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1
Wright, David, and Susan Brajtman. "Relational and embodied knowing: Nursing ethics within the interprofessional team." Nursing Ethics 18, no. 1 (January 2011): 20–30. http://dx.doi.org/10.1177/0969733010386165.
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In this article we attempt to situate nursing within the interprofessional care team with respect to processes of ethical practice and ethical decision making. After briefly reviewing the concept of interprofessionalism, the idea of a nursing ethic as ‘unique’ within the context of an interprofessional team will be explored. We suggest that nursing’s distinct perspective on the moral matters of health care stem not from any privileged vantage point but rather from knowledge developed through the daily activities of nursing practice. Because of their position vis-à-vis patients and families in everyday clinical care, nurses cultivate ethical knowledge of at least two forms: (1) relational knowledge; and (2) embodied knowledge. Through the integration of these forms of knowledge, nurses develop a unique moral perspective and can make a meaningful contribution to the realm of ethics in interprofessional care.
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Wagner, Nurit, and Ilana Ronen. "Ethical Dilemmas Experienced By Hospital and Community Nurses: an Israeli Survey." Nursing Ethics 3, no. 4 (December 1996): 294–303. http://dx.doi.org/10.1177/096973309600300403.
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The objective of this survey was to assess the extent to which nurses encounter and identify dilemma-generating situations in the light of the publication and circulation of the Israeli code of ethics for nurses in 1994. The results are being used as a basis for a programme aimed at promoting nurses' decision-making skills in coping with ethical dilemmas. In this era of major advances in medicine, the nurse's role as the protector of patient rights may bring about conflicts with physicians' orders, with institutional policies, or with patients' families. Nurses will then become confronted with ethical and moral dilemmas. A nationwide survey was carried out to identify and describe the ethical conflicts with which nurses in Israel are confronted in the course of their work. A third of the enumerated dilemmas were encountered by more than 50% of the nurses. The major determinant influencing encounters with dilemmas, as perceived by the participating nurses, was their work setting, namely, the hospital versus the community. It was shown that nurses seek support mainly among their peers, they are barely familiar with the Israeli Code, and they consider their own families as the predominant factor in shaping their ethical attitudes.
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Peter, Elizabeth, Shan Mohammed, and Anne Simmonds. "Sustaining hope as a moral competency in the context of aggressive care." Nursing Ethics 22, no. 7 (October 14, 2014): 743–53. http://dx.doi.org/10.1177/0969733014549884.
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Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. Research objectives: The purpose of this inquiry was to explore nurses’ moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social–moral space of nurses’ work in order to capture how competencies may reflect an adaptation to a less than ideal work environment. Research design: A critical qualitative approach was used. Participants: Fifteen graduate nursing students from various practice areas participated. Ethical considerations: After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed. Findings: One overarching theme ‘Mediating the tension between providing false hope and destroying hope within biomedicine’ along with three subthemes, including ‘Reimagining hopeful possibilities’, ‘Exercising caution within the social–moral space of nursing’ and ‘Maintaining nurses’ own hope’, was identified, which represents specific aspects of this moral competency. Discussion: This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope. Conclusion: The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings.
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Passos dos Santos, Raissa, Eliane Tatsch Neves, and Franco Carnevale. "The moral experiences of pediatric nurses in Brazil: Engagement and relationships." Nursing Ethics 26, no. 5 (March 1, 2018): 1566–78. http://dx.doi.org/10.1177/0969733017753744.
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Background: Pediatric nursing care involves many significant ethical challenges. Although nurses are broadly recognized as professionals with relevant knowledge about children and families, little is known about how nurses experience ethical concerns in their everyday practice. Objective: The objective of this study was to better understand the moral experiences and related moral distress experiences of nurses working in pediatric settings in Brazil. Design: Interpretative phenomenological study conducted through narrative interviews. Participants and research context: Nine nurses working in three pediatric settings of a teaching hospital in a city of Southern Brazil. Ethical considerations: The study was approved by the Research Ethics Committee of the research site, and research ethics principles were respected throughout the study. Findings: This investigation illuminated a broader dimension of nurses’ moral distress, which was recognized as moral experience. In advancing our understanding of nurses’ moral experiences, engagement was identified as a central phenomenon that is present in the understandings and actions of nurses within their relationships in their daily practice and lived experiences. Three themes were described with regard to nurses’ relationships and their moral experiences: (a) relationship with the healthcare team; (b) relationship with the family; and (c) relationship with the child. Discussion: The findings of this study are congruent with emerging health literature that demonstrated the focus on moral distress as limiting for bioethical inquiry. Moreover, it is important to better understand and recognize nurses’ relational environment and engagements to advance understandings of the ethical dimensions of pediatric nursing practice. Conclusion: This study provides a better understanding on how engagement affects moral experiences, demonstrating how nurses can experience distress but also satisfaction, gratification, rewarding feelings, and a sense of responsibility for the care they provide.
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Lee, Susan, Ellen M. Robinson, Pamela J. Grace, Angelika Zollfrank, and Martha Jurchak. "Developing a moral compass: Themes from the Clinical Ethics Residency for Nurses’ final essays." Nursing Ethics 27, no. 1 (April 28, 2019): 28–39. http://dx.doi.org/10.1177/0969733019833125.
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Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of decision-making that confront them in daily practice.” Six major themes corresponding to questions posed to the participants included the ability to advocate for good patient care; to support and empower colleagues, patients, and families; they experienced personal and professional transformation; they valued the multimodal nature of the program; and were using their new knowledge and skills in practice. However, they also recognized that their development as moral agents was an ongoing process. Discussion: Findings support that enhancing nurse confidence in their moral agency with a multimodal educational approach that includes mentored practice in ethical decision-making, enhancing communication skills and role-play can mitigate moral distress. A majority found the program personally and professionally transformative. However, they recognized that ongoing ethics discussion involvement and supportive environments would be important in their continued development of ethical agency. Conclusion: Multimodal ethics education programs have potential to be transformative and enhance nurse confidence in their ethical decision-making.
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Yaremin, B. I., S. Yu Pushkin, A. S. Navasardyan, A. A. Selyutin, K. K. Gubarev, and V. E. Alexandrova. "Moral and ethical aspects of organ donation for transplantation – catechism project." Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH), no. 1 (April 13, 2021): 97–108. http://dx.doi.org/10.20340/vmi-rvz.2021.1.tx.3.
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The moral and ethical aspects of organ donation for transplantation constitute a new section of the doctor's activity. The correct and motivated awareness of the answers to the main questions that may arise from members of the public, patients, members of their families, medical personnel, undoubtedly, is within the competence of the doctor. This work is devoted to the analysis of existing approaches to answering the main questions arising around the activity of preserving the organs of the deceased for transplantation. The work was done in the format of a catechism, questions and the answers offered to them. Answers are given as one of the options.
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Oddi, Lorys F., Virginia R. Cassidy, and Cheryl Fisher. "Nurses' Sensitivity To the Ethical Aspects of Clinical Practice." Nursing Ethics 2, no. 3 (September 1995): 197–209. http://dx.doi.org/10.1177/096973309500200303.
