The metamorphosis of medical ethics. A 30-year retrospective.
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Beneficence↗
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Results for “Principle-Based Ethics”
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Choosing a framework for ethical analysis in advanced practice settings: the case for casuistry.
The need for advanced practice nurses to incorporate ethical analysis into case management is becoming more apparent -- particularly for the increasingly independent practice settings of psychiatric and mental health nursing. The nursing literature contains many articles dealing with the more abstract treatment of clinical ethics, but for the practitioner there is unfortunately little information available that uses ethical principles in a practical framework, which addresses the concrete reality of daily, difficult clinical decision making. This article applies a model of reasoned analysis to an actual case study using the concepts of casuistry or case-based reasoning. This method offers an alternative to the more popular paradigm of principilism. Complicated by the existence of violence and abuse, the case examines several ethical issues including patient privacy and legitimate breaches of patient confidentiality.
Adolescent↗
A critique of principlism.
The authors use the term "principlism" to refer to the practice of using "principles" to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these "principles" do not function as claimed, and that their use is misleading both practically and theoretically. The "principles" are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for consideration when dealing with a moral problem. The "principles" lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory.
Beneficence↗
Moving forward in bioethical theory: theories, cases, and specified principlism.
The field of bioethics has deployed different models of justification for particular moral judgments. The best known models are those of deductivism, casuistry, and principlism (under one, rather limited interpretation). Each of these models, however, has significant difficulties that are explored in this essay. An alternative model, suggested by the work of Henry Richardson, is presented. It is argued that specified principlism is the most promising model of justification in bioethics.
Casuistry↗
The role of virtue ethics in psychiatric nursing.
The main purpose of this article is to discuss the place of the ethics of virtues and character in nursing and health care in general, and in psychiatric nursing in particular. To attain this goal, the relationship between the ethics of duty (i.e. rule based ethics) and the ethics of virtue and character will be clarified in order to defend our main hypothesis that these two types of ethics should complement each other, since both are necessary but neither by itself is sufficient for nursing. This means that any applied ethics, as in nursing, should consider the importance of the agent's moral character. To support our arguments, we shall use cases from the empirical reality of psychiatric and mental health care.
Character↗
Waiting for Godot: where is the philosophy of nursing?
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Empathy↗
Nonabandonment: a central obligation for physicians.
Nonabandonment is one of a physician's central ethical obligations; it reflects a longitudinal commitment both to care about patients and to jointly seek solutions to problems with patients throughout their illnesses. The depth of this commitment may vary depending on the physician's and the patient's values and personalities, their shared experiences, and the patient's clinical circumstances. Traditional principled ethical analyses must balance the personal histories, values, motivations, and intentions of the participants with more general considerations. Such analyses often focus on a particular act, isolated in time, and yet the consequences of one decision immediately lead to a new set of choices. Nonabandonment places the physician's open-ended, long-term, caring commitment to joint problem solving at the core of medical ethics and clinical medicine. There is a world of difference between facing an uncertain future alone and facing it with a committed, caring, knowledgeable partner who will not shy away from difficult decisions when the path is unclear.
Adult↗
The method of 'principlism': a critique of the critique.
Several scholars have recently criticized the dominant emphasis upon mid-level principles in bioethics best exemplified by Beauchamp and Childress's Principles of Biomedical Ethics. In Part I of this essay, I assess the fairness and cogency of three broad criticisms raised against 'principlism' as an approach: (1) that principlism, as an exercise in applied ethics, is insufficiently attentive to the dialectical relations between ethical theory and mortal practice; (2) that principlism fails to offer a systematic account of the principles of non-maleficence, beneficence, respect for autonomy, and justice; and (3) that principlism, as a version of moral pluralism, is fatally flawed by its theoretical agnosticism. While acknowledging that Beauchamp and Childress's reliance upon Ross's version of intuitionism is problematic, I conclude that the critics of principlism have failed to make a compelling case against its theoretical or practical adequacy as an ethical approach. In Part II, I assess the moral theory developed by Bernard Gert in Mortality: A New Justification of the Moral Rules, because Gert has recommended his approach as a systematic alternative to principlism. I judge Gert's theory to be seriously incomplete and, in contrast to principlism, unable to generate coherent conclusions about cases of active euthanasia and paternalism.
Beneficence↗
The terminally ill--secular and Jewish ethical aspects.
Many ethical, religious, social and legal dilemmas are involved in the care of dying patients. Major changes and developments in recent years have greatly intensified these moral problems. In this article a comprehensive analysis of the relevant principles and practical approaches is offered in order to enhance the ability of health care providers to attain morally sound decisions concerning the dying patient. The relevant ethical principles include the following: value of life, quality of life, nonmaleficence, beneficence, autonomy, paternalism, justice, and the physician's integrity. In practical terms, there are three major categories: the patient, the treatment and the decision maker. A comparative analysis between secular and Jewish attitudes towards the terminally ill patient has revealed significant differences both in the fundamental underlying principles as well as in the practical solutions to the diverse and difficult ethical problems.
Attitude to Health↗
Four approaches to doing ethics.
