Background: In Hospital Emergency Department and Emergency Medical Services professionals experience situations in which they face difficulties or barriers to know patient’s advance directives and implement them. Objectives: To analyse the barriers, facilitators, and ethical conflicts perceived by health professionals derived from the management of advance directives in emergency services. Research design, participants, and context: This is a qualitative phenomenological study conducted with purposive sampling including a population of nursing and medical professionals linked to Hospital Emergency Department and Emergency (...) Medical Services. Three focus groups were formed, totalling 24 participants. We performed an inductive-type thematic discourse analysis. Ethical considerations: This study was approved by ethical committees of Ethical Commitee of Clínic Hospital (Barcelona) and Comittee of Emergency Medical Services (Barcelona). The participants received information about the purpose of the study. Patients’ anonymity and willingness to participate in the study were guaranteed. Findings: There were four types of barriers that hindered the proper management of patients’ advance directives in Hospital Emergency Department and Emergency Medical Services: personal and professional, family members, organisational and structural, and those derived from the health system. These barriers caused ethical conflicts and hindered professionals’ decision-making. Discussion: These results are in line with those of previous studies and indicate that factors such as gender, professional category, and years of experience, in addition to professionals’ beliefs and the opinions of colleagues and family members, can also influence the professionals’ final decisions. Conclusion: The different strategies described in this study can contribute to the development of health policies and action protocols to help reduce both the barriers that hinder the correct management and implementation of advance directives and the ethical conflicts generated. (shrink)

Background: A predictive genetic test for Huntington’s disease can be used before any symptoms are apparent, but there is only sparse knowledge about the long-term consequences of a positive test result. Such knowledge is important in order to gain a deeper understanding of families’ experiences. Objectives: The aim of the study was to describe a young couple’s long-term experiences and the consequences of a predictive test for Huntington’s disease. Research design: A descriptive case study design was used with a (...) longitudinal narrative life history approach. Participants and research context: The study was based on 18 interviews with a young couple, covering a period of 2.5 years; starting 6 months after the disclosure of the test results showing the woman to be a carrier of the gene causing Huntington’s disease. Ethical considerations: Even though the study was extremely sensitive, where potential harm constantly had to be balanced against the benefits, the couple had a strong wish to contribute to increased knowledge about people in their situation. The study was approved by the ethics committee. Findings: The results show that the long-term consequences were devastating for the family. This 3-year period was characterized by anxiety, repeated suicide attempts, financial difficulties and eventually divorce. Discussion: By offering a predictive test, the healthcare system has an ethical and moral responsibility. Once the test result is disclosed, the individual and the family cannot live without the knowledge it brings. Support is needed in a long-term perspective and should involve counselling concerning the families’ everyday life involving important decision-making, reorientation towards a new outlook of the future and the meaning of life. Conclusion: As health professionals, our ethical and moral responsibility thus embraces not only the phase in direct connection to the actual genetic test but also a commitment to provide support to help the family deal with the long-term consequences of the test. (shrink)

Two recent events have caused renewed anxiety concerning the ethics of donor transplantation. The first is the report of the British Transplantation Society and the second is the Bill introduced by Mr Tam Dalyell MP (see page 61 of this issue) in which he seeks to establish by law that unless an individual in his life time has expressly contracted out his organs may after death be used for transplantation. Dr Mahoney in this paper therefore examines from the point of (...) view of ethics some of the personal and social aspects of both proposals. (shrink)

The purpose of this study was to describe the extent to which nurses perceive the ethical dimensions of clinical practice situations involving patients, families and health care professionals. Using the composite theory of basic moral principles and the professional standard of care established by legal custom as a framework, situations involving ethical dilemmas were gleaned from the nursing literature. They were reviewed for content validity, clarity and representativeness in a two-stage process by expert panels. The situations (...) were presented in a written format to a convenience sample of nurses (n = 125), who were primarily staff nurses (65.6%). Respondents' judgements about whether the main issue of each situation concerned ethics ranged from a low of 0.8% to a high of 40%. From analyses of the categories into which the majority of subjects placed each situation, it was concluded that these nurses generally perceived ethics as the main issue in situations that directly involve patients' autonomy. Analysis yielded unanticipated findings about the themes in ethical situations to which nurses in practice may respond. (shrink)

The Jewish Family Ethics Textbook guides teachers and students of all ages and backgrounds in mining classical and modern Jewish texts to inform decision making on hard choices.

1988 : Does being a Christian physician really matter? / Edmund D. Pellegrino, response by John Robinson -- 1989: Clinical medical ethics: a review of the first decade / Mark Siegler, response by Maura Ryan -- 1990 : Who or what is an embryo? / Richard McCormick, response Margaret Monahan Hogan -- 1991: Euthanasia: Where is the debate going? / Daniel Callahan, response by Paul Weithman -- 1992: The moral inevitability of two tiers of health care / H. Tristram (...) Engelhardt, Jr., response by Joel James Shuman -- 1993: Compasionate care of the dying / James F. Bresnahan, response by John Young. (shrink)

Was macht heute die Wirklichkeit der Familie aus und wie erklart sich ihre Vernachlassigung im protestantisch-ethischen Diskurs? Beide Fragen hangen sachlich zusammen: Sabine Plonz entwickelt einen praxis- und regimetheoretischen Begriff der Familie, der normative Aspekte einbezieht. Sie stellt dar, wie restaurativ und patriarchalisch denkende protestantische Akteure die Ideologie- und Sozialgeschichte von Wohlfahrtsstaat und Familie beeinflusst haben; und sie zeigt, wie diese Moraldiskurse den Regimewandel spiegeln. Viele Quellenzitate machen die Rekonstruktion lebendig. Uberlegungen zu einer evangelischen Ethik des privaten Lebens nehmen die (...) gewonnenen Einsichten auf. Das Werk konfrontiert die Theologie erstmals mit hegemonie-, geschlechter- und religionskritischen Analysen ihrer Diskurse. Es erganzt die Familien-, Wohlfahrts- und Geschlechterforschung um die Dimension des Moralregimes. So eroffnet das engagiert geschriebene Buch neue Perspektiven fur Ethik und politische Praxis. (shrink)