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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.
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Andersson, Petra Lilja, Åsa Petersén, Caroline Graff, and Anna-Karin Edberg. "Ethical aspects of a predictive test for Huntington’s Disease." Nursing Ethics 23, no. 5 (August 2016): 565–75. http://dx.doi.org/10.1177/0969733015576356.
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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.
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Juujärvi, Soile, Kirsi Ronkainen, and Piia Silvennoinen. "The ethics of care and justice in primary nursing of older patients." Clinical Ethics 14, no. 4 (September 19, 2019): 187–94. http://dx.doi.org/10.1177/1477750919876250.
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While the ethic of care has generally been regarded as an appropriate attitude for nurses, it has not received equal attention as a mode of ethical problem solving. The primary nursing model is expected to be aligned with the ethic of care because it emphases the nurse–patient relationship and enables more independent role for nurses in decision-making. The aim of this study was to examine nurses’ ethical decision-making in the context of primary nursing. Participants were seven nurses, and one physiotherapist from a geriatric rehabilitation unit of a public hospital in Finland. Data were collected through focus group interviews and qualitatively analyzed through Lyons’ coding scheme for moral orientations. The results showed that primary nurses employ empathic understanding and particularistic thinking when building relationships with patients and their families, and when assessing their needs for coping at home after discharge. Most ethical conflicts were related to discharge and were solved through balancing the ethics of care and justice considerations. It is concluded that care and justice are integrated in nurses’ everyday ethical decision-making. The ethic of care nurtures good patient–nurse relationships, while the ethic of justice is needed to address the fair delivery of care in the context of an aging population and diminishing public resources. Both ethics should be acknowledged in clinical practices and included in ethics education.
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Marsh, Wendy, Ann Robinson, Jill Shawe, and Ann Gallagher. "Removal of babies at birth and the moral distress of midwives." Nursing Ethics 27, no. 4 (September 16, 2019): 1103–14. http://dx.doi.org/10.1177/0969733019874503.
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Background Midwives and nurses appear vulnerable to moral distress when caring for women whose babies are removed at birth. They may experience professional dissatisfaction and their relationships with women, families and colleagues may be compromised. The impact of moral distress may manifest as anger, guilt, frustration, anxiety and a desire to give up their profession. While there has been much attention exploring the concept of moral distress in midwifery, this is the first study to explore its association in this context. Aim This article explores midwives’ experiences of moral distress when providing care to women whose babies were removed at birth and gives valuable insight into an issue nurses and midwives encounter in their profession. Methods Four mothers and eight midwives took part in this research. Narrative inquiry incorporating photo-elicitation techniques was used to generate data; mothers were interviewed face to face and midwives through focus groups. The images and audio data were collected, transcribed and analysed for emerging themes. For the purpose of this article, only the midwives’ stories are reported. This research received a favourable ethical opinion from the University of Surrey Ethics committee. Ethical considerations This study received a favourable ethical approval from a higher education institutes ethics committee. Results Midwives who care for women whose babies are removed at birth report it as one of the most distressing areas of contemporary clinical practice. Furthermore, they report feelings of guilt, helplessness and betrayal of the midwife–mother relationship. Many of the midwives in this study state that these experiences stay with them for a long time, far more than more joyful aspects of their role. Conclusion Midwives experience moral distress. Support systems, education and training must be available to them if we are to reduce the long-term impact upon them, alleviate their distress and prevent them from leaving the profession.
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Baxter, Rosario, Ann Long, and David Sines. "The Legal and Ethical Status of Children in Health Care in the UK." Nursing Ethics 5, no. 3 (May 1998): 189–99. http://dx.doi.org/10.1177/096973309800500302.
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Ethical issues about children’s rights in respect of matters concerning resource allocation or treatment opportunities are now a matter for public consumption and concern. Alongside this exists a long-frustrated desire by children’s nurses to promote children’s health. Long-held assumptions about the legal and moral status of children within the health care system in this country are now rightly scrutinized and challenged. Those of us who claim to represent children now possess an opportunity to exploit public attention for the benefit of these children. This article will explore selected major relevant legal and moral concepts that relate to children with the aim of making transparent some of the important and often confusing information available. It is anticipated that debates about the legal and ethical status of children may be stimulated and fuelled from the following discussion. It is strongly recommended that entering into dialogue with families and children about their perceived needs will go a long way towards advancing thoughtful nursing care of individual children, their families and the general population.
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Sasso, Loredana, Annamaria Bagnasco, Monica Bianchi, Valentina Bressan, and Franco Carnevale. "Moral distress in undergraduate nursing students." Nursing Ethics 23, no. 5 (August 2016): 523–34. http://dx.doi.org/10.1177/0969733015574926.
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Background: Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety. Objectives: The purpose of this review was to describe how dilemmas and environmental, relational, and organizational factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education. Research design: The research design was a systematic literature review. Method: The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check. Ethical consideration: Since this was a systematic review, no ethical approval was required. Findings: From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses. Conclusion: Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students.
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Fairchild, Roseanne Moody. "Practical ethical theory for nurses responding to complexity in care." Nursing Ethics 17, no. 3 (May 2010): 353–62. http://dx.doi.org/10.1177/0969733010361442.
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In the context of health care system complexity, nurses need responsive leadership and organizational support to maintain intrinsic motivation, moral sensitivity and a caring stance in the delivery of patient care. The current complexity of nurses’ work environment promotes decreases in work motivation and moral satisfaction, thus creating motivational and ethical dissonance in practice. These and other work-related factors increase emotional stress and burnout for nurses, prompting both new and seasoned nurse professionals to leave their current position, or even the profession. This article presents a theoretical conceptual model for professional nurses to review and make sense of the ethical reasoning skills needed to maintain a caring stance in relation to the competing values that must coexist among nurses, health care administrators, patients and families in the context of the complex health care work environments in which nurses are expected to practice. A model, Nurses’ Ethical Reasoning Skills, is presented as a framework for nurses’ thinking through and problem solving ethical issues in clinical practice in the context of complexity in health care.
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Ramos, Flávia Regina Souza, Laura Cavalcanti de Farias Brehmer, Mara Ambrosina Vargas, Ana Paula Trombetta, Luciana Ramos Silveira, and Laila Drago. "Ethical conflicts and the process of reflection in undergraduate nursing students in Brazil." Nursing Ethics 22, no. 4 (August 4, 2014): 428–39. http://dx.doi.org/10.1177/0969733014538890.
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Background: Nursing students on clinical placements as part of their professional training are routinely faced with situations involving ethical conflicts. The initial act of perceiving a situation as causing an ethical dilemma is the result of both the students’ personal values, drawn from their culture and families, and of the professional knowledge and values that they have acquired through training and experience. Objectives: Nursing students’ experiences on clinical placements in primary care settings were investigated in order to identify situations that they perceived as involving ethical conflict and describe the elements they took into consideration during their decision-making processes in these situations. Methods: The research design was qualitative descriptive case study. Around 50 students from three different intakes to a nursing degree answered a questionnaire and discussed it in focus groups. Ethical considerations: The study was designed in accordance with the principles guiding research with human beings and was approved by the Human Research Ethics Committee. Results: Synthesised into two principal axes: (a) ethical conflicts in primary care, linked with the domains of working processes, professional nursing ethics and human and social rights and (b) students’ decision-making processes – realisation, reflection and intervention. Conclusion: The student nurses saw themselves both as actors and spectators in situations involving ethical problems and demanding moral deliberation, demonstrating the ability to base their arguments soundly. They tended to emphasise the possibilities offered by dialogue and that different ethical values must be respected to find fair solutions to ethical problems.
