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PubMed1988

The peaceable pluralistic society and the question of persons.

In his recent book The Foundation of Bioethics, H. Tristam Engelhardt Jr. advances the idea of a peaceable pluralist moral society based on principles of autonomy, beneficience, and ownership. This paper tries to show that unless there is one and only one rationally sustainable definition of "a person", then the peaceable society cannot remain peaceable, but will be stirred up by groups with different and equally rational definitions. The paper further tries to show that Engelhardt's own definition of "persons in the strict sense" is an unsatisfactory solution to the problem, and the same is true for any of the possible compromises.

Beginning of Human Life↗
PubMed2005

The ethics of policy writing: how should hospitals deal with moral disagreement about controversial medical practices?

Every healthcare organisation (HCO) enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it.Using, as an example, the controversy about patient's refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency. Policy writing for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO's obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy.

Bioethical Issues↗
PubMed1995

Chinese Confucian culture and the medical ethical tradition.

The Confucian culture, rich in its contents and great in its significance, exerted on the thinking, culture and political life of ancient China immense influences, unparalleled by any other school of thought or culture. Confucian theories on morality and ethics, with 'goodness' as the core and 'rites' as the norm, served as the 'key notes' of the traditional medical ethics of China. The viewpoints of Confucianism on benevolence and material interests, on good and evil, on kindheartedness, and on character cultivation were all inherited by the medical workers and thus became prominent in Chinese traditional medical ethics. Hence, it is clear that the medical profession and Confucianism have long shared common goals in terms of ethics. Influenced by the excellent Confucian thinking and culture, a rather highly-developed system of Chinese traditional medical ethics emerged with a well-defined basic content, and the system has been followed and amended by medical professionals of all generations throughout Chinese history. This system, just to mention briefly, contains concepts such as the need: to attach great importance to the value of life; to do one's best to rescue the dying and to heal the wounded; to show concern to those who suffer from diseases; to practise medicine with honesty; to study medical skills painstakingly; to oppose a careless style of work; to comfort oneself in a dignified manner; to respect local customs and to be polite; to treat patients, noble or humble, equally, and to respect the academic achievements of others, etc. Of course, at the same time, Confucian culture has its own historical and class limitations, which exerted negative influences on traditional medical ethics. Now, if we are to keep up with the development of modern medicine, a serious topic must be addressed. That is how to retain the essence of our traditional medical ethics so as to maintain historic continuity and yet, at the same time, add on the new contents of medical ethics so as to incorporate modern features into our system. Therefore, when trying to reform medical practice in China, we are faced with the urgent need to inherit and promulgate the essence of Confucian ethics--discarding its obsolete concepts--while at the same time building up the new medical ethics that can meet the requirements of the outside world and the future.

Beneficence↗
PubMed1996

Ethical decision-making by staff nurses.

Ethical decision-making is inherent in nursing practice. Although a definite portion of the nursing literature is devoted to ethics and ethical decision-making, the profession is just beginning to ground its ethics research in the actual experience of nurses. Therefore, the purpose of this phenomenological study was to examine the experience of staff nurses as they engage in ethical decision-making. Interview data were collected from 19 staff nurses in a large, midwestern American metropolitan hospital. Interviews were subsequently transcribed and Giorgi's method of data analysis applied. The emerging description revealed four common aspects of ethical decision-making among staff nurses: context, trigger, ethical decision-making process (i.e. deliberation and integration), and outcomes. This description provides a foundation for future research regarding a descriptive theory of ethical decision-making in nursing.

Adult↗
PubMed2001

Response: persistent perplexities.

This response to the preceding five articles highlights the stubborn persistence of the philosophical perplexities surrounding commodification in the realm of medicine and biotechnology.

Bioethical Issues↗
PubMed1989

Community health nurses. Their most significant ethical decision-making problems.

Community health staff nurses confront a variety of significant ethical problems in practice that require focused attention in nursing education programs and in community nursing agencies. All community health nurses need to learn to identify ethical problems and to learn a process for resolving these problems that incorporates ethical perspectives. This is particularly critical because nursing colleagues depend on one another for help in dealing with ethical problems in practice. To ignore the ethical problems in community health nursing practice and to neglect to teach the knowledge and skills required to deal with them is to fail to provide nurses with essential skills for providing nursing and health care in community settings.

Beneficence↗
PubMed1989

Ethics committees in health care institutions in the New York City metropolitan region: a report of two nursing surveys.

Two surveys were conducted independently to ascertain whether health care institutions in the New York City metropolitan region currently have ethics committees and to gather information related to their functioning and use by nurses. Comparable findings in the overlapping samples suggest that approximately one-third of surveyed institutions do not have interdisciplinary ethics committees. Where the committees do exist, they may not be adequate to address nurses' ethical concerns.

Bioethical Issues↗