Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals typically described as community hospitals; as a result, the cases do not focus on esoteric, high-tech dilemmas--viz., genetic engineering or experimental protocols--but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to (...) send a frail, elderly patient who refuses to go to a nursing home; what role the family should play in making a treatment decision; what a hospital should do when it is getting stuck with too many unpaid bills. This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically for those participants in the Neiswanger Institute for Bioethics' web-based instructional program. This edition has also been restructured for teachability, and will feature reformatted and revised commentaries. (shrink)

IOS Prexs, 2002 Introduction This book is the final project report of the BIOMED II project Ethical Function in Hospital Ethics Committees Commission,-2001 ...

While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees, almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.

While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees , almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.

In the past 50 years, ethical concerns concerning human experimentation have arisen with the advancement of new medical research and technology. While the benefits of human experimentation are well known in the fields of biology, psychology, sociology, and medicine, the conditions of human subject research have been persistently controversial. This book discusses ethical perspectives, emerging developments and global challenged of patient rights. Topics include effective medical informed consent; rights to health and dental care; the ethics of HIV (...) screening targeted to the seriously mentally ill; and problems in ethics for medical publication. (shrink)

The existing literature in medical ethics does not serve the practical needs of medical students and trainees very well. Medical students or junior doctors often have their own set of ethical concerns and the dilemmas that arise are generally beyond their direct control. The editors have addressed the gap in the literature by compiling a series of case studies from around the world and inviting an international team of leading ethicists and clinicians to comment on them. This volume includes (...) over 80 actual cases that cover the range of possible problems a medical trainee may encounter on the ward. (shrink)

Hospital acquired infections (HAIs) are a major threat to patient safety. This paper addresses the following question: given what is known about the causes of and possible interventions on HAIs, to whom or what should the moral responsibility for preventing these infections be attributed? First, we show how generating robust evidence on the effectiveness of preventive hygiene measures is a complex endeavour and review the existing evidence on the causes of HAIs. Second, we demonstrate that the existing literature (...) on the ethical aspects of infection control has focused on responsibility at the individual-level. Thirdly, we argue that these accounts do not accommodate systemic factors relevant for HAI prevention. We show that the notion of collective responsibility is useful for making understandable how systemic factors, such as employment conditions in hospitals, are both causally and ethically relevant in infection control. (shrink)

Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem (...) important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record. (shrink)

Death is the destiny we all share, and this will not change. Yet the way we die, which had remained the same for many generations, has changed drastically in a relatively short time for those in developed countries with access to healthcare. For generations, if people were lucky enough to reach old age, not having died in infancy or childhood, in childbirth, in war, or by accident, they would take to bed, surrounded by loved ones who cared for them, and (...) fade into death. Most likely, they would have seen their parents and grandparents die the same way, and so this manner of dying would be familiar: it was part of the natural cycle of life. Now less than 25 per cent of Americans die at home, having reached much older ages than people would have dreamed of in past generations, often after surviving many illnesses and even diseases that would have been terminal for their grandparents. We are fortunate to live (and die) today, supported by myriad scientific, medical, and technological advancements, however we also face new problems as a result of the new way in which we die. We can no longer anticipate a peaceful waning at home with family. We know our lives will likely end in hospitals likely after we have endured grueling treatments to prolong life. We have to decide what decisions we want our loved ones, or care-givers, to make when we cannot choose for ourselves. We have to think about whether in any circumstances we would seek physician-assisted death. We know we face other questions as well, but we may not even know where to start. In the face of these decisions, we can feel daunted and afraid. The best remedy is information and planning. In this book, Gregory Eastwood - a physician who has cared for dying patients, served as an ethics consultant, and taught end of life issues to medical and other health profession students - draws from his substantial experience with patients and families to provide the information that will help us think clearly about the choices and issues we will face at the end of our own lives, and when faced with the deaths of our loved ones. With sensitivity and profound insight, Eastwood guides us through all the important questions about death and dying in straightforward, clear language, enhanced by real-life stories. Throughout, he shows us how we can take ownership of the way we want to die, when we must die, and feel more in control as death approaches. (shrink)

BackgroundNon-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.AimTo learn what ethical issues operating room nurses perceive as important regarding non-technical skills.Research designQualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke’s six phases for thematic analysis.Participants and research contextEleven experienced perioperative/operating room nurses working in an operating unit at (...) a Norwegian university hospital.Ethical considerationsApproval was given by The Norwegian Social Science Data Service in care of the hospital’s Data Protection Officer.FindingsThree 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.DiscussionDefending 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.ConclusionBeing 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)