Within the field of medical ethics there is a startling amount of diversity regarding which issues and relationships are deemed relevant for ethical inquiry and analysis, what strategies are appropriate for examining and resolving ethical conflict, what should be the goals for medical ethics, even who should participate in that project. What I will try to make clear in this paper is that how we go about this process of doing medical ethics, of examining, reflecting, decisionmaking, and behaving, makes a practical difference, and not just a philosophical one, in terms of the understandings we will reach about ethical matters. Without attempting to resolve any of the conflicts within or between different conceptions of doing ethics, I will try to articulate the differences in orientation, and particularly the tone and educational emphasis, that attend four major contemporary approaches to ethical inquiry and analysis: deductivism, principlism, modern casuistry, and feminist/relationist ethics.
Beneficence↗
Darren's case: narrative ethics in Perri Klass's Other Women's Children.
During the past fifteen years, the relationship between literature and medical ethics has evolved from the occasional use of stories as a substitute for the traditional case study in medical ethics to the emergence of a narrative approach to ethical analysis and decision making. Thus far, literary theory has been more important to narrative medical ethics than have works of literature themselves. Perri Klass's novel Other Women's Children deserves special scrutiny, however, because an analysis of it demonstrates ways that a narrative approach could enhance traditional philosophical and legal approaches to resolving ethical dilemmas in medicine.
Acquired Immunodeficiency Syndrome↗
Preventive ethics, professional integrity, and boundary setting: the clinical management of moral uncertainty.
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Clinical Competence↗
Ethical problems of recording physician-patient interactions in family practice settings.
Recordings of actual physician-patient interactions are an important tool for family medicine education and research. Their use, however, poses two sets of ethical problems: one dealing with privacy and confidentiality, and another related to limitations upon informed consent in the context of ordinary medical care. Experience with audiotaping and videotaping led to engaging in a "principle-based" method of ethical reasoning in which problems generated by difficult cases were examined in light of both current rules or guidelines and four fundamental ethical principles. Through this approach specific policies were developed for voluntary, informed consent and for protection of privacy, while recognizing that each case must be judged in the light of the physician's obligation to do the best for each patient.
Confidentiality↗
So many ways to think. An overview of approaches to ethical issues in geriatrics.
This article provides an overview of ways to think about ethical issues in geriatrics. Principle-based approaches include deontology, utilitarianism, virtue theory, and natural law. Case-based approaches include casuistry, care, and narrative ethics. Pragmatism and feminism are methods that mesh case-based with principle-based considerations. Each of these approaches is explained and critiqued in relation to specific cases in geriatrics. The author concludes that clinical ethical decisions are optimized by considering, but not necessarily following, all of the available approaches to ethical dilemmas.
Aged↗
Casuistry in medical ethics: rehabilitated, or repeat offender?
For a number of reasons, casuistry has come into vogue in medical ethics. Despite the frequency with which it is avowed, the application of casuistry to issues in medical ethics has been given virtually no systematic defense in the ethics literature. That may be for good reason, since a close examination reveals that casuistry delivers much less than its advocates suppose, and that it shares some of the same weaknesses as the principle-based methods it would hope to supplant.
Bioethical Issues↗
An analysis of some dimensions of the concept of moral sensing exemplified in psychiatric care.
There are few studies that focus on the interpersonal aspect of everyday ethical conflicts. Conceptual frameworks for research into ethical decision making in the health care system are mainly based on an ethic in which objectivity and principle-based thinking is emphasized, leaving the experience of concrete moral conflicts relatively unexplored. The aim of this paper is to analyze the dimensions of "moral sensing," a concept identified in an earlier grounded theory study of psychiatric nursing. Four dimensions of the concept of moral sensing, i.e., feeling, intuition, benevolence and genuineness, were synthesized by reviewing the works of past and contemporary philosophers. The analysis of moral sensing and its dimensions is exemplified by actual nurse-patient encounters in psychiatric nursing practice.
Decision Making↗
[Qualified particularism and affiliative virtue: emphasis of a recent trend in ethics].
This paper explores the implications for medical ethics of ethic of care. It characterizes the ethic of care in terms of two principal commitments, to qualified particularism and to the challenge to the centrality of affiliative virtue. Both of these commitments pose a much standard work in medical ethics characterizing moral judgment and responses as essentially impartial, principled and dispassionate. A care-oriented medical ethics will, it is suggested, call on us to focus on those virtues needed to sustain community and enhance effective communication and interpersonal understanding within the practices of health care. It stresses healing rather than curing as the objective of medical and nursing care; and it emphasizes the importance of trust in clinical relationship. As a methodological approach, the ethic of care highlights the limitations of principle-based approaches in guiding moral judgment and response, asserting the value of institutional narratives as guides to moral practice.
Bioethics↗
Emotions, care and particularity.
The main intention of this article is to illuminate the normative foundation of caring in nursing. I will focus on the debate between an ethics of care and an ethics of universal principles which has evolved both in nursing ethics and moral philosophy during the last decade. In spite of what a number of people have claimed, I shall argue that a care-based ethics is compatible with judgment based on universal, impartial principles. However, an ethics of care articulates other important aspects of morality and moral behavior than the justificational ones that are central to prevailing impartialist ethics. The paper explains why and how moral perception, sensitivity and emotional capacities are important for a modern professional nursing ethics. It focuses on capacities and preconditions for principle-based reflection and action by arguing that moral perception and certain emotional qualities are prerequisites for moral judgment and action. Achieving perceptual awareness and emotional sensitivity in understanding the situation and its particulars are genuine moral tasks in nursing. These qualities are essential in discovering the morally salient features of the situation. This perspective on an ethics of care also recognizes an important place to central positions in traditional nursing ethics, where developing personal qualities and altruistic capabilities have always been a fundamental normative claim.
Emotions↗