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In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram Engelhardt, Jr.. Both argue that ethics consultation is not a profession and the effort to professionalize is motivated by self-interest. One argument they offer against professionalization is that ethics consultants lack normative expertise. Although the question of expertise cannot be resolved completely, the accusation of self-interest can be addressed. Underlying these critiques is a concern for hubris, which can be addressed in certification and the vetting of candidates.Drawing on the virtue ethics literature of Alasdair MacIntyre and Edmund D. Pellegrino, I argue that medicine is a moral community in which ethics consultants are moral agents with a duty to foster the virtue of humility (or what Pellegrino and Thomasma call self-effacement). The implications of this argument include a requirement for self-reflection in one's role as a moral agent and reflection on one's progress toward developing or deepening virtuous engagement with the moral community of medicine. I recommend that professionalization of clinical ethics consultants include a self-reflective narrative component in the initial certification and ongoing renewal of certification where clinical ethics consultants address the emotional dimensions of their work as well as their own moral development. Adopting a teleological view of ethics consultation and incorporating narratives that work toward that purpose will mitigate the self-interest and hubris of the professionalization project., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: In the last two decades, academic medical centers in the United States have faced a new challenge, dealing with breaches of medical professionalism in their staff, house staff, and medical students. Medical education settings have largely directed their professionalism efforts toward responding reactively to negative outliers., Discussion: This paper contends that the warrant of medical education mandates a transformative path forward. While negative behavior must be responded to meaningfully, so, too, must positive role models of professional behavior be publicly lauded for their consequential culture change in their institutions, and promoted as positive role models. Further, the promotion of medical professionalism must be part of this culture by proactively engaging all learners and health care providers with medical ethics and humanities-based knowledge, critical thinking skills, and role modeling., Conclusion: Professionalism programs should be vested with the authority to implement an affirmative educational program intended to nurture and promote medical professionalism in each medical student, resident, fellow, and attending and utilize methods to that end employing both virtue and care ethics.

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician's lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts 'at the margins of professionalism' as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics overlaps with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard's account offers a framework for interpreting different types of moral conflicts 'at the margins of professionalism' to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Every practicing hand surgeon has had the challenging experience of treating a patient who demonstrates difficulty with, or inability to comply with medical advice. Patient noncompliance can lead to not only poor patient outcomes but also deterioration in the therapeutic relationship, physician burnout, high cost of care, and medical-legal risk. The guiding principles in the ethical practice of medicine render it important to consider noncompliance as a potentially modifiable risk factor, and every attempt should be made to work with these noncompliant patients to achieve the best possible outcomes. Data suggest that noncompliance may be affected by socioeconomic status and race; many of these patients are among the vulnerable. However, in some instances, treatment options may warrant alteration or adjustment to reflect the noncompliance of the patient. Rarely, it may be reasonable for a physician to discharge a patient from care once any urgent problems have been managed. Ethical and responsible management of a noncompliant patient requires a thoughtful and measured approach., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

In their role as providers of pharmaceutical products to society, pharmacists must demonstrate professionalism if they are to gain the trust of the community. The Japan Pharmaceutical Association has published the Pharmacist Platform in Japan and the Japanese Code of Ethics for Pharmacists; these resources provide clear guidelines for pharmacists and are an important component of the profession. Becoming a pharmacist involves joining a professional community and thereby pledging to accept a set of ethical standards. This concept of the pharmacy profession is shared by other countries, and the International Pharmaceutical Federation has indicated that professionalism is an issue that should be addressed in every country. This review introduces the Pharmacist Platform in Japan, the Japanese Code of Ethics for Pharmacists established by the Japan Pharmaceutical Association, and the background of each establishment.

In The Trusted Doctor: Medical Ethics and Professionalism (2020), Rosamond Rhodes presents a new theory of medical ethics based on 16 duties she considers central to medical ethics and professionalism. She asserts that her theory is "bioethical heresy," as it contradicts established "principlism" and "common morality" approaches to ethics in medicine. Rhodes advocates the development of parallelism between clinical and ethical decision-making and a systematic approach that emphasizes duties over principles and rules to facilitate the development of a "doctorly character" among medical decision-makers. Rhodes further asserts that her theory and approach necessitate the cultivation of virtues contained in Aristotle's Nicomachean Ethics. But Rhodes's insistence that "medical professionals," not just doctors, are covered by her theory is open to critique, as is her conflation of ethic and morals, especially around the question of the "doctorly character" upon which her duty-based theory hinges. This assessment argues that applicants to medical schools and allied health training programs be screened for specific virtues-honesty, diligence, curiosity, and compassion-to facilitate reinforcement of these pre-professionalized inclinations throughout the habituation processes of medical training. This would increase the probability of turning fear and hope to cure and care via reasoning and affective models performed within an ethical medical framework-even while what this ethical framework should reference remains under debate.

