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The difference between Kohlberg's theory of moral justice and Gilligan's conflicting theory of moral development based on sensitivity to human relations, has been addressed in recent literature. Here Chally looks at those theories, their use in nursing research, and their strengths and limitation for use by nurses.
Diagnosis is an important element in the therapeutic alliance. It informs treatment and management decisions in the interests of the patient. The relative and discretionary factors in diagnosis are prominent in psychiatry. The problematic nature of psychiatric diagnoses and the difficulty in demarcating physical from psychic disorders suggests an approach to patients with psychiatric symptoms that is alert to possible somatic causes. The well-being of the patient is primary in the therapeutic exchange. Thus, the moral principle to "do no harm" prevails. The potential costs to patients from missed physical diagnosis counsels an open attitude by psychiatrists in the diagnostic process. There are moral, scientific, and professional reasons to support this approach. Ultimately, the good of the patient and the good of the profession require it.
Antisocial personality is a problem-filled diagnosis. Even when diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) II manual, it was replete with value laden terminology. DSM III makes repeated criminal behavior central and includes a list of other behaviors that do not always truly imply an antisocial personality. In order to test the possibility that factors other than those listed in the manual may often influence the diagnosis, the prevalence of required characteristics in patients diagnosed antisocial personality was compared with the prevalence of required characteristics in another personality disorder, schizoid personality. The study involved a hospitalized Veteran's Administration (VA) population, employing DSM II criteria, which was used by the VA at that time. The difference was statistically highly significant. Examination of the case histories suggests that dislike of the patients or negative moral judgments about their actions frequently were involved in making a diagnosis of antisocial personality. It is therefore crucial that moral judgments not be disguised as scientific ones, and the meaning of an antisocial personality diagnosis as utilized by clinicians needs to be seriously questioned.
Moral action in nursing: reflections from an ethical point of view Does nursing need specific ethics? This question will be answered in two stages. First the history of how the profession came into being will be summarised. In the second stage the opportunities and the limitations will be touched on, regarding the shape of the profession. A short presentation of Kohlberg's theory is the starting point for an attempt to reconstruct the origins of moral competence. How far nursing will accept this is questioned. Ambivalence in the ideology of the caring-relationship is examined.
Current advancements in medical science, such as the progress seen in the area of organ transplantation, brings with it many ethical dilemmas for which there are no precedents. Obtaining informed consent for cadaver organ donation requires perioperative nurses to confront the moral responsibility that they have to their patients, their patients' families, and to the nursing profession as a whole. The perioperative nurse must question his or her own moral and cultural beliefs, face their own fears of death, and confront societal misconceptions about brain death. This evolution is emotionally demanding and often stresses one's support systems. However, with self-discovery and education, it can also be very rewarding.
In this paper I argue that Care theory has the resources to offer an insightful and original theoretical perspective on issues in medical ethics. The paper begins with a discussion of the sort of theory Care is, and argues that it closely resembles virtue theory. After a discussion of common features of Care theories, I respond to a few of the criticisms that have been levied against the theory. The final section of the paper is a discussion of the question of neutrality in public moral discourse. Care theory is not a neutral theory with regard to questions of the nature of the good life for humans, but I argue that this should not preclude Care from playing a part in the public debate over policy decisions.
Fourteen experienced nurses participated in an explorative study aimed at describing the experiential aspects of moral decision making in psychiatric nursing practice. In-depth interviews were conducted according to the grounded theory method. These were transcribed, coded and categorized in order to generate conceptual categories. The concept of benevolence was identified as a central motivating factor in the nurses' own accounts of situations in which decisions were made on behalf of the patient. This seems to conceptualize the nurses' expressed aim to do that which is 'good' for the patient in responding to his or her vulnerability. This study indicates the need for further research into the subjective, experiential aspect of ethical decision making from a contextual perspective.
In a contribution to The Journal of Medicine and Philosophy, Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kant's concept of autonomy and Aristotle's notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful only in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mill's ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know.
The Vatican Instruction on reproductive technologies and the OTA report, Infertility, both use "rights" language to advance quite different views of the same subject matter. The former focuses on the rights and welfare of the embryo, and the protection of the family, while the latter stresses the freedom and rights of couples. This essay uses the work of Alasdair MacIntyre and Jeffrey Stout to consider the different traditions grounding these definitions of rights. It is proposed that a potentially effective mediating language could be that of "human nature", and argued that donor methods raise more serious moral objections than homologous ones.
The theoretical considerations, operationalization of the constructs, and measurement issues of an ongoing program of research designed to explain ethical practice in nursing are presented. They illustrate the constant give and take among research, the empirical world, and theory building. This case study depicts the iterative and complex process of developing constructs and relationships, based on research findings, that explain moral behavior in nursing practice.
The response to suicidal clients is a recurrent and deep ethical problem in mental health practice. Rational suicide is rarely considered in relation to psychological suffering and is generally only discussed within the literature in connection with terminal illness. Focusing on a case example derived from a composite of patient experiences, this paper considers the premise that suicidal ideation may not be an irrational belief arising from mental disorder and analyses the ethical aspects of nursing care through the competing moral frameworks of the care-based and principle-based approaches to nursing ethics. We conclude that when the client is not capable of autonomous decision making, the two approaches lead to the same response. But when the client is capable of autonomous decision making, the two approaches lead to different responses. Specifically, from the care-based perspective, intervention to prevent suicide is easier to justify and helps formulate a nursing response, which promotes hope through the engagement.