This research aims to identify the ethical issues perceived by intensive care nurses in their everyday practice. It also aims to understand why these situations were considered an ethical issue and what interventions/strategies have been or are expected to be developed so as to minimize them. Data were collected using a semi-structured interview with 15 nurses working at polyvalent intensive care units in 4 Portuguese hospitals, who were selected by the homogenization of multiple samples. The qualitative (...) content analysis identified end-of-life decisions, privacy, interaction, team work, and health-care access as emerging ethical issues. Personal, team, and institutional aspects emerge as reasons behind the experience of these issues. Personal and team resources are used in and for solving these issues. Moral development and training are the most significant strategies. (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)

There is unanimous agreement regarding the need to ethically conduct research for improving therapy for patients admitted to hospital with acute conditions, including in emergency obstetric care. We present a conceptual analysis of ethical tensions inherent in the informed consent process for randomized clinical trials for emergency obstetric care and suggest ways in which these could be mitigated. A valid consenting process, leading to an informed consent, is a cornerstone of this aspect necessary for preservation and (...) maintenance of respect for autonomy and dignity. In emergency obstetric care research, obtaining informed consent can be problematic, leading to ethical tension between different moral considerations. Potential participants may be vulnerable due to severity of disease, powerlessness or impaired decisional capacity. Time for the consent process is limited, and some interventions have a narrow therapeutic window. These factors create ethical tension in allowing potentially beneficial research while avoiding potential harms and maintaining respect for dignity, human rights, justice and autonomy of the participants. Informed consent in emergency obstetric care in low- and middle-income countries poses numerous ethical challenges. Allowing research on vulnerable populations while maintaining respect for participant dignity and autonomy, protecting participants from potential harms and promoting justice underlie the ethical tensions in the research in emergency obstetric and newborn care. Those involved in research conduct or oversight have a duty of fair inclusion, to avoid denying participants the right to participate and to any potential research benefits. (shrink)

BackgroundThe nursing profession requires ethical and legal regulations to guide nurses’ performance. Ethical climate plays a part in shaping nurses’ ethical practice. Therefore, ethico-legal aspects and ethical climate contribute to improving nurses’ ethical practice and competencies with reducing medical errors in hospital settings.ObjectiveThis study examined the effect of ethico-legal aspects and ethical climate on managing safe patient care and medical errors among nurses.Materials and methodsA cross-sectional correlational study was carried out (...) on 548 nurses. Data were collected through self-administered questionnaires about nurses’ knowledge in both ethical and legal aspects, ethical practice, competencies, ethical climate and experience with medical error.ResultsThe main sources of nurses’ knowledge of ethical and legal aspects were undergraduate lectures, job experience and colleagues. Nurses’ knowledge in both ethical and legal aspects, nurses’ ethical practice and competencies were insufficient. Nurses fairly perceived their ethical climate. Also, nurses experienced medical errors about 22.6% in their units. Nurses’ knowledge of ethical and legal aspects, as well as the ethical climate were positive predictors of inadequate nurses’ ethical practice and competencies. Additionally, nurses’ knowledge in both ethical and legal aspects, ethical climate and practice had a negative influence on the occurrence of medical errors.ConclusionEnhancing nurses’ knowledge in both ethical and legal aspects as well as ethical climate could significantly influence improving nurses’ ethical practice, competencies and reducing medical errors in the study units. Therefore, planning for enhancing the nurses’ ethico-legal learning and ethical climate seems to be mandatory. (shrink)

Modern biomedical technologies managed to revolutionise the End-of-Life Care (EoLC) in many aspects. The dying process can now be "engineered" by managing the accompanying physical symptoms or by "prolonging/hastening" death itself. Such interventions questioned and problematised long-established understandings of key moral concepts, such as good life, quality of life, pain, suffering, good death, appropriate death, dying well, etc. This volume examines how multifaceted EoLC moral questions can be addressed from interdisciplinary perspectives within the Islamic tradition. Contributors (...) Amir Abbas Alizamani, Beate Anam, Hamed Arezaei, Asma Asadi, Pieter Coppens, Hans Daiber, Khalid Elzamzamy, Mohammed Ghaly, Hadil Lababidi, Shahaboddin Mahdavi, Aasim Padela, Rafaqat Rashid and Ayman Shabana. (shrink)

This case concerns aspects of the treatment of a post-surgical patient in a major public hospital in New Zealand during the author's experiences as a fourth year medical student. This case is used to consider the interlinked ethical issues of sympathy, moral virtue, dignity and how the medical environment can realign these values.

Care Ethics and Political Theory is a collection of fifteen original essays that explore the implications and applications of care to social and political policies, practices, and theories.

This textbook looks at how different world faiths approach ethics in health and social care, and how their faith informs their practice. Equipping practitioners with the information they need, it will help them to be more reflective regarding spirituality, ethics and their provision of care.

