It has become appallingly obvious that our technology has exceeded our humanity. —Albert Einstein A state legislature allotted its state health department $750,000 to match Ryan White federal funding for medication suf? cient to treat 20 patients with acquired immune de? ciency syndrome (AIDS).
However, there were 100 patients who needed the help. public health nurses in each district were asked to select patients for the medication program. A terminally ill cancer patient who is in great pain begs the nurse for more medication than the physician has ordered. What should the nurse do?
A man was diagnosed and treated for a venereal infection by his family nurse practitioner. He agreed that his wife should also be treated but he did not want her to know that he acquired the disease from a prostitute and infected her. He asked the nurse practitioner if there was any way to avoid sharing this information. When faced with situations like these, it sometimes feels like there are no “right” answers. What are your reactions to the three ethical dilemmas? What other information would be helpful to know about these situations to make a decision? CHAPTER FOCUS Virtue or Character Ethics
Principle-Based Ethics: Developing Moral Rules Utilitarian Theories: Doing the Most Good for the Most People Deontological Theories: Balancing Rights and Obligations Justice in health care Values and Health Policy Ethics of Care Ethical Problems Faced by Community Nurses: The Research Ethical Decision Making Service Learning: Discovering the Self and Developing Community Values QUESTIONS TO CONSIDER After reading this chapter, you will know the answers to the following questions: 1. What is bioethics, and how is it important to the community nurse? 2. What is the ethics of virtue, and what part do virtues play in the practice of nursing?
... consent, health providers are meeting their legal and ethical obligations surrounding patients consent. It is essential that student nurses have ... the broader community. One such example observed by the student nurse involves the hospitals policy preventing nurses from leaving ... in both the Queensland Health Public Patients Charter (2002) and the ANMC Code of Ethics for Nurses in Australia (nd. ). ...
3. What is meant by principle-based ethics? 4. How does Kant’s deontological approach differ from Mill’s utilitarian approach? 5. What role does each of the four major ethical concepts— bene? cence, nonmale? cence, autonomy, and justice—play in community nursing practice? 6. How can health care resources be distributed in a fair manner? 7. How does the ethical theory of care differ or agree with other theories? 8. What information does the nurse need to make ethically based decisions? 9. What is service learning, and how does it apply to community health? KEY TERMS Autonomy Benevolence Bioethics Casuistry
Compassion Consequentialism Deontological Discernment Ethic of caring Ethical decision making Ethical dilemma Ethics Integrity Justice Nonmale? cence Service learning Trustworthiness Utilitarianism Virtue ethics 249 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 1786X_CH11_248_269. pdf 249 12/30/08 10:30:30 AM 250 COMMUNITY-FOCUSED NURSING UNIT 2 In? uences on a Community’s Health “One of the dilemmas of today’s health care debate is that medical ethics, as currently structured and interpreted, is bad public policy and actually counterproductive to the total wellbeing of society.
” —Richard Lamm, Executive Director, Center for Public Policy and Contemporary Issues, and former governor of Colorado The situations we encounter as health care professionals may be complex and puzzling dealing with serious issues of well-being, life, and death. Our early experiences are usually of little help in guiding our actions in such complex situations. The philosophical discipline of ethics is the study of how we should behave, or how to determine the right thing to do in our interactions with others. Bioethics is the common name for the study of ethics as it relates to health
Nurse-to-Patient Ratios The healthcare in United States deals with many internal issues that the general public used to be unaware of, until recent times. Still, upon seeing nurses going on strike, most of the people conclude that it has only to do with their demands of better wages and additional social benefits, while in fact, this matter is much more complicated. Majority of nurses demand that ...
and the moral problems that arise as a result of advances in health technologies and our increasing ability to do more to treat illness and prolong life. The theories resulting from ethical study provide a guide to examining ethical situations and to articulating preferred ways of living and behaving as health care practitioners. We must, however, remain aware that differences of opinion exist among those well versed in bioethics regarding which theories best ? t which cases, as well as what kind of role character development plays in
preparation for acting ethically in the community. As our understanding of the universe, the nature of human behavior, and societal relationships has increased or changed, theories about ethical behavior have been modi? ed and new theories developed. One essential difference in the various approaches to ethical decision making has to do with the target of the action. For whom or for what are we interested in doing the right thing—ourselves, a co-worker, an individual patient, a family, an organization, a community, a nation, or the world?
