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BACKGROUND: Studying the contribution of individual countries to leading journals in a specific discipline can highlight which countries have the most impact on that discipline and whether a geographic bias exists. This article aims to examine the international distribution of publications in the field of bioethics.
METHODS: Retrospective quantitative study of nine peer reviewed journals in the field of bioethics and medical ethics (Bioethics, Cambridge Quarterly of Healthcare Ethics, Hastings Center Report, Journal of Clinical Ethics, Journal of Medical Ethics, Kennedy Institute of Ethics Journal, Nursing Ethics, Christian Bioethics, and Theoretical Medicine and Bioethics).
RESULTS: In total, 4,029 articles published between 1990 and 2003 were retrieved from the nine bioethical journals under study. The United States (59.3%, n = 2390), the United Kingdom (13.5%, n = 544), Canada (4%, n = 160) and Australia (3.8%, n = 154) had the highest number of publications in terms of absolute number of publications. When normalized to population size, smaller affluent countries, such as New Zealand, Finland and Sweden were more productive than the United States. The number of studies originating from the USA was decreasing in the period between 1990 and 2003.
CONCLUSIONS: While a lot of peer reviewed journals in the field of bioethics profile themselves as international journals, they certainly do not live up to what one would expect from an \"international\" journal. The fact that English speaking countries, and to a larger extent American authors, dominate the international journals in the field of bioethics is a clear geographic bias towards the bioethical discussions that are going on in these journals.

OBJECTIVE: The aim of this paper is to suggest that the study of ethics and ethical theories can enhance nursing practice.
CONCLUSIONS: Knowledge of ethical theories can be of practical use to nurses in at least three ways. First, it can help nurses uncover to what extent a problem is an ethical one. The questions faced in practice can be empirical, formal or philosophical. Very often, a practical decision requires us to tackle all three types. In the example of a \'Do not attempt resuscitation\' order, deciding on whether such an order is appropriate requires us to answer empirical questions such as how likely any attempt is to achieve success. It also requires us to answer formal questions such as whether the law permits such an order in the present circumstance. Finally, it requires us to answer ethical/philosophical questions, such as how we should weigh up quality of life against quantity. Second, it can enable practitioners to develop skills and tools to tackle ethical/philosophical questions. In this paper I describe two such tools: Socratic questioning and Aristotelian dialectic. Third, it can help practitioners to develop the soundness of their ethical values and beliefs. All ethical reasoning requires us to use our values and beliefs, and attending to them enhances the quality of our reasoning.
CONCLUSIONS: The study of ethics can enhance nursing practice.

OBJECTIVE: There is a prevailing belief expressed in the physical therapy literature that values influence behavioral choices. There is, however, meager research on physical therapists\' values. A values theory was used to study the organization of physical therapists\' basic values and to generate hypotheses about age-related value priority differences.
METHODS: Participants were volunteers from the Wisconsin Physical Therapy Association (N=565).
METHODS: Values importance ratings were gathered using a modified Schwartz Values Survey. Demographic data were obtained with an investigator-developed questionnaire. Analyses included descriptive and nonparametric statistics and nonmetric multidimensional scaling.
RESULTS: The organizational structure of therapists\' values was similar to the theoretical model. Physical therapists rated values associated with benevolence as most important and values associated with power as least important. Three of 7 age-related hypotheses were supported.
CONCLUSIONS: The theory adequately explained the organization of physical therapists\' values and provided rational explanations for age-based value priority differences. Compared with occupationally heterogeneous samples, the results suggest that physical therapists highly prize values that benefit others and give remarkably little importance to values associated with power.

Christian psychologists have questioned whether the code of ethics proposed by secular psychology is sufficient for the practitioner who is a Christian. However, little descriptive data exist on the ethical beliefs and behaviors of Christian psychologists. Survey data were obtained from 69 Christian clinicians indicating the frequency with which they engaged in 83 behaviors and the degree to which they believed the behaviors were ethical. Responses were tabulated for each option and on each behavior. Of the 83 items, four occurred in the practices of over 90% of the respondents, while six never occurred, the latter being mostly sexually related items. Agreement on ethics was found with 13 of the items, while nine behaviors, several of which involved financial issues, proved to be difficult ethical judgments. The data indicate that Christian psychologists are effectively understanding and implementing the ethical guidelines of the American Psychological Association although guidance may be needed regarding finances and homosexuality.