Berufliche Autonomie ist Voraussetzung für Zufriedenheit mit der eigenen Tätigkeit. Dem Arztberuf wird ein hohes Maß an Autonomie zugeschrieben, verbunden mit fachlicher und ethisch-moralischer Kompetenz für lebenswichtige Bereiche. Das sind wesentliche Elemente für das positive Image dieses Berufes. Zu Beginn der ärztlichen Tätigkeit ist die ethischmoralische Kompetenz weitgehend ausgebildet, während die fachliche Kompetenz erst erworben werden muss. Kliniken, in denen die Weiterbildung meist erfolgt, sind oft auch heute noch traditionell hierarchisch organisiert. Die z.T. feudalistischen oder militärischen Strukturen behindern autonome moralische (...) Entscheidungen und bewirken eine strukturelle Verantwortungslosigkeit. Behinderungen und Druck durch Vorgesetzte, finanzielle Sanktionen, Standesdünkel und Profilierungsbestreben werden an typischen Konfliktsituationen aufgezeigt. Es kommt dadurch zu Spannungen, Unzufriedenheit, Gewissenskonflikten und Erkrankungen bis zum Burn out. Engagement von Mitarbeitern wird verhindert, Kreativität nicht genutzt und Fehler werden nicht konstruktiv bearbeitet. Dadurch können Patienten unangemessen belastet oder geschädigt werden. Nicht nur Vorgesetzte, sondern auch Nachgeordnete können so in Gefahr geraten, ihre moralischen Werte anderen Interessen unterzuordnen. Es werden Wege zu einer autonomiefördernden Kultur zwischen Ärzten und mit anderen Berufsgruppen aufgezeigt. Dazu gehört eine institutionalisierte Kommunikation auf der Basis gegenseitiger Wertschätzung in einem partnerschaftlichen Team, das auch ethische Fragen im Diskurs bearbeiten kann. (shrink)

The entwined history of humans and elephants is fascinating but often sad. People have used elephants as beasts of burden and war machines, slaughtered them for their ivory, exterminated them as threats to people and ecosystems, turned them into objects of entertainment at circuses, employed them as both curiosities and conservation ambassadors in zoos, and deified and honored them in religious rites. How have such actions affected these pachyderms? What ethical and moral imperatives should humans follow to ensure (...) that elephants are treated with dignity and saved from extinction? In Elephants and Ethics, Christen Wemmer and Catherine A. Christen assemble an international cohort of experts to review the history of human-elephant relations, discuss current issues of vital concern to elephant welfare, and assess the prospects for the ethical coexistence of both species. Part I provides an overview of the vexatious human-elephant relationship, from the history of our interactions to understanding elephant intelligence and sense of self. It concludes with a discussion of the issues of stress, pain, and suffering as experienced by elephants in human care and the problems inherent in assessing these subjectively. The second part explores how humans use elephants as tools and entertainment. It reviews domestic uses in Asia, examines the history and roles of elephants in zoos and circuses, and discusses the methods and ethics of training and caring for captive elephants. In Part III the contributors examine the fragile and conflict-filled world of human-elephant interactions in the wild. Each chapter delves into a different angle of the "elephant problem" -- the all-too-human problem of our growing populations taking over space that was historically the domain of these pachyderms. The chapters explore attempts to tame and "train" elephants in populous areas, the struggle over balancing species preservation while maintaining biodiversity in protected areas, and the conundrums posed by hunting, tourism, and human-elephant competition on rural land. That the future health and survival of elephants is dependent on human actions is irrefutable. In addressing these issues from multiple perspectives, Elephants and Ethics promotes mutual understanding of the cultural, conservation, and economic difficulties at the root of the many troublesome human-elephant interactions and poses new questions about our responsibility toward these largest of land mammals. (shrink)

This paper investigates the process of moral agency development as a community-supported process. Based on a multimethod qualitative inquiry, including diaries, focus groups, and documentary analysis, we analyze the experiences of middle managers in two Norwegian hospitals during the first year of the COVID-19 pandemic. We find that moral agency is developed through a community-embedded value inquiry, emerging in three partially overlapping steps. The first step is marked by moral reflex, an intuitive, value-driven, pre-reflective response to a (...) crisis situation. In the second step, the managers involved the community in value calibration, a collective-ethical sensemaking. In the third step, they took active stances to translate values into actions, with an increased awareness of values and an ability to explain and justify their actions. We label the steps, respectively: value inquiry-in-action, value inquiry-on-action and reflective enactment of value. An analysis of the process reveals two aspects critical for moral agency development: it happens through confrontation with uncertainty, and it is relational, that is, embedded in a community. While uncertainty forces an intuitive moral response, dialogical reflection in the community develops value awareness and relationships of mutual care and support. (shrink)

This manual is a compendium of various health care policies, guidelines, protocols, and programs that concern clinical issues with ethical implications. The collection of policies, guidelines, and procedures are helpful in drafting and reviewing institutional procedures and helping policymakers develop useful mechanisms for assuring ethical treatment of patients and staff.