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Colaco, Keith A., Alanna Courtright, Sandra Andreychuk, Andrea Frolic, Ji Cheng, and April Jacqueline Kam. "Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs." Journal of Medical Ethics 44, no. 1 (July 27, 2017): 13–20. http://dx.doi.org/10.1136/medethics-2016-103531.
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ObjectiveWe sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments (EDs) in order to build ethics capacity and provide a foundation for the development of an ethics education programme.MethodsThis was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity.ResultsOf the 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress (16%), conflict management with patients or families (16%) and resource issues (15%). Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams (42%) was the most desired method.ConclusionsNurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists.
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Bjorklund, Pamela, and Denise M. Lund. "Informed consent and the aftermath of cardiopulmonary resuscitation: Ethical considerations." Nursing Ethics 26, no. 1 (April 26, 2017): 84–95. http://dx.doi.org/10.1177/0969733017700234.
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Background: Patients often are confronted with the choice to allow cardiopulmonary resuscitation (CPR) should cardiac arrest occur. Typically, informed consent for CPR does not also include detailed discussion about survival rates, possible consequences of survival, and/or potential impacts on functionality post-CPR. Objective: A lack of communication about these issues between providers and patients/families complicates CPR decision-making and highlights the ethical imperative of practice changes that educate patients and families in those deeper and more detailed ways. Design: This review integrates disparate literature on the aftermath of CPR and the ethics implications of CPR decision-making as it relates to and is affected by informed consent and subsequent choices for code status by seriously ill patients and their surrogates/proxies within the hospital setting. Margaret Urban Walker’s moral philosophy provides a framework to view informed consent as a practice of responsibility. Ethical considerations: Given nurses’ communicative skills, ethos of care and advocacy, and expertise in therapeutic relationships, communication around DNAR decision-making might look quite different if institutional norms in education, healthcare, law, and public policy held nurses overtly responsible for informed consent in some greater measure. Findings: Analysis from this perspective shows where changes in informed consent practices are needed and where leverage might be exerted to create change in the direction of deeper and more detailed discussions about CPR survival rates and possible consequences of survival.
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Arraf, Kelly, Ginny Cox, and Kathleen Oberle. "Using the Canadian Code Of Ethics for Registered Nurses to Explore Ethics in Palliative Care Research." Nursing Ethics 11, no. 6 (November 2004): 600–609. http://dx.doi.org/10.1191/0969733004ne741oa.
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Nursing research in palliative care raises specific and challenging ethical issues. Questions have arisen about whether such research is morally justified, given the low likelihood of direct benefit to dying patients as research participants. The Canadian Code of ethics for registered nurses outlines eight primary values intended to guide nursing practice. We use these values to explore the moral dimensions of research with the palliative care population. Our conclusion is that palliative care research is needed to foster excellent care for these patients and their families, but that nurses must remain constantly vigilant to ensure that participants are protected from resultant harms. Through this exploration we highlight particular considerations that nurse researchers must contemplate when accessing a vulnerable population.
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Ulrich, Connie M. "The Moral Distress of Patients and Families." American Journal of Bioethics 20, no. 6 (May 22, 2020): 68–70. http://dx.doi.org/10.1080/15265161.2020.1754522.
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Mohammed, Shan, and Elizabeth Peter. "Rituals, Death and the Moral Practice of Medical Futility." Nursing Ethics 16, no. 3 (May 2009): 292–302. http://dx.doi.org/10.1177/0969733009102691.
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Medical futility is often defined as providing inappropriate treatments that will not improve disease prognosis, alleviate physiological symptoms, or prolong survival. This understanding of medical futility is problematic because it rests on the final outcomes of procedures that are narrow and medically defined. In this article, Walker's `expressivecollaborative' model of morality is used to examine how certain critical care interventions that are considered futile actually have broader social functions surrounding death and dying. By examining cardiopulmonary resuscitation and life-sustaining intensive care measures as moral practices, we show how so-called futile interventions offer ritualistic benefit to patients, families, and health care providers, helping to facilitate the process of dying. This work offers a new perspective on the ethical debate concerning medical futility and provides a means to explore how the social value of treatments may be as important in determining futility as medical scientific criteria.
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Webb, Mary S., Denise Passmore, Genieveve Cline, and Denise Maguire. "Ethical issues related to caring for low birth weight infants." Nursing Ethics 21, no. 6 (January 24, 2014): 731–41. http://dx.doi.org/10.1177/0969733013513919.
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Background: Currently preterm births are the leading causes of newborn deaths and newborn mortality in developed countries. Infants born prematurely remain vulnerable to many acute complications and long-term disabilities. There is a growing concern surrounding the moral and ethical implications of the complex and technological care being provided to extremely low birth weight infants in neonatal intensive care units in the developed nations. Research purpose: The purpose of this study was to describe the ethical and moral issues that neonatal intensive care nurses experience when caring for low birth weight preterm infants and their families. Research design: A phenomenological method design was used to describe the lived experiences of nurses with ethical and moral issues encountered in the neonatal intensive care unit. One-on-one, semi-structured interviews using open-ended questions were used to gather data from the participants. Research participants: The setting for this study was a 97-bed neonatal intensive care. A total of 16 female nurses were interviewed. Ethical considerations: Approval to conduct the research study was obtained from the institutional review board of the hospital where the study was conducted. Formal signed consent was obtained from each participant. To ensure confidentiality, each participant was asked to choose a confederate name to be used in the interview and the transcriptions. Findings: The thematic analysis identified five recurring themes: (a) at the edge of viability, (b) infant pain and discomfort, (c) crucial decisions, (d) communicating with parents, and (e) letting go. Conclusion: Neonatal intensive care unit nurses indicated that they often had challenges to their own sense of morality as they struggled to protect the infant from pain and unnecessary discomfort, provide care to an infant and their family whom they thought was faced with a lifetime of challenges and poor health, accepting decisions made by parents, and feeling as if parents were not adequately informed about outcomes.
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Cedar, S. H. "Stem Cell and Related Therapies: Nurses and midwives representing all parties." Nursing Ethics 13, no. 3 (May 2006): 292–303. http://dx.doi.org/10.1191/0969733006ne862oa.
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Nurses and midwives are part of health care in all the stages of our lives from preconception to death. Recent scientific advances have introduced new techniques of screening and diagnosis linked to stem cell isolation and therapies. These could affect us at any age and therefore nurses will be involved as carers and patients advocates for these techniques. In this article stem cell techniques and therapies are outlined, as well as some of the ethical challenges faced by various nursing groups, whether in adult, learning difficulties, mental health, paediatric, primary care, public health or health visiting areas. Nurses have to understand the ethical issues and the rights of all parties (donor, recipient and families), which may conflict with each other, to be able to weigh up the benefits and costs to each group involved. Answers have to be found on a case-by-case basis within local moral frameworks and law. Nurses represent all parties in these therapies and act as advocates for every patient group. They need to act in an interprofessional environment to promote the best interests of all their clients, both clinically and ethically.
