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PubMed1995

Casuistry, care, compassion, and ethics data analysis.

Traditional approaches to descriptive ethics data analysis do not explicate the nature of ethical dilemmas in critical care and emergency nursing. Using sensitizing concepts of causes of nurse compassion, 168 stories of ethical dilemmas were categorized. They were analyzed from the theoretical perspective of an ethic of care using casuistry. Paradigm cases for each sensitizing concept were constructed. The nature of ethical dilemmas is in the disparity between actual and ideal nursing practice.

Adult↗
PubMed1992

Controversies in nursing ethics: a historical review.

The author critiques the dialectic between justice-based ethics and an ethic of caring from a historical perspective (by analogy with the dialectic between agape and friendship). Justice-based ethics have been problematic for nursing because of the decontextualized approach. The ethic of caring is problematic because caring, being contextual, is particularistic and therefore can be based on morally irrelevant factors, such as liking. There is a tradition of writing which seeks to reconcile the particularistic obligations of friendship with the moral duty to all others equally. Ideas from the following authors are reviewed for relevance to nursing: Aristotle, Aelred of Rievaulx, Augustine, John Cassian, Cicero, George Berkeley, Immanuel Kant, Michel de Montaigne, Jeremy Taylor and Max Weber. The authors concludes by noting that both sides of the dialectic are synthesized in the lived experience of individuals. A synthesis in thought is called for on this basis.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Paediatric nursing and research ethics: is there a conflict?

This paper briefly outlines the major ethical issues which need to be considered when conducting paediatric research. An overview of ethical theories and principles will highlight the difficulties which may be experienced when making decisions about children's competency to consent to participate in research. The congruency of the paediatric nurse as 'researcher' and 'practitioner' will be examined. Does the nurse involved in paediatric research experience a conflict between a commitment to research and safeguarding the interests and well-being of the child.

Child↗
PubMed1984

Moral reasoning as a criterion for admission to medical school.

To determine whether admission interviews could differentiate applicants on their personal qualities (such as integrity, empathy and commitment) 456 applicants from two medical schools were tested on the Defining Issues Test (DIT), which measures the amount of principled or post-conventional moral reasoning. No difference was found between the DIT scores of the accepted and the rejected applicants of the school in which the admission criteria are the traditional scholastic ones. On the other hand, a great difference was shown in the school which admits students for their personal characteristics as assessed by interviews. Yet only moderate correlation was shown between the DIT and the interview scores. Since moral reasoning is a key concept in medical professional behaviour and is correlated with clinical performance, the findings deserve special attention. A possible use of the DIT in the student selection process is discussed.

Education, Medical, Undergraduate↗
PubMed1996

Context in medical education: the informal ethics curriculum.

As some formal bioethics instruction has become the norm in American medical schools, a trend has emerged toward increased attention to context in both bioethics education and bioethical decision-making. A focus on classical dilemmas and a textbook knowledge of principles is yielding its previous dominance to permit a more detailed examination of ethical behaviour in actual practice in medicine. After documenting and analysing this emerging trend in bioethics education and its parallel in bioethics theory and research, we turn to the context of medical education itself to look beyond formal bioethics instruction to the 'informal curriculum' that is so central to the moral development of medical students and residents. A qualitative research strategy is being used to study the informal curriculum through analysing tape-recorded informal conversations students and residents have with their friends and colleagues at work about issues bearing on their professional development. Data presented are documenting 'the unwritten code' for medical students on a surgical clerkship and the senior residents' informal ways of producing a 'practical ethics of conduct' that shapes understanding of what is good, skilful, and right on that surgical service. How conceptions of appropriate conduct are conveyed, rewarded and sanctioned also reveals how professional demeanour is taught, permitting discussion about what should be retained and what changed. The context in which ethical issues arise enhances understanding of ethical practice in medicine.

Bioethics↗
PubMed2006

Perceiving the moral dimension of practice: insights from Murdoch, Vetlesen, and Aristotle.

This paper situates the moral domain of practice within the context of a particular description of nursing practice - one that sees human interaction at the heart of that practice. Such a description fits not only with professional rhetoric but also with literature from patients and recent empirical work exploring the nature of nursing practice. Martha Levine in her 1977 description of ethics, within the context of nursing practice, indicated that what was important from an ethical perspective was how we interact with each other, with patients and colleagues, on a daily basis. What enables such interaction to display moral sensitivity, insight into patient need, and a focus on the good for the patient? Of relevance when answering this question is the empirical evidence indicating that professional socialization, as a nurse or a doctor, may dull the individual's moral sense. If this is the case, cognizance needs to be taken of such evidence when identifying theoretical approaches from mainstream ethics that may provide insight and value for nurse education. It is suggested that such insight and value can be gained from a consideration of the work of Aristotle, Murdoch, and Vetlesen.

Empathy↗
PubMed1991

Privacy and disclosure in medical genetics examined in an ethics of care.