Integrated behavioral health models of care offer many benefits for patient experience and outcomes. However, multidisciplinary teams are comprised of professionals who each may have different professional norms and ethical obligations, which may at times be in conflict. This article offers a framework for negotiating potential conflicts between professional norms and expectations across disciplines involved in integrated behavioral health teams., Competing Interests: Disclosure No financial or relationship conflicts of interest relevant to this publication., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Data regarding ethical/professional issues affecting dermatopathologists are lacking despite their importance in establishing policy priorities and educational content for dermatopathology., Methods: A 14-item cross-sectional survey about ethical/professional issues in dermatopathology was distributed over e-mail to members of the American Society of Dermatopathology from June to September 2019., Results: Two hundred sixteen surveys were completed, with a response rate of 15.3%. Respondents ranked appropriate and fair utilization of healthcare resources (n = 83 or 38.6%) as the most often encountered ethical/professional issue. Conflict of interest was ranked as the most urgent or important ethical/professional issue (n = 83 or 39.3%). One hundred thirty-three (61.6%) respondents felt "somewhat" or "not at all" well equipped to handle ethical dilemmas in practice and 47 (22.8%) respondents identified a major or extreme burden (eg, have considered resigning/retiring) due to ethical challenges., Conclusions: Areas of priority in ethics and professionalism issues can guide future policy and educational content in dermatopathology., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Increasing focus on health equity is placing a spotlight on health professionals' roles. Recent public health crises-the opioid epidemic, maternal mortality, and the COVID-19 pandemic-have renewed focus on racial and ethnic inequity and underscored that trust is foundational to public health and health professionalism. Organizational, system, and policy reform demand that professionalism be redefined in terms of its capacity to motivate equity in health professions education and clinical practice., (© 2021 American Medical Association. All Rights Reserved.)

Increasing use of social media by patients and clinicians creates opportunities as well as dilemmas for pediatricians, who must recognize the inherent ethical and legal complexity of these communication platforms and maintain professionalism in all contexts. Social media can be a useful tool in the practice of medicine by educating both physicians and patients, expanding access to health care, identifying high-risk behaviors, contributing to research, promoting networking and online support, enhancing advocacy, and nurturing professional compassion. At the same time, there are confidentiality, privacy, professionalism, and boundary issues that need to be considered whenever potential interactions occur between physicians and patients via social media. This clinical report is designed to assist pediatricians in identifying and navigating ethical issues to harness the opportunities and avoid the pitfalls of social media., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

We investigated the social representation of fair price of French and English-speaking photographers using the free association method. In two independent studies, we performed a factorial analysis of correspondence of the words provided by the participants as well as a similitude analysis. The results indicated that "fair price" was mainly associated with time, effort and experience level of photographers. Both French- and English-speaking samples made similar associations around the concept of fair price but the order of importance varied. We observed some gender-related differences in both samples, although the relative number of male and female participants must be taken into consideration., Competing Interests: The authors have declared that no compenting interests exist.

Facing an investigation into performance concerns can be one of the most traumatic events in a doctor's career, and badly handled investigations can lead to severe distress. Yet there is no systematic way for National Health Service (NHS) Trusts to record the frequency of investigations, and extremely little data on the long-term outcomes of such action for the doctors. The document-Maintaining High Professional Standards in the Modern NHS (a framework for the initial investigation of concerns about doctors and dentists in the NHS)-should protect doctors from facing unfair or mismanaged performance management procedures, which include conduct, capability and health. Equally, it provides NHS Trusts with a framework that must be adhered to when managing performance concerns regarding doctors. Yet, very few doctors have even heard of it or know about the provisions it contains for their protection, and the implementation of the framework appears to be very variable across NHS Trusts. By empowering all doctors with the knowledge of what performance management procedures exist and how best practice should be implemented, we aim to ensure that they are informed participants in any investigation should it occur., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

