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PubMed1991

Conceptual issues in nursing ethics research.

Empirical studies that have attempted to describe nurses' ethical practice have used conceptual frameworks derived primarily from the disciplines of bioethics and psychology. These frameworks have not incorporated important concepts developed by nursing theorists over the past two decades. This article points out flaws in the past research frameworks and proposes a synthesis of ethical theory, nursing practice contexts, and empirical research methods to enrich theoretical development in nursing ethics.

Ethical Analysis↗
PubMed1991

Nurses and physicians on nutritional support: a comparison.

During the last decade, several court cases have focused attention on the moral and legal aspects of withholding or withdrawing food and fluids from certain patients. The courts have not been unanimous in their judgements on these matters. In attempting to explore this issue, this article reviews both the nursing and medical literature on the withdrawing and withholding of food and fluids with particular attention to empirical studies. Several themes which emerge from the literature are used to explore the similarities and differences between the practices of nursing and medicine where nutritional support is concerned.

Attitude of Health Personnel↗
PubMed1995

The inherent paternalism in clinical practice.

It is sometimes suggested that the physician should offer the patient "just the facts," preferably in a "value-free manner," explain the different options, and then leave it to the patient to make the choice. This paper explores the extent to which this adviser model is realistic. The clinical decision process and the various components of clinical reasoning are discussed, and a distinction is made between the biological, empirical, empathic/hermeneutic and ethical components. The discussion is based on the ethical norms of the public health services in the Nordic countries, and the problems are illustrated by a clinical example. It is concluded that the adviser model is unrealistic. Patient information is important, but the complexity of clinical reasoning makes it impossible to separate facts and value judgments. It is claimed that there is an inherent element of paternalism in clinical decision-making and that clinical practice presupposes a mutual trust between physician and patient.

Adult↗
PubMed1983

Conception and the concept of harm.

In recent years, science and the courts have created new options whereby prospective parents can avoid the birth of a diseased or defective child. We can ascertain the likelihood that certain genetic diseases will be transmitted; we can detect a number of fetal abnormalities in utero; we have legal permission to abort for any reason, including fetal abnormality. With these new options come new questions concerning our moral obligations toward our prospective offspring. An important conceptual question concerns whether such congenital diseases and defects constitute harms to the children who bear them. In this essay I shall examine the prevailing analysis of harm, the "Otherwise-Condition" approach, which denies that we can predicate harm of such abnormalities. I will show first that this analysis is inadequate even to account for certain very ordinary, clear cases of harm. It thus is suspect regardless of its stance on congenital anomalies. Second, it sets up an ill-considered connection between harm and causation - a connection which renders its harm ascriptions slippery, arbitrary. Finally, this analysis cannot be squared with certain of our deeply entrenched moral intuitions. By thus rebutting this most influential definition of harm, I will have opened the door to the possibility of ascribing harm for congenital disease and defect.

Abortion, Spontaneous↗
PubMed1983

Determining proxy consent.

The paper clarifies the relative merits and proper roles of standards of review in the determination of proxy consent for those unable to make decisions concerning their own medical treatment. The "substituted judgment" standard asks which treatment the incompetent person would choose if competent, while the "best interests" test asks which treatment would benefit the patient. The tests are discussed in relation to the moral principles of autonomy and beneficence which provide their justification. I distinguish six types of cases involving incompetent patients and argue that which standard is appropriate depends on the type of case involved. A "rational choice" standard, which asks "What would the incompetent patient choose if his or her choice were rational?", is proposed as a way of determining best interests.

Beneficence↗
PubMed1983

Proxy consent and counterfactual wishes.

I discuss conditions for the validity of proxy consent to treatment on behalf of an incompetent person. I distinguish those incompetents who, when previously competent, expressed an opinion on the treatment in question from those who were never competent or who, though previously competent, never expressed an opinion on the proposed treatment. In the former case valid proxy consent usually requires respecting the stated wishes of the patient. The latter case is more difficult. I consider a widely-held principle which appeals to the counterfactual wishes of the incompetent person. I argue that it is unacceptable and propose in its place a principle having to do with the best interests of the patient.

Beneficence↗
PubMed1984

The 'right' not to know.

There is a common view in medical ethics that the patient's right to be informed entails, as well, a correlative right not to be informed, i.e., to waive one's right to information. This paper argues, from a consideration of the concept of autonomy as the foundation for rights, that there can be no such 'right' to refuse relevant information, and that the claims for such a right are inconsistent with both deontological and utilitarian ethics. Further, the right to be informed is shown to be a mandatory right (though not a welfare right); persons are thus seen to have both a right and a duty to be informed. Finally, the consequences of this view are addressed: since the way in which we conceptualize our problems tends to determine the actions we take to resolve them, it is important properly to conceptualize patients' requests not to be informed. There may be many reasons for acting in accord with such a request, but it is a mistake to conceptualize one's act as 'respecting a right possessed by persons'.

Ethical Analysis↗
PubMed1984

Patient truthfulness: a test of models of the physician-patient relationship.

Little attention has been given in medical ethics literature to issues relating to the truthfulness of patients. Beginning with an actual medical case, this paper first explores truth-telling by doctors and patients as related to two prominent models of the physician-patient relationship. Utilizing this discussion and the literature on the truthfulness and accuracy of the information patients convey to doctors, these models are then critically assessed. It is argued that the patient agency (patient autonomy or contractual) model is inherently and seriously flawed in numerous circumstances, even those involving informed and competent adult patients.