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Wright, David Kenneth, Chris Gastmans, Amanda Vandyk, and Bernadette Dierckx de Casterlé. "Moral identity and palliative sedation: A systematic review of normative nursing literature." Nursing Ethics 27, no. 3 (October 21, 2019): 868–86. http://dx.doi.org/10.1177/0969733019876312.
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Background: In the last two decades, nursing authors have published ethical analyses of palliative sedation—an end-of-life care practice that also receives significant attention in the broader medical and bioethics literature. This nursing literature is important, because it contributes to disciplinary understandings about nursing values and responsibilities in end-of-life care. Research aim: The purpose of this project is to review existing nursing ethics literature about palliative sedation, and to analyze how nurses’ moral identities are portrayed within this literature. Research design: We reviewed discussion papers, written by nurses about the ethics of palliative sedation, which were cited in MEDLINE, CINAHL, Nursing and Allied Health, or Philosopher’s Index (search date March 2018). Twenty-one papers met selection criteria. We performed a comprehensive review and analysis (using the Qualitative Analysis Guide of Leuven), of the values, responsibilities, and relationships reflected in authors’ portrayal of the nursing role. Findings: Two different tones are apparent in the extant nursing ethics literature. One is educational, while the other is critically reflective. Irrespective of tone, all authors agree on the alleviation of suffering as a fundamental nursing responsibility. However, they differ in their analysis of this responsibility in relation to other values in end-of-life care, including those that depend on consciousness. Finally, authors emphasize the importance of subjective and experience-based understandings of palliative sedation, which they argue as depending on nurses’ proximity to patients and families in end-of-life care. Discussion and conclusion: Based on our findings, we develop three recommendations for future writing by nurses about palliative sedation. These relate to the responsibility of recognizing how consciousness might matter in (some) peoples’ moral experiences of death and dying, to the importance of moral reflectiveness in nursing practice, and to the value of a relational approach in conceptualizing the nursing ethics of palliative sedation.
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Joseph, Rachel A. "New Technology in the NICU: Challenges to Parents and Clinicians." Neonatal Network 35, no. 6 (2016): 367–74. http://dx.doi.org/10.1891/0730-0832.35.6.367.
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AbstractTechnology has revolutionized all aspects of care in the NICU—design, monitoring, diagnosis, documentation, and home care. Efforts to improve outcome in high-risk infants foster the emergence and integration of new technology in NICUs. Some of them include amplitude-integrated electroencephalogram (aEEG), therapeutic hypothermia, and devices for communication and remote viewing, to name a few. As more technology is integrated into the clinical arena, parents and clinicians face technological, moral, and ethical challenges. Learning to use and interpreting technology and making it meaningful for families can increase the workload of clinicians. Enabling families to participate in care and facilitate bonding requires skill, motivation, and confidence from a compassionate care team. Judicious use of technology may offer hope and comfort to families, although it will not replace human caring.
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BULLER, TOM. "The New Ethics of Neuroethics." Cambridge Quarterly of Healthcare Ethics 27, no. 4 (September 10, 2018): 558–65. http://dx.doi.org/10.1017/s0963180118000087.
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Abstract:According to a familiar distinction, neuroethics incorporates the neuroscience of ethics and the ethics of neuroscience. Within neuroethics, these two parts have provoked distinct and separate lines of inquiry, and there has been little discussion of how the two parts overlap. In the present article, I try to draw a connection between these two parts by considering the implications that are raised for ethics by scientific findings about the way we make moral decisions. The main argument of the article is that although neuroscience is “stretching” ethics by revealing the empirical basis of our moral decisions and, thereby, challenging our present understanding of the dominant ethical theories, substantial further questions remain regarding the impact that neuroscience will have on ethics more broadly.
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Zuzelo, Patti Rager. "Exploring the Moral Distress of Registered Nurses." Nursing Ethics 14, no. 3 (May 2007): 344–59. http://dx.doi.org/10.1177/0969733007075870.
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Registered nurses (RNs) employed in an urban medical center in the USA identified moral distress as a practice concern. This study describes RNs' moral distress and the frequency of morally distressing events. Data were collected using the Moral Distress Scale and an open-ended questionnaire. The instruments were distributed to direct-care-providing RNs; 100 responses were returned. Morally distressing events included: working with staffing levels perceived as `unsafe', following families' wishes for patient care even though the nurse disagreed with the plan, and continuing life support for patients owing to family wishes despite patients' poor prognoses. One high frequency distressing event was carrying out orders for unnecessary tests and treatments. Qualitative data analysis revealed that the nurses sought support and information from nurse managers, chaplaincy services and colleagues. The RNs requested further information on biomedical ethics, suggested ethics rounds, and requested a non-punitive environment surrounding the initiation of ethics committee consultations.
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Mooney-Doyle, Kim, and Connie M. Ulrich. "Parent moral distress in serious pediatric illness: A dimensional analysis." Nursing Ethics 27, no. 3 (March 5, 2020): 821–37. http://dx.doi.org/10.1177/0969733019878838.
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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.
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Wright, Darryl F. "EVALUATIVE CONCEPTS AND OBJECTIVE VALUES: RAND ON MORAL OBJECTIVITY." Social Philosophy and Policy 25, no. 1 (December 20, 2007): 149–81. http://dx.doi.org/10.1017/s0265052508080060.
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Those familiar with Ayn Rand's ethical writings may know that she discusses issues in metaethics, and that she defended the objectivity of morality during the heyday of early non-cognitivism. But neither her metaethics, in general, nor her views on moral objectivity, in particular, have received wide study. This article elucidates some aspects of her thought in these areas, focusing on Rand's conception of the way in which moral values serve a biologically based human need, and on her account of moral values as both essentially practical and epistemically objective in a sense fundamentally continuous with the objectivity of science. The bearing of her epistemological writings on her ethical thought is emphasized throughout, and her epistemology is defended against a line of criticism inspired by John McDowell's criticism of the so-called “myth of the given.”
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Greenberger, Chaya. "Enteral nutrition in end of life care." Nursing Ethics 22, no. 4 (August 4, 2014): 440–51. http://dx.doi.org/10.1177/0969733014538891.
