Nursing Ethics

A patient is diagnosed with the persistent vegetative state (PVS) when they show no evidence of the awareness of the self or the environment for an extended period of time. The chance of recovery of any mental function or the ability to interact in a meaningful way is low. Though rare, the condition, considering its nature as a state outwith the realm of the conscious, coupled with the trauma experienced by the patient's kin as well as health care staff confronted (...) with painful decisions regarding the patient's care, has attracted a considerable amount of discussion within the bioethics community. At present, there is a wealth of literature that discusses the relevant neurology, that elucidates the plethora of ethical challenges in understanding and dealing with the condition, and that analyses the real-world cases which have prominently featured in the mainstream media as a result of emotionally charged, divergent views concerning the provision of care to the patient. However, there is scarcely anything in the published scholarly literature that proposes concrete and practically actionable solutions to the now widely recognized moral conundrums. The present article describes a step in that direction. I start from the very foundations, laying out a sentientist approach which serves as the basis for the consequent moral decision-making, and then proceed to systematically identify and deconstruct the different cases of discord, using the aforementioned foundations as the basis for their resolution. A major intellectual contribution concerns the fluidity of the duty of care which I argue is demanded by the sentientist focus. The said duty is shown initially to have for its object the patient, which depending on the circumstances, can change to the patient's kin, or the health care staff themselves. In conclusion, the proposed framework represents the first comprehensive proposal regarding the decision-making processes involved in the deliberation on the provision of life sustaining treatment to a patient in a PVS. (shrink)

The sacrifices of nurses in hard-hit cities during the early stages of the COVID-19 pandemic and of family caregivers for people with late-stage Alzheimer’s disease present two puzzles. First, traditional accounts of supererogation cannot allow for the possibility of making enormous sacrifices that make one’s actions supererogatory simply to do what morality requires. These caregivers, however, are doing their moral duty, yet their actions also seem to be paradigmatic cases of supererogation. I argue that Dale Dorsey’s new account of supererogation (...) can solve this puzzle. Second, these caregivers often deny that they are heroic, but standard explanations of these assertions either diminish their sacrifice, say they are confused, or attribute to them a vice. If we want to understand them without diminishing them, we should instead see their denials as a response to what Beth DeVolder calls compulsory heroism. Compulsory heroism occurs when someone is foisted into the role of hero for doing their moral duty as a distraction from the social realities that make doing their duty involve inordinate sacrifice. (shrink)

The phrase ‘person‐centred care’ (PCC) reminds us that the fundamental philosophical goal of caring for people is to uphold or promote their personhood. However, such an idea has translated into promoting individualist notions of autonomy, empowerment and personal responsibility in the context of consumerism and neoliberalism, which is problematic both conceptually and practically. From a conceptual standpoint, it ignores the fact that humans are social, historical and biographical beings, and instead assumes an essentialist or idealized concept of personhood in which (...) a person is viewed as an individual static object. From a practical standpoint, the application of such a concept of personhood can lead to neglect of a person's fundamental care needs and exacerbate the problems of social inequity, in particular for older people and people with dementia. Therefore, we argue that our understanding of PCC must instead be based on a dynamic concept of personhood that integrates the relevant social, relational, temporal and biographical dimensions. We propose that the correct concept of personhood in PCC is one in which persons are understood as socially embedded, relational and temporally extended subjects rather than merely individual, autonomous, asocial and atemporal objects. We then present a reconceptualization of the fundamental philosophical goal of PCC as promoting selfhood rather than personhood. Such a reconceptualization avoids the problems that beset the concept of personhood and its application in PCC, while also providing a philosophical foundation for the growing body of empirical literature that emphasizes the psychosocial, relational, subjective and biographical dimensions of PCC. (shrink)