Senior lecturers/lecturers in mental health nursing (11 in round one, nine in round two, and eight in the final round) participated in a three-round Delphi study into the teaching of health care ethics (HCE) to students of nursing. The participants were drawn from six (round one) and four (round three) UK universities. Information was gathered on the organization, methods used and content of HCE modules. Questionnaire responses were transcribed and the content analysed for patterns of interest and areas of convergence or divergence. Findings include: the majority (72.8%) of the sample believed that insufficient time was allocated to the teaching of HCE; case studies were considered a popular, although problematic, teaching method; the \'four principles\' approach was less than dominant in the teaching of HCE; and virtue ethics was taught by only 36.4% of the participants. The Delphi technique proved adequate and worth while for the purposes of this study. Further empirical research could aim to replicate or contradict these findings, using a larger sample and recruiting more university departments. Reflection is required on several issues, including the depth and breadth to which ethics theory and, more controversially, meta-ethics, are taught to nursing students.

BACKGROUND: The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice.
METHODS: Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation.
RESULTS: No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients\' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients\' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients\' best interests.
CONCLUSIONS: The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.

OBJECTIVE: This paper reports a study exploring nurses\' views on the \'potential\' content and functions of an ethical code for nurses in Belgium. The term \'potential\' is used, because Belgian nurses do not have experience with an ethical code.
BACKGROUND: Ethical codes have been developed to guide nurses\' practice and to improve their professional status. Little empirical research, however, has been undertaken to determine nurses\' views on the content and functions of these codes. The available quantitative studies merely give some information on nurses\' (lack of) knowledge and use of their ethical code. No nursing ethical code currently exists in Belgium. Qualitative research exploring nurses\' views, therefore, was needed in order to find out which functions an ethical code could fulfil and what the code\'s content could be.
METHODS: Eight focus groups were conducted with 50 nurses in different healthcare settings in Belgium. Data were generated during 2003.
RESULTS: According to participants, an ethical code could fulfil several functions, including supporting their professional nursing identity (external function) and giving guidelines for nursing practice (internal function). In addition, some aspects of content were mentioned, including nurses\' responsibilities in a relational context: particular attention should be paid to the personality of the nurse and to the specificity of nursing as a relational activity. Most agreement was reached on the \'ethical\' function of the code, namely guiding nurses\' professional moral practice. Regarding disciplinary use and the need for legalization of the ethical code, on the contrary, opinions were divergent.
CONCLUSIONS: It is of utmost importance to take into account nurses\' views when developing an ethical code for their profession. This study gave a first picture of the views of nurses themselves. These initial findings should be completed with nurses\' views on the formulation, dissemination and promotion of the ethical code. Such evidence-based development of an ethical code will probably give more guarantees that the code will meet nurses\' expectations and will function optimally.

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BACKGROUND: Bioethics education has been recommended as a formal component of surgical residency training. The best method for teaching bioethics to residents is unclear. We compared the effectiveness of a standardized patient (SP)-based seminar to a traditional seminar format for teaching bioethics to surgical residents.
METHODS: We randomized 31 first- and second-year surgical residents to either a SP-based seminar or a traditional seminar on informed consent. Immediately after the seminars, we evaluated resident performance in patient encounters on informed consent by using an objective structured clinical examination. Their knowledge of informed consent was also evaluated by using a 20-question short-answer written examination immediately after the seminars and then 3 weeks later.
RESULTS: Twenty-nine residents completed the study; two withdrew because of an emergency. The SP seminar group had lower SP interview scores on the 22 item checklist compared with the traditional seminar group (57% versus 66%; difference -9%; 95% confidence interval [CI], -17% to -1%, P=.03). The SP seminar group also had lower knowledge scores on the questionnaire immediately after the seminar (60% versus 73%; difference -13%; 95% CI, -21% to -4%, P=.003). The difference in knowledge scores persisted at 3 weeks (41% for the SP group, 59% for the traditional seminar group; difference -18%; 95% CI, -29% to -7%; P=.002).
CONCLUSIONS: A traditional seminar was superior to an SP-based seminar for teaching informed consent to surgical residents.