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PubMed1998

Who is entitled to long-term health care? Emerging policy and moral debate.

This paper focuses on emerging British health policy which emphasizes the use of locally determined restrictive criteria to assess access to state provision for long-term health care and the individual's responsibility to plan to meet their own long-term health care needs. Inconsistency in current health policy and ambiguity in the relevant central guidance are explored. This is contextualized in a philosophical framework which seeks to highlight the moral justification underpinning different patterns for the distribution of health care. These issues are of direct relevance to nurse managers because these fundamental changes surface in dilemmas in the management of care and interaction in the multidisciplinary team.

Eligibility Determination↗

PubMed2003

Moral stress and burnout: qualitative content analysis.

The aim of the present study was to describe and interpret the narrative of an Australian nurse's experience of burnout. A qualitative content analysis was used for the text of the interview. The main findings of this study concern moral stress and burnout. Three themes were identified: shortcomings and health problems; hovering between suffering and desire; and responsibility for oneself. All themes are related to the nurse's identity, the nurse's personal experience of, and reflections on, ethical problems and the existential issues of suffering, and the responsibilities and difficulties nurses face. The findings are explained and discussed in light of several theories. In conclusion, nurses' needs have to be recognized. They need both emotional support and the right to receive systematic clinical supervision to help them reflect on their practical work and interpret the needs of patients.

Attitude of Health Personnel↗

PubMed2005

Indirect reciprocity, image scoring, and moral hazard.

Whether one-shot interactions can stably sustain mutual cooperation if they are based on a minimal form of reputation building has been the subject of considerable debate. We show by mathematical modeling that the answer is positive if we assume an individual's social network evolves in time. In this case, a stable mixture of discriminating and undiscriminating altruists can be proof against invasion by defectors. This sheds light on current discussions about the merits of different types of moral assessment, an issue where theoretical arguments and experimental findings seem at odds.Unexpectedly, our approach also relates to the proverbial observation that people tend to become more tightfisted with age.

Journal Article↗

PubMedDate not supplied

Physician-assisted suicide, euthanasia, and Christian bioethics: moral controversy in Germany.

Discussions in Germany regarding appropriate end-of-life decision-making have been heavily influenced by the liberalization of access to physician-assisted suicide and voluntary active euthanasia in the Netherlands and Belgium. These discussions disclose conflicting moral views regarding the propriety of physician-assisted suicide and euthanasia, threatening conflicts within not only the medical profession, but also the mainline churches in Germany, whose membership now entertains views regarding end-of-life decision-making at odds with traditional Christian doctrine. On the surface, there appears to be a broad consensus supporting the hospice movement and condemning physician-assisted suicide and euthanasia. The German Supreme Court has held that treatment decisions should, in absence of known patients' wishes, be made in light of commonly shared values, unless these violate the principle of "in dubio pro vita". The Roman Catholic church and the Evangelical Lutheran church in Germany have developed an advance directive for treatment choices at the end of life, while condemning physician-assisted suicide and euthanasia. This stance is in tension with the strong emerging support for physician-assisted suicide and euthanasia, a development that promises to open up foundational disagreements within mainline German Christianity regarding the appropriate approach to intentionally terminating human life.

Advance Directives↗

PubMed2004

The payment of drug addicts to increase their sterilisation rate is morally unjustified and not simply 'A Fine Balance'.

This paper argues that cash incentives offered to drug addicts in return for sterilisation are both legally and morally unacceptable. Such incentives act coercively, undermines one's freedom and autonomy and importantly invalidates real consent. This has important implications for any clinicians involved in such a scheme. The paper prompts more detailed studies into the use of incentives in modern-day health care.

Coercion↗

PubMedDate not supplied

Mandatory reporting of abuse: practical, moral, and legal issues for psychiatric home healthcare nurses.

Psychiatric home healthcare nurses (PHHNs) work directly with clients and their families in the community and serve as consultants to other home health nurses when concerns of mental health arise. They must be able to identify areas of possible or actual family violence or abuse and intervene appropriately. They must be cognizant of the laws regarding abuse reporting in their states. Decisions to report abuse are practical and moral and, when combined with legal imperatives, create ethical dilemmas for healthcare professionals. Guidelines are presented to help PHHNs understand the complex issues associated with mandatory reporting of abuse.

Adult↗

PubMedDate not supplied

Adult age differences in recall of a moral dilemma under intentional, incidental and dual task instructions.