In recent decades the improved treatment of childhood cancer has increased the proportion of children being cured. However, the intensive treatment required also implies a heavy burden for the children and their families. The purpose of this article is to judge the ethical aspects of different treatment regimens used for children with cancer by means of a case study. The analysis is based on the ethical model by Beauchamp and Childress. The assessment is based on every person, (...) or group of persons, involved and is on the principles of autonomy, nonmaleficence, beneficence and justice. The analysis shows that intensification of treatment of children with cancer is ethically justified from a deontological point of view. The consequences are more difficult to anticipate from a utilitarian perspective. Au cours de plusiurs décennies les traitements plus efficaces des cancers des enfants ont augmentés la proportion des enfants guéris. Pourtant, le traitement intensif pose aussi un lourd fardeau aux enfants et leurs familles. Le but de cet article est d'évaluer les implications éthiques des différents traitements utilisés pour enfants souffrants de cancer, à l'aide d'une étude particulière. L'analyse éthique est basée sur le modèle de Beauchamp et Childress. L'évaluation est basée sur chaque personne ou sur les groupes de personnes impliqués, et sur les principes d'autonomie, nonmaléficence, bénéficence et justice. L'analyse montre que l'intensification du traitement des enfants souffrant de cancer est justifié éthiquement du point de vue déontologique. Les conséquences de ces actions sont plus difficiles à prévoir vue d'une perspective utilitaire. Die verbesserte Behandlung von Kinderkrebs in den vergangenen Jahrzehnten hat die Proportion der geheilten Kinder ansteigen lassen. Die intensive Behandlung bedeutet aber auch eine schwere Belastung für die Kinder und ihre Familien. Der Zweck dieses Artikels ist es, die ethischen Aspekte der verschiedenen Behandlungsmethoden bei Kinderkrebs durch eine Fallstudie abzuwägen. Die ethische Analyse basiert auf dem ethischen Modell von Beauchamp und Childress. Die Beurteilung berücksichtigt jede betroffene Person oder Personengruppe und beruht auf den Prinzipien der Selbstbestimmung, Schädlichkeit bzw. Unschädlichkeit, Nutzen und Verträglichkeit und Gerechtigkeit. Diese Analyse zeigt, dass die Intensivierung der Behandlung von krebskranken Kindem von einem deontologischen Standpunkt aus ethisch vertretbar ist. Die Folgen der Behandlung sind jedoch vom Nützlichkeitsgesichtspunkt her schwieriger vorauszusehen. (shrink)

An Asian Indian Hindu family chose no intervention and hospice care for their newborn with hypoplastic right heart syndrome as an ethical option, and the newborn expired after five days. Professional nursing integrates values-based practice and evidence-based care with cultural humility when providing culturally responsive family-centered culture care. Each person’s worldview is unique as influenced by culture, language, and religion, among other factors. The Nursing Team sought to understand this family’s collective Indian Hindu worldview and end-of-life beliefs, values, and (...) practices, in view of the unique aspects of the situation while the team integrated evidence-based strategies to provide family-centered culture care. Parental care choices conflicted with those of the Nursing Team, and some nurses experienced moral distress and cultural dissonance when negotiating their deeply held cultural and religious views to advocate for the family. The inability to reconcile and integrate a stressful or traumatic experience impacts nurses’ well-being and contributes to compassion fatigue. Nurses need to be intentional in accessing interventions that promote coping and healing and moral resilience. Reflection and cultural humility, assessment, and knowledge in context, increase evidence-based culture care and positive outcomes. U.S. society’s views on ethical behavior continue to evolve, and some may argue that the law should place more limits on parents’ right to choose or to refuse treatment for their infants and children. Moral distress can lead to moral resilience and satisfaction of compassion when nurses provide family-centered culture care with cultural responsiveness and integrate values-based practice with evidence-based care, and aim to first do no harm. (shrink)

Patient self-management of disease is increasingly supported by technologies that can monitor a wide range of behavioural and biomedical parameters. Incorporated into everyday devices such as cell phones and clothes, these technologies become integral to the psychosocial aspects of everyday life. Many technologies are likely to be marketed directly to families with ill members, and families may enlist the support of clinicians in shaping use. Current ethical frameworks are mainly conceptualised from the perspective of caregivers, researchers, developers (...) and regulators in order to ensure the ethics of their own practices. This paper focuses on families as autonomous decision-makers outside the regulated context of healthcare. We discuss some morally relevant issues facing families in their decisions to monitor the health-related behaviours of loved ones. An example – remote parental monitoring of adolescent blood glucose – is presented and discussed through the lens of two contrasting accounts of ethics; one reflecting the predominant focus on health outcomes within the health technology assessment (HTA) framework and the other that attends to the broader sociocultural contexts shaping technologies and their implications. Issues discussed include the focus of assessments, informed consent and child assent, and family co-creation of system characteristics and implications. The parents’ decisions to remotely monitor their child has relational implications that are likely to influence conflict levels and thus also health outcomes. Current efforts to better integrate outcome assessments with social and ethical assessments are particularly relevant for informed decision-making about health monitoring technologies in families. (shrink)

