Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well‐being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service (...) goals and obligations. Different health care professions have evolved distinct perspectives about appropriate goals for, and the purposes of, their clinicians, even when the goal of improving health and well‐being for society is shared across professions. While medicine and nursing goals are shared in principle, they differ in the particulars. Given the centrality to nursing of ethical questions, the profession has a collective responsibility to help clinicians at all levels of practice become ethically savvy and to reinforce their moral agency as needed. Both knowledge of nursing ethics and knowledge of the interdisciplinary field of bioethics are critical to nursing work. (shrink)

Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the gestation period of approximately 23held hostagemoral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of (...) futility. (shrink)

This paper examines the extent to which parents have absorbed New Right ideas about education and acted accordingly. What emerges is that their commitment to the rhetoric of school choice is strong. However, concepts such as the market and competition are viewed less favourably. An important theme here is the avoidance by parents of any collective agenda in discussing education policy, a factor that may thwart those who attempt to predict their responses to government policy for schools.

The confusion/non-consequential thinking explanation proposed by Newstead, Girotto, and Legrenzi (1995) for poor performance on Wason's THOG problem (a hypothetico-deductive reasoning task) was examined in three experiments with 300 participants. In general, as the cognitive complexity of the problem and the possibility of non-consequential thinking were reduced, correct performance increased. Significant but weak facilitation (33-40% correct) was found in Experiment 1 for THOG classification instructions that did not include the indeterminate response option. Substantial facilitation (up to 75% correct) was obtained (...) in Experiment 2 with O'Brien et al.'s (1990) one-other-THOG classification instruction. In Experiment 3, a revised version of O'Brien et al.'s pre-test problem format also led to substantial facilitation, even with the use of the standard three-choice THOG classification instruction. These findings are discussed in terms of Newstead et al.'s theoretical proposal and possible attentional factors. (shrink)

The insights provided by a multi-disciplinary mix of health professionals from an acute medical ward of a regional Australian hospital indicate the value in extending the role of Hospital Ethics Committees to incorporating both ethics consultation and ethics education. It is the hope and expectation that the findings will assist other HECs in a similar stage of development.

Medical ethics has traditionally been governed by two guiding, but sometimes conflicting, principlesthe Substituted Judgment Standard shows our concern for autonomy, whereas the Best Interest Standard shows our commitment to benevolence. Both standards are vulnerable to criticisms. Further, the principles can seem to offer conflicting prescriptions for action. The criticisms and conflict figure prominently in discussion of advance directive decisionmaking and Alzheimer's disease. After laying out each of the current standards and its problems, with Alzheimer's issues as my central concern, (...) I offer a new standard that avoids the problems while honoring our concerns for both autonomy and benevolence. (shrink)

For qualitative researchers seeking the perspectives of people with unusual characteristics or circumstances, compliance with expectations about participant anonymity can be difficult, if not impossible. In the age of internet communications and emerging research methodologies, traditional strategies require ongoing re-examination to ensure cohesion between a project’s ethical framework and its research practice. This paper reflects on the approach to informed consent used in a study with parent carers whose children had high-level support needs. A two-step process of written consent was (...) developed in response to concerns about the possible re-identification of these parents as a result of their highly individual circumstances. This approach acknowledged the potential for identification, and maximised participants’ agency in choosing the level of risk that they were comfortable to accommodate. The paper discusses the researcher’s and participants’ responses to the adapted consent process and recommends that researchers and ethics review committees remain open to the development of collaborative and innovative approaches that are also culturally and contextually relevant, to enable people to contribute perspectives that might otherwise be silenced by the very ethical frameworks that purport to protect their interests. (shrink)

Issues surrounding the inclusion of transgender and intersex athletes in the women’s category in sport have spurred vigorous, and sometimes vicious, debate. The loudest voices on one edge of the de...

