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PubMed1990

Moral education for nursing decisions.

This paper attacks the Kantian conception of mortality that predominates in our society and the rationalist educational strategies that flow from it. In its place it offers an Aristotelian conception of ethics in which sensitivity and feeling are important components of practical reason. It argues that a nurse's ethical concerns extend further than the several moral dilemmas discussed in the daily press and that those concerns should be responded to in moral education by a process called 'empowerment'. Empowerment seeks to develop confidence and sensitivity in the making of difficult decisions and does so by training habits, developing attitudes, and encouraging reflection on actions performed.

Attitude↗
PubMed1990

Moral learning in nursing education: a discussion of the usefulness of cognitive-developmental and social learning theories.

The preparation of students for ethically sound practice is an essential concern for nurse educators. The theories of cognitive development and social learning theory are discussed as explanations of moral learning. The implications of the application of each of these theories to nursing education are discussed and the usefulness of each theory to nurse educators is reviewed. It is argued that neither theory is entirely satisfactory for application to nursing education and it is concluded that a pragmatic eclecticism is desirable in the approach to moral education in nursing.

Codes of Ethics↗
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↗
PubMed1989

Caregiver burden and moral development.

This paper presents an expanded understanding of both burden and moral development, identifying the traits of burden as being essential components of moral development. Steps in the interpretation of burden are shown to result in caregiver decisions that may be life-giving, oppressive, or a combination of both. This new understanding of burden is then related to Folkman and Lazarus's (1985) theory of stress and coping.

Adaptation, Psychological↗
PubMed1988

Biological processes and moral events.

It is often argued that the continuity of the processes of embryo development precludes the establishment of morally significant boundaries, once development is under way. These arguments typically claim that marking out any moral boundaries requires identifying particular significant events, and that in such circumstances this is either impossible or arbitrary. In this paper it is argued that arguments of this kind are not cogent. The paper concludes by indicating where the real problems lie.

Beginning of Human Life↗
PubMed1993

Beyond voluntary consent: Hans Jonas on the moral requirements of human experimentation.

In his essay, Philosophical Reflections on Experimenting with Human Subjects, Hans Jonas contends that except in cases of widespread medical emergencies, people do not have a moral or social obligation to volunteer to be subjects in medical experiments. He further argues that any appeal for volunteer subjects in medical experiments should whenever possible give priority to those who can identify with the project and offer a strong sense of commitment to its goals. The first of these claims is given support against some recent criticisms, but argument is offered to show that the second claim not only does little to enhance the stature of the standard requirement of free and informed consent but may even weaken the moral validity of the consent.

Ethics, Medical↗
PubMed2005

Human organs, scarcities, and sale: morality revisited.

Despite stringent and fine tuned laws most jurisdictions are not able to curb organ trafficking. Nor are they able to provide organs to the needy. There are reports of the kidnapping and murder of children and adults to "harvest" their organs. Millions of people are suffering, not because the organs are not available but because "morality" does not allow them to have access to the organs. Arguments against organ sale are grounded in two broad considerations: (1) sale is contrary to human dignity, and (2) sale violates equity. Both these objections are examined in this article and it is concluded that they reflect a state of moral paternalism rather than pragmatism. It is argued that a live human body constitutes a vital source of supply of organs and tissues and that the possibilities of its optimum utilisation should be explored. Commercialisation should be curbed not by depriving a needy person of his genuine requirements but by making the enforcement agencies efficient.

Adult↗
PubMed2004

Understanding the importance of values and moral attitudes in nursing care in preserving human dignity.

The purpose of this investigation was to explore when nursing becomes an art, and to develop a theory/model of nursing as art. The overall design of the investigation was qualitative, and phenomenological-hermeneutic. The five substantial categories in the theory/model are: Invitation and confirmation, encounter, values, moral attitude and demeanor, the act of good will, and aesthetic communication. One main finding of this nursing investigation based on the caring perspective was that values and a thoroughly moral attitude and demeanor are central when nursing becomes an art.

