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Must treatment be provided to subjects who acquire HIV during the course of a prevention study? An analysis of ethical foundation, regulation, and recent argumentation provides no basis for the obligation. We outline an alternative approach to the problem based on moral negotiation.
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This paper argues that we have a moral obligation to enhance human beings. It is argued that if one is committed to the moral obligation to treat and prevent disease, one is also committed to genetic and other enhancement in so far as this promotes human well-being. It is argued that this is not eugenic but expresses our fundamental human nature: to make rational decisions and to try to improve ourselves. To be human is to strive to be better.
The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants' examples of ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians' 'doings' and tensions in expressing moral awareness. A main theme was formulated as caring about--caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing.
The moral obligations and ethical duties of health care professionals responsible for the care of a pregnant woman, a fetus, and a child are complex and evolve with gestation and birth. Well-intentioned physicians and others concerned with the interests of pregnant women and their fetuses may disagree about the moral status of the fetus and ethical duties owed to both the woman and fetus. This article lays out a framework for thinking about these issues from several perspectives.
Common-sense holds that morality requires people who know that they are infected with the Human Immunodeficiency Virus (HIV) to disclose this fact to their sexual partners. But many gay men who are HIV-positive do not disclose, and AIDS Service Organizations (ASOs) promote public-health policies based on safer sex by all, rather than disclosure by those who know that they are infected. The paper shows that the common-sense view follows from a minimal sexual morality based on consent. ASOs' seeming rejection of the view follows from their need to take seriously widespread weakness of will in the realm of sexuality. The author argues that gay men take themselves to follow the common sense view, but hold that the possibility of a partner's HIV infection is background information that need not be disclosed for sexual consent. This suggestion is criticized. The paper concludes with a consideration of HIV disclosure and sexual ethics outside of the gay community and of legal restrictions on the sexuality of the HIV-positive.
After a unilateral focus on medical professional obligations to patients in most of the 20th century, there is a growing, if modest, interest in patient responsibility. This article critiques some public assertions, explores the ethics literature, and attempts to find some consensus and moral grounds for positions taken on the question, "Does a patient have moral obligations in the process of interactions with medical and other professional caregivers?" There is widespread agreement on a few responsibilities, such as "truth telling" and "avoiding harm to others," but no apparent consensus either on the list of duties or on the appropriate justification for such duties. The context and clinical realities of patient interactions are noted to suggest that feasibility is important in making judgments of patient obligations.
Although it is expected that a social dilemma is solved by giving people feedback information about others' cooperative behavior, previous studies demonstrated that the information may promote cooperative behavior in some situations but may promote non-cooperative behavior in other situations. The study hypothesize that the feedback information of the others' cooperative behavior promote cooperative behavior for those who feel high obligation to cooperate in a social dilemma situation, such as a problem of bicycle parking behavior on road, but promote defective behavior for those who have low moral obligation. This is because the former people are hypothesized to attribute the cause of other's cooperative behavior to their social and intrinsic motivation, but the latter are hypothesized to attribute it to the egoistic motivation. The data from an experiment (n = 126) supported the hypotheses.
The HIV/AIDS epidemic is increasingly a disease of the disadvantaged, a destroyer of nations, and a threat to global security and well-being. But this need not be so: the world has the scientific knowledge, technological innovations, and financial resources to significantly reduce the spread and suffering caused by the disease. This paper argues that the wealthy nations of the world, led by the United States, have a moral obligation to offer much greater assistance to developing countries where the epidemic is most severe. Using Zimbabwe as a case study, this essay examines the immediate and underlying factors behind the epidemic in order to make realistic and affordable policy recommendations that include new investments in global health care, debt relief, and long-term economic development. By demonstrating our ability to dramatically affect the future course and consequences of this unprecedented epidemic, the paper concludes that greater action is not only in the interest of public health, but is also a moral imperative. By investing the necessary resources to improve public health and to reduce global poverty, we promote and extend the fundamental rights and values that we profess to hold dear.