This article presents the findings of qualitative research which explored, from the mothers’ perspective, the process of decision-making about mode of delivery for a subsequent birth after a previous Caesarean Section. In contradiction to the clinical literature, the majority of mothers in this study were strongly of the opinion that a vaginal birth after caesarean (VBAC) posed a higher risk than an elective caesarean (EC). From the mothers’ perspective, risk discussions were primarily valuable for gaining support for their pre-determined choice, (...) rather than obtaining information. The findings posit ethical concerns with regards to informed consent and professional obstetric practice at a time when there is a documented and worrying trend towards an increase in births by caesarean section (CS). (shrink)

Although mainstream research institutions and health care organisations are now starting to acknowledge the important contribution of qualitative research, there are still many obstacles to obtaining funding. Consequently, at all points along the continuum of obtaining funds, enrolling participants and conducting the research, qualitative researchers will benefit from being able to refer to, or reference, a body of empirical knowledge that addresses ethical issues raised by those who have responsibility for decision-making about the implementation of research proposals. This article has (...) been written with this strategy in mind. One such ethical issue is a concern about the impact on participants of being involved in qualitative studies when they are in a vulnerable state from a distressing life experience. This article provides empirical data that describes the benefits associated with qualitative research process for parents enrolled in a longitudinal study looking at the issues associated with the diagnosis and treatment for paediatric haematological malignancies. The empirical findings affirm the significant beneficial contribution that qualitative research can make to the lives of those coping with an extremely challenging health care situation. (shrink)

Establishes that being in partnership with Nature is our birthright, explores the roots of our separation, and demonstrates that we are designed to communicate with Nature. Offers six principles of co-creative partnership with Nature that serve as a map for guiding us back to our rightful place as a part of Nature. Explains that plants can guide us in living according to our true essential nature and details the steps of creating and facilitating a plant initiation with common plants.

In recent years there has been an increasing critique of the philosophically based reasoning in bioethics which is known as principlism. This article seeks to make a postmodern contribution to this emerging debate by using notions of power and discourse to highlight the limits and superficiality of this , rationalistic mode of reflection. The focus of the discussion will be on the principle of autonomy. Recent doctoral research on a hospice organization (Karuna Hospice Service) will be used to contextualize the (...) debate to end-of life ethical dilemmas. The conclusion will be reached that the discursive richness of this organization's notion of autonomy or choice, which incorporates a holistic respect for the individual and the active creation of alternatives, can provide important insights to our understanding of autonomy in bioethics. The concern is raised that if autonomy is reified as a principle outside of the context of discourse, it may only complement the hegemonic power of biomedicine. (shrink)

It has been said that our ability to identify and describe consciousness is like that of a fish describing water. Since a fish has always been immersed in water it cannot provide an accurate description. It stands to reason then that those who have experienced alternative states of consciousness have unique insight into the nature of consciousness. The historic use of imagery, music, poetry and other creative forms to describe as well as communicate not only emotion, not only intellectual data, (...) but also states of consciousness – states of ‘being’ is well documented. Celtic poetry, Greek mythology, African ritual rhythms and contemporary creative works can be viewed as notational systems that encapsulate states of consciousness and could be investigated as such. As our creative instruments become more sophisticated our ability to express states of consciousness does as well and as a natural extension of this creative process, the artists’ exploration of consciousness equally intensifies and expands. As the Surrealists explored sub-consciousness, what areas of consciousness does contemporary creativity explore? (shrink)

Two contrasting theories-actor-network theory and nondecision making-are separately applied to the same case study, namely, technologies for automatically identifying road vehicles. By this process, the strengths and weaknesses of each approach are highlighted: The actor-network approach is useful for understanding local processes but lacks tools for easily illuminating patterns across countries; by contrast, the concept of nondecision making is useful for explaining the general lack of implementation of technology for automatic vehicle identification but not for explaining variations between developments in (...) different countries. This study highlights the importance of attempting to compare theories by using the same case study. (shrink)

It is now common in health care for a diverse range of professions and disciplines to work together in regular and close contact. Thus, there are now calls in the literature for research that documents insights on the ethical dimension of multidisciplinary relationships. Recent Australian research has responded to this call by examining how a multidisciplinary team of health professionals define and operationalize the notion of ethics in an acute ward hospital setting. This article provides findings from the research study (...) that indicate that, although there is a shared conceptualization of ethics as "patient-centered care", there can be times of conflict and tension in determining what is best for the patient. The discussion begins to build an understanding of how a multidisciplinary mix of health professionals responds to ethical conflict and tension. The authors' hope and expectation is that, by keeping the research focus on what health professionals in a multidisciplinary team (MDT) actually do, rather than exclusively on how they philosophically think about ethical dilemmas, the insights can be translated into practical strategies that can be utilized to strengthen the process of ethical decision making within the health care system. (shrink)