures and controversies

As medical education increasingly acknowledges the importance of the ethical and professional conduct of practitioners, and moves towards more formal assessment of these issues, it is important to consider the evidence base which exists in this area. This article discusses literature about the health needs and problems experienced by medical practitioners as a background to a review of the current efforts in medical education to promote ethical conduct and develop mechanisms for the detection and remediation of problems.

Inside ‘Inside View’: reflections on stimulating debate and engagement through a multimedia live theatre production on the dilemmas and issues of pre-natal screening policy and practice

Background The role of applied theatre in engaging both lay and professional publics with debate on health policy and practice is an emergent field. This paper discusses the development, production performance and discussion of ‘Inside View’.1 Objectives The objectives were to produce applied theatre from research findings of a completed study on genetic prenatal screening, exploring the dilemmas for women and health professionals of prenatal genetic screening, and to engage audiences in debate and reflection on the dilemmas of prenatal genetic screening. Methods ‘Inside View’ was developed from a multidisciplinary research study through identification of emergent themes from qualitative interviews, and development of these by the writer, theatre producer and media technologist with input from the researchers. Findings Inside View was performed in London and the Midlands to varied audiences with a panel discussion and evaluation post performance. The audiences were engaged in debate that was relevant to them professionally and personally. Knowledge translation through applied theatre is an effective tool for engaging the public but the impact subsequently is unclear. There are ethical issues of unexpected disclosure during discussion post performance and the process of transforming research findings into applied theatre requires time and trust within the multidisciplinary team as well as adequate resourcing.

Mothering and ‘insider’ dilemmas:feminist sociologists in the research process

This paper is about care, insider positions and mothering within feminist research. We ask questions about how honest, ethical and caring can we really be in placing the self into the research process as mothers ourselves. Should we leave out aspects of the research that do not fit neatly and how ethical can we claim to be if we do? Moreover, should difficult differences, secrets and silences that emerge from the research process and research stories that might 'out' us as failures be excluded from research outcomes so as to claim legitimate research? We consider the use of a feminist methods as crucial in the reciprocal and relational understanding of personal enquiry. Mothers invest significant emotional capital in their families and we explore the blurring of the interpersonal and intrapersonal when sharing mothering experiences common to both participant and researcher. Indeed participants can identify themselves within the process as 'friends' of the researcher. We both have familiarity within our respective research that has led to mutual understanding of having insider positions. Crucially individuals' realities are a vital component of the qualitative paradigm and that 'insider' research remains a necessary, albeit messy vehicle in social research. As it is we consider a growing body of literature which marks out and endorses a feminist ethics of care. All of which critique established ways of thinking about ethics, morality, security, citizenship and care. It provides alternatives in mapping private and public aspects of social life as it operates at a theoretical level, but importantly for this paper also at the level of practical application.

How people resolve dilemmas: An elicitation method for subjective decision factors

In human society, people encounter various deontic conflicts every day. Deontic decisions are those that include moral, ethical, and normative aspects. Here, the concern is with deontic conflicts: decisions where all the alternatives lead to the violation of some norms. People think critically about these kinds of decisions. But, just ‘what’ they think about is not always clear. ^ People use certain estimating factors/criteria to balance the tradeoffs when they encounter deontic conflicts. It is unclear what subjective factors people use to make a deontic decision. An elicitation approach called the Open Factor Conjoint System is proposed, which applies an online elicitation methodology which is a combination of two well-know research methodologies: repertory grid and conjoint analysis. This new methodology is extended to be a web based application. It seeks to elicit additional relevant (subjective) factors from people, which affect deontic decisions. The relative importance and utility values are used for the development of a decision model to predict people’s decisions. ^ Fundamentally, this methodology was developed and intended to be applicable for a wide range of elicitation applications with minimal experimenter bias. Comparing with the traditional method, this online survey method reduces the limitation of time and space in data collection and this methodology can be applied in many fields. Two possible applications were addressed: robotic vehicles and the choice of medical treatment. In addition, this method can be applied to many research related disciplines in cross-cultural research due to its online ability with global capacity. ^

The Development of an Ethical Strategy for Managers of International Hotels in Third World Countries

This article discusses some of the dilemmas of conscience that greet the international hotel manager in the Third World. It offers realistic and ethical guidelines for decision-making and problem-solving. Some of these guidelines require only common sense and good will to implement; others require a great deal of creativity, sensitivity, effort, and care; and a few will demand the courage to stand up for what is right in the face of competitive pressure.