Art↗
PubMed1998

Cultivating a moral sense of nursing through model emulation.

This paper reports part of a longitudinal research project, which sought to capture students' conceptualization of caring practice as they progressed to different levels of study in a nursing diploma programme in Hong Kong. Model emulation was found to be an effective means of focusing students' learning processes on the moral aspects of nursing practice. The theory of model emulation from a Chinese perspective and how it is applied to create a learning context to allow students to acquire a moral sense of nursing are discussed. The participating students are invited to be sincere enquirers in the pursuit of the good embedded in practice through introspective self-examination and dialogue. They are asked to describe and share their experience of positive and negative examples of nursing in written accounts. Van Kaam's phenomenological method was adopted to explicate the good and bad constituents of nursing from these examples, with the students assuming an active role in the explication process. The explication reveals that the students were able to articulate the good and bad practices in a variety of patient care situations.

Confucianism↗
PubMed1997

Moral judgments in the rationing of health care resources: a comparative study of clinical health professionals.

Social workers, physicians, and nurses from a major urban teaching hospital were assessed and compared regarding their attitudes toward the rationing of health care. Responses to eighteen statements of considered moral judgments in the rationing of health care resources were analyzed in terms of levels of agreement with each. All three professional groups rejected rationing based on patient age and socioeconomic worth. However, social workers and physicians were more likely than nurses to consider such factors as cost-benefit ratios, quality of life, relative strength of a patient's moral claim, and scarcity of resources in rationing decisions. Study findings appear to portray social workers and physicians as being more utilitarian and nurses more egalitarian in rationing decisions. Implications for practice in a managed care environment are presented.

Adult↗
PubMedDate not supplied

How to avoid flying blind. To truly improve U.S. healthcare, leaders must consider seven moral values.

To genuinely improve U.S. healthcare, we must base it on seven moral values familiar to Americans: Preserving individual dignity. Patients have a right to information about their medical condition and a right to participate in decisions about treatment. Society should make a basic package of healthcare available to all who need it. Caring for patients' welfare. As providers are obliged to have compassion for patients' suffering, they should also put patients' interests above their own and avoid conflicts of interest. Protecting the least well-off. Many who are poor, less educated, or members of racial or ethnic minorities bear disproportionate burdens of morbidity and mortality. They should receive care that compensates for those disadvantages. Seeking the common good. Our society has a strong disposition toward excessive individualism. We need greater emphasis on public health and preventive measures, as well as more opportunities for the public to help shape the healthcare system. Containing the healthcare costs. Waste is offensive both economically and morally. We can contain costs only by grappling explicitly with the need for healthcare rationing, which should be applied according to ethical criteria. Retaining a sense of responsibility. Society can help renew a sense of responsibility b anchoring it in the concept of subsidiarity, according to which the best government is the least government necessary to perform its appropriate tasks. Establishing high standards of quality. Providers should pursue excellence as measured by improved medical outcomes, uniform use of appropriate procedures, and increased consumer satisfaction. Quality-of-life judgments can be useful in making healthcare decisions, especially for persons who are dying.

Altruism↗
PubMedDate not supplied

Clinical cheating and moral development.

Clinical cheating is one of the most devastating ways students can breach moral principles, and its prevention should be a priority for nurse educators. Educators can promote the professional integrity of students by integrating moral development into all curricular efforts.

Curriculum↗
PubMed1996

What is the moral authority of family members to act as surrogates for incompetent patients?

Policy and practice regarding the proper role of family members in acting as surrogate decision makers for incompetent patients often suffer from an incomplete understanding of the diverse grounds of families' moral authority to act as surrogates. The different, sometimes conflicting, grounds of family surrogacy are explored: (1) its establishment by democratic decision processes; (2) the self-determination of the incompetent patient; (3) the fact that a family member usually acts according to the patient's wishes and interest; (4) the reality that family members are usually most affected by the patient's decisions; (5) consideration of these effects; (6) a recognition that the family is a moral unit, responsible for its members. Each of these grounds must be considered when selecting a surrogate or deciding on the proper scope of the surrogate's decision-making authority.