In response to the COVID-19 pandemic, the Association of American Medical Colleges has called for a temporary suspension of clinical teaching activities for medical students. Planning for the continued involvement of learners in patient care during this pandemic should include teaching learners professional formation. The authors provide an ethical framework to guide such teaching, based on the ethical principle of beneficence and the professional virtues of courage and self-sacrifice from professional ethics in medicine. The authors show that these concepts support the conclusion that learners are ethically obligated to accept reasonable, but not unreasonable, risk. Based on this ethical framework, the authors provide an account of the process of teaching professional formation that medical educators and academic leaders should implement. Medical educators and academic leaders should embrace the opportunity that the COVID-19 pandemic presents for teaching professional formation. Learners should acquire the conceptual vocabulary of professional formation. Learners should recognize that risk of infection from patients is unavoidable. Learners should become aware of established ethical standards for professional responsibility during epidemics from the history of medicine. Learners should master understandable fear. Medical educators and academic leaders should ensure that didactic teaching of professional formation continues when it becomes justified to end learners' participation in the processes of patient care; topics should include the professionally responsible management of scarce medical resources. The COVID-19 pandemic will not be the last major infectious disease that puts learners at risk. Professional ethics in medicine provides powerful conceptual tools that can be used as an ethical framework to guide medical educators to teach learners, who will bear leadership responsibilities in responses to future pandemics, professional formation.

Background: Use of digital devices have become ubiquitous in healthcare and can create professionalism issues. This study presents opinions of faculty, residents, and medical students to inform policy on the appropriate use of digital devices in the patient care setting., Materials and Methods: A survey was administered from September 2018 to October 2018 to faculty and residents within the general surgery department at a large academic medical center and all fourth-year medical students at an affiliated university. The survey included direct statements and case-based scenarios on similar themes to triangulate responses., Results: There were 114 participants in the survey-50 faculty, 26 residents, and 38 medical students. Digital device utilization was equivalent among all groups, and all participants use a smartphone. Digital devices were most frequently used during rounds and clinical conferences. Overall, digital device use was found more appropriate when seen in the case-based format rather than as a direct statement. Furthermore, use of these devices was seen as most appropriate when the provider explained its use or left the room to use the device., Conclusions: Digital devices are used by faculty and trainees at similar rates for parallel purposes, and the benefits for patient-related care are evident. However, the use of digital devices in the presence of patients should be minimized and always preceded by an explanation. These findings can inform institutional policy when creating guidelines on the professional use of these devices in the patient care setting., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Priority-setting is one way to develop research in a particular field., Aims: We aimed to identify and prioritize the most important medical ethics issues for research in the Islamic Republic of Iran., Methods: A 3-round Delphi survey was conducted using a questionnaire covering 77 medical ethics topics in 10 categories and subcategories (extracted from literature review); this was emailed to 40 experts in medical ethics. The participants rated categories and subcategories for importance on a 5-point Likert scale and ranked the topics based on their research priorities. The highest Likert score showed the most important issue and the lowest priority score indicated the first priority., Results: After consensus, the panel identified 6 categories as the highest priority and most important areas: professionalism [priority score = 2.66, standard deviation (SD) 2.63, importance score = 4.45, SD 0.72], education (priority score=3.12, SD 1.89, importance score = 4.25, SD 0.84), end of life (priority score = 3.79, SD 1.91, importance score = 4.47, SD 0.66), beginning of life (priority = 4.62, SD 1.68, importance score= 4.26, SD 0.61), public health (priority score = 5.20, SD 2.39, importance score = 4.29, SD 0.75), and ethics in research (priority score = 5.33, SD 1.97, importance score = 4.34, SD 0.64)., Conclusion: The rankings for priority and importance was not the same. Our results highlight a lack of applicable knowledge in the areas of professionalism and end of life. This study could be used as a foundation for developing further investigations by ensuring the most appropriate use of limited resources., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Social media has penetrated intrapersonal and professional communication, particularly among a younger generation of healthcare professionals and patients who have grown up in the digital age of communication. Social media tools provide a unique set of opportunities in healthcare, but with these new opportunities come a number of potential challenges. As health leaders navigate the increasingly complex world of social media, concerns have arisen regarding questions of ethics and professionalism and how the use of social media fits within the social contract between the medical profession and society. This article describes the changing parameters of professional conduct in digital environments and proposes a set of considerations and recommendations for health leaders to navigate this new frontier.