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Providing versus foregoing enteral nutrition is a central issue in end-of-life care, affecting patients, families, nurses, and other health professionals. The aim of this article is to examine Jewish ethical perspectives on nourishing the dying and to analyze their implications for nursing practice, education, and research. Jewish ethics is based on religious law, called Halacha. Many Halachic scholars perceive withholding nourishment in end of life, even enterally, as hastening death. This reflects the divide they perceive between allowing a fatal disease to naturally run its course until an individual’s vitality (life force or viability) is lost versus withholding nourishment for the vitality that still remains. The latter they maintain introduces a new cause of death. Nevertheless, coercing an individual to accept enteral nourishment is generally considered undignified and counterproductive. A minority of Halachic scholars classify withholding enteral nutrition as refraining from prolonging life, permitted under certain circumstances, especially in situations where nutritional problems flow directly from a fatal pathology. In the very final stages of dying, moreover, there is a general consensus that enteral nourishment may be withheld, providing that this reflects the dying individuals’ wishes. In the event of enteral nourishment becoming a source of overwhelming discomfort, two Halachic ethical mandates would come into conflict: sustaining life by providing nourishment and alleviating suffering. As in all moral conflicts, these would have to be resolved in practice. This article presents the issue of enteral nourishment as it unfolds in Halacha in comparison to secular and other religious perspectives. It is meant to serve as a foundation for nurses to reflect on their own practice and to explore the implications for nursing practice, education, and research. In a world that remains broadly religious, it is important to sensitize health practitioners to the similarities and differences among religions and between secular and religious approaches to ethical issues.
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Chen, Ruth P. "Moral imagination in simulation-based communication skills training." Nursing Ethics 18, no. 1 (January 2011): 102–11. http://dx.doi.org/10.1177/0969733010386163.
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Clinical simulation is used in nursing education and in other health professional programs to prepare students for future clinical practice. Simulation can be used to teach students communication skills and how to deliver bad news to patients and families. However, skilled communication in clinical practice requires students to move beyond simply learning superficial communication techniques and behaviors. This article presents an unexplored concept in the simulation literature: the exercise of moral imagination by the health professional student. Drawing from the works of Hume, Aristotle and Gadamer, a conceptualization of moral imagination is first provided. Next, this article argues that students must exercise moral imagination on two levels: towards the direct communication exchange before them; and to the representative nature of simulation encounters. Last, the limits of moral imagination in simulation-based education are discussed.
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Wiegand, Debra L., and Marjorie Funk. "Consequences of clinical situations that cause critical care nurses to experience moral distress." Nursing Ethics 19, no. 4 (May 22, 2012): 479–87. http://dx.doi.org/10.1177/0969733011429342.
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Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families.
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Santos, Maiara Rodrigues dos, Emanuelle Caires Dias Araújo Nunes, Isabella Navarro Silva, Kátia Poles, and Regina Szylit. "The meaning of a “good nurse” in pediatric care: a concept analysis." Revista Brasileira de Enfermagem 72, no. 2 (April 2019): 494–504. http://dx.doi.org/10.1590/0034-7167-2018-0497.
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ABSTRACT Objective: to analyze the attributes, antecedents and consequences of the concept a “good nurse” in the context of Pediatrics. Method: concept analysis study based on Rodgers’ evolutionary method. Theoretical stage consisted of searching for articles in the CINAHL, Embase and Pubmed databases and a practical stage of semi-structured interviews with pediatric nurses. The final analysis unified the two stages by categories of antecedents, attributes and consequences of the concept. Results: 20 articles and 10 interviews were analyzed revealing as antecedents aspects related to education, scientific development and ethical-moral skills and values. Responsibility, compassion, honesty and advocacy stand out as attributes of the “good nurse.” The consequences describe implications for children and families, as well as for professionals. Final Consideration: the analysis of the concept of the “good nurse” allowed us to clarify fundamental aspects for the execution of good practices, establishing parameters for investment in professional development programs.
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Leever, Martin G. "Cultural competence: Reflections on patient autonomy and patient good." Nursing Ethics 18, no. 4 (July 2011): 560–70. http://dx.doi.org/10.1177/0969733011405936.
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Terms such as ‘cultural competence’ and ‘transcultural nursing’ have comfortably taken their place in the lexicon of health care. Their high profile is a reflection of the diversity of western societies and health care’s commitment to provide care that is responsive to the values and beliefs of all who require treatment. However, the relationship between cultural competence and familiar ethical concepts such as patient autonomy has been an uneasy one. This article explores the moral foundations of cultural competence, ultimately locating them in patient autonomy and patient good. The discussion of patient good raises questions about the moral relevance of a value’s rootedness in a particular culture. I argue that the moral justification for honoring cultural values has more to do with the fact that patients are strongly committed to them than it does with their cultural rootedness. Finally, I suggest an organizational approach to cultural competence that emphasizes overall organizational preparedness.
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Voo, Teck Chuan, Zohar Lederman, and Sharon Kaur. "Patient Isolation during Infectious Disease Outbreaks: Arguments for Physical Family Presence." Public Health Ethics 13, no. 2 (July 1, 2020): 133–42. http://dx.doi.org/10.1093/phe/phaa024.
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Abstract This article argues that outbreak preparedness and response should implement a ‘family presence’ policy for infected patients in isolation that includes the option of physical visits and care within the isolation facility under some conditions. While such a ‘physical family presence’ (PFP) policy could increase infections during an outbreak and may raise moral dilemmas, we argue that it is ethically justified based on the least infringement principle and the need to minimize the harms and burdens of isolation as a restrictive measure. Categorical prohibition of PFP during the course of an outbreak or epidemic is likely to result in unnecessary harms to patients and families, and violate values such as the moral commitments of families to care for each other. Supporting the option of PFP under particular circumstances, on the other hand, will least infringe these moral considerations. An additional reason for a family presence policy is that it may facilitate voluntary cooperation with isolation and other restrictive measures. We provide an analysis of these considerations for supporting modes of family presence during an outbreak emergency, before defending the riskier option of PFP in the isolation facility from plausible objections and concerns.
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HÄYRY, MATTI. "Discoursive Humanity as a Transcendental Basis for Cognitive (Dis)Ability Ethics and Policies." Cambridge Quarterly of Healthcare Ethics 25, no. 2 (March 9, 2016): 262–71. http://dx.doi.org/10.1017/s0963180115000560.
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Abstract:This article explicates two approaches to the basis of moral worth and status: Eva Kittay’s relational view and Jeff McMahan’s psychological personhood view. It is argued that these theories alone do not provide adequate support for the conclusions Kittay and McMahan want to draw concerning individuals whose entitlement to fundamental protections can be challenged—infants with severe cognitive disabilities and infants without the support of their families and social environments. The real justification can in each case be found in deeply held convictions regarding entities that must and entities that must not be included in the core community of moral equals. Philosophical discussions about these convictions would be more useful for the advancement of our moral thinking than vain attempts to show that the absolute truth lies on either side of the ongoing debate.
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Crawford, G. C., and A. M. Lucassen. "Disclosure of genetic information within families: a case report." Clinical Ethics 3, no. 1 (March 2008): 7–10. http://dx.doi.org/10.1258/ce.2007.007051.
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There has been much discussion about what, if any, legal and moral duties professionals have to disclose relevant genetic information to the family members of someone with an identified disease predisposing mutation. Here, we present a case report where dissemination of such a genetic test result did not take place within a family. In contrast to previous literature, there appeared to be no deliberate withholding of information, instead distant relatives were unable to communicate relevant information appropriately. When communication was facilitated through the follow-up of a chance remark, the patient was able to avoid planned major surgery, with its attendant morbidity, and her high anxiety levels were much reduced. We believe this case highlights the need for an ongoing debate on how genetic services can best support patients and their families with disclosing relevant genetic information to other family members.