Unfortunately, what may seem to be the right thing to do for one person or group may not be the right thing for another. A situation characterized by con? icting rights or obligations is known as an ethical dilemma. Because of the variety of settings in which nurses practice and the philosophical assumption of the nursing community that nurses care for the whole person, nurses are often involved in all aspects of the patient’s life as it relates to health. Bishop and Scudder (1990) point out that a major characteristic of nursing is that nurses practice “in-between.
” By this, they mean that in addition to giving direct care to the patient, nurses must manage and coordinate other aspects of the patient’s care. This management includes advocating for the patient with the physician and other health care providers, interpreting the patient’s needs to the agency, and interpreting agency policy and other constraints to patients and families. For a community health nurse, it may also mean advocating for agencies and policies in the political arena. For the nurse practicing in the community, the community itself is another interested party in the patient’s health care.
The Term Paper on Explain the nature of different professional relationships in health and social care
... legal systems, social convention, or ethical theory. Within health and social care settings, many principles of support ... best placed to understand the needs of patients, and have the skills and knowledge ... liase with other agencies to help a person deal with their problems, i. e. ... work along side the health and social services include GP, Nurse, CPN, Health visitor, Physiatrist, Occupational Therapists ...
Fry points out that in addition to their moral accountability for individual patients, community health nurses have a moral accountability for “how they provide health services to maximize total net health in population groups” (1996, p. 108).
A different way of thinking about right and wrong actions may be needed in working with aggregate populations. The situation becomes more complex when we attempt to weigh individual rights and privileges against assessments of what is best for a larger group. Horn (1999) suggests that considerations that compete in our conscientious ethical
leanings and our ethical decision procedures include justice in distribution, the patient’s comfort level or happiness, the patient’s wishes, the expense of services, the patient’s responsibility in acquiring a condition, and the social role of the patient. One approach to increasing competence in dealing with ethical matters is to begin with clari? cation of your own values and identifying and understanding the values by which other people live. The cultural competence required for expert nursing care is a speci? c ethical demand on members of the profession to know and respect the values of others.
Steele and Harmon (1983) and Uustal (1991) have developed strategies to aid in values clari? cation. The steps in the clari? cation process help people discover which values they hold and how strongly they hold them in relation to others. Values are often the result of years of consciously seeking information and weighing the importance of one point of view against another. However, they are also simply adopted from family tradition, religious teaching, or modeling people whom we admire without much re? ection. Over the millennia, philosophers, theologians, and
others have attempted to formulate principles and rules that will guide us in ethical behavior. This chapter presents Everywhere, it appears, health care workers consider that “‘best’ health care is one where everything known to medicine the is applied to every individual by the highest trained medical scientist in the most specialized institutions. ” —M. Charlesworth, past director of the World Health Organization, 1993 Dr. Pat Kurtz, chapter author, counseling an elderly patient about a living will. © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 1786X_CH11_248_269. pdf 250
... Patient's Bill of Rights are not sanctioned in law, they are ethical standards, but not law. The AHA says this: Health care institutions, by virtue ... recognize the difference between ethics and the law. Ethical complaints (i. e. , the nurse did not treat me with respect) goes before ...
12/30/08 10:30:31 AM CHAPTER 11 Ethics and Health some of the basic principles of classical ethical theories (virtue ethics, deontology or formalism, and utilitarianism or consequentialism), as well as more recent formulations of biomedical ethics and care ethics. It includes a special focus on the justice issue of distribution of care and on the value systems that in? uence our national agendas for health care. Finally, research related to ethical dilemmas identi? ed by community health nurses will be reviewed and frameworks for ethical decision making presented. of a man is not where he stands in
“The ultimate measure convenience but where he stands at moments of comfort and times of challenge and controversy. ” “Our lives begin to end the day we become silent about things that matter. ” —Martin Luther King, Jr. Virtue or Character Ethics One of the earliest philosophical approaches to correct behavior was that of virtue ethics. According to this approach, if a person has a “good” character, that person will behave ethically as a matter of course. Virtue ethics is based on the writings of the Greek philosopher Aristotle (384–382 bce).
Aristotle (1975) believed that there was general agreement
that everyone has a “life goal” and that ultimate life goal was “happiness. ” Although each person has a different de? nition of happiness, Aristotle believed that happiness is achieved by what he called “excellence in performing rational activities” (thinking), which includes “excellence in choosing. ” Behavioral choices lie on a continuum between ultimate extremes. Gluttony or self-denial might be the two extremes of a continuum representing eating or any other behavior relating to psychological or physiological needs. Foolhardiness and cowardice might be the extremes of a risk-taking continuum.