This article addresses some critical aspects of the relationship between aesthetic medicine (AM) and ethics and proposes a possible deontological ethical line to pursue based on current practices. The role of AM has always been controversial and suffers from unclear practical and moral boundaries, even within academic settings, since it aims to improve the appearance of individuals, not to cure a disease. Today, it is essential and pertinent to discuss these issues, as AM specialists are dealing with (...) a growing and increasingly demanding patient population that has undergone profound evolution in recent years. Current challenges within the field of AM include a lack of global uniformity concerning the education of AM specialists, an increasing number of physicians practicing AM with diverse training backgrounds, the spread of AM being practiced outside of medical practice or hospital settings, and the influence of social media where the success is modelled and dictated by the identification of a youthful appearance). By the field of action enriched by technologies that aim not only at enhancement per se but also at the preservation and regeneration of tissues, it is necessary to establish an active multidisciplinary discussion on the definition of shared ethical limits. This discussion would allow AM to fully reclaim its identity as a specialty that aims to improve patient well-being whilst maintaining respect for patient aesthetic harmony, the expertise of specialists who practice AM, the essential role of safety, and awareness of the importance of a confidential doctor−patient relationship. (shrink)

The recent Covid-19 pandemic has brought a broad range of ethical problems to the forefront, raising fundamental questions about the role of government in response to such outbreaks, the scarcity and allocation of health care resources, the unequal distribution of health risks and economic impacts, and the extent to which individual freedom can be restricted. In this clear introduction to the topic Iwao Hirose explores these ethical questions and analyzes the central issues in the ethics of pandemic (...) response and preparedness such as: The general nature of pandemics and the ethics of preparedness Ethical questions about general goals of pandemic response and preparedness The distribution of scarce resources, e.g., ventilators, hospital beds, antiviral drugs and vaccines Restrictions on individual freedom Ethical questions in the wake of pandemics, including contact-tracing, vaccine passports and socioeconomic inequalities. With the use of real-life examples and a clear philosophical approach, The Ethics of Pandemics is a much-needed introduction to some of the most important ethical issues surrounding pandemics. It is essential reading for students of ethics, bioethics, and political philosophy and will also be of interest to those working in related areas such as public policy, public health, health law, nursing and life sciences. (shrink)

This paper examines the meaning of space and its relationship to value. In this paper, I draw on Henri Lefebvre to suggest that our ethics produce and are produced by spaces. Space is not simply a passive material container or neutral geographic location. Space includes the ideas on which buildings are modeled, the ordering of objects and movement patterns within the space, and the symbolic meaning of the space and its objects. Although often unrecognized, space itself is value-laden, and its (...) values are suggested as people interact within that space. By reflecting on the spaces of health care, we will see that we not only must attend to the quandaries caused by the delivery of health care in non-acute places, but also to the values that produce and are produced by spaces. These values influence our moral imagination and shape us as people. (shrink)

Background: Moral distress is an important and well-studied phenomenon among nurses and other healthcare providers, yet the conceptualization of parental moral distress remains unclear. Objective: The objective of this dimensional analysis was to describe the nature of family moral distress in serious pediatric illness. Design and methods: A dimensional analysis of articles retrieved from a librarian-assisted systematic review of Scopus, CINAHL, and PsychInfo was conducted, focusing on how children, parents, other family members, and healthcare providers describe parental (...) moral distress, both explicitly through writings on parental moral experience and implicitly through writings on parental involvement in distressing aspects of the child’s serious illness. Ethical considerations: To promote child and family best interest and minimize harm, a nuanced understanding of the moral, existential, emotional, and spiritual impact of serious pediatric illness is needed. The cases used in this dimensional analysis come from the first author’s IRB approved study at the Children’s Hospital of Philadelphia and subsequent published studies; or have been adapted from the literature and the authors’ clinical experiences. Findings: Three dimensions emerged from the literature surrounding parent moral distress: an intrapersonal dimension, an interpersonal dimension, and a spiritual/existential dimension. The overarching theme is that parents experience relational solace and distress because of the impact of their child’s illness on relationships with themselves, their children, family, healthcare providers, their surrounding communities, and society. Discussion: Elucidating this concept can help nurses and other professionals understand, mitigate, or eliminate antecedents to parental moral distress. We discuss how this model can facilitate future empirical and conceptual bioethics research, as well as inform the manner in which healthcare providers engage, collaborate with, and care for families during serious pediatric illness. Conclusion: Parent moral distress is an important and complex phenomenon that requires further theoretical and empirical investigation. We provide an integrated definition and dimensional schematic model that may serve as a starting point for future research and dialogue. (shrink)

