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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↗

On becoming non-judgmental: some difficulties for an ethics of counselling.

The growth in the availability of counselling services has been accompanied by growing concern about the conduct of counsellors, which in turn has led to the expressed need for an ethics of counselling. This paper will argue that there is an inherent tension between this need and the central tenets of one variety of counselling, client-centred counselling. The tension is identifiable on the basis of an inquiry into the nature of moral judgment which results in the recognition of the implicit value base in client-centred counselling. It is only when this value base is made explicit that any adequate ethics of counselling becomes a viable possibility.

Attitude of Health Personnel↗

Nurses and requests for female genital mutilation: cultural rights versus human rights.

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between culture-relative values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described.

Africa↗

Fundamentalism, multiculturalism and problems of conducting research with populations in developing nations.

A growing number of nurse researchers travel globally to conduct research in poor and underserved populations in developing nations. These researchers, while well versed in research ethics, often find it difficult to apply traditional ethical standards to populations in developing countries. The problem of applying ethical standards across cultures is explained by a long-standing debate about the nature of ethical principles. Fundamentalism is the philosophical stance that ethical principles are universal, while the anthropologically-based 'multicultural' model claims the philosophical position that principles are culturally bound. The authors explicate the two philosophical stances and advocate a morally sensitive but moderate position of 'ethical multiculturalism' rather than favouring either of the above philosophical positions. The final section suggests ways to promote ethical multiculturalism while planning and conducting nursing research.

Cultural Diversity↗

Nursing ethics into the next millennium: a context-sensitive approach for nursing ethics.

The aim of this article is to argue for the need for a context-sensitive approach to the understanding of ethical issues in nursing practice as we face the next millennium. This approach means that the idea of universalism must be questioned because ethics is an interpersonal activity, set in a specific context. This view is based on issues that arise in international collaborative research as well as in research focused on ethical problems in nursing practice. Moral values are indigenous to a particular culture and influence beliefs about health and illness as well as what priorities are to be made in providing health care. Nursing practice must include thoughtful reflection on the meaning of moral concepts and principles in terms of culture. Theoretical developments in nursing ethics must be based on empirical research focusing on contextual aspects of health care.

Cultural Diversity↗

Global influence of American nursing: some ethical issues.

This article raises some questions about the global influence of nursing in the USA and describes some problems that may come about because of it. Selected American values that are embedded in nursing and ethics are found in American nursing education, practice and research. These can then be exported to countries with very different cultural definitions and values. One such country is Japan. The discrepancy between national cultural norms and imported ideals of nursing practices can create ethical problems for nurses in these countries.

Cultural Characteristics↗

Western medical ethics taught to junior medical students can cross cultural and linguistic boundaries.

BACKGROUND: Little is known about teaching medical ethics across cultural and linguistic boundaries. This study examined two successive cohorts of first year medical students in a six year undergraduate MBBS program. METHODS: The objective was to investigate whether Arabic speaking students studying medicine in an Arabic country would be able to correctly identify some of the principles of Western medical ethical reasoning. This cohort study was conducted on first year students in a six-year undergraduate program studying medicine in English, their second language at a medical school in the Arabian Gulf. The ethics teaching was based on the four-principle approach (autonomy, beneficence, non-malfeasance and justice) and delivered by a non-Muslim native English speaker with no knowledge of the Arabic language. Although the course was respectful of Arabic culture and tradition, the content excluded an analysis of Islamic medical ethics and focused on Western ethical reasoning. Following two 45-minute interactive seminars, students in groups of 3 or 4 visited a primary health care centre for one morning, sitting in with an attending physician seeing his or her patients in Arabic. Each student submitted a personal report for summative assessment detailing the ethical issues they had observed. RESULTS: All 62 students enrolled in these courses participated. Each student acting independently was able to correctly identify a median number of 4 different medical ethical issues (range 2-9) and correctly identify and label accurately a median of 2 different medical ethical issues (range 2-7) There were no significant correlations between their English language skills or general academic ability and the number or accuracy of ethical issues identified. CONCLUSIONS: This study has demonstrated that these students could identify medical ethical issues based on Western constructs, despite learning in English, their second language, being in the third week of their medical school experience and with minimal instruction. This result was independent of their academic and English language skills suggesting that ethical principles as espoused in the four principal approach may be common to the students' Islamic religious beliefs, allowing them to access complex medical ethical reasoning skills at an early stage in the medical curriculum.

Cohort Studies↗