The debate on the ethical permissibility of euthanasia in medicine has a corollary in the ethical application of drugs. The overall moral limits of medical treatment apply evenly to the moral acceptability of the pharmacological aspect of the act of euthanasia. The pharmacological aspect of the act is of ethical importance not only for the person requesting an active ending of his or her life, but also for the grieving family. Keywords: effectivity, ideal euthanaticum, patient's/family's (...) interest, pharmacology of euthanasia, routes of application CiteULike Connotea Del.icio.us What's this? (shrink)

As a consequence of the collapse of a building in Barcelona, in December 1990, it was discovered that a large number of dwellings, mainly in Barcelona but also in other towns of Catalonia, were affected by a structural defect known as aluminosis, consisting of a deterioration of the reinforced concrete manufactured using aluminous cement, which considerably reduced its strength and that of the steel embedded in the concrete. This brought to light a series of economic, social, political and also (...) class='Hi'>moral problems, such as the use of the aluminous cement itself — a quality product but which requires careful handling —, the lack of regulation concerning the product and its use in construction, the poor state of repair of the buildings affected, the careless manner in which they had been built, the lag in technical knowledge, the financial situation of the people affected by the aluminosis, etc.This document provides a full account of the events and their historical, technical, economic and legal background, paying particular attention to the ethical problems created by the situation. (shrink)

This book provides the reader with a theoretical and practical understanding of two health care delivery models: the patient/child centred care and family-centred care. Both are fundamental to caring for children in healthcare organizations. The authors address their application in a variety of paediatric healthcare contexts, as well as the ethical and legal issues they raise. Each model is increasingly pursued as a vehicle for guiding the delivery of health care in the best interests of children. Such models of (...) health care delivery shape health care policies, programs, facility design, resource allocation decisions and day-to-day interactions among patients, families, physicians and other health care professionals. To maximize the health and ethical benefits these models offer, there must be shared understanding of what the models entail, as well as the ethical and legal synergies and tensions they can create. This book is a valuable resource for paediatricians, nurses, trainees, graduate students, practitioners of ethics and health policy. (shrink)

This study examines the effects of socializing activity of the owned family in family firms in order to find out if the special characteristics of the socializing processes in this type of firm can contribute to defining a climate that favors employees' commitment to the organization.For this purpose, this study uses the main arguments of the sociological approach known as moral economy. The data required for this analysis was collected using a self-administered postal questionnaire and the results show that (...) the special type of socialization that takes place in the family firm, and particularly the emotional mediation that this type of socialization tends to entail, favors the appearance of noneconomic links between employers and employees. Thus, in family firms the climate favors the management of the affective, normative, and symbolic aspects. The authors consider that this provides an explanation for the higher levels of identification, involvement, and loyalty — and consequently organizational commitment — that they find empirically among the employees of such firms. (shrink)

Mental health professionals face many complex questions in the course of their work with clients and patients. Among the most difficult are dilemmas that involve ethical issues. This book presents a forthright exploration of these dilemmas and the ethical considerations they raise. Drawing on extensive interviews, the author identifies common ethical problems that practitioners encounter. What happens, for example, when personal interests intrude into therapy? How can the therapist make an accurate assessment of his or her appropriateness (...) as a care provider for a particular patient? What about confidentiality? How are problematic financial arrangements best addressed? The author goes on to show how these dilemmas may be intensified by the unique assumptions of different therapeutic orientations--individual, group, family, marital, and organizational--and how professionals can learn from such experiences to better understand and apply their particular approach. This analysis--and the words of the therapists themselves--provide both a guide to practice and a unique store of experience for the growing number of researchers and students concerned with ethical problems in psychotherapy. (shrink)

This article is based on a qualitative longitudinal study that followed the subjective experiences of both people living with dementia and their family members during the early stages of the illness. The purpose of this article is to describe and reflect on the ethical and methodological issues that occurred during data collection. The article focuses on the situation of the person with dementia and the family member and the role of the researcher when conducting the research interviews. Based on (...) the results of this study, conducting research interviews with people with dementia and their family members poses several ethical and methodological challenges that must be addressed. In doing so, ethically sound dementia-specific research methods will be actively developed enhancing our understanding of living with dementia and providing new insights into the care of people with dementia and their family members. (shrink)

The family is hotly contested ideological terrain. Some defend the traditional two-parent heterosexual family while others welcome its demise. Opinions vary about how much control parents should have over their children's upbringing. Family Values provides a major new theoretical account of the morality and politics of the family, telling us why the family is valuable, who has the right to parent, and what rights parents should—and should not—have over their children. Harry Brighouse and Adam Swift argue that parent-child relationships produce (...) the "familial relationship goods" that people need to flourish. Children's healthy development depends on intimate relationships with authoritative adults, while the distinctive joys and challenges of parenting are part of a fulfilling life for adults. Yet the relationships that make these goods possible have little to do with biology, and do not require the extensive rights that parents currently enjoy. Challenging some of our most commonly held beliefs about the family, Brighouse and Swift explain why a child's interest in autonomy severely limits parents' right to shape their children's values, and why parents have no fundamental right to confer wealth or advantage on their children. Family Values reaffirms the vital importance of the family as a social institution while challenging its role in the reproduction of social inequality and carefully balancing the interests of parents and children. (shrink)

This study investigates the ethical aspects of deploying and researching into so-called climate engineering methods, i.e. large-scale technical interventions in the climate system with the objective of offsetting anthropogenic climate change. The moral reasons in favour of and against R&D into and deployment of CE methods are analysed by means of argument maps. These argument maps provide an overview of the CE controversy and help to structure the complex debate.

