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PubMed2000

Preparation for practice in the new millennium: a discussion of the moral implications of multifetal pregnancy reduction.

This article approaches the problem of multifetal pregnancy reduction from a moral perspective. It is one of many complex moral issues arising from reproductive technology and is one with which midwives and nurses are faced more frequently with advancing technology. The work is intended to be used as an educational tool for those who prepare tomorrow's nurses and midwives. The subject is discussed from three perspectives, the pregnant woman and her partner (clients), a midwife, and from a philosophical ethical perspective. In an attempt to introduce a degree of reality, the perspective of the clients is presented as a dialogue. The midwife's moral position and her professional difficulties are also discussed. The dialogue and discussion are supplemented with notes in which the issues raised by the characters are critically analysed and discussed. This article is designed to encourage reflection and critical thinking in tomorrow's health care professionals, and in those who have the responsibility of educating them for a future where reproductive technology is posed to generate more major moral quandaries.

Attitude of Health Personnel↗
PubMed2000

Determination of moral negligence in the context of the undermedication of pain by nurses.

The problem of undermedication of pain in health care is widely recognized and acknowledged; however, there is an obvious lack of exploration of this problem from an ethical perspective. When undermedication is raised as a moral concern, the underlying premise is that a patient may experience harm or not benefit from ineffective pain management practices. I will argue that the harm is of a particular type, that is, moral negligence. My intention is to increase nurses' awareness of both the type of moral harm they are causing, and their professional and moral duties to provide appropriate medication, more particularly to avoid undermedication. I hope that this heightened awareness will be incorporated into practice. As a nurse, I chose to focus on nursing for this article, but my claims are applicable to other health professions, such as medicine.

Analgesics↗
PubMed2005

Women's and doctors' accounts of their experiences of depression in primary care: the influence of social and moral reasoning on patients' and doctors' decisions.

BACKGROUND: Little is known about how general practitioners (GPs) manage depression within everyday clinical practice, particularly in relation to the issue of 'problem definition'. In addition, there has been relatively little research on the patients' perspective of depression and its management in primary care. METHODS: Qualitative interviews explored women's and GPs' experiences of recognizing depression and their experiences of the management of depression. Thirty-seven women and 20 GPs were recruited from practices in four National Health Service Board areas of Scotland. Each participant was interviewed at the start of the study, and 30 women and 19 GPs were revisited approximately 9-12 months later so that the process of care could be reviewed. RESULTS: The findings demonstrate the social and moral reasoning that lies behind women's decisions to seek help and to subsequently accept their GPs' explanation and advice, and that the acceptance of antidepressants created a moral dilemma for the women. For GPs, the diagnosis and management of depression led to contemplating the boundaries of their professional role, and social and moral reasoning was also evident in their decision-making processes. DISCUSSION: The implication is that, for the majority of women, a chronic-disease model for the management for depression in primary care would be likely to increase rather than reduce the moral dilemma. In addition, the management of depression is not solely based on clinical decisions, so the applicability of a chronic-disease model to primary care requires further consideration.

Adult↗
PubMed2002

The 'morality' of occupational health.

Both ethics and law are based on value systems. George Lakoff has contributed to our understanding of the value systems that influence attitudes toward public issues in his book, Moral Politics: What Conservatives Know That Liberals Don't (University of Chicago Press, 1996). He argues that two antagonistic but co-existing moral systems influence attitudes toward public issues. Both are derived from metaphors of family life and child development and the "morality" of allowing certain actions. One moral system stresses individual responsibility and risk-taking, the other empathy and mutual assistance. The tension between these value systems explains much in political debate; issues generally tend to fall on one side or the other. Occupational health and related issues, almost uniquely, have the unfortunate characteristic of falling short in both. Our best efforts may be judged "immoral" by the strictest interpretations of both systems, even when they are successful. The practical implication is that we must not accept this pattern of thinking. The work relationship is not like a family. It is important to separate issues in occupational health from this pattern of thinking in both professional and public discourse.

Journal Article↗
PubMed1999

Lying and deceiving--moral choice in public and private life.

Suppose that there are good or morally defensible reasons for not responding truthfully to a question or request for information. Is a lie or a deception better as a means to avoid telling the truth? There are many situations in public and private life in which the answer to this question would serve as a useful moral guide, for instance, clinical situations involving dying patients, educational situations, involving young children and personal situations involving close friends. Intuitively, we feel that there is a moral asymmetry in favor of deceiving over lying. However, doubts have been cast on such intuition. The aim of this paper is to bolster this intuition. It will be argued that the claim of moral asymmetry in favor of deception can be supported on a consideration of the different degrees of expectation involved in communicative ethics. Two other objections to the claim of asymmetry will also be considered.

Communication↗
PubMed2000

[Overview of basic approaches in assessing the moral status of the human embryo].