Background: Development of professional nursing values is critical within registered nurse-to-bachelor of science in nursing programs to prepare nurses for increasingly complex and diverse work environments. The results of previous studies have been inconsistent, with few studies focusing on online registered nurse-to-bachelor of science in nursing programs. In addition, little is known regarding the effectiveness of the educational methods used to support advancement of professional values and ethical practice., Objective: The object of this study was to gain an understanding of nursing students' attitudes and beliefs about professional values at entry and exit of an online registered nurse-to-bachelor of science in nursing program that includes a standalone ethics course and integrates American Nurses Association Code of Ethics provisions throughout the curriculum., Research Design: For this one-group pretest-posttest, quasi-experimental design, longitudinal matched-pair data were gathered at program entry and exit using the Nurses Professional Values Scale-Revised., Participants and Research Context: In all, 119 students of an online registered nurse-to-bachelor of science in nursing program at a Midwest public university who completed entry and exit surveys between spring 2015 and spring 2018 were included in this study., Ethical Considerations: This study was reviewed and determined to be exempt by the university's institutional review board., Findings: The results showed a significant increase in total posttest scores when considering all participants. However, students who took the ethics course after the pretest demonstrated a significant increase in posttest scores, while students who took the ethics course prior to the pretest demonstrated a small increase that was not statistically significant. Significant increases were also found in the professionalism, activism, and trust factors., Discussion: This study supports previous study findings where students scored higher on caring and lower on activism and professionalism factors. The largest gains were made after completing the ethics course., Conclusion: The results suggest that requiring a standalone ethics course in the registered nurse-to-bachelor of science in nursing curriculum had a positive impact on self-reported professional values.

Background: The literature on unprofessional behavior is reviewed. It is well accepted that unprofessional behavior, including a lack of civility and respect, can have a negative impact on patient safety and quality of care., Methods: We used a focused review in the context of 20 years of experience of assessing, treating, and remediating unprofessional behavior. The review highlights that unprofessional behavior can stem from a variety of sources, including health, psychological/psychiatric issues, social functioning or support, or a combination of these. The review covers the challenges in the work environment and the relationship between outcome, as experienced by the physician, and the likelihood the physician will repeat or modify his or her behavior., Results: Based on the evidence provided in the review and our clinical and research experience, we offer a new framework for the assessment, treatment, and remediation of physicians with professionalism transgressions: the Environmentally Valid Learning Approach. The approach is related to and expands on Miller's Pyramid by adding bio-psycho-social functioning and professional identity to the Pyramid. It emphasizes the dynamic and environmental characteristics of professional identity., Conclusions: Effective intervention is possible. Consideration of contributory factors, addressing/treating those factors, teaching/remediating skill deficiencies, and determining elements that need to be in place to foster implementation and maintenance of the developing skills are necessary components for successful resolution. The behavior is fully remediated when a self-sustaining alternative to the unprofessional behavior is established and the desired behavior becomes a permanent part of the physician's behavioral repertoire., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Increasingly, physicians are being asked to provide technical services that many (in some cases, most) believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, I endeavor, firstly, to clarify the meaning of some of these terms: conscience, conscientious action, professional judgment, conscientious objection, conscience clauses, civil disobedience, and tolerance. I argue that use of the term conscientious objection to describe these refusals by health care professionals is mistaken and confusing. Secondly, relying on a proper understanding of the moral and technical character of medical judgment, the optimal deference that the state and markets ought to have toward professions, and general principles of Lockean tolerance for a diversity of practices and persons in a flourishing, pluralistic, democratic society, I offer a defense of tolerance with respect to the deeply held convictions of physicians and other health care professionals who hold minority views on contested but legal medical practices.

Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one's under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation., (Copyright 2019 The Journal of Clinical Ethics. All rights reserved.)

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today's high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians' actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Confusion exists around the nature and best practices for authors in biomedical fields seeking to disclose conflicts of interest (COIs) and other information that can produce bias. Guidelines often provide principles for action and to avoid granularity that can limit their general usefulness. Journal editors must also interpret various guidelines to produce and enhance their own disclosure and COI policies. We discussion COIs and present heuristics that can enhance disclosure practices by individual authors and inform policy and practice among medical journal editors., Methods: The authors reviewed the biomedical literature and drew on professional and academic experience to develop examples and a suggested matrix for decision making., Findings: Most COI commentary centers on financial relationships. Disagreement still exists about the nature and impact of various forms of COI, making critical reasoning essential when making and interpreting disclosures. Journal editors, authors, critics, and other experts express varying opinions about best practices regarding COIs. Policy decisions should be balanced and reasonable. Narrative context may help readers understand the meaning and relevance of disclosures and COIs., Implications: A balance of personal responsibility and critical thinking can enhance disclosure practices as well as confidence in the medical literature. Using a heuristic to think through possible areas of conflict can help authors provide more complete disclosure information. Providing narrative context can ease the burden of peer reviewers, editors, and readers trying to understand disclosures., (Copyright © 2019 Elsevier Inc. All rights reserved.)