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PubMed1995

The elimination of morality.

Anne Maclean has written a book which purports to identify and then definitively to reject the claims which she perceives to be the claims of bioethics. If she is right, then the enterprise to which this journal is dedicated is misconceived and worthless. In this paper, I attempt to show why so far from being not right she is comprehensively wrong, both in her understanding of the nature of bioethics and in the specific moral claims she makes about those she terms 'bioethicists'. Since much of her book-length study is devoted to a criticism of my own work, this paper analyses the extent to which Maclean's criticisms of me, and by extension, of other bioethicists, are sustainable.

Bioethics↗
PubMed2002

Arguments at cross-purposes: moral epistemology and medical ethics.

Different beliefs about the nature and justification of bioethics may reflect different assumptions in moral epistemology. Two alternative views (put forward by David Seedhouse and Michael H Kottow) are analysed and some speculative conclusions formed. The foundational questions raised here are by no means settled and deserve further attention.

Bioethical Issues↗
PubMed2001

Informed consent: moral necessity or illusion?

There is a professional and legal consensus about the clinical duty to obtain informed consent from patients before treating them. This duty is a reflection of wider cultural values about the moral importance of respect for individual autonomy. Recent research has raised practical problems about obtaining informed consent. Some patients have cognitive and emotional problems with understanding clinical information and do not apparently wish to participate in making decisions about their treatment. This paper argues that such research does not undermine their potential to provide informed consent. Rather, sufficient resources are required to create better communication skills among clinicians and more effective educational materials for patients. Finally, cognitive and emotional inequality among patients is maintained to be a reflection of wider social and economic inequalities. Researchers who take the right to informed consent seriously should also address these.

Communication↗
PubMed2006

Randomised trial of in-hospital geriatric intervention: impact on function and morale.

BACKGROUND: In two previous publications, we have shown that treatment of acutely sick, frail elderly patients in a Geriatric Evaluation and Management Unit (GEMU) compared to treatment in the general Medical Wards (MW) reduced mortality and improved the chances of living at home in contrast to living in nursing homes or being dead. OBJECTIVE: The aim of this presentation was to study the impact on function, symptoms of depression and general well-being of treatment in the GEMU as compared to treatment in MW. METHODS: Acutely sick, frail patients aged >or=75 years, admitted as emergencies to the Department of Internal Medicine, were randomised either to treatment in the GEMU (n = 127) or the MW (n = 127). In the GEMU the treatment strategy emphasised comprehensive interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilisation, rehabilitation and discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow-up. Activities of daily living (ADL), instrumental ADL, cognitive function, symptoms of depression and general well-being were assessed 3, 6 and 12 months after discharge from hospital. RESULTS: There was no difference in function, depression or general well-being in the GEMU as compared to the MW group. If the dead were included in the analysis at the highest ADL dependency level, there was better function in the GEMU group at 3 months (p = 0.03). CONCLUSION: Treatment in the GEMU had no measurable beneficial impact on function, morale or symptoms of depression. Taken the previously shown mortality reduction into consideration an additional effect on function was less likely and the overall treatment effect was considered to be positive.

Activities of Daily Living↗
PubMed2001

The care-based ethic of Nazi medicine and the moral importance of what we care about.

This article reports on an inquiry into ideas used to justify the shift of medical ethos in Germany prior to and during the Nazi era, specifically the principles of care advocated by Erwin Liek and Karl Kotschau, the era's most influential medical theorists, who argued that commitments to care of individual sick persons (Fursorge) had to give way to a preventive care that respects emerging needs of the entire society (Vorsoge). The article examines both the socio-cultural factors that shaped, and the far-reaching effects of, this manipulation of care. It argues that we should be attentive to the meaning and requirements of the care revealed in this debate, the ancient Greek idea of care as a concerned moral option.

Cultural Characteristics↗
PubMed2006

Medicine and moral virtue in the Expositio Problematum Aristotelis of Peter of Abano.