Aristotle argued that the best choices lie between the two extremes, preferably somewhere in the middle, which he called the golden mean. The person who selects and acts on these middle-ground choices is virtuous. A person who does so with a pattern of consistency born of practice is thought to have good character. Aristotle believed that becoming a virtuous person was a matter of habit and could be learned over time. The more one acts virtuously, the stronger the character trait becomes. In the throes of a crisis, character traits come to the fore and are more likely than relying on sudden decision making to
Ethics is a way of considering the reality of humanity and the universe in regard to a perception of what is right and what is wrong. Human beings are in constant interaction with their environments, with their surroundings, other people, and the dynamics of the entire world. In aiming to figure out the best way to comprehend and figure out the meaning of ethics, there are basically two branches ...
result in good outcomes. From this standpoint, part of becoming a “good” nurse would require that students should practice a life of moderate choices based on those choices they believe an ethically ideal role model would make. Continuing to practice in this vein is believed to foster good habits that have the best likelihood of leading to right actions in professional practice. That is, the virtuous nurse would simply be disposed to do the ethically right thing, rather than 251 having to reason to an ethical solution by some procedure. The word ethics actually stems from the Greek word ethos,
which means “well-developed habits. ” Like many other experiences in life, a given behavior may or may not be considered virtuous, depending on the culture of the individual. Honesty is often considered a virtue. However, if you belong to a criminal community or to a poverty-stricken family or community, honesty may not be valued in the same way it is in a community of middle-class property owners. Likewise, not all virtues are ethical in nature. Cheerfulness may be considered a virtuous social trait, but it is ethical only when displayed within an ethical situation.
Even a right action is not ethical by itself, according to Aristotle, unless the action comes from ethical motivation. In other words, to be considered virtuous, not only must the behavior be the right action, purposefully done, but it must also come from an ethically appropriate inner urge to do the right thing. Box 11-1 describes characteristics of virtue ethics. Characteristic of certain roles, occupations, and professions are expectations that its practitioners will have character and virtues beyond those of other people. In the
case of nursing, it is expected that nurses will be (possess the virtue of) caring and will express that caring in all aspects of patient–nurse interaction. As a virtue, caring may be considered a mean between extremes on a continuum of attention to and feeling for others. At the one extreme would be rejection and callousness; at the other extreme would be over-involvement and indulgence. From a patient’s point of view, caring includes or implies other virtues. For example, if nurses are caring, they are also trustworthy and can be relied upon to give ? tting priority to the
ABSTRACT There has been an enormous focus on the impending increase in baby boomers approaching the year 2025 and the predicted shortage of primary care providers. This focus has only increased with the implications the Affordable Care Act has created through its provisions of increased insurance coverage for the uninsured. The numbers that are being predicted as shortfalls of health care ...
patient’s welfare. The Florence Nightingale Pledge identi? es some virtues that were expected of nurses in the past. These virtues include purity, obedience, loyalty, and willingness to assume the handmaiden role to the physician (Davis & Aroskar, 1991).
Changes in the societal expectations of the role of women in general and expectations from within nursing have devalued some of these historical virtues and replaced them with virtues of assertiveness, loyalty to and advocacy for the patient, and willingness to take appropriate risks. BOX 11-1 Virtue Ethics: Aristotle
The ultimate goal of life is to achieve happiness, which comes from excellence of thinking. An important aspect of excellence of thinking is excellence of choosing virtuous action—the golden mean. A virtuous action is moral only when it is done from a motivation to do the right thing. Virtue, for those of good character, is learned over time by the practice of acting in virtuous ways. Virtues are partly discerned from observing instances of sustained exemplary behavior by role models. © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 1786X_CH11_248_269. pdf 251 12/30/08 10:30:33 AM
252 COMMUNITY-FOCUSED NURSING UNIT 2 In? uences on a Community’s Health It is not uncommon for nurse educators and other nurses to question the virtuousness of today’s nursing students and novice nurses. They complain that some nurses are joining the profession for its high salaries and security and do not show the ethical character traits of caring and the strict honesty that they believe are required of nurses. Beauchamp and Childress (1994) have identi? ed four virtues that they consider primary to the ethics of health professionals: compassion, discernment, trustworthiness, and integrity.