How People Resolve Dilemmas: An Elicitation Method for Subjective Decision Factors

In human society, people encounter various deontic conflicts every day. Deontic decisions are those that include moral, ethical, and normative aspects. Here, the concern is with deontic conflicts: decisions where all the alternatives lead to the violation of some norms. People think critically about these kinds of decisions. But, just ‘what’ they think about is not always clear. People use certain estimating factors/criteria to balance the tradeoffs when they encounter deontic conflicts. It is unclear what subjective factors people use to make a deontic decision. An elicitation approach called the Open Factor Conjoint System is proposed, which applies an online elicitation methodology which is a combination of two well-know research methodologies: repertory grid and conjoint analysis. This new methodology is extended to be a web based application. It seeks to elicit additional relevant (subjective) factors from people, which affect deontic decisions. The relative importance and utility values are used for the development of a decision model to predict people’s decisions. Fundamentally, this methodology was developed and intended to be applicable for a wide range of elicitation applications with minimal experimenter bias. Comparing with the traditional method, this online survey method reduces the limitation of time and space in data collection and this methodology can be applied in many fields. Two possible applications were addressed: robotic vehicles and the choice of medical treatment. In addition, this method can be applied to many research related disciplines in cross-cultural research due to its online ability with global capacity.

As artes marciais chinesas para pessoas com deficiência : contextos, dilemas e possibilidades = Chinese martial arts for people with disabilities : contexts, dilemmas and possibilities

Universidade Estadual de Campinas . Faculdade de Educação Física

The need for adequate ethical guidelines for qualitative health research

O artigo discute a adequação de aplicar a Resolução 196/961 do Conselho Nacional de Saúde - CNS, às pesquisas qualitativas em saúde, que se baseiam em paradigmas não positivistas. Nestas pesquisas, freqüentemente as decisões sobre a pesquisa são tomadas conjuntamente com a comunidade em estudo. Há a preocupação de favorecer a justiça e a mudança social. E, uma vez que a subjetividade pode ser considerada seu instrumento privilegiado, busca-se o balanço entre objetividade e subjetividade, e discute-se como superar a visão do pesquisador. Estudamos o âmbito de aplicação e a concepção de pesquisa presentes nas diretrizes éticas internacionais e brasileiras. Verificamos que elas adotam uma concepção positivista de pesquisa, que prevê: teste de hipótese, definição prévia de todos os procedimentos pelo pesquisador e neutralidade do pesquisador e do conhecimento produzido. Serão apresentadas algumas características das pesquisas qualitativas, as implicações éticas da maneira como a pesquisa qualitativa é concebida nos paradigmas não positivistas e um breve histórico dos documentos sobre ética em pesquisa. Concluímos que não é adequado analisar estas pesquisas com base nestes documentos e sugerimos a elaboração de diretrizes específicas

The ethical component of professional competence in nursing: An analysis

The purpose of this article is to initiate a philosophical discussion about the ethical component of professional competence in nursing from the perspective of Brazilian nurses. Specifically, this article discusses professional competence in nursing practice in the Brazilian health context, based on two different conceptual frameworks. The first framework is derived from the idealistic and traditional approach while the second views professional competence through the lens of historical and dialectical materialism theory. The philosophical analyses show that the idealistic view of professional competence differs greatly from practice. Combining nursing professional competence with philosophical perspectives becomes a challenge when ideals are opposed by the reality and implications of everyday nursing practice.