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PubMed1977

Freedom of inquiry and subjects' rights: historical perspective.

The author presents an historical overview of the various attitudes toward animal and human experimentation. He cites advocates (Bacon, Welch) and opponents (Johnson, Shaw) and traces the debate from the Graeco-Roman era, through the rise of the scientific establishment, to the present. Controversy over the fundamental rights of individual research subjects versus a future-oriented freedom of inquiry has been and continues to be a dilemma for clinicians and research scientists.

Animals↗
PubMed2003

Frankensteins and cyborgs: visions of the global future in an age of technology.

This paper draws attention to the role of representation in the depiction of scientific and technological innovation as a means of understanding the narratives that circulate concerning the shape of things to come. It considers how metaphors play an important part in the conduct of scientific explanation, and how they do more than describe the world in helping also to shape expectations, normalise particular choices, establish priorities and create needs. In surveying the range of metaphorical responses to the digital and biotechnological age, we will see how technologies are regarded both as 'endangerment' and 'promise.' What we believe 'technology' is doing to 'us' reflects important implicit philosophies of technology and its relationship to human agency and political choice; yet we also need to be alert to the assumptions about 'human nature' itself which inform such reactions. The paper argues that embedded in the various representations implicit in the new technologies are crucial issues of identity, community and justice: what it means to be (post)human, who is (and who is not) entitled to the rewards of technological advancement, what priorities (and whose interests) will inform the shape of global humanity into the next century.

Biomedical Technology↗
PubMed2000

Recovering ethics after 'technics': developing critical text on technology.

Much modern science and ethics debate is on high-profile problems such as animal organ transplantation, genetic engineering and fetal tissue research, in discourse that assumes technical tones. Other work, such as narrative ethics, expresses the failed promise of technology in the vivid detail of human experience. However, the essential nature of contemporary technology remains largely opaque to our present ethical lens on health care and on society. The limited controversies of modern science and ethics perpetuate 'technics', a technical, problem-solving mindset that fails to grapple successfully with the complexity of technology. A critical dialectic between practice and scholarship widens the ethical conversation in nursing to consider technology as an ongoing set of daily and fundamental moral choices on how we live. Critical text on technology recovers ethics from the limits of technics, and assists nurses to develop an inherent knowledge of technology that is needed to provide ethical care in a technological world. There are overlooked ethical challenges in the mundane, everyday routine activities of professional practice, and these have gone largely unexamined. Ethical behavior is not the display of one's moral rectitude in times of crisis. It is the day-to-day expression of one's commitment to other persons and the ways in which human beings relate to one another in their daily interactions.

Choice Behavior↗
PubMed2000

'Healthy viewing?': experiencing life and death through a voyeuristic gaze.

Recent times have witnessed a groundswell in the number of British television programmes that deal with the 'real life' experiences of people in various health care settings. Such programmes tend to focus upon the two interrelated strands of the experience of those who deliver professional care and those who are at the receiving end of it. The usual rationale given for such programmes is that they offer insights about the delivery of health care that are not readily accessible to members of the public. This article will look beneath the rationale and reasons offered by programme makers for the existence of such documentaries. It will explore insidious and questionable elements that go beyond revealing the 'lived experience' of professional carers and those for whom they care. Emerging from this is the challenging notion that such programmes deliver the opportunity to experience the vulnerability, suffering and even death of others through a voyeuristic gaze.

Attitude to Death↗
PubMed1996

Exploring ethical dilemmas in perioperative nursing practice through critical incidents.

This article describes the nature of ethical dilemmas in perioperative nursing practice. Using the Critical Incident Technique, common ethical dilemmas experienced by perioperative nurses are explored. The aim of the study was to elicit the ethical dilemmas that arise in perioperative nurses' practice. The study has a descriptive design and the data are critical incidents described by 48 anaesthetic nurses and 76 operating theatre nurses. An analysis of the critical incidents gave four domains of ethical dilemmas: those arising as value conflicts in the intraoperative phase of surgery; those emanating from the patient's right of self-determination; those arising in caring for patients; and those resulting from the allocation of scarce resources and the demands of increased effectiveness.

Conflict, Psychological↗
PubMed1998

Practical dignity in caring.

It is difficult to understand the meaning of 'dignity' in human rights, bioethics and nursing literature because the word is used so vaguely. Unless dignity's meaning is spelt out it can disappear beneath more tangible priorities. In this article we define dignity and show how this can help health workers to maintain the dignity of people in their care.

Beneficence↗
PubMed1999

Living with dementia: communicating with an older person and her family.

This article is designed to explore and examine the key components of communication that emerged during the interactional analysis of a role play that took place in the classroom. The 'actors' were nurses who perceived the interaction to reflect an everyday encounter in a hospital ward. Permission to tape the interaction was sought and given by all persons involved. The principal 'players' in the scenario were: the patient, a 70-year-old-woman who had been admitted with dementia, her son and daughter, and the nurse in charge of the ward. The fundamental dynamics of the use of power and restriction, truth telling, family stress, interpersonal conflict, ageism, sexism, empathy and humanism surfaced during the analysis. The findings show that therapeutic communication should be the foundation on which nursing should stand. The article continues with an exploration of the theoretical frameworks that guided the analysis of interaction and concludes by suggesting tentatively some meaningful implications for nursing practice. It plans to furnish provocative new insights into the sometimes covert communication dynamics occurring within the nurse-patient relationship. Finally, it aims to generate discussion on this little-charted realm of human social interaction.