BackgroundDuring a commercial surrogacy arrangement, the event of embryo transfer can be seen as the formal starting point of the arrangement. However, it is common for surrogates to undergo a failed attempt at pregnancy conception or missed conception after an embryo transfer. This paper attempts to argue that such failed attempts can be understood as a loss. It aims to reconstruct the experiences of loss and grief of the surrogates and the intended parents as a consequence of their collective failure (...) to conceive a surrogate pregnancy.MethodsDrawing on a qualitative study conducted over a period of eight months between 2014 and 2015 at two fertility clinics in Delhi and two in Kolkata, India, this paper examines the experiences of the surrogates and the intended parents when faced with missed conceptions or failed conceptions during a surrogacy arrangement.ResultsWe argue that while the surrogate grieves the non-arrival of a ‘good news’ as an uncertain loss, the intended parents experience yet another, failure in addition to the losses they might have incurred during their previous fertility treatments. The body of the surrogate becomes a site of ‘a lost opportunity’. The surrogate embodies a loss in her quest to achieve social mobility and the intended parents experience a disembodied pregnancy loss. This very emotional experience stands in stark contrast to the conceptualisation of such failed attempts as non-events within the discourse of the surrogacy industry. The experience of loss of the intended parents is recognised but their grief is given no space. We argue that such ambiguity around the nature of losses resulting out of a missed or failed conception during surrogacy is an outcome of lack of interpersonal relationship between the surrogate and the intended parents.ConclusionsSince commercial surrogacy is a relational process, the only way in which the experiences of losses and failures of the actors at the preconception stage can be better addressed is through developing close sharing and understanding between each other through an ethics of care. Therefore, to nurture caring relationships, surrogacy needs to be understood as a moral commitment by –the surrogates and intended parents. To enable such a commitment, there is a need to reconsider the pre-defined and legally regulated professional duty of the doctors, agents and agencies. It cannot be a one-sided commitment, but has to have elements of mutuality. (shrink)

Background In 2021, Spain became the first Southern European country to grant and provide the right to euthanasia and medically assisted suicide. According to the law, the State has the obligation to ensure its access through the health services, which means that healthcare professionals’ participation is crucial. Nevertheless, its implementation has been uneven. Our research focuses on understanding possible ethical conflicts that shape different positions towards the practice of Medical Assistance in Dying, on identifying which core ideas may be (...) underlying them, and on suggesting possible reasons for this disparity. The knowledge acquired contributes to understanding its complexity, shedding light into ambivalent profiles and creating strategies to increase their participation. Methods We conducted an exploratory qualitative research study by means of semi-structured interviews (1 h) with 25 physicians and nurses from primary care (12), hospital care (7), and palliative care (6), 17 women and 8 men, recruited from Madrid, Catalonia, and Andalusia between March and May 2023. Interviews were recorded, transcribed, and coded in Atlas.ti software by means of thematic and interpretative methods to develop a conceptual model. Results We identified four approaches to MAiD: Full Support (FS), Conditioned Support (CS), Conditioned Rejection (CR), and Full Rejection (FR). Full Support and Full Rejection fitted the traditional for and against positions on MAiD. Nevertheless, there was a gray area in between represented by conditioned profiles, whose participation cannot be predicted beforehand. The profiles were differentiated considering their different interpretations of four core ideas: end-of-life care, religion, professional duty/deontology, and patient autonomy. These ideas can intersect, which means that participants' positions are multicausal and complex. Divergences between profiles can be explained by different sources of moral authority used in their moral reasoning and their individualistic or relational approach to autonomy. Conclusions There is ultimately no agreement but rather a coexistence of plural moral perspectives regarding MAiD among healthcare professionals. Comprehending which cases are especially difficult to evaluate or which aspects of the law are not easy to interpret will help in developing new strategies, clarifying the legal framework, or guiding moral reasoning and education with the aim of reducing unpredictable non-participations in MAID. (shrink)

Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This (...) article reports on the findings of a systematic review of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement. (shrink)

Battle lines have been drawn over involuntary treatment. On one side, there are those who oppose involuntary psychiatric treatments under any condition. Activists who take up this cause often don't acknowledge that psychiatric symptoms can render people dangerous to themselves or others. They also don't allow for the idea that the civil rights of an individual may be at odds with the heartbreak of a caring family. On the other side are groups pushing for increased use of involuntary treatment. These (...) proponents are quick to point out that people with psychiatric illnesses often don't recognize that they are ill, which (from their perspective) makes the discussion of civil rights moot. They may gloss over the sometimes dangerous side effects of psychiatric medications, and they often don't admit that patients, even after their symptoms have abated, are sometimes unhappy that treatment was inflicted upon them. In Committed, psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy--all within the context of civil rights-- Miller and Hanson illuminate the personal consequences of this controversial practice through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it. The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions--mental health court, crisis intervention training, and pretrial diversion--that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public. (shrink)