In this paper, I discuss some central ethical aspects of self-forgiveness. A first comparison is made between interpersonal forgiveness and self-forgiveness. It would seem that self-forgiveness follows much of the same structure as interpersonal forgiveness, although with some exceptions. One noticeable difference is that with self-forgiveness, the forgiver and forgiven is one and the same person. The main ethical question discussed is when self-forgiveness is morally permissible. I argue that self-forgiveness is only morally permissible when the wrongdoer acknowledges (...) wrongdoing and display genuine repentance. He must also, insofar as possible, ask the victim for forgiveness before contemplating self-forgiveness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Why the Family is Beautiful (Lacan Against Badiou)Eleanor Kaufman (bio)The theory of ethics that can be distilled from the work of Jacques Lacan and Alain Badiou bears no resemblance to many commonly received notions of the ethical, especially any that would link ethics to a system of morality. In fact, ethics is not necessarily the central concept in their work, even in Lacan's The Ethics of Psychoanalysis or (...) Badiou's recent Ethics: An Essay on the Understanding of Evil. If anything, it is defined vicariously and in relation to other more central concepts, such as the workings of desire for Lacan and the fidelity to an event—or truth-process—for Badiou. Nonetheless, an examination of the network of concepts held together under the umbrella of the ethical allows for a sharp distinction between the work of Lacan and Badiou, one that Badiou—himself avowedly indebted to Lacan—is hesitant to make. Where Lacan elevates the beautiful over the good in his reading of Sophocles's Antigone, Badiou elevates the truth-process over the evil betrayal of such an event, drawing on examples ranging from National Socialism to the love relation between two people. A truth-process is a situation-specific adherence, or fidelity, to the revolutionary potential of an event that may take place in one of the four realms of politics, art, science, and love. Perhaps Badiou's best example of a truth-process—what I will also refer to as fidelity to an event—is one not described in the text under consideration here: the apostle Paul's proclamation of and fierce loyalty to the event of Christ's resurrection. It is in the particular form in which the ethical fidelity to a truth-process may be hard to distinguish from evil that I will take issue with Badiou, for both his political examples and his evocation of love as one of four conduits to a truth-process reflect a difficult inflexibility in his extraordinarily lucid and provocative system. Lacan, on the other hand, uses Antigone's strange family values to suggest a more flexible model of ethics, one that is focused on the encounter with the inhuman and the fragile boundary between life and death.Lacan's most sustained discussion of ethics occurs in his seminal Seminar Seven from 1959-60, entitled The Ethics of Psychoanalysis.1 Not only does this seminar register a gradual shift from an earlier emphasis on desire to a later focus on the real and the drive, but it is also a crucial articulation of what might seem for some to be an oxymoronic conjunction—psychoanalysis and ethics. Such a conjunction, as opposed to a Sartrean or Levinasian model that would situate ethics in relation to the Other,2 takes as its [End Page 135] touchstone Freud's stinging critique in Civilization and Its Discontents of the biblical injunction to love the neighbor as oneself. Here it is not merely a question of understanding why the neighbor may be equally an object of hatred, but of understanding how contradictory sentiments are also to be found at the heart of the self, and hence why a viable system of ethics must take this into consideration.3 In other words, ethics is not to be thought primarily as a relation to the other so much as a nonrelation to the self.4 Thus, when Lacan opposes the good to the beautiful, it is precisely the relational aspect of the good that he denigrates.Lacan links the good to the dialectic and to the power to deprive others, situating it squarely in the realm of morality. The beautiful, by contrast, marks a space of nonrelation where it is not so much a matter of two distinct selves but rather of a single self whose desire is not its own. In Seminar Six from the previous year, Lacan analyzes Hamlet and suggests that the reason Hamlet does not kill Claudius is that he is traversed by his mother's desire. He emphasizes that Hamlet's desire is "the desire not for his mother, but of his mother."5 Between Seminars Six and Seven, Lacan shifts his focus from desire to ethics, from... (shrink)

The psychosocial morbidity associated with HIV infection and responses to such infection may exceed morbidity associated with medical sequelae of such infection. This paper argues that negative judgements on those with HIV infection or in groups associated with such infection will cause avoidable psychological and social distress. Moral judgements made regarding HIV infection may also harm the common good by promoting conditions which may increase the spread of HIV infection. This paper examines these two lines of argument with regard (...) to the ethical aspects of psychological bases of health care, clinical contact, public perceptions of AIDS and the comparative perspective. It is concluded that the psychosocial aspects of HIV infection impose ethical psychological, as well as medical, obligations to reduce harm and prevent the spread of infection. (shrink)

This book concerns the ethics of having children through adoption or technologically-assisted reproduction. Some people who choose between these methods struggle between them. Others do not agonize in this way, perhaps because they have a profound desire for a genetic link to the child(ren) they will parent and so prefer assisted reproduction, they view adoption as the only morally decent choice in an overcrowded world, or for some other reason. This book critically examines moral choices that involve each of (...) these ways of making or expanding families with children. The contributors discuss how adoption and assisted reproduction are morally distinct from one another, but also emphasize how they are morally similar, given that both are forms of family‐making. (shrink)