Ethical controversy over transplantation of human fetal tissue has arisen because the source of tissue is induced abortions. Opposition to such transplants has been based on various arguments, including the following: rightful informed consent cannot be obtained for use of fetal tissue from induced abortions, and fetal tissue transplantation might result in an increase in the number of abortions. These arguments were not accepted by the National Institutes of Health (NIH) Human Fetal Tissue Transplantation Research Panel. The majority opinion of the panel stated that abortion and fetal tissue use are entirely separate issues, and that tissue use is ethically acceptable because it can be morally insulated from the issue of abortion. In support of this view, panel members and others have replied to the arguments put forward by opponents of fetal tissue use. However, replies to the two arguments mentioned above have been unsatisfactory, and the shortcomings of those replies are identified herein. Examination of the arguments pro and con suggests that fetal tissue use cannot be completely insulated from the issue of abortion. Thus, in seeking an ethical justification for fetal tissue transplantation we must consider reasons other than those put forward by the NIH panel. In this paper it is argued that whatever wrong is involved in using fetal tissue from induced abortions must be balanced against the benefits for patients, and it is on this basis that fetal tissue transplantation can be ethically justified.
Does it signify morally whether a deception is achieved by a lie or some other way? David Bakhurst has challenged my view that it can signify. Here I counter his criticisms--firstly, by clarifying the terminology: What counts as a lie? Secondly, by exploring further what makes lying wrong. Bakhurst maintains that lying is wrong in that it infringes autonomy--and other deceiving stratagems, he says, do so equally. I maintain that lying is wrong in that it endangers trust--and other types of deceiving stratagems do not do so equally. Lying to patients, I contend, is an abuse of their trust. Other forms of their intentional deception need not be so, although, in our autonomy-minded culture, they are likely to be so.
Unlike the managerially oriented reforms that have brought auditing and accounting into such prominence in the UK National Health Service (NHS), and which seem alien to the culture of the caring professions, consumerist reforms may seem to complement moves towards the acceptance of wide definitions of health, and towards increasing patient autonomy. The empowerment favoured by those who support patient autonomy sounds like the sort of empowerment that is sometimes associated with the patient's charter. For this reason moral criticism of recent NHS reforms may stop short of calling consumerism into question. This, however, would be a mistake: consumerism can be objectionable both within and beyond the health care market.
In 1997, a court in Cyprus jailed Pavlos Georgiou for fifteen months for knowingly infecting a British woman, Janet Pink, with HIV-1 through unprotected sexual intercourse. Pink met Georgiou in January 1994 whilst on holiday. She discovered that she had contracted the virus from him in October 1994 but continued the relationship until July 1996 when she developed AIDS. She returned to the UK for treatment and reported Georgiou to the Cypriot authorities. There have been a number of legal cases involving deliberate transmission of HIV, but most have involved forced exposure to infected bodily fluids for example, rape or biting, and have been dealt with using the existing legislation for rape or assault. While it is often difficult to prove responsibility for transmission in cases of forced exposure to HIV, it is even more contentious in cases like those of Janet Pink where an individual has consented to sex but claims that he/she was not forewarned of his/her partner's HIV-positive status. At present there is no specific criminal offence of having unprotected sexual intercourse without disclosing one's HIV-positive status but a prosecution could possibly be brought under any one of a number of existing offences. Perhaps a change of policy needs to be considered. The Home Office has issued a consultation document which outlines a proposal that will allow the criminalization of intentional transmission of diseases, like HIV, that are likely to cause serious harm. This revised legislation would cover all other potentially fatal diseases (including salmonella and legionnaire's disease, for instance) but seems primarily to be targeted at HIV transmission. Should transmission of HIV through consensual sex, without the HIV-positive status of the individual being disclosed, be an offence? This question, and that of whether there is a moral obligation to disclose a positive HIV status prior to having a sexual relationship is the subject of this paper.
Conflict exists between medical model and civil liberties approaches to involuntary hospitalization for mental illness. The amassing and analysis of data will not resolve this conflict because the two sides view the problem from differing moral vantage points. Medical model adherents are influenced chiefly by utilitarian or consequentialist considerations, while the civil libertarians take more of a deontological or absolutist position. Opinions about such issues as hospitalization criteria of dangerousness versus medical necessity and the relative role of rights versus obligations and of autonomy versus paternalism can be seen largely to depend on such underlying value judgments. Neither side has a monopoly on truth or right in the question of involuntary hospitalization.
Any significant involvement of AADR/IADR in ensuring responsible research among their members must be grounded in a widely accepted consensus that there are good moral reasons for such involvement. One important source of such reasons is AADR/IADR's identity as a scientific research, a professional, and a dental association. These identities and the commitments to society and to clients implicit in them generate several mutually reinforcing reasons for taking responsibility for the reliability of members' research. With regard to scientific research, these reasons arise from what it means to do such research, and from the various ways the larger society supports that activity. With regard to the professional dimension, the reasons arise from what it means to be a profession in this society and can be best seen in relation to the four major characteristics of professions. With regard to AADR/IADR's being a dental profession, such reasons arise from dental researchers' specific role in the dental family of professions' goal of delivering optimal care to the clients of practitioners. The clients' perspective, specifically the need to be able to trust that one will receive the best care possible, is a final source for such reasons. Two current issues, the sharing of findings and commercial/industrial support for research, give new urgency to this question of the Association's role in ensuring responsible research.
This paper explores the nature of rights, and their implications for the ethics of nursing. A right is seen as an entitlement which is justified on moral and/or legal grounds, and which may take the form of a right of action or a right of recipience, or both; in either case, correlative duties are generally imposed on others. Some of the conflicts which can occur among two or more conflicting rights are examined through three hypothetical scenarios, and approaches to their resolution are suggested. The question of whether nurses, as nurses, possess rights is then considered, and it is suggested that they do not. In conclusion, it is argued that, if rights are to be a helpful concept, they must be carefully defined and analysed, and their relationship to one another, and to duties, must be clarified.