Compassion, a notion related to caring, includes a concern for others and an awareness of their pain or suffering. The compassionate person is disposed to respond with appropriate feelings of sympathy and mercy, as well as a desire to help decrease pain and other suffering. Ethically, being disposed to show these feelings also may be a critical factor in a patient’s perception of being cared for. While compassion has a strong emotional component, discernment is an intellectual trait. The discerning person is able to take decisive action based on insight resulting from a history of clear judgment and understanding.
He or she is able to make ethical judgments without being unduly in? uenced by other personal or political factors. The person sees to the heart of the matter without the bias of personal involvement or personal feelings, without the common ethical ? aw known as “con? ict of interest. ” The discerning person is able to see what needs to be done, when, and in what way in situations involving ethical considerations. Trustworthiness is a character trait that gives other people con? dence that an individual will consistently do the right thing for the right (ethical) reasons. Beauchamp and
Childress believe that the presence or lack of trustworthiness may be the most in? uential factor in whether a relationship continues between a patient and a caregiver. Importantly, in national polls, nurses have been consistently rated by the public as being the most trustworthy group among professionals. Integrity, according to Beauchamp and Childress, exists when an individual habitually behaves in a way that is consistent with that individual’s core values and beliefs. Persons of integrity, so to speak, “walk their virtuous talk. ” Integrity may be disturbed when the individual must compromise
some beliefs and values. This compromising often results in a tension known as moral distress. People are said to have integrity when they are known not to compromise their ethical principles. We are more likely to trust people who we believe have integrity. Principle-Based Ethics: Developing Moral Rules In principle-based approaches to ethics, the right or ethical action is determined not by the virtues (or habits) of individuals or authoritative tradition, but rather by the support of a set of beliefs developed by careful reasoning. Such beliefs include ideas about who has what kinds of rights and which
rights or obligations have priority over other rights and ob- Life’s under no obligation to give us what we expect. We take what we get and are thankful it’s no worse than it is. —Margaret Mitchell ligations. For example, who has the right to make decisions about a patient’s health care, and in what ways are health care providers obligated to support a decision with which they disagree? The two major principle-based approaches are utilitarianism and deontology. Utilitarian Theories: Doing the Most Good for the Most People The primary belief of people who have adopted the
utilitarian position is that the most ethical action is the one that results in the greatest good (happiness) for the greatest number. A corollary to this notion would be that the best action is the one that causes the least harm to the fewest people. The philosopher cited most frequently as a proponent of utilitarianism is John Stuart Mill (1806–1873).
To a utilitarian, the important thing is not so much your good will toward others, but rather the consequences that result from your action. (Utilitarianism is also known as consequentialism. ) Determining which action to take requires that all possible actions in the situation and the
potential outcomes of each be examined for every person or group who may be involved. After the different outcomes are weighed and balanced, the action that leads to the best outcome for the most people is selected. The utilitarian approach has obvious limitations. The ?rst that may come to mind is the problem of how we can know what the outcomes will be for all the persons involved, because many factors beyond our control—or even beyond our knowledge—in? uence outcomes. Another problem arises when the preferred action and/or outcome is itself unethical. An example would be falsifying records in a home health
agency so that the insurers will continue to pay for visits to otherwise ineligible patients. If the purpose of the falsi? cation was to continue needed services to patients who would otherwise not receive them, the consequence is positive for the patient; however, the means are still unethical (as well as illegal).
Recognizing this possible misuse of the theory as a rationalization for unethical behavior, Mill (1859/1871/1993) acknowledged that some behaviors were inherently unethical and could not be condoned, no matter what the favorable outcome. He speci? cally cited slavery as an example.
A more relevant issue in our time might be the use of migrant labor at pay rates below minimum wage and without decent provisions for living to produce cheaper food for the U. S. larger population. To avoid the misuse of this ethical approach, commonly expressed as “the ends justify © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 1786X_CH11_248_269. pdf 252 12/30/08 10:30:35 AM CHAPTER 11 Ethics and Health the means,” there must be general agreement about the ethical appropriateness of the proposed action and possible outcomes. Another common criticism of the utilitarian approach
is that it may not be practical for the average person. The principle of maximizing bene? t for the greatest number may place the individuals making the decision in a position of always having to sacri? ce their own preferences for the greater good. This self-sacri? ce may be too dif? cult for the average person and raises questions about what the limits of our obligation to maximize bene? t in that way are and whether it is even possible to make fair decisions in situations in which we may either be bene? ted or harmed. For example, suppose you are asked to support legislation that would provide increased health bene?
ts for you and your family. After examining the proposed legislation, you realize that it will exclude many needy people who are bene? ting from current legislation. In this instance, opposition to the proposed legislation would bene? t more people, but at your expense. The utilitarian approach is also criticized because it appears to give undue advantage to the majority population. For example, legislation that mandates increased health bene? ts (e. g. , mammography) for participants in a health maintenance organization (HMO), Medicaid recipients, or those who have other private insurance will bene? t a large number of people.