Postmerger integration is a highly challenging and demanding task. Its success depends not only on economic factors but also on the organisational members' feelings and their personal contribution to the new entity. Mergers are usually made for the sake of profitability in the first place, whereas less attention is paid to employees in such situations. This article describes various ethical observations made in our study on corporate mergers in the Nordic Electro-business industry. We examine how the organisational change was (...) experienced by personnel, what kinds of ethical reflections surfaced in different phases of the process, and what conclusions might be drawn from them. The main focus is on the ethical meanings that emerged in our interviewees' stories spontaneously, without the topic of ethics having been separately brought up in the interview situation. The organisational members: we interviewed 35 electro-business employees who were either transferred from Vattenfall's contracting unit to the acquiring company or were already working there at the time of the merger. These persons were interviewed twice: first in 2001, the year of the initial merger, and again in 2005, 4 years from the start of the process and 1 year from the final ownership change. The merger process seemed to lead to decreased responsibility among the organisational members, which highlights the discrepancy between genuine ethical thinking and executive talk. Our study also revealed a dramatic shift in the moral attitudes of the managers who fell from power in the turmoil of organisational change. This moral dimension is evident in their sharply critical argumentation against the new operating model and new corporate management, as well as in their eventual indifference and non-commitment to the organisation. The ethical meanings of 'the good life' and a happy work community slowly disintegrated and were replaced by a longing for the earlier communality and sense of togetherness in their old organisation. This meant that 'the good life' would have to be sought elsewhere. (shrink)

The neoclassical paradigm assumes that shareholders'' utility is solely a function of their wealth, and prescribes that management should act in a manner consistent with share price maximization. The stakeholder view also assumes that shareholders'' utility derives from wealth, but prescribes that managers must balance the shareholder wealth maximization objective against the rights of other constituencies. Thus, while neoclassicists and stakeholder theorists have different prescriptives for management behavior, their definitions of the shareholders'' interest are consistent — shareholders are self-interested economic (...) agents whose utility is best served by share price maximization. However, if shareholders are other-interested, and attack importance to ethical and moral values, then both the neoclassical and stakeholder view derive from invalid assumptions. In this paper, I present evidence that much shareholder behavior is ethically motivated. As a result, the basis for both the neoclassical and the stakeholder view are weakened. (shrink)

Battlefield euthanasia, the purposeful killing of wounded soldiers (or even civi- lians) in order to hasten their foreseeable death, has been an issue in military medicine and in soldiers’ moral codes at all times. During conflicts since anti- quity, there have been severely wounded who would not die immediately but whose fate seemed clear, nevertheless. But can it ever be morally justified to kill those wounded out of mercy in order to end their suffering? Can death ever be the (...) better option? And if so, what conditions have to be fulfilled? This paper investigates some of the moral aspects of battlefield euthanasia. Analogies to physician-assisted suicide in civil settings will be drawn and contrasted with the additional aspects that the military environment adds to the problem. (shrink)

A lot of interest has been generated by the possibility of deriving gametes from embryonic stem cells and bone marrow stem cells. These stem cell derived gametes may become useful for research and for the treatment of infertility. In this article we consider prospectively the ethical issues that will arise if stem cell derived gametes are used in the clinic, making a distinction between concerns that only apply to embryonic stem cell derived gametes and concerns that are also relevant (...) for gametes derived from adult stem cells. At present, it appears preferable to use non-embryonic stem cells for the derivation of gametes. Adult stem cell derived gametes do not present any problems with regard to the moral status of the human embryo, bypass the safety risks linked to SCNT and do not present any ambiguity or novel problems with regard to informed consent, psychological consequences for the child or genetic parenthood. A remaining ethical concern, however, regards the safety of the procedure in terms of the welfare of the resulting children. This should spark a thorough reflection on how far one must go to accommodate a person’s wish to have a genetically related child. (shrink)

Professor Dunstan has selected certain aspects of the preceding papers on artificial insemination by donor and subjected these to the scrutiny of a moral theologian.

Rapid development of e-learning courses for ethics-and-compliance programs led to substantial success in producing engaging multimedia training toolkits aimed at breaking through barriers of indifference and distrust by combining learning with fun. However, a pleasant training experience is no guarantee of its ultimate success in improving organizational ethics. Drawing on Paivio’s Dual Coding Theory, this paper presents a model for evaluating multimedia learning from a moral viewpoint. The main argument advanced in the paper is that entertaining multimedia training modules, (...) as commonly offered in the business world, may deliver an unintended message which runs counter to the very goal of ethics training. The Rocked or Shocked? videogame—a multimedia-based ethics training module—will serve as a case study for detecting the complicated role of entertainment in ethics training and examining the ethical meanings conveyed through the pictorial/event channel. The paper concludes with recommendations for the design of multimedia ethics training. (shrink)

Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional (...) Review Board of the Kaohsiung Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses. (shrink)