This paper examines a set of questions concerning moralia in Peter of Abano's Expositio Problematum (1310) and shows that its author takes a naturalistic approach, heavily reliant on medical doctrine, to propose that not only the lower virtues, but also those dependent on the rational soul, are closely tied to physiological states. For the irrational soul, this close connection with the body is not surprising. However, in the case of the rational virtues, the dependence on the body is more unusual and offers a significant example of Peter's application of medical doctrine beyond the established bounds of the discipline. His is a very different approach to human virtue than that of his contemporaries, and it blurs the distinction between moral virtue and natural virtue throughout his exposition. At the same time, this commentary offers insight into Peter's broader position on the soul.

History, Ancient↗
PubMed2003

Prisoners' perception of informing to the authorities: an analysis in terms of functional moral judgment.

A series of functional measurement experiment show that prisoners modulate their moral judgments of violations of their in-group regulations. The participants were 67 women and 80 men, sentenced for at least three years for murder, robbery, drug-traffic or white collar offenses. Each was asked, individually, to imagine a series of incidents where incriminating information on in-group or out-group inmates is delivered to the prison authorities or to an ingroup source and to rate the deserved denigration of the informer, who was characterized as a leader or not and as a drug-addict or not who had a prison-leave or not. An assignment of approximately equal weight for social status, drug use and prison leave was found, beyond gender and type of offense. In line with the hypothesis of judgmental modularity, informing to an out-group source was judged much more severely than informing to in-group arbiter and than informing on an out-group inmate.

Adult↗
PubMed2006

The relationship between moral reasoning, provictim attitudes, and interpersonal aggression among imprisoned young offenders.

This study examined the relationship between moral reasoning, provictim attitudes, and interpersonal aggression among imprisoned young offenders. The participants were 60 imprisoned male young offenders from a young offender institution or remand centre. Using the Direct and Indirect Prisoner Behaviour Checklist, the offenders were categorised as one of four groups: perpetrator, victim, perpetrator-victim, or not involved. Participants in the four groups were compared on measures of provictim attitudes and sociomoral reasoning. The results showed that the majority of the participants were involved in victimising behaviours, with 43.3% falling into the perpetrator-victim category. Victims had significantly more empathic attitudes toward victims than did those in the perpetrator-victim group. No significant differences were found among the four groups on the sociomoral reasoning measure, nor was there a significant correlation between sociomoral reasoning and provictim attitudes. The results are discussed in terms of previous research and their implications for practice.

Adolescent↗
PubMed2000

The influence of clinical supervision on nurses' moral decision making.

The aim of this study was to investigate the influence of clinical supervision on nurses' moral decision making. The sample consisted of 15 registered nurses who took part in clinical supervision sessions. Data were obtained from interviews and analysed by a hermeneutic transformative process. The hermeneutic interpretation revealed four themes: increased self-assurance, an increased ability to support the patient, an increased ability to be in a relationship with the patient, and an increased ability to take responsibility. In conclusion, it seems that clinical supervision enhances nurses' ability to provide care on the basis of their decision making. However, the qualitative and structural aspects of clinical supervision have to be investigated further in order to develop professional insight into the way that nurses think and react.

Adult↗
PubMed2001

Malfeasance and regaining nursing's moral voice and integrity.

This article discusses some of the most recent developments in US mental health services that follow on the heels of the for-profit hospital scandal that was brought to public attention less than a decade ago. As individuals and as a profession, nurses have a responsibility to uncover, openly discuss and condemn malfeasance when it occurs, yet there has been a collective silence about these developments. The authors explore the reasons for this and make recommendations for regaining nursing's moral voice and integrity.

Ethics, Institutional↗
PubMed1995

Measuring nurses' moral reasoning.

The purpose of this exploratory study was to examine the possibility of designing a satisfactory method, using written responses to hypothetical scenarios, for evaluating the quality of moral reasoning in student nurses. Scenarios were developed from interviews with practising nurses. Nurses and student nurses provided written responses to the scenarios, and nursing faculty members from six institutions sorted the responses according to their perceptions of quality (i.e. 'best', 'next best', 'worst' etc.). There was very little agreement among faculty members on the quality of the responses. Consequently, it was impossible to develop a 'best' response on which the faculty members could agree. Analysis revealed a framework used by the participants for ethical decision-making. The results of this study have important implications for the way in which we think about the teaching and the evaluation of nursing ethics.