Aims and Objectives The purpose of this paper was to clarify the concept of ethical conflict in nursing and highlight the importance of tackling this issue. -/- Background Ethical conflict is on the rise in the nursing context. It is associated with the compromise of nurses' well-being and patient care. However, there is no thorough conceptual understanding of this concept. -/- Design Concept analysis. -/- Methods Databases (PubMed, PsycINFO, CINAHL, Scopus, Embase, Web of Science and SocINDEX) were searched for studies (...) between 1984 and 2021. Both quantitative and qualitative studies related to ethical conflict in nursing were included. Walker and Avant's method of concept analysis was used to identify the defining attributes, antecedents and consequences of the concept of ethical conflict in nursing. We followed the PRISMA-ScR checklist to report the study. -/- Results Thirty studies were included for conceptualization. Defining attributes were divided into four categories: (1) emotional responses, (2) incompatible values, (3) competing interests and (4) ambiguous obligations. The antecedents were (1) ethical sensitivity, (2) negative ethical climate, (3) insufficient authority, (4) unrealistic expectations, (5) poor collaboration and (6) inadequate resources. The consequences were identified as (1) moral residue, (2) loss of identity, (3) professional burnout and (4) poor patient care. -/- Conclusions A unified conceptual model of ethical conflict in nursing shed light on the ethical issues nurses might come across in practice. Despite the fact that ethical conflict is inherently negative, we conceptualised this concept as a neutral fact and an opportunity for nursing action. The construct identification provides basis for both the development of practice and the development of staff support and education. (shrink)

Empathy is a topic of continuous debate in the nursing literature. Many argue that empathy is indispensable to effective nursing practice. Yet others argue that nurses should rather rely on sympathy, compassion, or consolation. However, a more troubling disagreement underlies these debates: There’s no consensus on how to define empathy. This lack of consensus is the primary obstacle to a constructive debate over the role and import of empathy in nursing practice. The solution to this problem seems obvious: Nurses need (...) to reach a consensus on the meaning and definition of empathy. But this is easier said than done. Concept analyses, for instance, reveal a profound ambiguity and heterogeneity of the concept of empathy across the nursing literature. Since the term “empathy” is used to refer to a range of perceptual, cognitive, emotional, and behavioral phenomena, the presence of a conceptual ambiguity and heterogeneity is hardly surprising. Our proposal is simple. To move forward, we need to return to the basics. We should develop the concept from the ground up. That is, we should begin by identifying and describing the most fundamental form of empathic experience. Once we identify the most fundamental form of empathy, we will be able to distinguish among the more derivative experiences and behaviors that are addressed by the same name and, ideally, determine the place of these phenomena in the field of nursing. The aim of this article is, consequently, to lay the groundwork for a more coherent concept of empathy and thereby for a more fruitful debate over the role of empathy in nursing. In Part 1, we outline the history of the concept of empathy within nursing, explain why nurses are sometimes warry of adapting concepts from other disciplines, and argue that nurses should distinguish between adapting concepts from applied disciplines and from more theoretical disciplines. In Part 2, we show that the distinction between emotional and cognitive empathy—borrowed from theoretical psychology—has been a major factor in nurses’ negative attitudes toward emotional empathy. We argue, however, that both concepts fail to capture the most fundamental form of empathy. In Part 3, we draw on and present some of the seminal studies of empathy that can be found in the work of phenomenological philosophers including Max Scheler, Edmund Husserl, and Edith Stein. In Part 4, we outline how their understanding of empathy may facilitate current debates about empathy’s role in nursing. (shrink)