This fascinating anthology focuses on the question of how we make families, and how bionormative assumptions shape or distort our collective thinking about parenting, children’s welfare, and state obligations to parents and children. The editors are primarily interested in the question of whether parents’ moral responsibilities toward children differ for children produced through assistive reproductive technologies compared to children brought into the family via adoption. As the editors point out, in the realm of ART, most of the philosophical (...) literature has been focused on parental autonomy and rights to assistance in reproducing, while the adoption literature is almost entirely focused on the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Not by Nature but by Grace: Forming Families through Adoption by Gilbert C. MeilaenderThomas O'BrienNot by Nature but by Grace: Forming Families through Adoption Gilbert C. Meilaender notre dame, in: university of notre dame press, 2016. 136 pp. $25.00I was adopted as an infant through a Catholic Charities office in 1961, and just three years ago, thanks to an online DNA analysis service, I met both (...) of my biological parents, with whom I have an ongoing, loving relationship. So my keen interest in this book and its topic is more than just theological [End Page 209] curiosity. It includes personal and emotional dimensions, as I'm sure it will for many readers.This book is an attempt to understand modern adoptive practices from a primarily Christian/Catholic perspective, with helpful allusions to the beliefs and practices of the other Abrahamic faiths. Overall, I believe the book succeeds in presenting a solid theological foundation for adoption in general and, more specifically, for its current mainstream manifestation in the developed world. The author doesn't shy away from the various controversies related to adoption—like assisted reproduction, LGBTQ adoption, embryo adoption—and he takes on other authors who make claims about adoption that he believes distract or obscure the central purpose of adoption, which is to provide a child a "needed place of belonging" within the network of loving relationships that is the ideal of the family (38).My reservations about the book are two. The first has to do with the inconsistent tone of the book, which tends to swing, abruptly at times, from a theological and analytical tone to one that feels more popular and homiletic—even to the point of being maudlin. As stated earlier, I have high regard for most of the analytical sections and find the overarching thesis convincing. Generally, in these sections, the method begins with the lived experience of adoptees and their parents and works through scripture, tradition, and critical reflection to arrive at a reasonable conclusion. However, occasionally the book drifts into uncritical and merely emotive territory, and this is especially the case in the sections called "interludes," where the author presents letters to adoptees from their parents reprinted from the Christian Century magazine. These seem out of place and even distracting. Of even greater concern is the concluding chapter, where the author should be summarizing and highlighting the strengths of his thesis. Instead he chose to draw homiletic lessons from Anne of Green Gables (110).My second reservation is not so much a critique of this book but of the state of contemporary Catholic sexual ethics, which forms a backdrop for the entire book. The book accurately reflects a mainstream position in Catholic sexual ethics, which abandoned a narrow focus on procreation decades ago in favor of one highlighting the unitive and relational aspects of human intimacy. This move away from a strictly deontological framework stressing the duty to procreate and toward a teleological ethic stressing the need to model human relationships after divine ones has been celebrated for good reasons, but it has not come without costs. Like all teleological ideals, this sexual ethic is attractive to purveyors of high philosophy but tends to be thoroughly abstract and almost entirely incapable of offering concrete, practical guidance. Because it is so abstract, its application to specific moral issues can seem arbitrary and at the whim of the author. Such is the case in this book, for instance, when this teleological ideal is wielded to shed doubt on LGBTQ adoption. It is particularly telling [End Page 210] that the author neglects to consult lived experience in this section, ignoring the mountains of evidence readily available that LGBTQ families can be just as loving and nurturing as those of traditional families. Ultimately, a second Renaissance would benefit Catholic sexual ethics—one that balances deontological and teleological elements by introducing practical, consequential, and proportional methods.Thomas O'BrienDePaul UniversityCopyright © 2018 Society of Christian Ethics... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics CommentaryMichael Robertson, Senior Research FellowThe French philosopher Michel Foucault once recounted the story of the English King, George III, being restrained by his guards at the direction of his physician Dr. Willis. King George, presumably deranged by a psychotic mania consequent upon porphyria, was incapable of self-rule and his power was usurped by the medical profession in an act of coercion tantamount to treason. This for Foucault was (...) a profound metaphor of psychiatric power.1The plight of Mdm. W yokes the two most emotive issues in psychiatry — involuntary treatment and the administration of ECT. Whilst only utilised at an extremity of clinical practice, both of these are the most misunderstood of actions performed by the psychiatric profession. Yet, in many circumstances, they are life-saving.In essence, we are confronted with a profoundly depressed woman, whose illness is seemingly resistant to first line treatment and poses a serious, credible risk of harm. Most psychiatrists would regard this as somewhat of a psychiatric emergency. We are informed that Mdm. W’s family has transcended any cultural taboos about mental illness and is engaged in her care, has an extensive lived experience of her severe mood disorder and accepts, indeed welcomes, the use of ECT to terminate a severe episode of depression. In the course of a psychotic depression, Mdm. W is suffering profound distress and presents a risk of either suicide or serious medical complications if the episode persists. Despite the minimal discomfort during the actual administration of ECT, Mdm. W’s distress will be compounded by the further restraint needed to prevent from her eating and drinking prior to anaesthesia.It is difficult to know what Mdm. W’s experience of this situation would [End Page 230] be. Through the prism of her disturbed mental state, with its derangements in thinking, cognitive functioning and apprehension of reality, she would likely experience the situation as one of fear or terror; she would likely interpret ECT and the enforced restriction of oral intake prior to the procedure as punitive — further evidence of her “sins”, reinforcing her delusional guilt and nihilism. Yet to speak to Mdm. W in circumstances of euthymia or normal mood, where such derangements no longer occur, might reveal an utterly different perspective on the situation. Like many people with episodic mental illnesses, Mdm. W might, when such a scenario was put to her, consent to future treatment with ECT without equivocation. Indeed, many patients with bipolar disorder formulate advance directives in regard to the specific management of their possible future episodes of illness.If the clinical and legal aspects of this situation are so clear, why is there a sense of a dilemma in the realm of clinical ethics? Beyond the emotive nature of the situation, we see a deeply distressed woman being provided potentially life-saving treatment, which is being denied to her by the profound impairments of insight and judgement consequent upon her illness.In Singapore, such detention and enforced treatment under the Mental Capacity Act (2010) applies to a person with a mental illness or disorder who lacks capacity to make decisions in their own best interests based upon impairment of mind or brain. This would be considered a “capacity” based mental health law. In other jurisdictions, the legal test and evidentiary justification for such care may be predicated upon risk of harm to self or others. In either setting, Mdm. W’s clinical situation provides adequate legal justification for such enforced care.The moral justification of such laws falls into two general categories — the “risk” argument and the “capacity” argument. In mental health legislation, the “harm principle”, as first elaborated in John Stuart Mill’s On Liberty,2 is usually defined in terms of the construct of “risk”. Risk is a term that has multiple meanings in different disciplinary contexts, although all approaches to “risk” attempt to apply knowledge to an area of uncertainty.3 The notion of “risk assessment” is usually considered as the process of categorising individuals by their perceived likelihood of causing serious harm to themselves or harm to others. In the insurance industry, actuarial assessment is a mathematical discipline aimed at computing a probability of adversity... (shrink)