Age changes in memory discourse were examined under conditions where participants were asked to listen to a passage about a moral dilemma: (a) for later recall of main ideas and details (Intentional Recall); (b) to propose solutions for it (Incidental Recall), or (c) to do both (Dual Task). Sixty young (19-32 years) and 60 old (60-76 years) adults participated, 20 of each age in each condition. Older adults gave fewer verbatim responses but more inferences, elaborations and overgeneralizations, an outcome which contrasted with earlier findings that older adults cannot process implied meanings. Verbatim recall was lower with Dual Task than with Intentional Recall instructions, suggesting that doing two tasks required more processing capacity, but there were no age x condition interactions with any measure. The results were discussed in relation to possible age decrements in processing capacity and possible age differences in interpreting the recall instructions.

Adult↗

PubMedDate not supplied

Deception in psychology: moral costs and benefits of unsought self-knowledge.

Is it ethically permissible to use deception in psychological experiments? We argue that, provided some requirements are satisfied, it is possible to use deceptive methods without producing significant harm to research participants and without any significant violation of their autonomy. We also argue that methodological deception is at least at the moment the only effective means by which one can acquire morally significant information about certain behavioral tendencies. Individuals in general, and research participants in particular, gain self-knowledge which can help them improve their autonomous decision-making. The community gains collective self-knowledge that, once shared, can play a role in shaping education, informing policies and in general creating a more efficient and just society.

Behavioral Research↗

PubMed1996

Health, fortune, and moral authority in medicine.

The Christian conviction about Divine Providence encourages a novel account of the moral content of health and authority in the health care context. While health can be understood as the disposition of a living body to be able to proceed in the world well, as a species of freedom it is informed by the particular projects and concerns that Christians hold deepest. This is due to the fact that health acquires content, and thus becomes desirable as a particular type of good, only in relation to judgments about the good life. Aquinas' reflections concerning the good of health and its partial slavery to fortune reveal a Christian past that dwelt on the intrinsic and instrumental good of health. A rich Christian tradition in which health as intrinsically good, a good of the body, is ordained to the interests of right Christian virtue. Each of these factors affects the character of the health to be pursued and the authority of the physician as determining the ends and means of medicine.

Christianity↗

PubMed1994

The morality of clinical research--a case study.

The paper is a record of a debate which took place between a group of clinicians and the author concerning a clinical trial of a drug supposed to postpone the time when HIV-patients develop AIDS. A problem with the trial was that on available (inconclusive) evidence it appeared that one patient out of 500 was killed by the drug. The question raised was whether, in view of this evidence, it was morally defensible to go on with the trial. The discussion came to involve general topics such as the appropriate role of the ideal of autonomy as well as more particular topics of quantitative and qualitative risk assessments. The main thrust of the argument is that different conceptions of rationality may provide rationales of conflicting clinical decisions. Philosophy matters to medicine.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Nephrarious goings on. Kidney sales and moral arguments.

From all points of the political compass, from widely different groups, have come indignant outcries against the trade in human organs from live vendors. Opponents contend that such practices constitute a morally outrageous and gross exploitation of the poor, inherently coercive and obviously intolerable in any civilized society. This article examines the arguments typically offered in defense of these claims, and finds serious problems with all of them. The prohibition of organ sales is derived not from the principles and argument usually invoked in support of prohibition, but rather, from strong feelings of repugnance which exert an invisible but powerful influence on the debate, distorting the arguments [and working] to the detriment of the [very] people most in need of protection.

Commerce↗

PubMed2002

Lessons from everyday lives: a moral justification for acute care research.

Progress in emergency and critical care requires that clinical research be performed on patients who are incapable of granting consent for research participation. Analyses of the ethics of such research have left some questions incompletely answered. Why should we be permitted to expose vulnerable patients to research risks without their consent? In particular, how do we justify research interventions that have no potential benefit for participants (nontherapeutic interventions)? This article presents a moral justification for nontherapeutic interventions in emergency research. By relying on a framework for assessing research risks, and by drawing on the example of pediatric research, this justification is founded in how institutional review boards, and society in general, analyze risk. Our justification for emergency research also suggests additional protections for emergency research participants, including a stringent threshold for research risk, that still permit important research to proceed.

Child↗

PubMed1997

Key moral principles applied to managed care.

