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PubMed2003

Integrity in the care of elderly people, as narrated by female physicians.

Three female physicians were interviewed as part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experience of being in ethically difficult care situations in the care of elderly people. The interviewees expressed great concern for the low status of care for elderly people, and the need fight for the specialty and for the care and rights of their patients. All the interviewees' narratives concerned problems relating to perspectives of both action ethics and relational ethics. The main focus was on problems concerning the latter perspective, expressed profound concern and respect for the individual patient. Secondary emphasis was placed on relationships with relatives and other professionals. The most common themes in action ethics perspective were too little treatment and the lack of health services for older patients, together with overtreatment and death with dignity. These results were discussed in the light of Løgstrup's ethics, which emphasize that human life means expressing oneself, in the expectation of being met by others. Both Ricoeur's concept of an ethics of memory and Aristotle's virtue ethics are presented in the discussion of too little and too much treatment.

Adaptation, Psychological↗
PubMed2003

A pilot study of selected Japanese nurses' ideas on patient advocacy.

This pilot study had two purposes: (1) to review recent Japanese nursing literature nursing advocacy; and (2) to obtain data from nurses on advocacy. For the second purpose, 24 nurses at a nursing college in Japan responded to a questionnaire. The concept of advocacy, taken from the West, has become an ethical ideal for Japanese nurses but one that they do not always understand, or, if they do, they find it difficult to fulfil. They cite nursing leadership support as necessary to enacting this role. Discussion on meaning of and the rationale for advocacy in a society where goodness or badness is relative to social situations and its impact may reveal two parallel but overlapping views of morality. Such a situation would not only influence notions of advocacy but also possibly render them more complex.

Adult↗
PubMed2004

Dignity and respect for dignity--two key health professional values: implications for nursing practice.

It is argued that dignity can be considered both subjectively, taking into account individual differences and idiosyncrasies, and objectively, as the foundation of human rights. Dignity can and should also be explored as both an other-regarding and a self-regarding value: respect for the dignity of others and respect for one's own personal and professional dignity. These two values appear to be inextricably linked. Aristotle's doctrine of the mean enables nurses to reflect on the appropriate degree of respect for the dignity of others and of respect for themselves. To develop an understanding of the rationale for and the significance and implications of dignity in health care practice, a view of human nature is proposed that implies vulnerability and fallibility, and that urges that an ethic of aspiration is embraced. Anonymized vignettes are included to illustrate points about the everyday nature of dignity.

Ethical Relativism↗
PubMed1991

Animals in biomedical research: the undermining effect of the rhetoric of the besieged.

It is correctly asserted that the intensity of the current debate over the use of animals in biomedical research is unprecedented. The extent of expressed animosity and distrust has stunned many researchers. In response, researchers have tended to take a strategic defensive posture, which involves the assertation of several abstract positions that serve to obstruct resolution of the debate. Those abstractions include the notions that the animal protection movement is trivial and purely anti-intellectual in scope, that all science is good (and some especially so), and the belief that an ethical consensus can never really be reached between the parties.

Animal Experimentation↗
PubMed1992

Nonrelativist ethical standards for goal setting in psychotherapy.

In this article, I discuss two principles that can be viewed as universally applicable in psychotherapy and counseling: respect for clients' welfare and respect for their self-determination. Consideration of the practical application of these principles leads to the formulation of a set of guidelines to aid therapists and counselors in making choices about instrumental and end goals. These guidelines are intended to be applicable regardless of the particular personal and cultural values of the therapist and client.

Altruism↗
PubMed1992

The ethical judgment of animal research.

One hundred sixty subjects acted as members of a hypothetical Institutional Animal Care and Use Committee and evaluated five proposals in which animals were to be used for research or educational purposes. They were asked to approve or reject the proposals and to indicate what factors were important in reaching their ethical decisions. Gender and differences in personal moral philosophy were related to approval decisions. The reasons given for the decisions fell into three main categories: metacognitive statements, factors related to the animal, and factors related to the design of the experiment.

Animal Care Committees↗
PubMed1995

Case vignette: child abuse or acceptable cultural norms -- child psychiatrist's response; ethical issues in culturally relevant interventions; cultural contexts.

Three families from the nation of the Gambia have become socially acquainted in the greater Metropolis area where they have relocated from their native country. All three families have preadolescent daughters. None of the girls has as yet undergone the ritual "female circumcision" commonly practiced in their native country. Five of the six parents think it would be a good idea to hold such a ritual ceremony in Metropolis next month. The sixth parent is uneasy about the procedure and wonders if it is appropriate anyway. The parent comes to talk with you, a physician or mental health professional, about this. The parent describes concerns about the procedure and the practice in general, but notes that some groups in the United States do "similar things," referring to the ritual circumcision of Jewish boys at 8 days of age. The parent adds that if the procedure is not possible in the United States, it could be done in the Gambia when the family returns there on holiday. Discussants were asked for their opinions regarding advice to the parent's ethical obligations (especially in the case of mandated reporting of suspected child abuse).

Africa↗
PubMed2002

Cultural considerations in release of information.

In most mental health professions, confidentiality is probably the most important ethical principle in psychology, aside from nonmalfeasance. However, confidentiality is embedded in the Western values of individuality and autonomy. This creates a moral and ethical dilemma for clinicians working with clients from other cultures. This article presents 3 cases to highlight the conflict that many clinicians are likely to face with regard to confidentiality when working with clients from South Asia and similar cultures. The importance of understanding how cultural values may contradict professional ethics and some ways in which the clinician can address them are also discussed.