At the same time, it excludes a minority who has no insurance and who may have more need for the services, but lacks the ability to pay for them. The criterion of justice (discussed in detail later)—so important in other approaches—may be missing from the utilitarian approach. Box 11-2 lists the major descriptors of utilitarianism/consequentialism. A major area in which utilitarianism aids decision making is in public policy development, wherein it is often referred to as cost–bene? t analysis. It is the presumed goal of policy makers that whatever money is appropriated or whatever regulations are adopted will further the general
good of society. Developing public policy requires the careful examination of all possible options and the probable consequences of each. It is not uncommon that legislation is passed with good intentions, only to ? nd later that a group of people has been left out, that the new legislation con? icts with other important practices, or that it encourages poor or fraudulent practices. It is important that nurses be at the BOX 11-2 Utilitarianism/Consequentialism The major determinant of ethical behavior is that it provides the most bene? t to the most people or the least harm to the fewest people.
The decision to act must be based on a careful examination of all possible actions in the situation and the possible consequences of each action. Regardless of consequences, actions themselves must be deemed to be ethical. 253 cynic “aA cof? n. is a man who, when he smells ? owers, looks around for ” —H. L. Mencken ETHICAL CONNECTION Stason and Weinstein studied the cost-effectiveness of screening and treating hypertension using data from the Framingham longitudinal study and results of other hypertension studies. They projected various models of cost from initial screening to long-term treatment, considering such factors as dropout
rates; nonadherence to medication; side effects; probability of more expensive events, such as stroke and myocardial infarction; and age. They found that it is more cost-effective to fund programs designed to increase adherence to the treatment regimen for those already in treatment than to institute screening for new cases. They also found that it is more cost-effective if hypertensive men start treatment when they are young, but women begin when they are older. The recommendation was that if screening is instituted, the focus should be on young men and older women. What are the disadvantages to this utilitarian approach?
Do you agree or disagree with this approach? Source: Stason, W. B. , & Weinstein, M. C. (1977).
Public health rounds at the Harvard School of Public Health: Allocation of resources to manage hypertension. New England Journal of Medicine, 296(3), 732–739. decision-making table to provide data about these options and consequences from their perspectives as caregivers and advocates. Further information about how to be effective in these activities is found in Chapter 8. Deontological Theories: Balancing Rights and Obligations Ethical theories categorized as deontological uphold
the position that whether an action is ethical depends on the action itself—principally the motivational basis for the action. The word “deontological” was originally meant to differentiate an ethic of duty from the more utilitarian ethic of consequences. Today, the term includes any mixture of considerations that emphasizes other than consequences. Immanuel Kant (1724–1804) is the philosopher who proposed the basis for our major theory of deontological ethics in his attempt to elaborate a rationale for ethical behavior based on pure reason, rather than tradition or authoritative pronouncement. Kant (1997) proposed two
foundational principles, or rules, that he called “categorical imperatives” or unconditional “ethical laws. ” “Law” here means the generalized reason for an action, which would hold universally and which everyone must follow. If a rule meets that criterion, then it will always be true for every similar instance, and the individual is therefore obligated to follow the rule in every instance. © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 1786X_CH11_248_269. pdf 253 12/30/08 10:30:38 AM 254 COMMUNITY-FOCUSED NURSING UNIT 2 In? uences on a Community’s Health For example, you might want to determine whether it
is ethical to lie to a patient about a diagnosis or prognosis. Is lying ethical? Based on Kant’s procedures to determine the imperative, you would ? rst determine whether lying could be an acceptable ethical behavior. Rationally, you would have to conclude that it could not; otherwise, no relationships that required trust could be developed. Therefore, lying is not ethical and is not acceptable in any situation. “Never lie” would be a categorical imperative. It could be argued, however, that some health care patients are special cases and that telling them the truth might cause psychological harm.