English summary: Does pastoral care require ethical competence in order to fulfil its task properly? And, conversely, to what extent does ethical reflection require feedback from pastoral experience in order to remain true to life and of practical relevance? Wilfried Sturm examines the way hospital pastors deal with ethical challenges and conflict situations in neonatal clinics and enquires into the insights that can be gained from them for the relationship of pastoral care and ethics. (...) German description: Braucht Seelsorge ethische Kompetenz, um ihrem Auftrag gerecht zu werden? Inwiefern bedarf umgekehrt die ethische Reflexion der Ruckkopplung an seelsorgerliche Erfahrung, um lebensnah und praxisrelevant zu bleiben? Wilfried Sturm untersucht den Umgang von Klinikseelsorgerinnen und -seelsorgern mit ethischen Herausforderungen und Konfliktsituationen in der Fruh- und Neugeborenenmedizin und fragt, welche Einsichten sich daraus fur das Verhaltnis von Seelsorge und Ethik gewinnen lassen. (shrink)

This article develops an approach to ethical globalization based on a feminist, political ethic of care; this is achieved, in part, through a comparison with, and critique of, Thomas Pogge's World Poverty and Human Rights. In his book, Pogge makes the valid and important argument that the global economic order is currently organized such that developed countries have a huge advantage in terms of power and expertise, and that decisions are reached purely and exclusively through self-interest. Pogge uses (...) an institutional rights framework to argue that direct responsibility for global poverty and inequality lies with the citizens of developed countries, since suffering and death are caused by global economic arrangements designed and imposed by our governments. While this argument is certainly compelling, I have argued that it tells us little about the actual effects of globalization on the real people of the South - including women, children and the elderly. As a result, it can offer little in the way of real alternatives or policy prescriptions. As a moral orientation, a care ethic relies on a relational moral ontology, and leads us to consider different values in terms of human flourishing. Moreover, it pushes us to consider the normative implications of aspects of the global political economy which are usually not 'seen' at all, including the global distribution of care work and the corresponding patterns of gender and racial inequality, the underprovision of care and resources for caring work in both the developed and developing world, and the ways in which unpaid or low-paid caring work helps to sustain a cycle of exploitation and inequality on a global scale. (shrink)

This article addresses some critical aspects of the relationship between aesthetic medicine (AM) and ethics and proposes a possible deontological ethical line to pursue based on current practices. The role of AM has always been controversial and suffers from unclear practical and moral boundaries, even within academic settings, since it aims to improve the appearance of individuals, not to cure a disease. Today, it is essential and pertinent to discuss these issues, as AM specialists are dealing with (...) a growing and increasingly demanding patient population that has undergone profound evolution in recent years. Current challenges within the field of AM include a lack of global uniformity concerning the education of AM specialists, an increasing number of physicians practicing AM with diverse training backgrounds, the spread of AM being practiced outside of medical practice or hospital settings, and the influence of social media where the success is modelled and dictated by the identification of a youthful appearance). By the field of action enriched by technologies that aim not only at enhancement per se but also at the preservation and regeneration of tissues, it is necessary to establish an active multidisciplinary discussion on the definition of shared ethical limits. This discussion would allow AM to fully reclaim its identity as a specialty that aims to improve patient well-being whilst maintaining respect for patient aesthetic harmony, the expertise of specialists who practice AM, the essential role of safety, and awareness of the importance of a confidential doctor−patient relationship. (shrink)

Background Intensive and critical care nurses need to demonstrate ethical sensitivity especially in recognizing and dealing with ethical dilemmas particularly as they often care for patients living with life-threatening conditions. Theories suggest that there is a convergence between nurses’ empathy and ethical sensitivity. Evidence in the literature indicates that nurses’ emotional, demographic, and work characteristics are associated with their level of empathy and ethical sensitivity. Aim To investigate the relationship between nurses’ empathy and (...) class='Hi'>ethical sensitivity, considering their emotional states (depression, anxiety, and stress), demographic and work characteristics, and test an empirical model describing potential predictors of empathy (as a mediator) and ethical sensitivity using path analysis. Research design Using a cross-sectional design, the philosophical theory of care ethics and empathy was extended and adopted as a conceptual framework for this study and tested by path analysis. Participants and research context Data were collected from 347 intensive care nurses recruited by ten educational-medical hospitals in Iran using a questionnaire between February and March 2021. Ethical considerations The study was reviewed by the Ethical Advisory Board in Iran and conducted according to the Declaration of Helsinki. Findings Study participants demonstrated a mild level of stress, anxiety, and depression, alongside a relatively high level of empathy and ethical sensitivity. Nurses with good socioeconomic status had higher empathetic behavior with patients than those with weak status. Nurses aged over 40 who had received ethics training and had higher work experience were associated with higher ethical sensitivity compared to nurses under 20 years of age. Empathy directly affected ethical sensitivity; however, anxiety had an indirect effect on ethical sensitivity through empathy. Among demographic factors, age had a positive direct effect on ethical sensitivity. Conclusions Less anxiety and a high level of empathy contribute to higher levels of ethical sensitivity among intensive and critical care nurses. (shrink)

Introduction -- The ethics of care and global politics -- Rethinking human security -- 'Women's work' : the global care and sex economies -- Humanitarian intervention and global security governance -- Peacebuilding and paternalism : reading care through postcolonialism -- Health and human security : gender, care and HIV/AIDS -- Gender, care, and the ethics of environmental security -- Conclusion. Security through care.