Asia↗
PubMed2003

The ethical ideologies of psychologists and physicians: a preliminary comparison.

The ethical ideologies of psychologists (who provide health services) and physicians were compared using the Ethics Position Questionnaire. The findings reveal that psychologists tend to be less relativistic than physicians. Further, we explored the degree to which physicians and psychologists report being influenced by a variety of factors (e.g., family views) in their ethical decision making. Psychologists were more influenced by their code of ethics and less influenced by family views, religious background, and peer attitudes than were physicians. We argue that these differences reflect the varied professional cultures in which practitioners are trained and socialized.

Codes of Ethics↗
PubMed2004

Universal ethical principles in a diverse universe: a commentary on Monshi and Zieglmayer's case study.

Monshi and Zieglmayer's case study presents Sri Lankan participants as having views on the privacy of health information that differ radically from those commonly found in Western nations. This article explores 2 questions that their case study raises for the ethical review of research in international settings: First, are allegedly universal ethical principles--of the sort promulgated in the Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978)--useful in international settings?, and second, how should research oversight bodies address the challenges that arise in international behavioral and social science research?

Behavioral Research↗
PubMed1994

In the light of the splendor: Veritatis Splendor and moral theology.

In the last 25 years, Roman Catholic moral theology has debated issues ranging from the sources of moral theology to the role of ecclesiastical authority in moral theology. In 1993, Pope John Paul II issued his encyclical letter Veritatis Splendor, which addresses issues in fundamental moral theology. The encyclical must be understood against the background of ongoing debates since Pope Paul VI's 1968 encyclical on birth control (Humanae Vitae). It is not clear what the impact of Veritatis Splendor will be. However, it seems safe to say that it will be deployed in debates about issues such as birth control, artificial reproduction, sterilization, and abortion.

Abortion, Induced↗
PubMed1996

Looking back and judging our predecessors.

The Advisory Committee on Human Radiation Experiments has correctly argued that persons and institutions can sometimes be held responsible for actions taken more than a half-century ago, when practices and policies on the use of research subjects were strikingly different. In reaching its conclusions, the Committee did not altogether adhere to the language and commitments of its own ethical framework. In its Final Report, the Committee emphasizes judgments of wrongdoing, to the relative neglect of culpability; it discusses mitigating conditions that are exculpatory, but does not provide a thoroughgoing assessment of either culpability or exculpation. However, the Committee's shortcomings are mild in comparison to the deficiencies in the "Report of the UCSF Ad Hoc Fact Finding Committee on World War II Human Radiation Experiments" of the University of California at San Francisco. The latter report reaches no significant judgments of either wrongdoing or culpability. The findings that should have been reached by both committees are discussed.

Advisory Committees↗
PubMed1998

A theory of international bioethics: multiculturalism, postmodernism, and the bankruptcy of fundamentalism.

The first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews "moral fundamentalism," the theory that cross-cultural moral judgments and international bioethical codes are justified by certain "basic" or "fundamental" moral priniciples that are universally accepted in all cultures and eras. Initially propounded by the judges at the 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model -- a model of negotiated moral order -- as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.

Advisory Committees↗
PubMed1998

A theory of international bioethics: the negotiable and the non-negotiable.

The preceding article in this issue of the Kennedy Institute of Ethics Journal presents the argument that "moral fundamentalism," the position that international bioethics rests on "basic" or "fundamental" moral prinicples that are universally accepted in all eras and cultures, collapses under a variety of multicultural and postmodern critiques. The present article looks to the contractarian tradition of Hobbes and Locke -- as reinterpreted by David Gauthier, Robert Nozick, and John Rawls -- for an alternative justification for international bioethics. Drawing on the central themes of this tradition, it is argued that international bioethics can be rationally reconstructed as a negotiated moral order that respects culturally and individually defined areas of nonnegotiability. Further, the theory of a negotiated moral order is consistent with traditional ideals about human rights, is flexible enough to absorb the genuine insights of multiculturalism and postmodernism, and yet is strong enough to justify transcultural and transtemporal moral judgments, including the condemnation of the Nazi doctors at Nuremberg. This theory also is consistent with the history of the ethics of human subjects experimentation and offers insights into current controversies such as the controversy over changing the consent rule for experiments in emergency medicine and the controversy over exempting certain clinical trials of inexpensive treatments for preventing the perinatal transmission of AIDS from the ethical standards of the sponsoring country.

Bioethics↗
PubMed1998

The mettle of moral fundamentalism: a reply to Robert Baker.

This article is a reply to Robert Baker's attempt to rebut moral fundamentalism, while grounding international bioethics in a form of contractarianism. Baker is mistaken in several of his interpretations of the alleged moral fundamentalism and findings of the Advisory Committee on Human Radiation Experiments. He also misunderstands moral fundamentalism generally and wrongly categorizes it as morally bankrupt. His negotiated contract model is, in the final analysis, itself a form of the moral fundamentalism he declares bankrupt.

Advisory Committees↗
PubMed1998

A defense of fundamental principles and human rights: a reply to Robert Baker.

This article seeks to rebut Robert Baker's contention that attempts to ground international bioethics in fundamental principles cannot withstand the challenges posed by multiculturalism and postmodernism. First, several corrections are provided of Baker's account of the conclusions reached by the Advisory Committee on Human Radiation Experiments. Second, a rebuttal is offered to Baker's claim that an unbridgeable moral gap exists between Western individualism and non-Western communalism. In conclusion, this article argues that Baker's "nonnegotiable primary goods" cannot do the work of "classical human rights" and that the latter framework is preferable from both a practical and a theoretical standpoint.

Advisory Committees↗