The introduction of in vitro fertilization in 1978 provoked a broad debate about the ethical problems of technological intervention on the human reproduction. It is obvious, that the issue of whether the human embryo is or is not a person seems to be most important in current debates on the morality of selected abortion, cryopreservation and embryo experimentation. The seeking of the moral status of embryo addresses this fundamental question in a multidisciplinary manner. It is clear, that the philosophical or ontological approach to the embryo has a direct bearing upon a practical issues. This work deals with the moral status of embryo. The author claims, that we can establish his or her moral status by two different way. First it is a substantial approach. Then the embryo is the person since the conception. Second is the historical approach. Then the person is a concept of human being, that is unintelligible apart from social and historical context. But when we are not sure whether embryo is a person or not, it is wise to treat the embryo like a person.

Embryo, Mammalian↗
PubMed2000

An inquiry into moral virtues, especially compassion, in psychiatric nurses: findings from a Delphi study.

A three-round Delphi study was conducted to gather data on ethical reasoning among psychiatric nurses (N = 26 in round one (R1), decreasing to N = 14 in the final round (R3)). Transcripts of questionnaires were carefully read and compared. Responses were manually sorted into categories, themes and patterns of interest. Eight debates emerged from the data. This article discusses two in detail: the nature of moral virtues and the meaning of compassion in psychiatric nursing. A sympathetic overview of virtue ethics is also provided. The nurses' responses included a lot of virtue terms, such as, 'honest', 'fair', and 'care". However, 'nurses' moral virtues' was ranked low in importance as a notion invoked in ethical decision making in the round-one ranking exercise. Only half of the sample believed that the moral character of a psychiatric nurse is important in ethical decision-making. Further, most of the round-one sample thought the virtues could not be acquired. Compassion was identified as crucial to psychiatric nursing and the nurse-client relationship, though, as expected, many diverse meanings were attributed to this notion. While the Delphi method proved adequate for our purposes, problems with regard to accurately understanding the respondents' intended meanings highlighted a major weakness of this technique, in common with other methods relying on questionnaires. Further inquiry is needed regarding the role of moral virtues and virtue ethics in both psychiatric nursing and nurse education.

Delphi Technique↗
PubMed1988

Moral distress in clinical practice: implications for the nurse administrator.

The purpose of this paper is to describe the experience and effect of moral distress in clinical practice and to present the implications of this phenomena for nurse administrators. Findings from three recent investigations provide the descriptive data for this paper. Nurses in clinical practice are frequently confronted with situations which challenge personal moral beliefs. Life and death events, sudden unexpected emergencies and professional role conflict have been identified as some examples of the kinds of situations that are most difficult to cope with. Feelings of emotional distress may occur as a result of participation in a patient care situation which involves an ethical issue. Personal and professional wholeness may be significantly compromised by the ineffective resolution of such issues. Moral distress may affect the nurse's ability to care for the patient and may require a significant period of resolution. Moral distress has been identified as one reason that nurses choose to leave their jobs and occasionally to leave the profession. Implications for the nurse administrator include a responsibility to be aware and supportive of the nurse in this situation. Commitment to developing effective strategies to assist nurses to cope successfully with the ethical dimension of clinical practice is an important management concern.

Adaptation, Psychological↗
PubMed1989

The psychiatrist as moral advisor.

This paper is a critique of a paper by Robert Lipkin. Arguments for the following claims are put forward: (1) that what is 'essential' to the psychiatric relationship is what we want it to be for utilitarian reasons; (2) it would not be to our advantage to allow the medicalization of morality; (3) what we should expect from the psychiatrist is prudential advice, not moral advice, and that Lipkin has a confused view about the relationship between these two areas; and (4) we should not allow the psychiatrist to restrict individuals on moral grounds, but only on public safety grounds.

Counseling↗
PubMed2003

Should we presume moral turpitude in our children?--small children and consent to medical research.

When children are too young to make their own autonomous decisions, decisions have to be made for them. In certain contexts we allow parents and others to make these decisions, and do not interfere unless the decision clearly violates the best interest of the child. In other contexts we put a priori limits on what kind of decisions parents can make, and/or what kinds of considerations they have to take into account. Consent to medical research currently falls into the second group mentioned here. We want to consider and ultimately reject one of the arguments put forward for putting medical research into the second category. We will argue that some objections to children's participation in research are either based on an implausibly restrictive conception of what is in fact in the child's best interests or that there is an implicit and false premise hidden in this argument; i.e., the premise that our children have so deeply fallen into moral turpitude that we must assume that they would not want to fulfill their moral obligations, or, that they will grow up to be morally deficient and will then wish not to have acted well while a child.

Child↗
PubMed1998

An adjusted version of Kohlberg's moral theory: discussion of its validity for research in nursing ethics.

