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. (shrink)

Emotion processing is known to be impaired in psychopathy, but less is known about the cognitive mechanisms that drive this. Our study examined experiencing and suppression of emotion processing in psychopathy. Participants, violent offenders with varying levels of psychopathy, viewed positive and negative images under conditions of passive viewing, experiencing and suppressing. Higher scoring psychopathics were more cardiovascularly responsive when processing negative information than positive, possibly reflecting an anomalously rewarding aspect of processing normally unpleasant material. When required to experience emotional (...) response, by ‘getting into the feeling’ of the emotion conveyed by a negative image, higher factor 1 psychopathic individuals showed reduced responsiveness, suggesting that they were less able to do this. These data, together with the absence of corresponding differences in subjective self-report might be used to inform clinical strategies for normalising emotion processing in psychopathic offenders to improve treatment outcome, and reduce risk amongst this client group. (shrink)

Next SectionMaking threats and offers to patients is a strategy used in community mental healthcare to increase treatment adherence. In this paper, an ethical analysis of these types of proposal is presented. It is argued (1) that the primary ethical consideration is to identify the professional duties of care held by those working in community mental health because the nature of these duties will enable a threat to be differentiated from an offer, (2) that threatening to act in a way (...) that would equate with a failure to uphold the requirements of these duties is wrong, irrespective of the benefit accrued through treatment adherence and (3) that making offers to patients raises a number of secondary ethical considerations that need to be judged on their own merit in the context of individual patient care. The paper concludes by considering the implications of these arguments, setting out a pathway designed to assist community mental healthcare practitioners to determine whether making a specific proposal to a patient is right or wrong. (shrink)

This paper outlines, from a sociological and social psychological perspective, a theoretical framework with which to define and analyse consciousness, emphasizing the importance of language, collective representations, conceptions of self, and self-reflectivity in understanding human consciousness. It argues that the shape and feel of consciousness is heavily social, and this is no less true of our experience of collective consciousness than it is of our experience of individual consciousness. The paper is divided into two parts. Part One argues that the (...) problem of consciousness can be approached fruitfully by beginning with human group and collective phenomena: community, language, language-based communication, institutional and cultural arrangements, collective representations, self-conceptions, and self-referentiality. A collective is understood as a group or population of individuals that possesses or develops collective representations of itself: its values and goals, its structure and modes of operating, its strategies, developments, strengths and weaknesses, etc. Collective reflectivity emerges as a function of an organization or group producing and making use of collective representations of the self in its discussions, critical reflections, and planning. A collective monitors its activities, achievements and failures, and reflects on itself as a defined and on-going collective being. In this perspective, human consciousness is understood as a type of reflective activity: observing, monitoring, judging and re-orienting and re-organizing self; considering what characterizes the self, what self perceives, judges, could do, should do . The reflectivity is encoded in language and developed in conversations about collective selves. Part Two of the paper applies the framework to analysing the individual experience of consciousness, self-representation, self-reference, self-reflectivity and self-development. (shrink)

Community treatment orders are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able to receive beneficial care and support that maximises their welfare in the longer-term. This empirical ethics paper presents an analysis of 75 interviews with psychiatrists, patients and (...) family carers to show how these ethical considerations map onto the different ways that community treatment orders are used and experienced in practice. A complex and nuanced account of how the requirements to respect patients’ autonomy, to respect patients’ liberty and to act beneficently should be interpreted in order to make judgements about the ethics of community treatment orders is presented. The article argues that, due to such complexity, no general ethical justification for community treatment orders can be provided, but a justification on the basis of the promotion of patients’ autonomy could provide an ethical reason for community mental health practitioners to make use of a community treatment order in some limited circumstances. (shrink)

Community treatment orders are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able to receive beneficial care and support that maximises their welfare in the longer-term. This empirical ethics paper presents an analysis of 75 interviews with psychiatrists, patients and (...) family carers to show how these ethical considerations map onto the different ways that community treatment orders are used and experienced in practice. A complex and nuanced account of how the requirements to respect patients’ autonomy, to respect patients’ liberty and to act beneficently should be interpreted in order to make judgements about the ethics of community treatment orders is presented. The article argues that, due to such complexity, no general ethical justification for community treatment orders can be provided, but a justification on the basis of the promotion of patients’ autonomy could provide an ethical reason for community mental health practitioners to make use of a community treatment order in some limited circumstances. (shrink)

This article argues that parliamentary institutions have increasing difficulty in addressing and dealing with the growing complexity, highly technical character and rapidity of many developments in modern societies. Deficits in representation, in knowledge and competence, and in engagement or commitment effectively erode the authority and status of parliamentary government. Major rule- and policy-making activities are being substantially displaced from parliamentary bodies and central governments to global, regional and local agents as well as agents operating in the many sectors of a (...) highly differentiated, modern society. Governance - and sovereignty - are increasingly diffused upward, downward and outward beyond parliament and its government. The author identifies problems, practical as well as normative, with this general development and discusses the possibilities and limitations of reform. (shrink)

This article illustrates the important scientific role that a systems approach might play within the social sciences and humanities, above all through its contribution to a common language, shared conceptualizations, and theoretical integration in the face of the extreme (and growing) fragmentation among the social sciences (and between the social sciences and the natural sciences). The article outlines a systems theoretic approach, actor-system-dynamics (ASD), whose authors have strived to re-establish systems theorizing in the social sciences (after a period of marginalization (...) since the late 1960s). This is done, in part, by showing how key social science concepts are readily incorporated and applied in social system analysis. (shrink)

This article presents a relatively straightforward theoretical framework about distributive justice with applications. It draws on a few key concepts of Sociological Game Theory. SGT is presented briefly in section 2. Section 3 provides a spectrum of distributive cases concerning principles of equality, differentiation among recipients according to performance or contribution, status or authority, or need. Two general types of social organization of distributive judgment are distinguished and judgment procedures or algorithms are modeled in each type of social organization. Section (...) 4 discusses briefly the larger moral landscapes of human judgment – how distribution may typically be combined with other value into consideration. The article suggests that Rawls, Elster, and Machado point in this direction. Finally, it is suggested that the SGT framework presented provides a useful point of departure to systematically link it and compare the Warsaw School of Fair Division, Rawls, and Elster, among others. (shrink)