Therefore, it is more ethical to lie than to risk causing harm. The imperative that one should never lie would have to be rejected or, at least restated, if this is thought to be true. Got an Alternative? As more people seek out alternative health practices, nurses face a challenge. Nurses are often less familiar about these nontraditional treatments, so how can they practice in an ethical manner when their values are based on traditional medical treatment? Kant’s second principle is that everyone should be treated as ends and not means to an end. Modern versions
of deontological theory all include this second imperative in rules related to respect for individuals (the principle of autonomy).
Box 11-3 describes deontological ethics according to Kant. We have many examples of other approaches to this rule-based ethics. Of speci? c interest are theories of justice, notably those of Rawls and Nozick, which will be discussed later. Western civilization has had the Judeo-Christian ethic, which includes the Ten Commandments, which are universal rules proposed for adherents of those religions. Other religions have similar rules for behavior.
Codes of ethics for professional groups are also examples of this approach. Nurses rely to a large extent for guidance in ethical matters on the American Nurses Association Code of Ethics (ANA, 2001) and accompanying interpretive comments. This code focuses on professional responsibilities and on obligations of the nurse toward all patients. It clearly includes the community as a type of patient and the role of the nurse in the community. It does not go into detail about ethics with populations but is clearly consistent with the recently BOX 11-3 Deontological Ethics: Immanuel Kant
Individuals establish their own moral rules based on the criterion that the generalized intention of their action could apply to everyone—that is, could become a “law. ” The rules apply to every similar situation. People must be treated as ends and not means (given respect as autonomous persons).
can “A lieon itstravel halfway around the world while the truth is putting shoes. ” —Mark Twain published code of ethics for public health team members. The “Principles of the Ethical Practice of Public Health” are listed in the Cultural Connection feature. Modern bioethics is another form of the deontological
approach to ethics. Two events have in? uenced the development of modern bioethical theory: the medical experiments of German physicians during World War II (Davis & Aroskar, 1991) and the increasing development and use of technology in medicine (Beauchamp & Childress, 1994).
In the ? rst instance, interest in gaining new knowledge that would be helpful in the Nazi war effort, together with a disrespect for certain groups of people (e. g. , Jews, Gypsies, mentally handicapped), motivated the Nazi doctors to perform experiments that were excruciatingly painful, degrading, and murderous.
Revelation of these experiments at the Nuremberg trials following the war shocked the world community and increased awareness of humankind’s capacity for in? icting harm. Further awareness and shock came with the revelation of inhumane research being conducted in the United States. Some, like the Tuskegee syphilis study being conducted on Southern African American men, was supported by the U. S. Public Health Service. The results of these and other revelations were a series of national and international codes of ethics for the conduct of research. The introduction of increasingly more sophisticated
technology over the last 40 years has enabled health care ETHICAL CONNECTION In 1932, the U. S. Public Health Service funded research to study the natural course of syphilis, a disease that at the time had no known, reliable treatment. Subjects for that study consisted of a group of 200 Black men who were infected with the disease and 100 Black men who were uninfected from the small area of Tuskegee, Alabama. The study continued for 40 years, during which time the infected population became more ill and had a much higher mortality rate than the uninfected control group.
By the 1940s, it was found that penicillin was an effective treatment; however, none of the men were given the antibiotic. Many of the men did not know that they were subjects of a research study, were not told that penicillin would help them, and faithfully continued to appear for the periodic exams, believing that they were being treated. Articles reporting on the study were published in medical journals and, in addition to the nurse and physicians involved, many physicians from the Tuskegee medical center and around the state knew about the work.
It was not until the project was exposed in 1972 in a Washington newspaper that the public became aware and expressed outrage about it. At this point the study was finally discontinued. Source: Brandt, A. M. (1978).
Racism and research: The case of the Tuskegee syphilis study. Hastings Center Report, 8(6), 21–29. © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 1786X_CH11_248_269. pdf 254 12/30/08 10:30:41 AM CHAPTER 11 Ethics and Health providers to perform complicated surgical procedures, such
as heart bypass and organ transplants; to keep premature infants alive; to identify genetic abnormalities in a fetus; and to maintain nutrition, hydration, and respiration in patients in irreversible coma. In the struggle to ? nd the right actions in these and other situations, solutions for many ethical dilemmas were eventually sought from the courts. ENVIRONMENTAL CONNECTION Toxic waste dumps and other contaminants that affect people’s health are often located near impoverished and vulnerable populations. What are the ethical implications of this practice and how doe