Johannine ethics was a problematic topic for a long time and has only been an acceptable and fruitful area of research since 2012. To stimulate and guide future research, this article proposes a model of Johannine ethics that consists of five aspects: (1) Graeco-Roman virtue ethics is the broad ethical context for Johannine ethics; (2) family is the theological context for Johannine ethics; (3) mimesis is central to Johannine ethics; (4) moral reasoning is the cognitive route to ethics; (...) (5) Spirit and community empower ethical living. The argument is that the Johannine writings present ethics as divine family education that has mimesis at its centre and is facilitated by moral reasoning and the Spirit as the moral force. An Appendix contains a list of publications on Johannine ethics between 2012 and 2022. (shrink)

Introduction Hospital delirium is a frequent, serious, costly, and underrecognized acute disorder of attention and cognition. Therefore, the prevention of hospital delirium is not only desirable for patients, caregivers, healthcare professionals, and the health system itself, but also a moral duty. Objective To identify and synthetize the main ethical aspects that arise related to the prevention of hospital delirium in patients 65 years and older. Methods A scoping review was carried out in Embase, Medline, and Web of Science. (...) Articles published in English or Spanish analyzing any pharmacologic, non-pharmacologic, or multicomponent intervention for prevention of delirium in hospitalized patients aged 65 years and over were included. Results Twenty-seven studies were included. Based on the frequency of appearance and the relevance, our findings were organized into three main areas. The first one was related to the principle of nonmaleficence and collected findings about the iatrogenic causes of hospital delirium and the use of restraints systems. The second area analyzed the impact of delirium in patients, families, and healthcare professionals from a relational ethics perspective, and addressed the family presence as a factor to prevent delirium. Finally, the third area is related to the quality of care. Conclusion Prevention of delirium in hospitals is essential to avoid the discomfort and potential clinical complications of patients, as well as the suffering of their relatives, caregivers, and healthcare professionals. Policymakers and healthcare managers are encouraged to make the required efforts to prevent delirium in hospitalized older patients. (shrink)

Theories of ethical leadership provide important insights about the effect of leader’s ethics on the relationship between leaders and followers. However, there is an increasing demand for addressing key constructs that enhance the capacity to explain theoretical aspects of ethical leadership. The purpose of this study is to expand the theoretical framework of ethical leadership based on Korean traditional leadership by focusing on personal cultivation, morality, and social responsibility. Using a framework of intrapersonal process as leadership and (...) core value and competence as components of leadership, this study examines the ethical aspects of Korean traditional leadership and provides the implications to further develop the theory of ethical leadership. It is found that ethical integrity ensued from sugi is an essential precondition to develop leadership, and the core value of ethical leadership includes Zhixin-Chijing and the competence co.. (shrink)

Situated within the framework of Confucian family-oriented ethics, this book explores the issue of familial partiality and specifically discusses whether it is morally praiseworthy to love one's family partially. In reviewing the tension between familial partiality and egalitarian impartiality from different perspectives while also drawing on binary metrics to understand the issue - that is, the weak and strong sense of familial partiality in Confucian moral theory - the author carefully discusses the efficacy of three major arguments to justify (...) moral partiality. It is concluded that the tree argument fails to justify moral partiality in Confucianism, the evolutionary argument only justifies moral partiality in the weak sense that we should devote more resources to our family, and the care argument fails to justify moral partiality in the strong sense that family takes priority in any case even at the expense of the principle of justice. Seeking to address the quandary, the author advances an alternative argument based on Thomas Aquinas' theory of love to interpret Confucian view of partial relationships, holding that partial treatment is assumed in partial relationships. The title will appeal to scholars and students interested in Confucianism, Chinese Philosophy, Moral Philosophy, and Comparative Philosophy. (shrink)

The fundamental ethical problem in bankruptcy is that insolvents have promised to pay their debts but can not keep their promise. The Ethics of Bankruptcy examines the morality of bankruptcy. The author compares and contrasts the Humean doctrine of promises as useful conventions with the Kantian view of autonomous agency constituting promissory obligations; he explores ethical concerns raised by forgiveness, utilitarianism and distributive justice and the moral aspects of insolvents' contractual, fiduciary, tortious and criminal liability. Finally, the (...) author assesses recent bankruptcy law reforms. Bankruptcies severly hurt creditors and society. For the insolvents and their families the experience is painful and stigmatising, yet philosophers have paid little attention to the moral aspects of this violent social phenomenon. The Ethics of Bankruptcy is the first comprehensive study that employs the tools of ethics to examine the controversies surrounding insolvency, which makes valuable and sometimes controversial reading in a decade recovering from the Recession. (shrink)

