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PubMed2000

The morality of abortion and the deprivation of futures.

In an influential essay entitled Why abortion is wrong, Donald Marquis argues that killing actual persons is wrong because it unjustly deprives victims of their future; that the fetus has a future similar in morally relevant respects to the future lost by competent adult homicide victims, and that, as consequence, abortion is justifiable only in the same circumstances in which killing competent adult human beings is justifiable. The metaphysical claim implicit in the first premise, that actual persons have a future of value, is ambiguous. The Future Like Ours argument (FLO) would be valid if "future of value" were used consistently to mean either "potential future of value" or "self-represented future of value", and FLO would be sound if one or the other interpretation supported both the moral claim and the metaphysical claim, but if, as I argue, any interpretation which makes the argument valid renders it unsound, then FLO must be rejected. Its apparent strength derives from equivocation on the concept of "a future of value".

Aborted Fetus↗
PubMed2002

Is there a moral duty for doctors to trust patients?

In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors.

Attitude of Health Personnel↗
PubMed2006

Group morality and intergroup relations: cross-cultural and experimental evidence.

An observational, cross-cultural study and an experimental study assessed behaviors indicative of a moral code that condones, and even values, hostility toward outgroups. The cross-cultural study, which used data from the Standard Cross-Cultural Sample (Murdock & White, 1969), found that for preindustrial societies, as loyalty to the ingroup increased the tendency to value outgroup violence more than ingroup violence increased, as did the tendencies to engage in more external than internal warfare, and enjoy war. The experimental study found that relative to guilt-prone group members who were instructed to remain objective, guilt-prone group members who were instructed to be empathic with their ingroup were more competitive in an intergroup interaction. The findings from these studies suggest that group morality is associated with intergroup conflict.

Adult↗
PubMed1994

Using Gilligan's framework to analyze nurses' stories of moral choices.

The manner in which nurses address and eventually solve ethical and moral questions and institutional problems is not yet well explained. This is a qualitative descriptive study examining the moral decision-making processes used by 24 nurses. The work of Carol Gilligan provides the framework for this study. The perspectives of the nurses was explored and a determination was made as to whether the justice or caring orientation prevailed in the situation. The method described by the Gilligan group is explained. Three stories are presented to serve as exemplars of the various orientations and of institutional forces that were active in the nurses' stories. The caring orientation was clearly present, as was the justice orientation to a lesser degree. Other issues such as power and financial security also were apparent.

Choice Behavior↗
PubMed1995

Moral reasoning among professional caregivers in nursing homes.

This article examines the responses from a sample of Swedish nursing home staff workers to a hypothetical ethical conflict highlighting the issue of restraint. The responses were analyzed in two ways: first, Piaget's theory of moral development was used to differentiate between "autonomous" and "heteronomous" awareness, and second, the responses were analyzed from the perspective of ethical principles, that is, autonomy, beneficence, nonmaleficence, and justice. The findings indicate that autonomous ethical awareness took precedence over heteronomous ethical awareness. The dominant moral values were the principle of beneficence, followed by the principle of autonomy.

Aged↗
PubMed1986

Moral philosophy and suicide.

There are two main moral issues regarding suicide: first, whether suicide is morally permissible, and if so, in what circumstances; and second, whether a person who knows that someone is contemplating or attempting suicide has an obligation to intervene and if so, how strong that obligation is. With respect to the first issue, it is difficult to resist the conclusion that suicide is not wrong in itself. To characterize suicide as murder of one's self is incorrect. Even if people who commit suicide deprive the community of some good, there is no general duty to provide good services to others. Theological objections to suicide are not persuasive. And suicide could be rational. For example, if one's scheme of values is to maximize the overall value of experience, and if at some point in the future negative value outweighs positive value, suicide would be rationally indicated. With respect to intervention, different considerations apply to persons involved with someone contemplating or attempting suicide, professionals, and the general public. Those who are involved have their own lives to live and need not alter them even when another person's life is at stake. Professionals should not become paternalistic authorities who keep subjects alive against their will and miserable for indefinite periods. The general public has only a weak duty to save strangers from suicide.

Humans↗
PubMed2000

The morality of treating patients with depot neuroleptics: the experience of community psychiatric nurses.