Transhumanism is a movement that seeks to transcend certain limitations inherent in the human condition as we know it. But does it justify overriding the dignity of current human beings in order to satisfy the desire to increase human potential and improve human beings as such, in order to obtain other human beings? Does it justify disregarding the dignity of women in order to obtain new human beings through fertilization? To answer these questions, we have made a sweep over the (...) ideas of transhumanism that drive this type of techniques, to later understand the vision that women have in the use of in vitro fertilization, the hidden discrimination under these procedures and the clarification of the true emancipation and restoration of women's rights in relation to the use of in vitro fertilization. -/- El transhumanismo es un movimiento que busca trascender ciertos límites inherentes a la condición humana como la conocemos. Sin embargo, ¿justifica dejar de lado la dignidad de los seres humanos actuales por cumplir el deseo de aumentar el potencial humano y mejorar al ser humano como tal para obtener otros seres humanos?, ¿justifica pasar por encima de la dignidad de una mujer para obtener nuevos seres humanos a través de la fertilización in vitro? Para responder a estas preguntas hemos hecho un barrido sobre las ideas del transhumanismo que impulsa este tipo de técnicas, para luego comprender la visión que se tiene de la mujer en el uso de la fertilización in vitro, la discriminación oculta bajo estos procedimientos y la aclaración de la verdadera emancipación y restablecimiento de los derechos de la mujer en relación con el uso de la fertilización in vitro. (shrink)

As in many other fields of practical ethics, virtue ethics is increasingly of interest within nursing ethics. Nevertheless, the virtue ethics literature in nursing ethics remains relatively small and underdeveloped. This article aims to categorize which broad theoretical approaches to virtue have been taken, to undertake some initial comparative assessment of their relative merits given the peculiar ethical dilemmas facing nurse practitioners, and to highlight the prob- lem areas for virtue ethics in the nursing context. We find the most common (...) approaches fall into care approaches grounded in sentimentalist or feminist ethics, eudaimonist approaches grounded in neo-Aristotelianism, and those grounded in MacIntyre’s practice theory. Our initial assessment is that the eudaimonist approach fares best in terms of merit and relative to criticisms of virtue ethics. But an outstanding issue concerns the motivational psychology of virtuous nursing and whether virtue ethical accounts of right action are self-effacing, i.e. justify an act on grounds that cannot function as the agent’s reason for doing it if she is to act well. One of us, Newham, believes that a virtue consequentialist approach is the best response to these issues. Some form of pluralistic theory, such as Christine Swanton’s, may be needed to explain the many competing values and goods involved in ethical nursing. (shrink)

In the United States, roughly 1 out of 4 births takes place at a hospital certified as Baby-Friendly. This paper offers a multi-disciplinary perspective on the Baby-Friendly Hospital Initiative (BFHI), including empirical, normative, and historical perspectives. Our analysis is novel in that we trace how medical practices of “quality improvement,” which initially appear to have little to do with breastfeeding, may have shaped the BFHI. Ultimately, we demonstrate that a rich understanding of the BFHI can be obtained by tracing how (...) norms of gender/motherhood interact with, and are supplemented by, other normative, historical, and institutional realities. We conclude with suggestions for practical revisions to the BFHI. (shrink)

My ambition in this paper is to provide an account of an unacknowledged example of blameless guilt that, I argue, merits further examination. The example is what I call carer guilt: guilt felt by nurses and family members caring for patients with palliative-care needs. Nurses and carers involved in palliative care often feel guilty about what they perceive as their failure to provide sufficient care for a patient. However, in some cases the guilty carer does not think that he has (...) the capacity to provide sufficient care; he has, in his view, done all he can. These carers cannot legitimately be blamed for failing to meet their own expectations. Yet despite acknowledging their blamelessness, they nonetheless feel guilty. My aims are threefold: first, to explicate the puzzling nature of the carer guilt phenomenon; second, to motivate the need to solve that puzzle; third, to give my own account of blameless guilt that can explain why carers feel guilty despite their blamelessness. In doing so I argue that the guilt experienced by carers is a legitimate case of guilt, and that with the right caveats it can be considered an appropriate response to the progressive deterioration of someone for whom we care. (shrink)