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Behan, Justine M., Ramandeep Singh Arora, Franco A. Carnevale, Sameer Bakhshi, Bani Bhattacharjee, and Argerie Tsimicalis. "An Ethnographic Study of the Moral Experiences of Children with Cancer in New Delhi, India." Global Qualitative Nursing Research 8 (January 2021): 233339362199581. http://dx.doi.org/10.1177/2333393621995814.
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There is a paucity of research examining children’s experiences with cancer in India. Childhood ethics is an emerging field, focusing on the moral dimension of children’s experiences, to promote children’s participation in their health care. A focused ethnography, using a moral experience framework, was conducted to better understand children’s participation in decisions, discussions, and actions in three oncology settings in New Delhi, India. We interviewed key informants, retrieved key documents, and conducted semi-structured interviews and participant observations with children. All 22 children demonstrated interest in varying aspects of their cancer care. Certain factors facilitated or impeded their participation. Some children became distressed when they lacked information about their treatment or were not given opportunities to enhance their understanding. The results advance our understanding of the moral experiences of children with cancer in India for healthcare professionals, policy makers, families, and interested others.
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Mooney-Doyle, Kim, Jessica Keim-Malpass, and Lisa C. Lindley. "The ethics of concurrent care for children: A social justice perspective." Nursing Ethics 26, no. 5 (April 15, 2018): 1518–27. http://dx.doi.org/10.1177/0969733018765308.
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Recent estimates indicate that over 40,000 children die annually in the United States and a majority have life-limiting conditions. Children at end of life require extensive healthcare resources, including multiple hospital readmissions and emergency room visits. Yet, many children still suffer from symptoms at end of life—including fatigue, pain, dyspnea, and anxiety—with less than 10% of these children utilizing hospice care services. A critical barrier to pediatric hospice use was the original federal regulations associated with the hospice care that required a diagnosis of 6 months to live and the discontinuation of all curative treatments. The Concurrent Care Provision of the United States’ Affordable Care Act eliminated the need to forgo curative therapies in order to enroll in hospice for children in Medicaid or Children’s Health Insurance Program. Concurrent care for children can help mitigate the tension families experience in choosing between essential forms of care, as well as contribute to improved end-of-life outcomes for the child and possibly bereavement outcomes for the family. Understanding concurrent care for children from a social justice perspective has important advocacy and research implications for hospice and palliative care clinicians providing care for children and their families. We apply Powers and Faden’s theory of social justice “as the moral foundation of public health and health policy” to the provision of concurrent care to children near end of life and families in the United States. The goals of applying this theory are to explore additional insights and perspectives into concurrent care policy may provide and to assess the usefulness of this theory when applied to end-of-life health policy. We argue that concurrent care policy is socially just since it has potential to promote well-being in vulnerable children and families and can limit the inequity children at end-of-life experience in access to high-quality hospice care.
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Josse-Eklund, Anna, Marie Jossebo, Ann-Kristin Sandin-Bojö, Bodil Wilde-Larsson, and Kerstin Petzäll. "Swedish nurses’ perceptions of influencers on patient advocacy." Nursing Ethics 21, no. 6 (January 29, 2014): 673–83. http://dx.doi.org/10.1177/0969733013515488.
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Background: A limited number of studies have shown that patient advocacy can be influenced by both facilitators and barriers which can encourage and discourage nurses to act as patient advocates. Objective: This study’s aim was to describe Swedish nurses’ perceptions of influencers on patient advocacy. Research design and context: Interviews with 18 registered nurses from different Swedish clinical contexts were analysed using the phenomenographic method. Ethical considerations: Ethical revisions were made in accordance with national legislation and guidelines by committees for research ethics at Karlstad University. Findings: Three levels of hierarchically related influencers on patient advocacy were found in the descriptive categories. The fundamental influencer, the nurse’s character traits, was described in the perceptions that advocacy is influenced by nurse’s having a moral compass, having control over the care situation, being protective and feeling secure as a nurse. The second most vital influencer, the nurse’s bond with the patient, was expressed in the perceptions of knowing the patient and feeling empathy for the patient. The third level of influencers, the organisational conditions, was described in the perceptions that the organisational structures and organisational culture influence patient advocacy. Discussion: The results correspond with findings from earlier research but add an understanding that influencers on patient advocacy exist at three hierarchically related levels. Conclusion: The nurse’s character traits are the fundamental influencer to patient advocacy, but in order to be comfortable and secure when advocating for patients, nurses also need to be familiar with both the patient and the situation. A supposition could be that all influencers interact, which needs to be further addressed in future studies.
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Benitz, William E. "A Paradigm for Making Difficult Choices in the Intensive Care Nursery." Cambridge Quarterly of Healthcare Ethics 2, no. 3 (1993): 281–94. http://dx.doi.org/10.1017/s0963180100004291.
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In the 10 years since the birth of “Baby Doe,” the decisions confronted daily by neonatologists and parents of sick or premature infants have been the focus of a great deal of attention. Issues raised by these decisions have been vigorously debated and discussed in the popular media in political and governmental forums, and in the professional literatures of a variety of academic disciplines. These discourses have illuminated a number of moral and ethical principles that may govern these decisions and have contributed to the development of regulatory and procedural constraints upon this process, including requirements for establishment of infant care review committees at all hospitals that provide neonatal intensive care services. However, the philosophical concepts espoused by theoreticians, although often helpful as abstractions, are rarely invoked at the bedside as decisions are sought for individual patients. No clear consensus has emerged on how these ideas should be incorporated into clinical practice or on the role of mandated ethics committees or discretionary ethics consultants. Consequently, there are wide disparities in decision-making processes both within and among institutions. Failures of these systems to protect neonatal patients or their families remain distressingly common and have attracted considerable attention in the lay press. Although there can be no universal decision tree that can dictate the course of this complex process in all cases, a clearly articulated operative paradigm that defines essential features of an effective and equitable decision-making process is essential to identify the causes of failures and conflicts that arise when the process is dysfunctional and to prevent such problems by providing a framework for training practitioners to deal with these issues.
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Nuño, Antón Alvar. "Ocular Pathologies and the Evil Eye in the Early Roman Principate." Numen 59, no. 4 (2012): 295–321. http://dx.doi.org/10.1163/156852712x641769.
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Abstract Ocular pathologies are a natural phenomenon that can be detected empirically. All over the world, such phenomena are often interpreted as an index of inherent personal capacity for causing harm. The Graeco-Roman world was no exception. During the early Roman Principate, the literary representation of such malformations was clearly influenced by two genres that had been developed in the Greek world during the Hellenistic period. The first was the paradoxographic or mirabilia tradition, a literary genre that in the aftermath of Alexander’s conquests inventoried supposed natural and anthropological wonders, reports that were subsequently brought up to date and adapted by Roman authors such as Cicero and Varro. The second was physiognomics, the systematization, mainly by the Peripatetics but also by some Hippocratic authors, of the popular idea that ethical character can be read from somatic signs. This paper understands Pliny the Elder’s accounts of peoples and families able to cast the evil eye, objectified in the possession of a double pupil, as a significant aspect of his socio-moral account of the effects of world-empire upon Rome. In transposing the theme to his figure of the procuress Dipsas almost a century earlier, Ovid created a synecdoche for moral disorder at Rome itself shortly before the two Augustan laws of 18 b.c.e. regulating sexual conduct. In short, if we are to progress in our understanding of Roman socio-moral instrumentalization of ocular malformation in relation to the evil eye, we must pay careful attention to the contexts and strategies of our texts.