Conflict of Interest↗
PubMed1996

Effects of work stressors and work climate on long-term care staff's job morale and functioning.

Relationships between work stressors and work climate, and job morale and functioning were examined. Initial and 8-month follow-up data were obtained from 405 staff in 14 long-term care facilities. Relationship and workload stressors were related to less job satisfaction and intent to stay in the job, and more job-related distress, depression, and physical symptoms. Patient care task stressors were associated with better outcomes. More positive work climates were linked to higher job morale. Initial work stressors predicted poorer functioning, and coworker cohesion predicted more intent to stay in the job at follow-up.

Adult↗
PubMed1987

Presymptomatic testing for Huntington chorea: guidelines for moral and social accountability.

Clinical trials of a presymptomatic test for Huntington chorea (HC) are beginning, and the test may set precedents in screening for other genetic disorders in this way. Therefore, it seems an opportune time to consider the moral and social implications of such testing. The strategy proposed here takes the form of guidelines for research, development, and clinical application of the HC test and any future similar tests. The guidelines cover four stages (preliminary research, verification, refinement, and clinical application). They draw on past experience, on existing guidelines for research involving human subjects, and on some general moral and legal principles. In addition to traditional concerns about relationships between counselors and consultants, they emphasize more contemporary concerns about the interests of third parties and social institutions in what occurs in modern methods of genetic screening. In all cases, however, the guidelines are provisional and are offered here mainly for purposes of discussion and to encourage similar efforts at policymaking by those who become involved with these forms of testing.

Age Factors↗
PubMed1993

Inclusion, motivation, and good faith: the morality of coercion in mental hospital admission.

We administered a semi-structured interview to 157 patients shortly after their admission to a psychiatric hospital. In the first, and open-ended, part of the interview, patients were asked to talk about what had been going on in their lives that led to their coming into the hospital. Then, in a more structured format, they were asked more specific details about who was involved, the patients' relationships with those involved, whether any attempts were made to influence the patient to come into the hospital, and whether such attempts were perceived as fair by the patient. This article presents a qualitative review of the transcripts of a subset of these interviews. It attends specifically to patients' perceptions of the morality of attempts by others--primarily family members, friends and mental health professionals--to influence them to be admitted to the hospital, and of the morality of the process by which these influence attempts resulted in admission.

Coercion↗
PubMed2001

Moral justification for Tarasoff-type warnings and breach of confidentiality: a clinician's perspective.

After brief review of the background and context of the Tarasoff case and its impact on clinicians, the author examines the "Tarasoff warning," proposed in the 1974 Tarasoff opinion, from a moral position, with brief discussion of its clinical and risk management dimensions. Moral issues considered include confidentiality itself, agency, fiduciary duty, a shift in the victim paradigm, the emergency context, a novel risk, and a proposed approach. The dilemma presented by the original Tarasoff fact situation is re-examined. The author stresses the need for individualized responses to the risks posed by patients.

California↗
PubMed1981

Moral treatment and the therapeutic community.

History can serve as a useful tool for better understanding contemporary mental health programs. At present, much interest is directed at apparent parallels between 19th century moral treatment and modern milieu therapies, especially the therapeutic community. A common emphasis on a humane living environment is typically cited as the major parallel between the treatments. However, on closer examination, it appears that moral treatment and the therapeutic community exemplify different conceptions of what constitutes a humane living environment. Moreover, the two overall treatment philosophies differ significantly. These differences are tied to the historical contexts and responses to cultural stress in the mid-19th and mid-20th centuries, and consequent conceptions of mental well-being. A heretofore overlooked, but suggestive parallel between the treatments, which may help explain their efficacy, is the importance of peer self-help as a therapeutic tool. However, whereas the therapeutic community actively encourages peer self-help, 19th century asylum superintendents were unaware of its value.

Humans↗