Ethics, religion, and spirituality -- Spirituality in care -- Spirituality and ethics -- Love -- The community of care : fit for purpose -- Values, virtues, and the patient -- Challenging faith -- Spirituality and the domain of justice.

In the 1960s, human experimentation and public funding of research increased significantly, and with the rise of the modern teaching hospital, the distinction between clinical care and experimentation became more and more blurred. Yet little in the way of meaningful government regulation existed in the United States prior to 1970. In 1966, Paul Freund, the president of the American Academy of Arts and Sciences, appointed an interdisciplinary working group to consult on the issues being raised by human experimentation. (...) Contributions from the group were published in a 1969 issue of Daedalus titled Ethical Aspects of Experimentation with Human Subjects. In the lead essay, Hans Jonas challenged then‐conventional understandings of the moral problems posed by research involving humans and argued for an alternative moral framework. To Jonas, it mattered whether the physician was trying to make the patient well rather than trying to find out how to improve the health of future patients. (shrink)

How care can resist the stifling force of the neoliberal paradigm In a world brimming with tremendous wealth and resources, too many are suffering the oppression of precarious existences--and with no adequate relief from free market-driven institutions. Care Ethics in the Age of Precarity assembles an international group of interdisciplinary scholars to explore the question of care theory as a response to market-driven capitalism, addressing the relationship of three of the most compelling social and political subjects today: (...) care, precarity, and neoliberalism. While care theory often centers on questions of individual actions and choices, this collection instead connects theory to the contemporary political moment and public sphere. The contributors address the link between neoliberal values--such as individualism, productive exchange, and the free market--and the pervasive state of precarity and vulnerability in which so many find themselves. From disability studies and medical ethics to natural-disaster responses and the posthuman, examples from Māori, Dutch, and Japanese politics to the COVID-19 pandemic and the Black Lives Matter movement, this collection presents illuminating new ways of considering precarity in our world. Care Ethics in the Age of Precarity offers a hopeful tone in the growing valorization of care, demonstrating the need for an innovative approach to precarity within entrenched systems of oppression and a change in priorities around the basic needs of humanity. Contributors: Andries Baart, U Medical Center Utrecht, Tilburg U, and Catholic Theological U Utrecht, the Netherlands; Vrinda Dalmiya, U of Hawaii, Mānoa; Emilie Dionne, U Laval; Maggie FitzGerald, U of Saskatchewan; Sacha Ghandeharian, Carleton U; Eva Feder Kittay, Stony Brook U/SUNY; Carlo Leget, U of Humanistic Studies in Utrecht, the Netherlands; Sarah Clark Miller, Penn State U; Luigina Mortari, U of Verona; Yayo Okano, Doshisha U, Kyoto, Japan; Elena Pulcini, U of Florence. (shrink)

This title offers an ethical framework for end-of-life decision making in healthcare settings. Its objective is to foster and support ethically and legally sound clinical practice in end-of-life treatment and care in Ireland.

The ethics of care, developed in early 1980s within feminism as a critique on the biases of neokantian ethics, is 40 years old. This book presents its key insights, the developments and debates over the years and the challenges care ethics faces. Internationally renown scholars from various continents have contributed, a clear sign that care ethics has spread over the globe. The key insights regard issues close by, care from person to person, but also at an (...) institutional level and questions of global impact. Vulnerability and relationality are examples of these insights. What can caring practices, ranging from social welfare to palliative care, learn from care ethics? Has care ethics had an impact on ethics at large and what is its future? (shrink)

BackgroundCommentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units. Our aim was twofold: to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and determine the association between the ethical climate, moral distress, and intention to leave.MethodsWe performed a cross-sectional questionnaire study between May 2021 and August 2021 involving (...) 206 nurses and physicians in a large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire and the Measure of Moral Distress for Healthcare Professionals tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave.ResultsNurses perceived the ethical climate for decision-making as less favorable than physicians. They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units and also demonstrated lower moral distress scores and lower “intention to leave” scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated ; moral distress and "intention to leave" was positively correlated ; and ethical climate and “intention to leave” were negatively correlated.ConclusionsSignificant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care. (shrink)