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McCarthy, Joan, Katherine O’Donnell, Louise Campbell, and Dolores Dooley. "Ethical arguments for access to abortion services in the Republic of Ireland: recent developments in the public discourse." Journal of Medical Ethics 44, no. 8 (May 18, 2018): 513–17. http://dx.doi.org/10.1136/medethics-2017-104728.
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The Republic of Ireland has some of the most restrictive abortion legislation in the world which grants to the ‘unborn’ an equal right to life to that of the pregnant woman. This article outlines recent developments in the public discourse on abortion in Ireland and explains the particular cultural and religious context that informs the ethical case for access to abortion services. Our perspective rests on respect for two very familiar moral principles – autonomy and justice – which are at the centre of social and democratic societies around the world. This article explains the context for the deployment of these concepts in order to support the claim that the current legislation and its operationalisation in clinical practice poses serious risks to the health, lives and well-being of pregnant women, tramples on their autonomy rights and requires of them a self-sacrifice that is unreasonable and unjust.
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Tigard, Daniel W. "Taking the blame: appropriate responses to medical error." Journal of Medical Ethics 45, no. 2 (November 9, 2018): 101–5. http://dx.doi.org/10.1136/medethics-2017-104687.
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Medical errors are all too common. Ever since a report issued by the Institute of Medicine raised awareness of this unfortunate reality, an emerging theme has gained prominence in the literature on medical error. Fears of blame and punishment, it is often claimed, allow errors to remain undisclosed. Accordingly, modern healthcare must shift away from blame towards a culture of safety in order to effectively reduce the occurrence of error. Against this shift, I argue that it would serve the medical community well to retain notions of individual responsibility and blame in healthcare settings. In particular, expressions of moral emotions—such as guilt, regret and remorse—appear to play an important role in the process of disclosing harmful errors to patients and families. While such self-blaming responses can have negative psychological effects on the individual practitioner, those who take the blame are in the best position to offer apologies and show that mistakes are being taken seriously, thereby allowing harmed patients and families to move forward in the wake of medical error.
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Papadodima, Efi. "The Rhetoric of Fear in Euripides’Phoenician Women." Antichthon 50 (November 2016): 33–49. http://dx.doi.org/10.1017/ann.2016.4.
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AbstractIn accordance with its notoriously rich plot,Phoenician Womenexplores diverse aspects of fear that affect, and are thematised by, various parties at different stages of the plot.1Against the background of a virtually ‘irrational’ and inescapable divine necessity (treated as a source of dread in itself), Euripides presents the play’s central crisis as being largely determined by rational and controlled decision-making, within an array of moral disputes that enter the scene. The agents’ decision-making standardly comprises diverging, conflicting, or inconsistent attitudes towards fear and related emotions, such as shame (in both past and present).The rhetoric of fear thus reflects and further highlights the characters’ conflicting viewpoints, as well as Euripides’ trademark tendency to toy with his audience’s expectations and assumptions about ethical values and what is ‘right’. This article argues that his approach is substantially different from the Aeschylean treatment of the same myth (Seven against Thebes). By offering a concrete and abstract treatment of the situational anxieties over war and familial feud, Euripides’ rhetoric of fear ultimately shifts the focus to the complexities and contradictions of human motivation.
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Spital, Aaron. "Intrafamilial Organ Donation Is Often an Altruistic Act." Cambridge Quarterly of Healthcare Ethics 12, no. 1 (January 2003): 116–18. http://dx.doi.org/10.1017/s0963180103121147.
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In their recent article, Glannon and Ross remind us that family members have obligations to help each other that strangers do not have. They argue, I believe correctly, that what creates moral obligations within families is not genetic relationship but rather a sharing of intimacy. For no one are these obligations stronger than they are for parents of young children. This observation leads the authors to the logical conclusion that organ donation by a parent to her child is not optional but rather a prima facie duty. However, Glannon and Ross go a step further by suggesting that because parent-to-child organ donation is a duty, it cannot be altruistic. They assert that “altruistic acts are optional, nonobligatory…supererogatory…. Given that altruism consists in purely optional actions presupposing no duty to aid others, any parental act that counts as meeting a child's needs cannot be altruistic.” Here I think the authors go too far.
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Latysheva, Daria. "THE INFLUENCE OF STUDEN FAMILY MARRIAGE RELATIONS ON INTELLECTUAL AND PHYSICAL DEVELOPMENT OF CHILDREN IN XXI CENTURY (ON THE MATERIALS OF THE CITY OF KYIV)." Journal of Ukrainian History, no. 40 (2019): 83–91. http://dx.doi.org/10.17721/2522-4611.2019.40.11.
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This article deals with the problem of children education and upbringing by young student families in Kyiv city and those parents’ influence on the child’s intellectual and physical development. The students’ family life undergoes dramatical changes when a child is born. Just from this moment the students begin to consider themselves as a full-fledged family, and their relationship reach a new level. In turn, the child needs for a proper comprehensive education, so young parents shall quickly adapt to their new role. After the spouses’ baby birth, the focus embracing education object already switches from them as persons onto their first-born child. As a rule, even before their baby birth, the expectant mother and father begin to prepare themselves to that newcomer in the family: they ask for advice from relatives and friends, get consultations with specialists, read the special sources on child care and upbringing. However, the child’s birth especially when it comes to a young students’ family, often entails numerous problems and becomes a strong stress factor for parents. However, this stress factor is completely offset by such positive moments as the parents’ health improvement during their child upbringing. Another positive factor refers to not very significant difference in age between parents and their children, that in turn allows render much easier their communication and mutual understanding. As everyone knows, from the earliest times, every nation appreciated as true value the human’s intellect, intelligence and education. Just due to intellectual and physical abilities progress our ancestors became able to create our history and the world today we do live in. Each mankind history époque valued various knowledge, skills and abilities of a person. However, with new challenges constantly dependent on changes in society and social development, the humanit gained ever new knowledge, gradually pushing out the obsolete ones. And concurrently the principles of raising children also changed. The basic directions of forming the child’s future personality are mental development, physical and religious education. These three upbringing factors quality imply what kind of person the child will be in the future. Namely the individual’s cognitive activity, education in various science fields, physical strength and power are forms today a conscious citizen who will develop the country in the future. A more complete world perception as formed in the person also is influenced by the spiritual life aspect. Accordingly, that aspect of education also plays an integral role in the life of both individual national and the state as a whole, since moral principles and ethical norms form the human mental activity which in turn influences the person’s environment. Consequently, along many centuries, education was a major aspect in human personality forming still constant changes in society and social development generated a new need, this one for civic consciousness formation. The parents play the main role in all educational process types. Therefore, now, as the new personality main creators, they must not only remain educators of a high moral creative individual, but also form a conscious national of his motherland. Despite the lack of prior paternity experience, young student parents should make every possible effort to educate the child in the context of creating a strong personality, which will be a moral example in the society. On the other hand, the topic of children education at young student families within the Kyiv city boundaries is not covered by the humanities sciences. Therefore, to get this problem’s more detailed study we turned to the use of ethnological research practical methods: sample survey, included observation, questionnaires and respondents interviewing. However, switching to more specific figures and data, the vast majority of student couples (90,7%) tend to that both the father and mother should pay equal attention to their child upbringing. Similarly, young student families achieve unanimity on specific issues considering the child intellectual and physical development. Thus, 78,7% respondents believe that the child intellectual development should be both father’s and mother’s responsibility, and 58,7% believe that both spouses should also be responsible for the child’s physical development. Student families also agreed that the atmosphere in the family also produces a direct impact on the child development. This opinion was supported by 97,3% of respondents. Although the respondents could not agree on which cultural level of parents shall be convenient and satisfying for the child’s proper mental progress. Thus, 40% believe that enough shall be to visit cultural centers, 29,3% think that desirable will be to have a home library, and 21,7% consider necessary reading the special pedagogical literature. According to this survey results, we see that in children education, modern student families are, for the most part, adherent to those traditional norms, that formed on centuries-old representations of Ukrainian nation during the traditional society period.