Beneficence↗
PubMed1997

Professional solidarity versus responsibility for the health of the public: is a nurses' strike morally defensible?

The purpose of this article is to deliberate the moral and legal dilemma entailed in the weapon of the labour strike as a pressure tactic on the Israeli Finance Ministry regarding job slots, budgets and, in effect, violating the collective agreement signed by the nurses and impairing patients' treatment, as opposed to refraining from striking and suffering the heavy burden of work, the lack of trained personnel, low wages, and the inability to give patients proper, high quality treatment.

Codes of Ethics↗
PubMed1998

Racism and its implications in ethical-moral reasoning in nursing practice: a tentative approach to a largely unexplored topic.

Nursing as a profession seems to avoid considering the problem of racism. There is, however, a need to address this topic and to evaluate its implications for nursing practice. This article attempts to establish a rationale for nursing to address racism and introduce it into academic discourse. The results of a small-scale study by the author are analysed and the implications for ethical-moral reasoning in nursing practice are discussed in relation to professional codes of conduct developed by nurses' professional organizations in the UK and elsewhere.

Conflict, Psychological↗
PubMed1999

Care as a moral attitude in nursing.

The concept of care can be explained in various ways, and it can present a different meaning to each person. Nurses are increasingly aware that good nursing care consists of 'more' than the competent performance of a number of caring activities. For many nurses it is less clear what this 'more' means and what importance it has in nursing. This article will develop a view concerning care considered as a moral attitude. It is argued that care can be considered as a foundational normative concept in the ethics of the nursing profession. The aim is to clarify that nurses do not derive their specific caring identity just from the set of tasks that they perform but also from the way in which they commit themselves to the caring process.

Empathy↗
PubMed2004

Stories, moral judgment, and medical care in an intensive care unit.

A division of labor exists between nurses and doctors in a surgical intensive care unit. Nurses perform a culturally identified feminine expressive role, caring about patients as well as for them. Doctors perform a culturally identified masculine instrumental role, concerned with curing patients' bodies. The nurses are interested in the patients' stories; the doctors attempt to ignore the stories to concentrate on returning patients to function. Based on the patient's story, however, the nurses make severe judgments as to moral worth. Such judgments can impair medical care. Must doctors, then, disregard patients' stories? In other words, must they limit themselves to caring for patients' bodies, attempting to ignore the individuals, situated in a web of social relationships, who inhabit those bodies?

Aged↗
PubMed2001

Neuroscience and morality.

Humans are social animals who use specialized brain mechanisms to assess the actions of others. This system for social cognition can be studied by imaging techniques, and its damage can lead to inappropriate social and moral behavior. Neuroscience can thus enrich our understanding of behaviors traditionally thought to be outside the province of science.

Brain↗
PubMed2005

Moral understanding in children with autism.

Children with autism were compared with control groups on their ability to make moral judgements. Participants were presented with pairs of vignettes in which actions were either deliberate or accidental and caused injury to a person or damage to property. Participants were asked to judge which protagonist was the naughtier and to verbally justify this judgement. Results showed that the children with autism were as likely as controls to judge culpability on the basis of motive, and to judge injury to persons as more culpable than damage to property. Children with autism also offered some appropriate verbal justifications for their judgments although most justifications were of poor quality and reiterated the story. Results are discussed in terms of theory of mind and the possible role of deficits in complex reasoning and executive functions.

Autistic Disorder↗
PubMed2006

The moral experience of parents regarding life-support decisions for their critically-ill children: a preliminary study in France.

The common paediatric critical care practice in France is for physicians (rather than parents) to maintain the ultimate responsibility for lifesupport decisions in children. Some French literature asserts that it is inappropriate for parents to bear such responsibilities because they do not have the required knowledge and should be protected from feeling culpable for such decisions. The aim of this grounded theory preliminary study was to examine the moral experience of parents of critically-ill children that required life-support decisions in France. A convenience purposive sample of seven parents was recruited in Paris. Five principal themes emerged as significant from these interviews: (1) a need for more information; (2) physicians should be responsible for life-support decisions; (3) the child's concerns and wishes need to be better heard; (4) maternal guilt; and (5) physicians require better training in parent communication. These findings raise important issues for clinical practice and further research in France.

Adaptation, Psychological↗