Critics of Kohlberg's moral theory today focus on the content of his theory and more specifically on its justice-orientated moral concept. This has led to the well-known 'justice-care debate'. The purpose of this article is to critically examine the validity of Kohlberg's moral theory for research in nursing ethics from a caring perspective (referring to the content) as well as from a cognitive-structural perspective (referring to the basic assumptions of the model). The analysis points to the usefulness and value of the cognitive-structural model to empirically study nurses' ethical behaviour; the content of Kohlberg's model, however, needs to be adapted by adding a caring perspective as well as some personal and situational variables. An adjusted version of Kohlberg's model is proposed and discussed.

Cognition↗
PubMed1998

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.

Empathy↗
PubMed1989

The effect of teaching medical ethics on medical students' moral reasoning.

A study assessed the effect of incorporating medical ethics into the medical curriculum and the relative effects of two methods of implementing that curriculum, namely, lecture and case-study discussions. Results indicate a statistically significant increase (p less than or equal to .0001) in the level of moral reasoning of students exposed to the medical ethics course, regardless of format. Moreover, the unadjusted posttest scores indicated that the case-study method was significantly (p less than or equal to .03) more effective than the lecture method in increasing students' level of moral reasoning. When adjustment were made for the pretest scores, however, this difference was not statistically significant (p less than or equal to .18). Regression analysis by linear panel techniques revealed that age, gender, undergraduate grade-point average, and scores on the Medical College Admission Test were not related to the changes in moral-reasoning scores. All of the variance that could be explained was due to the students' being in one of the two experimental groups. In comparison with the control group, the change associated with each experimental format was statistically significant (lecture, p less than or equal to .004; case study, p less than or equal to .0001). Various explanations for these findings and their implications are given.

Control Groups↗
PubMed1995

Professional caring: the moral dimension.

The concept of caring, its intentions, actions and its achievements, as it relates to nursing is a concept on which many nurses' minds have been focused. The concern and at times a major preoccupation with the need to explore and explain caring among the nursing body is a concern which is rooted in socio-political and cultural phenomena related to the evolution of nursing. The need to explore and explain caring through philosophical discourse is a necessary and an ongoing part of this evolutionary process. This paper represents an attempt to partake in such discourse. More precisely, the paper undertakes an analysis of the concept of caring as it happens in both nonprofessional and in professional caring contexts and represents an attempt to characterize professional caring. In an effort to do this the author considers the moral-ethical dimension of caring in the light of important theoretical positions on social morality. When considered against these theories of social morality and against the professionally derived imperatives which guide caring actions, professional caring may be construed as a distinct mode of caring.

Codes of Ethics↗
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↗
PubMed2006

Facilitating the development of moral insight in practice: teaching ethics and teaching virtue.

Abstract The teaching of ethics is discussed within the context of insights gleaned from ancient Greek ethics, particularly Aristotle and Plato and their conceptions of virtue (arete, meaning excellence). The virtues of excellence of character (moral virtue) and excellence of intelligence (intellectual virtue), particularly practical wisdom and theoretical wisdom, are considered. In Aristotelian ethics, a distinction is drawn between these intellectual virtues: experience and maturity is needed for practical wisdom, but not for theoretical wisdom. In addition to this, excellence of character is acquired through habitual practice, not instruction. This suggests that there is a need to teach more than theoretical ethics and that the ethics teacher must also facilitate the acquisition of practical wisdom and excellence of character. This distinction highlights a need for various educational approaches in cultivating these excellences which are required for a moral life. It also raises the question: is it possible to teach practical wisdom and excellence of character? It is suggested that virtue, conceived of as a type of knowledge, or skill, can be taught, and people can, with appropriate experience, habitual practice, and good role models, develop excellence of character and become moral experts. These students are the next generation of exemplars and they will educate others by example and sustain the practice of nursing. They need an education which includes theoretical ethics and the nurturing of practical wisdom and excellence of character. For this purpose, a humanities approach is suggested.

Attitude of Health Personnel↗
PubMedDate not supplied

Moral decision making in neonatal intensive care.

OBJECTIVE: To gain information about the perspective that neonatal intensive-care unit nurses use to make moral decisions. DESIGN: Descriptive. SETTING: Neonatal intensive-care unit of a large teaching hospital in the midwestern United States. PARTICIPANTS: Convenience sample of 26 female nurses working in a neonatal intensive-care unit. METHOD: Audiotaped, semistructured interviews and demographic questionnaires. RESULTS: The results indicated that most (65%) of the nurses used the care perspective to make moral decisions. A small number (12%) used the justice perspective, and the remaining nurses (23%) used a combined care and justice perspective. CONCLUSIONS: Both the care and justice perspectives were found to be important for understanding how nurses make moral decisions.

Adult↗
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↗