As we rush around attending to the essentials of our lives (family, friends, clients, employers), what is left? Nursing Forum invites readers to engage in thoughts and activities that may awaken an untouched place. We hope these writings will kindle your personal involvement in something that was previously avoided--because of bias, fear, or uneasiness--in order to stretch your mind and spirit. The purpose of this paper is to explore the act of speaking up as a moral obligation and its relationship to moral courage and habit. The difficulties of speaking up and the consequences of silence are examined. The benefits of speaking up are raising self-respect, gaining courage, forming good habits and passing on that legacy.
The frequency with which casual breaches of confidentiality occur in hospitals suggests that relatively few health care professionals regard confidentiality as a matter of serious moral concern. A number of factors contribute to this laxness. First, breaches are almost never motivated by malice. Second, the person who breached confidentiality will probably be unaware of any harm that may result or of his or her role in having caused it. Third, such harm likely will consist of feelings of shame and embarrassment--consequences that lack moral seriousness for many persons. Finally, the sheer quantity of patient information that is supposed to be confidential, combined with the number of personnel who have a legitimate "need to know," militates against any serious attitude toward confidentiality. But confidentiality is a serious moral issue. An essential element of self-identity is the right to choose who has access to the intimate details of our lives. To undermine that right is to undermine individual autonomy. A number of steps can be taken to strengthen a hospital's commitment to confidentiality: Upon admission, nonemergency patients should be informed of who will have access to their medical record and why. patients should be asked who should be kept informed of the details of their medical condition and who should be denied such details. Health care professionals should not be intimidated by persons who demand patient information but have no clear right to it. Such individuals should be referred to someone who can determine whether they are entitled to the information.
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Previously we had speculated that the patient-proxy relationship existed on a contractual to covenantal continuum. In order to assess this hypothesis, and to better understand the moral obligations of the patient-proxy relationship, we surveyed 50 patient-proxy pairs as well as 52 individuals who had acted as proxies for someone who had died. Using structured vignettes representative of three distinct disease trajectories (cancer, acute stroke, and congestive heart failure), we assessed whether respondents believed that proxies should follow explicit instructions regarding life-sustaining therapy and act contractually or whether more discretionary or covenantal judgments were ethically permissible. Additional variables included the valence of initial patient instructions--for example, "to do nothing" or "to do everything"--as well as the quality of information available to the proxy. Responses were graded on a contractual to covenantal continuum using a modified Likert scale employing a prospectively scored survey instrument. Our data indicate that the patient-proxy relationship exists on a contractual to covenantal continuum and that variables such as disease trajectory, the clarity of prognosis, instructional valence, and the quality of patient instructions result in statistically significant differences in response. The use of interpretative or covenantal judgment was desired by patients and proxies when the prognosis was grim, even if initial instructions were to pursue more aggressive care. Nonetheless, there was a valence effect: patients and proxies intended that negative instructions to be left alone be heeded. These data suggest that the delegation of patient self-determination is morally complex. Advance care planning should take into account both the exercise of autonomy and the interpretative burdens assumed by the proxy. Patients and proxies think inductively and contextually. Neither group viewed deviation from patient instructions as a violation of the principal's autonomy. Instead of adhering to narrow notions of patient self-determination, respondents made nuanced and contextually informed moral judgments. These findings have implications for patient education as well as the legal norms that guide advance care planning.
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The emergence of HIV infection and AIDS has refocused concern on the obligations surrounding the carrying and transmission of communicable diseases. This article asks three related questions: Is there a general duty not to spread contagion? Are there special obligations not to communicate disease in the workplace? And does the mode of transmission of the disease affect the ethics of transmission and, if so, how and to what extent? There seems to be a strong prima facie obligation not to harm others by making them ill where this is avoidable, and this obligation not to communicate disease applies as much to relatively trivial diseases like the common cold as it does to HIV disease. The reasonableness of expecting people to live up to this obligation, however, depends on society reciprocating the obligation in the form of providing protection and compensation.