Wish to die statements are becoming a frequent phenomenon in terminally ill patients. Those confronted by these statments need to understand the complexity of such wishes, so they can respond competently and compassionately to the requests. If misunderstood, the statements can be taken at face-value and the practitioner may not recognise that a patient is in fact experiencing ambivalent feelings at the end of life, or they may misinterpret the expressed wish to die as a sign of clinical depression. Public (...) debate about the morality and ethics of various end-of-life care options has exploded in recent years. However, it has never been sensitive to the finer aspects of clinical reality or the experiences of patients. The Patient's Wish to Die: Research, Ethics, and Palliative Care brings together that reality and the patient's voice, combining them with different research approaches. It presents the best available knowledge and research methodologies about patients' wishes at the end-of-life, together with a series of ethical views and a discussion about the clinical implications for palliative care. The book presents material in an open and unbiased manner whilst remaining sensitive to the spiritual and existential dimensions of dying, and to the different cultural views that provide meaning to the individual. Written by the best specialists and ethics scholars from around the world, including palliative care practitioners and end-of-life scholars from countries where assisted dying practices are legalized and from those where it isn't, The The Patient's Wish to Die: Research, Ethics, and Palliative Care will prove essential reading for all those working or studying in the field of palliative care. (shrink)

Definition of the problemStaff and patients in institutions of organized health care experience and express a variety of adverse conditions of these organizations. Within a theoretical framework of institutional pathology we can explain some of these “miserable conditions” as effects of the activities of organizations belonging to the political system (health policy) and to the economic system (health economy). Clinical ethics committees (CECs) cannot effectively handle such adversities or even address them properly. Standard organizational ethics can address them but (...) cannot handle them effectively.ArgumentsI propose to strengthen organizational ethics by a theory of institutional pathology. Basic nosological distinctions such as disease, illness and sickness, whose primary reference is to biological organisms and persons, can be analogically extended to socially constituted entities (e.g. hospitals) in terms of functional deficiency, miserable conditions, and need for reform of such entities. A very promising focus for analysis are organizational disorders of responsibility allocation. This group of institutional pathological disorders engenders, amongst other kinds of miserable conditions, specifically morally relevant miserable conditions.ConclusionThe institutional pathology paradigm, oriented to concrete institutions and organizations, can help “clinical” organizational ethics to considerably expand, in theoretical ethics as well as in ethically guided practice e.g. for members of CECs and organizational ethics advisors, the capacities for observing, evaluating and, if necessary, amending disturbed relations of responsibility. (shrink)

Background:Emergency care providers are frequently faces with situations in which they have to make decisions quickly in stressful situations. They face barriers to ethical decision-making and recognizing and finding solutions to these barriers helps them to make ethical decision.Objectives:The purpose of this study was to identify barriers of ethical decision-making in Iranian Emergency Medical Service personnel.Methods:In this qualitative research, the participants (n = 15) were selected using the purposive sampling method, and the data were collected by (...) deep and semi-structured interviews. Finally, the data are analyzed using the content analysis approach.Ethical considerations:Permission to conduct the study was obtained from the Ethics Committee of the Shahid Beheshti University of Medical Sciences. The objectives of the study were explained to the participants and written consent was received from them. Also, participants were assured that necessary measures were taken to protect their anonymity and confidentiality.Findings:The results of the analysis are classified in five main categories. It encompasses the following areas: perception of situation, patient-related factors, input and output imbalance, uncoordinated health system, and paradoxes.Conclusion:Emergency Medical Service personnel make ethical decisions every day. It is important that prehospital personnel know how to manage those decisions properly so that clients’ moral rights are respected. Hence, by identifying the dimensions and obstacles of ethical decision-making in Emergency Medical Service personnel, it is possible to enhance the moral judgment and ethical accountability of the personnel and develop the strategies necessary for ethical decision-making in them. (shrink)

Coercive Care: The Ethics of Choice in Health and Medicine asks probing and challenging questions regarding the use of coercion in health care and social services. This book combines philosophical analysis with comparative studies of social policy and law in a large number of industrialized countries and proposes an ideal of judicial security on a global scale.

What is the spirit that animates collective action? What is the ethos of democracy? _Worldly Ethics _offers a powerful and original response to these questions, arguing that associative democratic politics, in which citizens join together and struggle to shape shared conditions, requires a world-centered ethos. This distinctive ethos, Ella Myers shows, involves care for "worldly things," which are the common and contentious objects of concern around which democratic actors mobilize. In articulating the meaning of worldly ethics, she reveals the (...) limits of previous modes of ethics, including Michel Foucault's therapeutic model, based on a "care of the self," and Emmanuel Levinas's charitable model, based on care for the Other. Myers contends that these approaches occlude the worldly character of political life and are therefore unlikely to inspire and support collective democratic activity. The alternative ethics she proposes is informed by Hannah Arendt's notion of _amor mundi_, or love of the world, and it focuses on the ways democratic actors align around issues, goals, or things in the world, practicing collaborative care for them. Myers sees worldly ethics as a resource that can inspire and motivate ordinary citizens to participate in democratic politics, and the book highlights civic organizations that already embody its principles. (shrink)