Moral distress is a well-documented phenomenon in the nursing profession, and increasingly thought to be implicated in a nation-wide nursing shortage in the US. First identified by the philosopher Andrew Jameton in 1984, moral distress has also proven resistant to various attempts to prevent its occurrence or at least mitigate its effects. While this would seem to be bad news for nurses and their patients, it is potentially good news for philosophical counselors, for whom there is both socially important and (...) philosophically interesting work to be done. In an effort to encourage such work, this paper explicates the philosophical (as opposed to more purely psychological or institutional) contours of the problem. A subsequent paper, titled 'A Philosophical Counseling Approach to Moral Distress,' will highlight ways in which such a response would differ from the strategies so far deployed within the nursing profession. (shrink)

Ong, Caroline As health systems become more complex, moral distress is increasingly being recognised as a significant phenomenon amongst health professionals. It can be described as the state of being distressed when one is unable to act according to what one believes to be morally right. It may compromise patient care, the health professional involved and the organisation. Cumulative experiences of incompletely resolved moral distress - a phenomenon which is called moral residue - may leave us susceptible to more frequent (...) and more severe moral distress. Clear open communication, respect, inclusivity, openness to differences, compassion, support, education and the capacity to grow in self-awareness are key aspects in minimising moral distress. Early recognition of its symptoms and addressing both personal and external constraints of actions can also minimise moral residue and build resilience to further distress. (shrink)

In the Terry Achane case, a birth father who was in the military was not notified when his child's birth mother put up their child for adoption. Birth fathers are often stereotyped as uninvolved and irresponsible, especially when they are not married to the birth mother. Terry Achane was married. The adoption agency made little effort to contact him, raising ethical issues about the roles played by the race, economic status, and perhaps religious beliefs of the adopting parents.

Starting from two observations regarding nursing ethics research in the past two decades, namely, the dominant influence of both the empirical methods and the principles approach, we present the cornerstones of a foundational argument-based nursing ethics framework. First, we briefly outline the general philosophical–ethical background from which we develop our framework. This is based on three aspects: lived experience, interpretative dialogue, and normative standard. Against this background, we identify and explore three key concepts—vulnerability, care, and dignity—that must be observed in (...) an ethical approach to nursing. Based on these concepts, we argue that the ethical essence of nursing is the provision of care in response to the vulnerability of a human being in order to maintain, protect, and promote his or her dignity as much as possible. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. The authors focus on the individual nurse’s responsibilities, as well as considering the wider issues affecting patients, colleagues and society as a whole. This third edition is fully updated, and takes into account recent changes in ICN position statements, WHO documents, as well as addressing (...) current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes. (shrink)

Nursing Theories and Nursing Practice, 2nd Edition, shows your undergraduate and graduate students how theory will help them improve the ways in which they practice nursing. It contains contributions by the original theorists, including discussion of how theories can be used in practice and examples of implementation written by nurses themselves. to help your students develop critical thinking skills, clear explanations of multiple ways of knowing are detailed, in addition to reflective practice, and background information on the process of theory (...) development. (shrink)

Goold and Stern (2006) offer a much needed dose of insight into the weakness of medical education from the perspective of resident and nonresident physicians. One of their findings pertains not to...

Moral distress is the sense that one must do, or cooperate in, what is wrong. It is paradigmatically faced by nurses, but it is almost a universal occupational hazard.

Margaret Urban Walker argues that hospital ethics committees should think of their task as "keeping moral space open." I develop her suggestion with analogies: Enlarge the windows (i.e., expand what counts as an ethical issue); add rooms and doors (i.e., choose particular issues to engage). Examples include confidentiality defined as information flow, and moral distress in the healthcare workplace.

For a long time discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. However, a narrow focus on medical resources prevents us from seeing that there are many cases-- perhaps the majority-- in which less dramatic but equally important issues of rationing occur. The allocation of nurses' time is one such issue.

For a long time, discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. This narrow focus on medical resource prevents us from seeing that there are many cases-- perhaps even the majority--in which time is the real scarce resource, particularly nurse time. What ethical principles should apply to nurse time as a scarce health care resource?