The aim of this qualitative study was to gain an understanding of the meaning that community psychiatric nurses impart to their everyday interactions with patients in depot neuroleptic treatment situations. Nine experienced community psychiatric nurses were interviewed using semistructured, open-ended questions. Data analysis was by the phenomenological descriptive method according to Giorgi. Four themes were identified, highlighting aspects of the moral meaning of treating patients with depot neuroleptics: (1) 'benevolent justification' occurs when nurses perceive that the patient's welfare is at stake; (2) 'inability to advocate the patients' best interest' occurs when nurses feel they are at a disadvantage; (3) 'accommodative interactions' occur when nurses are able to respond to a patient's expressed needs; and (4) 'acceptable advocacy' occurs when physicians are sensitive to nurses' suggestions on patients' treatment. The findings indicate that treatment care planning involving both patients and nurses is essential to enhance patients' autonomy, which is a precondition for satisfactory interactions. This phenomenological study describes the meaning that nurses give to administering depot neuroleptic injections to patients in the context of community psychiatric clinics. The phenomenon of concern was identified as the moral aspect in the interactions with individual patients in the treatment situation.

Adult↗
PubMed1994

To feed or to nourish? Thoughts on the moral significance of meals in hospital.

This paper explores the issue of the serving of food in hospital from both a moral and a philosophical point of view. The concepts of 'having a meal' and of 'feeling nourished by food' are examined; it is suggested that the former is a necessary condition for the latter. The implications of this for nursing care are considered and it is argued that there is a moral imperative for us to try and serve 'meals', rather than simply 'food' to patients. The importance of this is highlighted by current concerns about malnutrition in hospital.

Ethics, Nursing↗
PubMed1998

Information disclosure: the moral experience of nurses in China.

While the movement to ensure patient's rights to information and informed consent spreads throughout the world, patient rights of this kind have yet to be introduced in mainland China. Nonetheless, China is no different from other parts of the world in that nurses are expected to shoulder the responsibility of safeguarding patients' best interests and at the same time to uphold their right to information. This paper expounds on the principle of protectiveness grounded in traditional Chinese medical ethics concerning the practice of informed consent. Nurses in China have a moral obligation to treat patients with sincerity. This notion carries a strong sense of parental protectiveness. As far as information-giving is concerned, nurses in China are ambivalent about the notion of truthfulness. The findings of an empirical study undertaken in seven Chinese cities reveal that nurses in China experience similar difficulties related to the disclosure of information as their counterparts in other parts of the world. A nurse's narrative, the Chan case, is used to illustrate the typical difficult situation that nurses in China often encounter in looking after vulnerable patients who would like to learn more about their therapeutic regimens. The moral tension embedded in nursing practice is analysed. It is found that most nurses would prefer to tell the truth to patients, but their primary ethical justification is not that of respect for patients' autonomy or safeguarding patients' right to self-determination. Rather, it is basically beneficent in nature; that is, they base their decision to reveal the truth on whether or not patients will receive more relevant treatment and better nursing care.

Beneficence↗
PubMed1999

Intrusion into patient privacy: a moral concern in the home care of persons with chronic mental illness.

The aim of this study was to identify and analyse ethical decision making in the home care of persons with long-term mental illness. A focus was placed on how health care workers interpret and deal with the principle of autonomy in actual situations. Three focus groups involving mental health nurses who were experienced in the home care of persons with chronic mental illness were conducted in order to stimulate an interactive dialogue on this topic. A constant comparative analysis of the transcribed audiotaped sessions identified a central theme that concerned the moral symbolic meaning of 'home'. This reflected the health care workers' conflict between their professional role and their moral role, which they perceived as unclear.

Chronic Disease↗
PubMed2006

Self-managing and managing self: practical and moral dilemmas in accounts of living with chronic illness.

BACKGROUND: Patient education self-management programmes draw on sociological understanding of experiencing single chronic illnesses, but health practitioners do not always recognize the tensions and ambiguities permeating individuals' management experiences, particularly for those with multiple morbidity. The aim of this study was to illuminate how people negotiate multiple chronic illness, and everyday life. METHODS: A sample of 23 people in their early 50s was recruited from a community health survey in Scotland. The participants had four or more chronic illnesses and were interviewed twice. The qualitative data that were generated highlighted the impact of illness and associated management strategies, as people attempted to continue familiar lives. Analysis was based on constant comparison and informed by a narrative approach. RESULTS: People used multiple techniques to manage symptoms and conveyed a moral obligation to manage 'well'. However, maintaining valued social roles, coherent identities and a 'normal life' were prioritized, sometimes over symptom containment. This led to tensions, and participants faced moral dilemmas as they self-managed. DISCUSSION: Self-management policies, programmes and healthcare practitioners need to recognize the tensions that people experience as they negotiate symptoms, valued social roles, positive identities, and daily life. Addressing these issues may improve opportunities to support patients in particular contexts, and enhance self-management.

Adaptation, Psychological↗
PubMed2000

Morale within operating departments.

Perioperative nurses spend so much time taking care of the needs of their patients that their own needs can be neglected. The amount of work done every day in operating departments means that there is often little or no time given to looking after staff. The morale within a department is not usually a high priority--until there is a crisis, or staff start leaving. Mandy Livesley's article presents the results of a survey of staff morale in an operating department. Some of the findings will not surprise you; others may stimulate debate....

