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A Social Contract for Medical Librarians?

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I continue to read Wicclair’s Conscientious Objection in Health Care. In the second chapter he, somewhat doggedly, examines multiple ethical theories of the health professions. The formula is: name a theory, describe it, show how it does not necessitate a position of conscience absolutism (that one’s conscience must over rule all other factors in every decision), nor does it necessitate a position professional incompatibility (that one’s professional duties must over rule, in every case, the dictates of one’s conscience).

Inadvertently, the chapter gives a pretty good overview of the ethical theories which guide moral decision making in the medical professions. I can’t help but think about my own “profession.” (I suppose I really should make an effort to finish reading Preer’s Library Ethics.) What are the grounds upon which the medical library profession has established its codes? How is it that medical librarians navigate ethical dilemmas? Or, that is, what self-knowledge as a librarian guides them through these dilemmas?

Do medical librarians have an “internal morality” … one grown organically from the nature of the services that we provide?

Do medical librarians have an understood social contract? In other words, does society expect something from us in exchange for granting us professional authority? (Which begs the question: what do people expect from us?)

Or … do we (merely?) practice, by association, borrowing the ethical frameworks of our institutions? Hospitals, clinics, academic medical centers?

I suppose I am still struggling to understand who medical librarians are as a profession. Depending on the circumstance the medical librarian may be professionally embedded in clinical care, teaching students, conducting health research, or providing the services which are common to all libraries. Thus, it would seem, that no one ethical or professional self-conception would guide them.

I also worry that efforts to transform the profession–such as re-branding ourselves as “informationists”–will serve to alienate the professional from the historical practices which guide ethical reasoning … but that is a digression for another day.

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Written by Jere

May 14, 2012 at 12:14 pm

Rebeginning again and reading

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I have read less of the history of medical libraries that I had planned. I have read less of everything than I had planned, but that is a fact of life. I am 3 pages deep (and months stalled) into Gertrude L. Annan’s “The Medical Library Association in Retrospect, 1937-1967” (Bull Med Libr Assoc. 1998 Apr;86(2):270-8.). I vaguely recall an impression that the beginnings of the profession were inauspicious, born of print-based indexes, and (later) necessitated by unfriendly databases. And the whole thing leads one to wonder, what would be the state of medical libraries were it not for the creation of the NLM? But I’ll return to that train later.

Now I am reading “ethics.” And the saddest sentences of the day (after noting that physicians making “justice-based” refusals may be said to be acting on conscience only if they meet three criteria: 1. they have a core set of moral beliefs; 2. justice is one of those beliefs; 3. providing care would conflict with the doctor’s concept of justice), Mark Wicclair writes:

Without questioning the sincerity of physicians with justice-based objections to providing medical treatment, it is unlikely that many will satisfy the second condition. If a person’s conception of justice is among her core moral beliefs, she is likely to experience guilt, remorse, loss of self-respect, and/or shame if her actions are incompatible with her conception of justice. Regrettably, however, injustice is something that many physicians and non-physicians alike have learned to tolerate and live with.

Wicclair, M. R. (2011). Conscientious objection in health care: An ethical analysis. Cambridge: Cambridge University Press. p.8.

Written by Jere

May 1, 2012 at 11:20 am

Posted in Conscience, Ethics, Libraries

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Bioethics Journals: 88% Obscure

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A Twitter friend, “orgmonkey“, recently sent me a link to a post on the openness of ethics journals. Jim Till, of Be openly accessible or be obscure, examines the open access policies and the frequency of “free full text” (FFT) publication in leading bioethics journals. In “Assessing medical ethics journals”, Till uses three, free, online tools to build his lists of highly ranked ethics journals: eigenFACTOR.org, Journal-Ranking.com, and SCImago Journal & Country Rank. Thereby avoiding the standard (but not “open”) tool for this sort of research—Thomson Reuters’ Citation Indexes and Journal Citation Reports. Till’s method identified seven, top-ranked titles, publishing a total of 1,472 articles in two years, and providing FFT (as indicated by PubMed) to 181 articles. (Note, however, that 178 of these FFT articles were published in one journal, BMJ’s Journal of Medical Ethics.) Which means that Till’s “leading” bioethics journals are about 12% open (181/1472) – or, to borrow a term from the title of Till’s blog, 88% (1291/1472) “obscure”. In contrast, a similar analysis by Till of immunology journals found that the three top-ranked titles of the field were about 41% open (274/672)—see: “Assessing immunology journals”, 16 April 2008.

If Till’s analysis is correct and bioethics journals are comparatively “obscure”, his post opens the door to three questions:

1. Why are bioethics journals “obscure”?
2. Should ethicists, editors, readers and publishers do anything about this obscurity?
3. If so, what should or could be done to encourage an increase in open access publication of ethics literature?

I have a few ideas on the first question, an opinion on the second, and (thus far) not much to offer on the third. However, if I find the time to share, rest assured that my thoughts here are always “open” and hopefully “accessible”.

Written by Jere

June 28, 2008 at 12:06 am

Posted in Ethics

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Who Needs “Gray Literature”?

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Bioethics readers and writers may be among some of the biggest consumers of gray literature. The consumption and production of gray literature in bioethics will never equal the pace set by scientists employed by large governmental agencies like NASA, but the advisory and consultative nature of the discipline lends itself to the “gray” pages. Ethics commissions and committees are often international, non-governmental, semi-governmental, interdisciplinary, and (of course) not-for-profit. Given these circumstances, and the general value to be found in making ethical guidelines and reports broadly available, many of these documents will be published in ways that are not easily indexed or discovered.