BackgroundThe quality of ethics consults is notoriously difficult to measure. Survey-based assessments cannot capture nuances of consultations. To address this gap, we conducted interviews with health professionals who requested ethics consults during the initial phase of the COVID-19 pandemic.MethodHealthcare professionals requesting ethics consultation between March 2020 and May 2020 at a tertiary academic medical centre were eligible to participate. We asked participants to comment on the consults they called and thematically analysed responses to identify features associated with optimal quality consultations.ResultsOf (...) 14 healthcare providers, 8 (57%) were women and professions were as follows: 11 (79%) medical doctors, 1 (7%) social worker, 1 (7%) physician assistant and 1 (7%) nurse practitioner. Two aspects of quality emerged: satisfaction and value. Themes within the domain of satisfaction included: responsiveness of the ethics consultant, willingness to consult, institutional role of the ethics service and identifying areas for improvement. When describing value, respondents spoke of the intrapersonal and interpersonal worth of consultation.ConclusionParticipants were generally satisfied with ethics consultation services, similar to opinions of those found in pre-COVID-19 survey studies. Our qualitative approach allowed for a richer exploration of the value of ethics consultation during the pandemic and has implications for ethics consultation services more broadly. Ethics consultation—emphasising both the process and outcome—created valuable moral spaces, promoting thoughtful and ethical responses to dilemmas in patient care. Future assessments should incorporate patient and family/surrogate perspectives and explore the domain of education as an additional quality measure. (shrink)

Exploring the intricacies of heterogeneity in tax avoidance practices within family firms, a growing trend acknowledges the significant role of chief executive officers (CEOs) in setting the ethical tone and shaping corporate tax strategies. However, these studies often overlook the influence of the CEO’s transgenerational orientation, which becomes crucial when assessing ethics in family businesses. Therefore, the paper aims to analyse to what extent the CEO’s transgenerational responsibility (the moral obligation that incumbent leaders have vis-à-vis next generation family (...) members) affects tax avoidance with a utilitarianism lens. Relying on a sample of 272 firm-year observations of Italian listed family companies along the period 2014–2018, the panel regression model finds a positive relationship. Moreover, the involvement in the business of the next generation of family members strengthens this relationship, suggesting that the immediate proximity with other relatives fosters the conversion of the CEO’s transgenerational responsibility into tax avoidance practices. Finally, when the family firm is in financial distress, CEOs with greater transgenerational responsibility tend to avoid more taxes. (shrink)

Many people want to spend the last stages of their lives at home, in familiar surroundings, and possibly with people they know. However, this increasing desire on the part of older, ill, or even dying people also makes support from other people unavoidable, which in many cases involves family members, loved ones, or even friends. These family caregivers care for the person concerned, even though they lack the professional skills of nursing staff, for example, and have usually not been prepared (...) for this task. This article focuses on the ethical significance of the moral identity of family caregivers. While the effects of this care constellation on the caregivers have often been discussed in the scientific literature, ethical considerations regarding moral identity have so far been neglected. In the first step, the question of what is actually meant by the term moral identity is examined. The second step shifts attention to those people who have taken on the care of a loved one. The relevance of this previously discussed identity is emphasized by using study results and work in this context, and placed in relation to family caregivers. The third step shows that (1) moral identity must be understood as a necessary prerequisite for adequate and humane care, (2) this identity can be enhanced through the caregiving relationship, and (3) the activities undertaken by family caregivers reveal their moral identity. These considerations are finally summarized, provided with ethical aspects, and awareness of this important work of family caregivers is raised. (shrink)

This book takes a unique organizational approach towards understanding the concept of ethics in educational systems. It provides a global perspective and connects theory and praxis through team-based simulations, case studies and scenarios, thus presenting an integrative approach towards tackling teachers' withdrawal behaviors.

Background: Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field. Objectives: This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis. Research design: We used qualitative content analysis. Ethical considerations: The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required. Findings: (...) The analysis shows that all 12 textbooks describe and present people who are considered as psychotic from a ‘perspective from above’. In this perspective, the readers are learning about psychosis in the professional’s language and from the author’s viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a ‘perspective from within’. Here, the readers are learning about psychosis from the patients’ own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person. Discussion and conclusion: Drawing partly on Rita Charon’s writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients’ own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness. (shrink)

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in (...) this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life. (shrink)

Background Non-technical skills are cognitive and interpersonal skills underpinning technical proficiency. Ethical values and respect for human dignity make operating room nurses responsible for nursing decisions that are clinically and technically sound and morally appropriate. Aim To learn what ethical issues operating room nurses perceive as important regarding non-technical skills. Research design Qualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke’s six phases for thematic analysis. Participants and research context Eleven experienced perioperative/operating room (...) nurses working in an operating unit at a Norwegian university hospital. Ethical considerations Approval was given by The Norwegian Social Science Data Service in care of the hospital’s Data Protection Officer. Findings Three main themes were found: respect and care for the patient, making the patient feel safe, and respect within the perioperative team. These features or themes, which incorporate collaboration and communication, are closely connected to patient safety. Discussion Defending the patient’s dignity is part of caring for and respecting the patient. The manner in which the operating room team collaborates is important for the patient to feel safe and secure. Poor teamwork may have dire consequences. Reciprocal respect within the team includes respect for each other’s tasks and responsibilities and to talk to one another in a friendly manner. Conclusion Being respectful and contributing to a caring atmosphere are central ethical skills in the operating room. To patients, harmonious teamwork translates into a feeling of safety and being cared for. The nurses see respect and patient safety, and respect and reciprocal politeness among the members of the perioperative team as central ethical non-technical skills. Lack of respect influences the team negatively and is detrimental for patient safety. Good communication is an important safety measure during surgery and creates a feeling of good ‘flow’ within the operating room team. (shrink)

Ethical Practice in the Human Services by Richard D. Parsons and Karen L. Dickinson moves beyond addressing ethical issues and principles to helping readers actually practice ethical behavior through awareness of their personal morals, values, and choices. With coverage of ethical standards from six different associations, the text addresses ethical issues and principles in social work, counseling, psychology, and marriage and family therapy. Robust pedagogy includes case illustrations and guided exercises to give readers a deeper (...) understanding of the underlying moral principles and values that serve as a foundation for the various ethical codes. (shrink)