Although MCOs pose many challenges to the ethics of healthcare delivery, they also have the potential to minimize some previously existing unethical practices. The focus on maximum quality and cost-effectiveness places more demands on the provider with increased accountability. In the old unstructured, noncompetitive healthcare environment, providers were not as accountable to the patient for providing the best quality care at the best price. As home care agencies integrate with managed care networks, outcome measurement becomes increasingly important (National Association for Home Care, 1996). In the managed, integrated market, competition is strong and quality becomes a benchmark when alliances and mergers occur. Home care is in a prime position to be a major player in this new healthcare system and continue to expand services in a capitated environment while being challenged to uphold the ethical practice philosophy outlined in the basic moral principles discussed in this article.

Community Health Nursing↗

PubMed1994

The moral geography of home care.

One result of the historical division of labor between nurses and physicians is that nurses became the eyes and ears of the physician, extending their perceptual capabilities across space and time. This "gaze of medicine" has evolved with the rise of technology, hospitals, and the medical profession to a sort of scientific totalitarianism. Protecting and enhancing patient agency, which is part of the moral work of nursing practice, can be difficult under such circumstances. Yet the geography of sickness is changing as patients move from the hospital back to the home. Because home is thought of as private, as the patient's domain, nurses may think that supporting patient agency will be easier with this transformation of health care. But that assumption may not be warranted since the gaze of medicine will follow patients and change the landscape of the home. The challenge for nursing will be to sharpen the "gaze of nursing," which is an antidote to the strictly biomedical understanding of disease.

Ecology↗

PubMedDate not supplied

Speaking truth to power: nursing's legacy and moral imperative.

Critical caring has been proposed as a mid-range theory to guide public health nursing. One of its carative health promoting processes, contributing to the creation of supportive and sustainable physical, social, political, and economic environments, is particularly suited to enacting Nightingale's legacy of political action as an expression of caring. Increasing evidence supports the link between broad societal influences on health inequities. Relative and absolute poverty are significant influences on health and contribute significantly to differential health statuses of populations within and between countries. Nurses, who practice at the intersection of public policy and personal lives, are, therefore, ideally situated and morally obligated to include political advocacy and efforts to influence health public policy in their practice. The health of the public and the future of the profession may depend on it.

Ethics, Nursing↗

PubMedDate not supplied

Responding to threats of workplace violence: the effects of culture and moral panic.

Healthcare organizations, like all organizations, are increasingly more concerned about workplace violence. This paper discusses the collision of a cultural context that encourages macho posturing and moral panic related to highly publicized violence in schools and workplaces. At issue is the need for healthcare organizations to react to evidence of potential workplace violence but not to overreact.

Adult↗

PubMed2003

Moral justifications for surrogate decision making in the intensive care unit: implications and limitations.

Because patients are often unable to participate in the end-of-life decision making, caregivers turn to close family members to participate in discussions regarding care in the intensive care unit. This article describes the moral justifications for families being given considerable decision-making authority. However, embedded within these justifications are also some limitations to surrogate decision making. Rather than attempt to dogmatically resolve these thorny cases regarding a surrogate's request for what healthcare providers believe are unreasonable requests, we believe more attention should be paid to how healthcare providers and intensive care units can promote a surrogate's ability to make ethical decisions. We end by offering a number of specific suggestions for improving communication with surrogates.

Decision Making↗

PubMed2000

Reefer madness: legal & moral issues surrounding the medical prescription of marijuana.

California, Arizona, and several other states have recently legalized medical marijuana. My goal in this paper is to demonstrate that even if one grants the opponents of legalization many of their contentious assumptions, the federal government is still obligated to take several specific steps toward the legalization of medical marijuana. I defend this claim against a variety of objections, including the claims: that marijuana is unsafe, that marijuana cannot be adequately tested or produced as a drug, that the availability of synthetic THC makes marijuana superfluous, and especially that legalizing medical marijuana will increase recreational use by 'sending the wrong message.' I then go on to argue that given the intransigent position of the federal government on this issue, state governments are justified in unilaterally legalizing medical marijuana as an act of civil disobedience. A large portion of this paper consists of an extensive response to the objection that legalizing medical marijuana will 'send the wrong message'--which I take to be the primary impediment to legalization. This objection basically claims that the consequences of withholding legalization (especially preventing increased recreational use) are superior to those of legalizing medical marijuana. I argue that legalization is justified even if one were to grant both that the harms of legalization outweighed its benefits and that utilitarianism is true. This requires a subtle and somewhat extended discussion of utilitarian moral and political theory.

Cannabis↗