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PubMed2003

Legal consequences of the moral duty to report errors.

Increasingly, clinicians are under a moral duty to report errors to the patients who are injured by such errors. The sources of this duty are identified, and its probable impact on malpractice litigation and criminal law is discussed. The potential consequences of enforcing this new moral duty as a minimum in law are noted. One predicted consequence is that the trend will be accelerated toward government payment of compensation for errors. The effect of truth-telling on individuals is discussed.

Disclosure↗
PubMed1996

Empowerment: the right medicine for improving employee commitment and morale in the NHS?

States that in recent years, empowerment of National Health Service (NHS) Trust employees has been given substantial political and managerial support. Examines the extent to which the commitment and morale of staff in two NHS Trust hospitals has altered following the introduction of a raft of techniques under the empowerment label. The researchers interviewed substantial numbers of staff with managerial responsibilities, personnel specialists and conducted written surveys seeking employee opinion. Reports the findings, which confirm that, under empowerment, the work of both managers and staff has become more intensive, but managers claim that their commitment has risen, while for non-managerial employees, severe problems of commitment to the Trust, declining morale and high stress were exposed. Identifies reasons for these difficulties which were: the salience of budgetary and operational priorities; lack of training; resistance to the implementation of empowerment; and recognition that little real authority was being devolved to employees. Concludes that the limited effects attributable to empowerment could be explained by its association with harder-edged manpower policies introduced to meet financial and competitive pressures. Under favourable contextual conditions, empowerment may exert more positive effects.

Attitude of Health Personnel↗
PubMed1999

Virtue, personality, and social relations: self-control as the moral muscle.

Morality is a set of rules that enable people to live together in harmony, and virtue involves internalizing those rules. Insofar as virtue depends on overcoming selfish or antisocial impulses for the sake of what is best for the group or collective, self-control can be said to be the master virtue. We analyze vice, sin, and virtue from the perspective of self-control theory. Recent research findings indicate that self-control involves expenditure of some limited resource and suggest the analogy of a moral muscle as an appropriate way to conceptualize virtue in personality. Guilt fosters virtuous self-control by elevating inter-personal obligations over personal, selfish interests. Several features of modern Western society make virtue and self-control especially difficult to achieve.

Adaptation, Psychological↗
PubMed1988

Experimental study to evaluate nursing staff morale in a high stimulation geriatric psychiatry setting.

This work is part of a larger study carried out at Murray Royal Hospital, Perth, Scotland. The study was concerned with staff morale under two distinct management approaches towards the care of the elderly patient with dementia. In one ward a dynamic, high stimulation approach was adopted including reality orientation, reminiscence therapy and socialization therapy. This was run in a well-structured manner by the ward staff and other agents. The other ward had no such structure imposed and was left to carry out 'traditional' nursing care to a high standard. The tool used to collect the data was a precoded questionnaire developed by Jones & Galliard. The hypothesis on which the study was based was as follows, 'that morale is increased in nursing staff involved in a high stimulation ward environment for the hospitalized elderly patient with dementia'. The findings of the study appear to indicate that the hypothesis is supported. It appears that the imposition of the structured high stimulation management approach was responsible for such an outcome and that nursing staff respond well to such an approach.

Aged↗
PubMed1988

Nursing care as a moral, practical, communicative and creative activity.

In this paper nursing care is studied by philosophical inquiry. According to the outlined philosophical theory, nursing can be conceived as a moral, practical, communicative and creative activity. This means that nursing care is viewed as a manifestation of a conception of the good life, that it is related to some kind of changes or non-changes with respect to the patient, that it is oriented towards reaching understanding and that something new, unpredictable and meaningful is created in the nursing interaction. The theory is defended by scientific, moral and practical arguments. Habermas' theory of communicative action plays a central part in the outlined theory of nursing care.

Creativity↗
PubMed1996

'Bioethics' is subordinate to morality in Japan.

Disputes over brain death and euthanasia are used to illuminate the question whether there really is a Japanese way of thinking in bioethics. In Japanese thought, a person does not exist as an individual but as a member of the family, community or society. I describe these features of Japanese society as 'mutual dependency'. In this society, an act is 'good' and 'right' when it is commonly done, and it is 'bad' and 'wrong' when nobody else does it. Thus, outsiders to this ring of mutual dependency encounter ostracism. One feature of this society is a lack of open discussion which leads to the existence of multiple standards. This Japanese morality even prevails over written laws. In Japan, there is a public stance that euthanasia does not exist. On the other hand, there are certain decisions which have permitted euthanasia. Similarly, organ transplants were performed from brain dead donors, while that procedure was not accepted officially by the medical profession. In this situation, there is a danger that human rights will be neglected. So far bioethical approaches have not helped to work out these problems. This may be because Japanese think that bioethics is subordinate to morality. The current dispute over brain death involves a struggle for the establishment of a rational society in Japan. Overcoming mutual dependency and ostracism is essential to resolve this struggle and to lead Japan into a society of mutual respect where all individuals, families and communities are esteemed.

