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The moral reasoning of HEC members.
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Healthcare ethics committees: re-examining their social and moral functions.
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Values, ethics, and moral reasoning among healthcare professionals: a survey.
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Moral perception and the pursuit of medical philosophy.
This paper begins by examining the claim that the practice of medicine is essentially a moral endeavor. According to this view, all clinical practice has moral content, and each clinical situation has a moral dimension. I suggest that in order to recognize this moral dimension, clinicians must engage in an interpretive process, and that they must be able to interpret clinical data in ethical terms. However, clinicians often lack the 'moral perception' required to appreciate this moral dimension. I will argue that physicians lack moral perception when the clinical data they are given do not offer sufficient opportunity for interpretation. This paper draws on the work of Merleau-Ponty to suggest that this loss of interpretation is, paradoxically, the result of the way that patients experience illness. This thesis may be productive, first, because it suggests opportunities to explore the process of moral perception. This thesis also suggests ways for ethicists and educators to enhance clinicians' perception of the ethical dimensions of clinical practice. Finally, the concept of moral perception, when grounded in the patient's experience of illness, creates a fruitful area of inquiry that warrants inclusion in what may someday be the philosophy of medicine's canon.
Complicity in thought and language: toleration of wrong.
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Feminist perspectives on empathy as an epistemic skill and caring as a moral virtue.
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Learned industriousness.
Extensive research with animals and humans indicates that rewarded effort contributes to durable individual differences in industriousness. It is proposed that reinforcement for increased physical or cognitive performance, or for the toleration of aversive stimulation, conditions rewards value to the sensation of high effort and thereby reduces effort's aversiveness. The conditioning of secondary reward value to the sensation of effort provides a dynamic mechanism by which reinforced high performance generalizes across behaviors. Applications to self-control, moral development, and education are described.
Clinical ethical decision making: an investigation of the rationales used to justify doing less than one believes one should.
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Benevolence, a central moral concept derived from a grounded theory study of nursing decision making in psychiatric settings.
Fourteen experienced nurses participated in an explorative study aimed at describing the experiential aspects of moral decision making in psychiatric nursing practice. In-depth interviews were conducted according to the grounded theory method. These were transcribed, coded and categorized in order to generate conceptual categories. The concept of benevolence was identified as a central motivating factor in the nurses' own accounts of situations in which decisions were made on behalf of the patient. This seems to conceptualize the nurses' expressed aim to do that which is 'good' for the patient in responding to his or her vulnerability. This study indicates the need for further research into the subjective, experiential aspect of ethical decision making from a contextual perspective.
Role, role enactment and the health care practitioner.
When thinking about the composition of ethics courses for health care practitioners it is necessary to consider carefully the role of the health care practitioner. An analysis of the concept of role and of the role of the health care practitioner will, the author argues, help to clarify what it is reasonable for society to expect from its health care practitioners, from the moral point of view. The author argues that the most helpful way to view the connection between a person and her/his role is one in which the individual interacts with and is formed by her/his role and in turn shapes and influences the role. The latter is evidenced by the quality of the person's role enactment. This interactive relationship between person and role has particular implications for the education of health care practitioners. The author argues that the quality of the practitioner's role enactment and moral sensitivity has a direct bearing upon patient care. Given that this is the case, emphasis should be placed on the ideas of role, role enactment and moral strategy during the education of health care practitioners.
Uncertainties in the teaching of ethics to students of nursing.
Whilst ethics is now commonplace on nursing curricula in the United Kingdom there remains doubt as to how and what to teach. This doubt has its origins in interlinked uncertainties within nursing, ethics and education. In nursing there are uncertainties about whether we are teaching ethics to professionalize or because we are a profession, and about whether there is something which is uniquely 'nursing ethics'. In ethics there are competing paradigms of ethical theory and competing theories of moral development. In education there are competing epistemologies, theories of learning and models of curriculum planning. These uncertainties are interlinked and an understanding of them will help clarify the debate as to what to teach and how to teach it.
Preserving moral integrity: a follow-up study with new graduate nurses.
The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow-up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the 'real world' of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho-social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one's moral convictions. Data supported that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.
Sterilizations reconsidered?
Cowdin and Tuohey argue for a rethinking of Catholic bioethical principles and the Church's moral authority. Citing the Second Vatican Council for support, they argue that if the Church were to respect the proper autonomy of medicine, it would allow sterilizations. In this essay I argue against Cowdin and Tuohey's understanding that the Church has derived its moral laws independent of consultation with medicine and that it treats medicine simply as a source of technical expertise. I also argue that they misunderstand that nature of autonomy as well as the Church's position regarding the type of autonomy they request for medicine. I will especially argue against their understanding of the principles of totality and double effect as "dispensations" from the moral order. I conclude that they have provided no grounds to cause the Church to reconsider its condemnation of all sterilizations.
The ethics of care: a feminist virtue ethics of care for healthcare practitioners.
In this paper I seek to distinguish a feminist virtue ethics of care from (1) justice ethics, (2) narrative ethics, (3) care ethics and (4) virtue ethics. I also connect this contemporary discussion of what makes a virtue ethics of care feminist to eighteenth and nineteenth century debates about male, female, and human virtue. In conclude that by focusing on issues related to gender--primarily those related to the systems, structures, and ideologies that create and sustain patterns of male domination and female subordination--we can begin to appreciate that true care and bona-fide virtue can flourish only in societies that treat all persons with equal respect and consideration.
Impartial principle and moral context: securing a place for the particular in ethical theory.
This essay critically assesses two strategies of accommodation used by defenders of impartialism in ethics to argue that the care orientation represents no genuine challenge to impartialist theoretical paradigms. One strategy focuses on impartiality as a constraint on moral deliberation, the other as a constraint on moral justification. While highlighting respects in which the commitment to impartiality is more consonant with the care orientation than many advocates of care have acknowledged, this essay attempts to clarify crucial ways in which each accommodationist strategy fails, thus locating some of the more important contributions and challenges the care orientation offers to moral theory.
Care theory and the ideal of neutrality in public moral discourse.
In this paper I argue that Care theory has the resources to offer an insightful and original theoretical perspective on issues in medical ethics. The paper begins with a discussion of the sort of theory Care is, and argues that it closely resembles virtue theory. After a discussion of common features of Care theories, I respond to a few of the criticisms that have been levied against the theory. The final section of the paper is a discussion of the question of neutrality in public moral discourse. Care theory is not a neutral theory with regard to questions of the nature of the good life for humans, but I argue that this should not preclude Care from playing a part in the public debate over policy decisions.