Adult↗
PubMed2003

What is Catholic about Catholic Charities?

Sectarian social services agencies play an important and increasing role in contemporary social welfare. Among sectarian social welfare organizations, Catholic Charities USA has emerged as the largest private provider of social welfare services. This article reviews the history, services, and practice controversies of Catholic Charities USA and examines issues regarding the ability of sectarian social services organizations to provide nonbiased and fair services. Through an analysis of this organization, the authors raise and discuss questions of accountability and philosophical approaches.

Catholicism↗
PubMed2000

Attitudes of community-living staff toward the integration of persons with mental retardation in the community.

The present study was conducted to determine the extent to which the current philosophical approach of inclusion and integration in the community of persons with mental retardation is embodied in the attitudes of staff members who are charged with implementing it. The research sample was comprised of 106 staff members who work in three major geographical districts of community-living settings in Israel. Overall, the results suggest that a true understanding of and agreement with this philosophy is far from being achieved. The findings of this study provide evidence that staff members charged with providing services and support to persons with mental retardation have not fully adopted the attitudes of the community-living approach. Findings are interpreted in relation to practice.

Adult↗
PubMed1991

Empathy as an ethical and philosophical basis for nursing.

This article reconstructs the concept of empathy. Current conceptualizations in nursing, psychology, and lay usage and philosophic approaches are examined. Factors of empathetic situations are defined. Key issues of the object, moral implications, and the locus of empathy are discussed using illustrations from fictional and professional literature. In the proposed concept, a common humanity is the object of empathy, and the empathetic process occurs within individuals. Ability to empathize varies with the broadness of the base with which each individual is able to perceive the common humanity within another. Moral implications include a duty to base actions in empathy.

Empathy↗
PubMed1991

Principle-oriented ethics and the ethic of care: a creative tension.

Research to date in the field of nursing ethics has overlooked the nature of the guiding moral framework in nursing practice, while focusing primarily on the moral reasoning and moral behaviors among nurses. This research depicts two moral frameworks--a principle-oriented ethic and the ethic of care--as they are experienced by practicing critical care nurses. The interdependence of these two frameworks as they inform the moral experience of the nurse is demonstrated in the analysis of a complex nurse narrative that depicts the nurse's moral struggle.

Beneficence↗
PubMedDate not supplied

Gently into the light: a call for the critical analysis of end-of-life outcomes.

This article overviews the holistic, hospice, and palliative care models as they relate to end-of-life (EOL) care outcomes. Freire's model of overcoming oppression, which builds on Hegel's philosophical approach, is used as a framework for raising nurses' awareness of end-of-life issues. Concerns that require critical dialogue, as well as questions that warrant discussion, are posited.

Attitude of Health Personnel↗
PubMed2006

Human development VIII: a theory of "deep" quantum chemistry and cell consciousness: quantum chemistry controls genes and biochemistry to give cells and higher organisms consciousness and complex behavior.

Deep quantum chemistry is a theory of deeply structured quantum fields carrying the biological information of the cell, making it able to remember, intend, represent the inner and outer world for comparison, understand what it "sees", and make choices on its structure, form, behavior and division. We suggest that deep quantum chemistry gives the cell consciousness and all the qualities and abilities related to consciousness. We use geometric symbolism, which is a pre-mathematical and philosophical approach to problems that cannot yet be handled mathematically. Using Occam's razor we have started with the simplest model that works; we presume this to be a many-dimensional, spiral fractal. We suggest that all the electrons of the large biological molecules' orbitals make one huge "cell-orbital", which is structured according to the spiral fractal nature of quantum fields. Consciousness of single cells, multi cellular structures as e.g. organs, multi-cellular organisms and multi-individual colonies (like ants) and human societies can thus be explained by deep quantum chemistry. When biochemical activity is strictly controlled by the quantum-mechanical super-orbital of the cell, this orbital can deliver energetic quanta as biological information, distributed through many fractal levels of the cell to guide form and behavior of an individual single or a multi-cellular organism. The top level of information is the consciousness of the cell or organism, which controls all the biochemical processes. By this speculative work inspired by Penrose and Hameroff we hope to inspire other researchers to formulate more strict and mathematically correct hypothesis on the complex and coherence nature of matter, life and consciousness.

Behavior↗
PubMed1997

Crossing boundaries: communication between professional groups.

The NHS reforms increased emphasis on a managerial culture. In primary care this raised questions about responsibility and philosophical approaches. Greater integration between agencies brings benefits, but creates tensions. Failure to bridge the gap may result in dysfunctional teams and compromised quality of patient care. The different orientations may manifest themselves in several ways but lead to frictions that can breed hostility and prevent effective teamwork. Explores issues involving social service and community nurse teams in Dorset to identify a new framework for working, by recognizing and respecting differences and by creating a climate of dialogue. The process involves three stages. First, mutual awareness by use of meta planning which revealed several important themes, different priorities, political dynamics and organizational constraints. Second, behavioural contracting facilitated by role reversal and third, the development of consensus working protocols as a bridge for professional gaps.

Communication↗