Adaptation, Psychological↗
PubMed2006

Ethical dilemmas and moral distress in oncology nursing practice.

Although ethical values and principles guide oncology nursing practice, nurses often are challenged to fulfill every professional core duty and responsibility in their everyday practice. Nurses commonly encounter clinical situations that have ethical conflicts, and they often have difficulty recognizing and articulating them. Unresolved conflicts can cause feelings of frustration and powerlessness, which can lead to compromises in patient care, job dissatisfaction, disagreements among those in the healthcare team, and burnout. This article reviews the ethical principles and values individual nurses bring to their practice as well as those basic to the profession of nursing. This article also discusses ethical conflicts in oncology practice and describes how nurses, especially students and novice nurses, may react to such situations with moral uncertainty or distress. In addition, a process for analyzing and resolving ethical problems in clinical situations is outlined. Increasing awareness and dialogue about ethical issues is an important first step in the process. Additional resources in the clinical setting may encourage nurses to actively participate in ethical decision making and take deliberate action as moral agents.

Adaptation, Psychological↗
PubMed1981

Self-report measures of mood and morale in elderly depressives.

The self-report scales of mood and morale were administered to 45 elderly in-patient depressives and 45 non-patient controls, matched for age and sex. The responses of the two groups differed significantly in the predicted direction. When 18 patients from the depressive group were re-tested 6 to 8 weeks later, at discharge, significant declines in self-reported depression, and increases in "life-satisfaction' were reported. Within the depressive group, there was a significant relationship between "overt' depressive behaviour on the ward and self-reporting of greater depressive symptoms, and lower "life-satisfaction'. The importance of independent validation of self-report measures of mood and morale in elderly populations is discussed.

Aged↗
PubMed2000

Narrative representations of moral-affiliative and conflictual themes and behavioral problems in maltreated preschoolers.

Examined whether maltreated preschoolers are more likely than nonmaltreated preschoolers to have fewer moral-affiliative and more conflictual narrative representations and whether these representations mediate child behavior problems. A structured narrative story-telling task was administered to assess representations, and independent ratings of behavior problems were obtained from teachers. The narratives of maltreated children contained more conflictual and fewer moral-affiliative themes. Maltreated children also exhibited more internalizing and externalizing behavior problems. A partial mediation effect of conflictual representations on the relation between child maltreatment and externalizing behavior problems was found. The results demonstrate the relation between child maltreatment and children's organization of their life experiences and their behavioral symptomatology.

Child Abuse↗
PubMed1992

Psychological morale and job satisfaction among homecare workers who care for persons with AIDS.

This paper reports the findings of a study of 103 home care workers who have cared for PWAs. It investigated degree of "exposure" to AIDS cases, perception of risk of occupational contagion, client/worker relationships, attitudes toward homosexuality and drug abuse and other work related factors for their relationship with psychological morale and job satisfaction. Multivariate analyses found sociodemographic characteristics and physical health to be the strongest predictors of morale. The quality of client/worker relationships and risk perception were the strongest predictors of job satisfaction. These findings, and that of the relative lack of importance of exposure to AIDS cases and attitudes toward the risk groups in accounting for job satisfaction, are discussed in terms of qualitative data collected from respondents during informal small group discussions.

Acquired Immunodeficiency Syndrome↗
PubMed1984

The ethical and moral implications of sexual classification: a commentary.

This paper reviews the relationship between psychiatric diagnosis and morality, suggesting that moral reasoning has been the primary determinant in the diagnosis of sexual disorders. It suggests two hypotheses to explain why homosexuality was eliminated from DSM. One, that homosexuality is now viable as a lifestyle and therefore has become socially regulated; and two, that the normal is the intractible. It further suggests that there is no scientific reason to keep the paraphilias in DSM.

Ethics, Medical↗
PubMed1995

The effect of characteristics of human service workers on subsequent morale and turnover.

The authors examine the relationship of sociopsychological characteristics of human services workers to their subsequent morale and continuance on the job. Eighty-two intensive case managers (half of them social workers) who had caseloads of clients with severe mental disorders were invited to participate in a four-wave panel study. Explored are the relationships between 16 predictors (general background, prior work experience and training, and social psychological variables) and worker outcomes (beliefs, attitudes, perceptions, and turnover). The major finding was that better personal well-being at the time of hiring was the most consistent and significant predictor of lower burnout, higher job satisfaction, and generally higher worker morale at later points in time. Those from higher social class backgrounds and those with lower starting salaries were more likely to leave the job. Those workers with more experience had a tendency to perceive greater client improvement.

Adult↗