While ethics researchers can find some of this literature with careful internet search engine strategies, searching the wide open Web may not be the most efficient way to browse and to discover new “gray” bioethics publications. Although Brian S. Matthews (C&RL News, March 2004, Vol. 65, No. 3) provides a long, useful list, for finding gray literature, few of these are likely to include bioethics material. I did, however, recently use one of these, The New York Academy of Medicine Grey Literature Report, to find a “gray” publication on the ethical issues relevant to pandemic influenza preparedness – The Eleventh Futures Forum [PDF – 515 KB] – a recent publication of the WHO.

The NYAM Grey Literature Report appears to be a useful tool, but will I remember to use it in the future? I guess one thing that worries me about search tools specifically devoted to “gray literature” is the concept itself. Who thinks to themselves while researching, “I need to check the ‘gray literature'”? In short, the concept serves librarians, publishers, and (perhaps) tenure committees well. Those who evaluate publications, index titles, or build collections will find that segregating documents into a “gray” pile is, from time-to-time, a necessity. Others, however, are likely to find this material (if they know what they are looking for) without thinking about the “gray” status of the literature.

Written by Jere

June 7, 2008 at 12:04 am

Posted in Ethics

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Finding a Brief Introduction to Bioethics

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If a recent reference request from a curriculum development friend is indicative of the state of medical education, students are demanding quick fixes. It seems that medical students are busy people (no surprise) and for better or for worse (no, just “for worse”), they’re just not ready to sit down and read a thorough, tried-and-true introduction to principles of bioethics. Although the demands of the market (money and time) probably do much to erode the ethical foundations of even the most conscientious medical professional, I believe these foundations would be a good bit stiffer if all were required to read and discuss Beauchamp and Childress’s Principles of biomedical ethics (New York: OUP, 2001) or Veatch’s The basics of bioethics (Upper Saddle River, N.J.: Prentice Hall, 2003).

So, what is one to do? Can one provide a good introduction to biomedical ethics in less than 10 pages? Let’s be honest … many students will merely give themselves a crash course by perusing Wikipedia. Which means, if there’s a good brief introduction to bioethics available online, it must be at least as easy to access and to read as are Wikipedia’s entries on bioethics and medical ethics.

I should note here that, although faculty will be reluctant to use Wikipedia, the page on medical ethics is not bad. In fact, it’s more thorough than many of the popular Web pages written by bioethicists as introductions to the field. Too often these introductions focus on the latest hot topic (e.g., stem cell research) or the great scandals of medical research (e.g., Tuskegee), without sharing the philosophical underpinnings that inform contemporary ethical scrutiny and decision making. The Wiki entry provides a few sentences for the main principles and a paragraph for some of the key tools and concepts, like “informed consent”. Links to many of the hot topics and events in the history of medical ethics are also provided.

As an alternative to the Wikipedia entry, I recommend Thomas R. McCormick’s “Bioethics Tools: Principles of Bioethics“. This page is a part of a module created and maintained by the The Bioethics Education Project at the Department of Medical History & Ethics at the University of Washington School of Medicine. The page provides the most succinct and well-written summary of Beauchamp and Childress that I have seen online. (If someone knows of something better, please let me know.) The page was created in the late 90s and the web design certainly looks dated, but links are provided to case studies and to additional resources and topics covered by the entire Ethics in Medicine website [site map]. This resource isn’t perfect: oddly the site does have a home page, but once you’re inside the site, it’s hard to find your way back … well-written content, poor design. Also, it appears that the site was written with the University of Washington School of Medicine students foremost in mind. While this doesn’t change the value of the material, it does limit the appeal for non-UW readers. The Bioethics Education Project was built with the support of an award from the Robert Wood Johnson Foundation. So, like many innovative programs in bioethics, its future development will probably need added grant support. Nevertheless, if you’re looking for a good online introduction to bioethics, the University of Washington School of Medicine’s Ethics is Medicine is my current favorite … and, if the good folks at the RWJF are reading, please consider revisiting this project.

Written by Jere

May 25, 2008 at 12:02 am

Posted in Ethics

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Privacy Risks – Social Bookmarking on a Medical Library Website?

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If you have been following me on Twitter, you know that I’ve been thinking a lot about the privacy risks of using social networking tools. Of course, if you’ve been following me on Twitter, I doubt that you have too many concerns about your own privacy risks when using these tools. And, if I were truly concerned about my own risks, I wouldn’t use them either; in fact I wouldn’t write this blog post. So, why do I care. Well, it’s not my risks that I’m worried about, but the library users’ risks that concern me. I am working on an academic website that will allow users to create profiles and share their interests … especially their interests in medicine. While the site will mainly be used by researchers, it will also be used by the community. Therefore, an unsuspecting community member could misinterpret the option to share interests as a place to list one’s medical conditions. If this individual also created a profile that was easily identifiable … a photo, a simple user name … then that person’s private medical information could be disclosed to employers, insurers, friends, colleagues, law enforcement, marketers, and anyone else that might used the site and recognize the person.

One solution would be to make it painfully clear to participants that they, by using the site, are exposing themselves to risks … but what are these risks, exactly? And how does one best communicate them to patrons, patients, researchers, and the any other person that might use the networking service?

Written by Jere

May 7, 2008 at 12:00 am

Posted in Ethics, Libraries

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