The progress of genetic knowledge magnifies existing ethical problems in medical genetics. Among the most troubling types of problems -- for medicine, patients, and the larger society -- are those of privacy and disclosure. Examples of the range of problems involving privacy and disclosure are: 1) disclosure of false paternity to an unsuspecting husband; 2) disclosure of a patient's genetic make-up to his or her unknowing spouse; 3) disclosure of information, against a patient's wishes, to relatives at genetic risk; 4) disclosure of ambiguous test results; 5) disclosure of adventitious nonmedical information, e.g., fetal sex; and 6) disclosure to institutional third parties, such as employers and insurers....

Attitude↗
PubMed1995

Moral expertise: a problem in the professional ethics of professional ethicists.

Philosophers, particularly moral philosophers, are increasingly being involved in public decision-making in areas which are seen to raise ethical issues. For example, Dame Mary Warnock chaired the 'Committee of Inquiry into Human Fertilization and Embryology' in the UK in 1982-4; the Philosophy Department at Auckland was commissioned by the Auckland Regional Authority to report on the ethical aspects of fluoridating the public water supply in 1990; and many of us are serving on ethics committees of various sorts. Not only are philosophers actually being called on or consulted, but many of us would argue that a philosophical contribution in such areas is essential. The involvement of moral philosophers in public policy decisions raises a question of professional ethics, viz, what role should a philosopher's own moral perspective or judgements play in the advice s/he gives, or contribution s/he makes, to public decision-making on ethical issues. Like most problems in professional ethics, this prompts reflection on the nature of the profession, and in particular on the expertise we take moral philosophy to offer. It also prompts reflection on how processes of public decision making in ethically problematic areas should be understood. I explore these issues in this paper.

Advisory Committees↗
PubMed1993

Structuring moral meaning in psychiatric nursing practice.

Comparatively little is known about the experiential aspect of moral decision making in psychiatric nursing. Earlier research in this area has mainly focused on the cognitive aspects of moral reasoning, using hypothetical cases. The purpose of this study was to examine the experience of moral decision making in psychiatric nursing practice. In-depth interviews with fourteen nurses, purposively selected for their reputed competency and long experience in psychiatric care, were conducted. By using the strategy of 'constant comparative analysis', the grounded theory, 'structuring moral meaning' was derived, which consists of three interrelated processes, perceiving, knowing and judging. This process identifies the nurse's manner of making sense of a perceived moral conflict and justifying 'good' actions within the nurse-patient framework.

Beneficence↗
PubMed1995

The moral reasoning of nurse practitioners.

This qualitative research study was conducted to describe the moral reasoning utilized by participating nurse practitioners to resolve moral dilemmas in their clinical practice. Five major essential features of moral reasoning emerged from the data: the contextual framework for moral reasoning, values, influencing factors, recognizing the dilemma, and outcomes. The interrelationship of the essential features of moral reasoning provided insight into how NPs deal with moral dilemmas as well as the role that caring and the nurse-patient relationship played as a part of the moral decision making process.

Adult↗
PubMed1986

How children can be respected as 'ends' yet still be used as subjects in non-therapeutic research.

The question of whether or not children may be used as subjects in non-therapeutic research projects has generated a great deal of debate and received answers varying from 'no, never' to 'yes, if societal interests are served'. It has been claimed that a Kantian, deontological ethics would necessarily rule out such research, since valid consent would be impossible. The present paper gives a deontological argument for allowing children to be subjects in certain types of research.

Child↗
PubMed1986

Moral dilemmas in surgical training: intent and the case for ethical ambiguity.

It is often assumed that the central problem in a medical ethics issue is determining which course of action is morally correct. There are some aspects of ethical issues that will yield to such analysis. However, at the core of important medical moral problems is an irreducible dilemma in which all possible courses of action, including inaction, seem ethically unsatisfactory. When facing these issues ethical behaviour depends upon an individual's understanding and acceptance of this painful dilemma without recourse to external moral authority.

Clinical Competence↗
PubMed1988

Euthanasia, letting die and the pause.

There is a marked disparity between medical intuitions and philosophical argument about euthanasia. In this paper I argue that the following objections can be raised. First, medical intuitions are against it and this is an area in which judgement and sensitivity are required in that death is a unique and complex process and the patient has many needs including the need to know that others have not discounted his or her worth. Also, part of the moral constitution of a good doctor is a devotion to the protection and preservation of life whatever reasons are produced to dissuade her. Finally, we do not know what the final events of a person's life might hold.

Ethical Analysis↗
PubMed1992

Learning to see: moral growth during medical training.

During medical training students and residents reconstruct their view of the world. Patients become bodies; both the faults and the virtues of the medical profession become exaggerated. This reconstruction has moral relevance: it is in part a moral blindness. The pain of medical training, together with its narrowness, contributes substantially to these faulty reconstructions. Possible improvements include teaching more social science, selecting chief residents and faculty for their attitudes, helping students acquire communication skills, and helping them deal with their own pain. Most importantly, clearer moral vision requires time and scope for reflection.

Attitude of Health Personnel↗