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Pesut, Barbara, Sally Thorne, Megan L. Stager, Catharine J. Schiller, Christine Penney, Carolyn Hoffman, Madeleine Greig, and Josette Roussel. "Medical Assistance in Dying: A Review of Canadian Nursing Regulatory Documents." Policy, Politics, & Nursing Practice 20, no. 3 (May 6, 2019): 113–30. http://dx.doi.org/10.1177/1527154419845407.
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Canada's legalization of Medical Assistance in Dying (MAiD) in 2016 has had important implications for nursing regulators. Evidence indicates that registered nurses perform key roles in ensuring high-quality care for patients receiving MAiD. Further, Canada is the first country to recognize nurse practitioners as MAiD assessors and providers. The purpose of this article is to analyze the documents created by Canadian nursing regulatory bodies to support registered nurse and nurse practitioner practice in the political context of MAiD. A search of Canadian provincial and territorial websites retrieved 17 documents that provided regulatory guidance for registered nurses and nurse practitioners related to MAiD. Responsibilities of registered nurses varied across all documents reviewed but included assisting in assessment of patient competency, providing information about MAiD to patients and families, coordinating the MAiD process, preparing equipment and intravenous access for medication delivery, coordinating and informing health care personnel related to the MAiD procedure, documenting nursing care provided, supporting patients and significant others, and providing post death care. Responsibilities of nurse practitioners were identified in relation to existing legislation. Safety concerns cited in these documents related to ensuring that nurses understood their boundaries in relation to counseling versus informing, administering versus aiding, ensuring safeguards were met, obtaining informed consent, and documenting. Guidance related to conscientious objection figured prominently across documents. These findings have important implications for system level support for the nursing role in MAiD including ongoing education and support for nurses' moral decision making.
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Singh, Deler, and Dipali S. Bhandari. "Legacy of Honor and Violence: An Analysis of Factors Responsible for Honor Killings in Afghanistan, Canada, India, and Pakistan as Discussed in Selected Documentaries on Real Cases." SAGE Open 11, no. 2 (April 2021): 215824402110223. http://dx.doi.org/10.1177/21582440211022323.
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The present study scrutinizes the cases of honor killings in Afghanistan, India, Pakistan, and Canada through selected documentary films. The case focuses on the social, moral, and religious aspects that coerce some people to take the lives of their own family members in case they defy norms. The documentaries chosen as case studies provide the perspectives of both the victims and the victimizers regarding the concepts of honor, dishonor, and honor killings. People in certain societies reject progressive new thought as attempts to contaminate their perceived cultural purity. People from these communities who try to assimilate liberal ideas are often shunned, especially when the emancipation of women is concerned. Even the seemingly progressive males are very unforgiving about the female members of their families embracing the modern ways of life. The women who try to defy set traditions are branded as being rebellious and are punished to serve as a precedent for future rebellions by women and to save society from their alleged bad influence. In some patriarchal societies, women are seen as the preservers of the family’s honor, and their conduct often reflects the family’s culture, morality, and ethics. Any lapse on a woman’s part allegedly taints the family’s name, and punishment must be given to the erring party to restore the family’s honor. The case also studies the influence of society as a compelling factor in honor killings.
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Metzker, Zdenko, and Justas Streimikis. "CSR ACTIVITIES IN THE CZECH SME SEGMENT." International Journal of Entrepreneurial Knowledge 8, no. 1 (June 30, 2020): 49–64. http://dx.doi.org/10.37335/ijek.v8i2.101.
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The aim of the study is to find out the perception of the concept of corporate social responsibility (CSR) by the segment of small and medium-sized enterprises in the Czech Republic. In connection with the objectives of the study, a questionnaire survey was carried out on a sample of 419 respondents – business owners and managers. The data were collected from September 2019 to January 2020. χ2 and Z-score were used to assess the hypotheses. It was found that there were statistical differences in the perception of some aspects of the positive impact of the introduction of the CSR concept in case of monitoring responses based on the geographic scope of the business. The results showed that although the manager should take into account the ethical and moral implications of his decisions, less than half of the respondents are familiar with the concept of CSR and enforce it in their management practice and ultimately managers cannot identify positive benefits from CSR implementation – it declares positive answers whose values oscillate around 30%. The findings show that there are no statistically significant differences in the answers of managers depending on the size of the company - this proves that micro, small and medium enterprises, respectively their managers do not differ in their attitudes to the topic of CSR. The final effect of the paper is to show the perception of the concept of CSR of entrepreneurs - respondents in the Czech Republic.
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Lukyanchenko, E. A. "Human Capital: Moral and Ethical Aspects." MGIMO Review of International Relations, no. 3(30) (June 28, 2013): 142–43. http://dx.doi.org/10.24833/2071-8160-2013-3-30-142-143.
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Sychev, A. A., E. V. Zaytseva, and P. S. Tolkachev. "MORAL-ETHICAL ASPECTS OF THE DIGITAL ECONOMY." Vestnik Universiteta, no. 1 (March 23, 2020): 36–42. http://dx.doi.org/10.26425/1816-4277-2020-1-36-42.
Full textAbstract:
At the present stage, the digital (information) economy is playing an increasingly important role in the world economy and national economies. Using rapid exchange of information benefits allows economic agents at all levels (from ordinary consumers to large corporations and state bodies, regulating economic relations) to make more accurate decisions in various economic issues. It is obvious, that the creation of the Russian information system will be able to increase the efficiency of our national economy (including the objectives of its state regulation) and at the same time raise the level of the country’s security. However, the effective use of the digital economy does not only depend on the level of development of the technical base of the information system. Only the moral state of society can send the information received for the benefit of all its members.