Adaptation, Psychological↗
PubMed1999

Reflections on the meaning of care.

Health care is increasingly delivered by using medical technologies and specialized procedures. However, the systems through which it is delivered are coming under attack as lacking in care. Medicine is very capable of treating the human body, but it may be losing its sensitivity towards persons, especially concerning the vulnerability they are experiencing. Nurses are finding that the demands for more efficiency and cost-effective measures do not allow them sufficient time to offer the personal care for which they have always felt responsible. The question of the meaning of care surfaces especially in treating those who are approaching death. The need is to balance the various dimensions of care, keeping its focus on the well-being of persons.

Attitude of Health Personnel↗
PubMed2002

The clergy as advocates for the severely demented.

The author sets forth the argument that pastoral caregivers ought to consider expanding their traditional role of ministering to dementia patients by pressing the issue of whether appropriate medication might significantly lessen the suffering of these persons. After discussing and documenting the current understanding regarding the nature of pain, the author outlines several advocacy, ethical, and procedural issues that could be included in providing pastoral care to this population, at the same time not miminizing more traditional faith-based activities.

Analgesics↗
PubMed2006

Human dignity in the Nazi era: implications for contemporary bioethics.

BACKGROUND: The justification for Nazi programs involving involuntary euthanasia, forced sterilisation, eugenics and human experimentation were strongly influenced by views about human dignity. The historical development of these views should be examined today because discussions of human worth and value are integral to medical ethics and bioethics. We should learn lessons from how human dignity came to be so distorted to avoid repetition of similar distortions. DISCUSSION: Social Darwinism was foremost amongst the philosophies impacting views of human dignity in the decades leading up to Nazi power in Germany. Charles Darwin's evolutionary theory was quickly applied to human beings and social structure. The term 'survival of the fittest' was coined and seen to be applicable to humans. Belief in the inherent dignity of all humans was rejected by social Darwinists. Influential authors of the day proclaimed that an individual's worth and value were to be determined functionally and materialistically. The popularity of such views ideologically prepared German doctors and nurses to accept Nazi social policies promoting survival of only the fittest humans.A historical survey reveals five general presuppositions that strongly impacted medical ethics in the Nazi era. These same five beliefs are being promoted in different ways in contemporary bioethical discourse. Ethical controversies surrounding human embryos revolve around determinations of their moral status. Economic pressures force individuals and societies to examine whether some people's lives are no longer worth living. Human dignity is again being seen as a relative trait found in certain humans, not something inherent. These views strongly impact what is taken to be acceptable within medical ethics. SUMMARY: Five beliefs central to social Darwinism will be examined in light of their influence on current discussions in medical ethics and bioethics. Acceptance of these during the Nazi era proved destructive to many humans. Their widespread acceptance today would similarly lead to much human death and suffering. A different ethic is needed which views human dignity as inherent to all human individuals.

Animal Rights↗
PubMed1991

Animals in biomedical research: the undermining effect of the rhetoric of the besieged.

It is correctly asserted that the intensity of the current debate over the use of animals in biomedical research is unprecedented. The extent of expressed animosity and distrust has stunned many researchers. In response, researchers have tended to take a strategic defensive posture, which involves the assertation of several abstract positions that serve to obstruct resolution of the debate. Those abstractions include the notions that the animal protection movement is trivial and purely anti-intellectual in scope, that all science is good (and some especially so), and the belief that an ethical consensus can never really be reached between the parties.

Animal Experimentation↗
PubMed1989

Ethical criteria for procuring and distributing organs for transplantation.

This article provides an ethical analysis and assessment of various actual and proposed policies of organ procurement and distribution in light of moral principles already embedded in U.S. institutions, laws, policies, and practices. Evaluating different methods of acquisition of human body parts--donation (express and presumed), sales, abandonment, and expropriation--the author argues for laws and policies, including required request, to maintain and facilitate express donation of organs by individuals and their families. Such laws and policies need adequate time for a determination of their effectiveness before society moves to other major alternatives, such as a market. In organ allocation and distribution, which have close moral connections with organ procurement, the author defends the judgment of the federal Task Force on Organ Transplantation that the community should have dispositional authority over donated organs, that professionals should be viewed as trustees and stewards of donated organs, and that the public should be heavily involved in the formation of policies of allocation and distribution. Concentrating on policies being developed in the United Network for Organ Sharing, the author examines the point system for cadaveric kidneys, the access of foreign nationals to organs donated in the U.S., and the multiple listings of patients seeking transplants. He concludes by identifying two major problems of equitable access to donated organs that will have to be addressed by social institutions other than UNOS: access to the waiting list for donated organs and the role of ability to pay in extrarenal transplants.

Beneficence↗