Attitude↗
PubMed1986

Sex differences in moral reasoning: response to Walker's (1984) conclusion that there are none.

Data from the Family Socialization and Developmental Competence Project are used to probe Walker's conclusion that there are no sex differences in moral reasoning. Ordinal and nominal nonparametric statistics result in a complex but theoretically meaningful network of relationships among sex, educational level, and Kohlberg stage score level, with the presence and direction of sex differences in stage score level dependent on educational level. The effects on stage score level of educational level and working status are also shown to differ for men and women. Reasons are considered for not accepting Walker's dismissal of studies that use (a) a pre-1983 scoring manual, or (b) fail to control for education. The problems presented to Kohlberg's theory by the significant relationship between educational and stage score levels in the general population are discussed, particularly as these apply to the postconventional level of moral reasoning.

Adult↗
PubMed1995

Traditional and evaluative aspects of flexibility in gender roles, social conventions, moral rules, and physical laws.

Traditional and evaluative aspects of flexibility regarding transgressions across several domains (masculine and feminine gender roles, moral rules, social etiquette, and physical law) were assessed in 24 4-year-olds, 40 8-year-olds, and 46 college undergraduates. Traditional and evaluative aspects of flexibility yielded distinctly different patterns of response. Data indicated an age-related increase in flexibility on traditional measures (i.e., traditional rule flexibility, cultural relativity) for transgressions in all domains, except physical laws. In contrast, subjects in all age groups were consistently negative in their evaluations of transgressions in moral rules, etiquette, and masculine gender roles. Female subjects viewed masculine gender role transgressions with greater flexibility and less negativity than did male subjects. Results demonstrate the multidimensional character of flexibility development in different social and physical domains. Results suggest that masculine and feminine gender roles and social etiquette may not fall within a common domain of social convention.

Adolescent↗
PubMed2006

The ethic of care development: a longitudinal study of moral reasoning among practical-nursing, social-work and law-enforcement students.

The study investigated changes in care-based moral reasoning, in the context of justice development over the 2-year period among practical-nursing, bachelor-degree social-work and law-enforcement students (N = 59). Main measures were Skoe's Ethic of Care Interview and Colby et al.'s Moral Judgment Interview. Of the participants 34% progressed in care reasoning, and 48% in justice reasoning. Social-work and nursing students progressed in care reasoning, and all groups progressed in justice reasoning. One participant (1.7%) regressed in care reasoning. Care and justice reasoning were parallel in terms of internal consistency, and they were positively related to each other. Findings suggest that care reasoning follows a developmental sequence, involving three main and two transitional levels, as suggested by Gilligan (1982). Main levels include self-concern (Level 1), caring for others (Level 2), and balanced caring for self and others (Level 3).

Adult↗
PubMed2006

The politics of end-of-life decision-making: computerised decision-support tools, physicians' jurisdiction and morality.

With the increasing corporate and governmental rationalisation of medical care, the mandate of efficiency has caused many to fear that concern for the individual patient will be replaced with impersonal, rule-governed allocation of medical resources. Largely ignored is the role of moral principles in medical decision-making. This analysis comes from an ethnographic study conducted from 1999-2001 in three US Intensive Care Units, two of which were using the computerised decision-support tool, APACHE III (Acute Physiological and Chronic Health Evaluation III), which notably predicts the probability that a patient will die. It was found that the use of APACHE presents a paradox regarding concern for the individual patient. To maintain jurisdiction over the care of patients, physicians share the data with the payers and regulators of care to prove they are using resources effectively and efficiently, yet they use the system in conjunction with moral principles to justify treating each patient as unique. Thus, concern for the individual patient is not lessened with the use of this system. However, physicians do not share the data with patients or surrogate decision-makers because they fear they will be viewed as more interested in profits than patients.

APACHE↗
PubMed1999

The rising agenda of physician-assisted suicide: explaining the growth and content of morality policy.

Employing theories and methods of agenda-setting analysis, this article explains the rapid rise of physician-assisted suicide (PAS) on the national political agenda based on its status as a morality policy. PAS reached the mass agenda before the professional agenda, probably because PAS is an outgrowth of previous right-to-die policies and Dr. Jack Kevorkian's assisted suicides provided major focusing events. As in other morality policies, competing groups fight for the last word, but PAS has been blocked on most governmental agendas because its image and media tone has been mostly negative and public opinion is divided. Groups in a few generally liberal states have tried to enact policy through referenda when legislators failed to address the issue. We speculate that competing interest groups will become more active and that state courts will become a venue of choice in the future.

Humans↗
PubMed2004

The moral lens of population control: condoms and controversies in southern Malawi.

The study presents an investigation of stories about condoms in southern Malawi. Malawians' concerns about coercive population control imposed by a national government or international cabal provide a moral lens through which condoms and other health promotions are viewed, with unknown but probably negative impact on the use of condoms. The focus of the study is on the long shadow cast by population control because it is underresearched and, in fact, virtually unmentioned in most studies of health promotion, yet appears to be common if not ubiquitous. Moreover, this long shadow poses a distinct challenge to HIV-prevention and intervention efforts. The data for the study were gathered by six Malawian research assistants in Balaka district, in southern Malawi, who kept journals over a period of three years in which they recorded conversations and everyday chats that they observed. These journals demonstrate that condoms do not arrive in communities as neutral, value-free objects; rather they enter a social setting permeated with ideas about health, self-protection, and danger. The lens of population control has proved to be both durable and flexible, providing a moral context in which both commodities and actors can be understood. Disentangling condoms from the symbolic nexus in which they are fused with disease, population control, and malevolence will be an ongoing challenge in the struggle to prevent the spread of HIV/AIDS in Malawi.

Adult↗
PubMedDate not supplied

Speaking up: a moral obligation.

As we rush around attending to the essentials of our lives (family, friends, clients, employers), what is left? Nursing Forum invites readers to engage in thoughts and activities that may awaken an untouched place. We hope these writings will kindle your personal involvement in something that was previously avoided--because of bias, fear, or uneasiness--in order to stretch your mind and spirit. The purpose of this paper is to explore the act of speaking up as a moral obligation and its relationship to moral courage and habit. The difficulties of speaking up and the consequences of silence are examined. The benefits of speaking up are raising self-respect, gaining courage, forming good habits and passing on that legacy.

Communication↗
PubMed1994

Morale in general practice: is change the problem or the solution.

Despite the pervading gloom about morale in general practice it can still offer a rewarding career. This article, which is the first in a series examining ways to improve general practitioners' job satisfaction, weighs the evidence for low morale in the profession and examines the factors that cause most dissatisfaction. The main causes of discontent seem to be increased paperwork and out of hours work, and many blame the 1990 contract for their problems. Dissatisfaction was growing before the contract was introduced, however, and some doctors believe that it has had positive effects. Further change seems inevitable if general practice is to offer a stimulating career for life.

Family Practice↗
PubMed1989

Informed consent and moral integrity.

Informed consent is required for any medical procedure although the situations in which it is given are beset by uncertainties and indeterminacies. These make medicolegal scrutiny of such situations very difficult. Although some people find the decision in the Sidaway case incomprehensible because of its continuing regard for a 'professional practice standard' in informed consent, I will argue that an important fact in many cases is the moral integrity of the doctor concerned and the pattern of his practice. This may provide the only morally principled and legally accessible evidence enabling a correct decision to be made in a difficult case. Although the epistemological significance of a professional practice standard is thereby defended the 'prudent patient standard' for what counts as consent is left intact.

Communication↗
PubMed1996

Does teaching by cases mislead us about morality?

Those who teach or are taught medical ethics with a heavy reliance on case studies should be warned first of all that the practice tends to exaggerate the degree to which morality is controversial. Secondly, they ought to realise that it is often quite unclear what problems count as moral problems. Thirdly, they will need to bear in mind that there may be -- and presumably are -- limits to what we may regard as open to discussion. It would be quite superficial to assume that ethics teachers, going along with what is generally accepted by their colleagues in this matter, would never tempt students to disregard these limits.

Ethical Analysis↗
PubMed1997

Compensation for subjects of medical research: the moral rights of patients and the power of research ethics committees.

Awareness of the morally significant distinction between research and innovative therapy reveals serious gaps in the legal provision for compensation in the UK for injured subjects of medical research. Major problems are limitations inherent in negligence actions and a culture that emphasises indemnifying researchers before compensating victims. Medical research morally requires compensation on a no-fault basis even where there is proper consent on the part of the research subject. In particular, for drug research, there is insufficient provision in the current patient guidelines of the Association of the British Pharmaceutical Industry, since they make "no legal commitment" to paying compensation for injury to patient subjects. There is a need for the provision of both adequate insurance and contractual arrangements for making payments. The solution is for Local Research Ethics Committees (LRECs) to make use of their power to withhold approval of medical research where compensation is not legally enforceable.

Clinical Trials as Topic↗
PubMed1997

Moral assessment of growth hormone therapy for children with idiopathic short stature.

The prescription of growth hormone therapy for children who are not growth hormone deficient is one of the controversies in contemporary paediatric endocrinology. Is it morally appropriate to enhance the growth, by means of medical treatment, of a child wish idiopathic short stature? The medical, moral, and philosophical questions in this area are many. Data on the effects of human growth hormone (hGH) treatment will not on their own provide us with answers, as these effects have to be evaluated from a normative perspective. In this article we consider hGH treatment for children of idiopathic short stature from three normative perspectives: the goals of medicine, the good of the patient, and the public good. We argue that the prevention of psychological and social problems due to short stature (and not merely the enhancement of growth) should be the ultimate goal of medical treatment and research.

Adaptation, Psychological↗