This paper seeks to describe and evaluate the work of the late Iris Marion Young as a critical reference point for values and ethics in the social professions. Her credentials are both experiential and theoretical, having studied analytical then postmodern and phenomenological thought, publishing a series of influential books on political and ethical concepts from a critical feminist position. Her theory and practice were closely related: she actively campaigned for feminist and related social causes for many years. The aim is (...) to provide a broad review of her work, with special reference to aspects particularly relevant to the social professions, and some discussion of implications for practice. It is not the intention to set out a systematic framework of concepts but to suggest the fruitfulness of some of her ideas, particularly those relevant to social professionals, and encourage the reader to go back to the original work. (shrink)

This article discusses the nature of interprofessional ethics and some of the ethical issues and challenges that arise when practitioners from different professions work closely together in the fields of health and social care. The article draws on materials from a conference on this theme, covering issues of confidentiality and information sharing in practice and research with vulnerable people; challenges for teaching and learning about ethics in interprofessional settings; the potential of virtue ethics and an ethic of care for understanding (...) and handling ethical issues in interprofessional practice; and the extent to which interprofessional working may be about surveillance and control. It concludes that the need to understand and handle ethical issues in interprofessional working is contributing to the revitalisation of professional ethics as a dynamic field of study. (shrink)

In this article we discuss generosity, a virtue that has received little attention in relation to nursing practice. We make a distinction between material generosity and generosity of spirit. The moral imagination is central to our analysis of generosity of spirit. We discuss data taken from a team meeting and identify the components of generosity, for example, the role of the moral imagination in interrupting value judgements, protecting the identity of the chronically ill patient through use of the psychosocial format, (...) and displaying empathetic maturity. The talk of the team enables us to understand and make visible the link between generosity, moral imagination and identity construction. The topic of generosity, although contextualized in a UK setting, has relevance to other cultural contexts. (shrink)

This paper explores some ways in which Immanuel Kant’s ethical theory can be brought to bear on professional and health care ethics. Health care professionals are not mere individuals acting upon their own ends. Rather, their principles of action must be defined in terms of participation in a cooperative endeavor. This generates complex questions as to how well their roles mesh with one another and whether they comprise a well-formed collective agent. We argue that Kant’s ethics therefore, and perhaps surprisingly, (...) requires us to consider the institutions, procedures, and politics that decide who should play what part in a complex collective enterprise. Likewise, professional responsibility involves – alongside a readiness to play one’s individual part – a concern for these collective aspects of healthcare. (shrink)

The relations of power between healthcare-related institutions and the professionals that interact with them are changing. Generally, the institutions are gaining the upper hand. Consequently, the intellectual abilities necessary for professionals to pursue the internal goods of healthcare are changing as well. A concrete case is the struggle over sickness benefits in Sweden, in which theSwedish Social Insurance Agency(SSIA) and physicians are important stakeholders. The SSIA has recently consolidated its power over the sickness certificates that doctors issue for their patients. (...) The result has been a stricter gatekeeping of sickness benefits. In order to combat the inroads made by state institutions into sickness certification, and into the sphere of medical practice, some doctors have developed cunning “techniques” to maximize the chance to have their sickness certificates accepted by the SSIA. This article attempts to demonstrate that cunning intelligence—the ability of the weak to “outsmart” a stronger adversary—plays an important role in the practice of medicine. Cunning intelligence is not merely a defective form of prudence (phronesis), nor is it simply an instance of instrumental reason (techne), but rather an ability that occupies a distinct place among the intellectual abilities generally ascribed to professionals. (shrink)

In this paper I will examine how the Mental Capacity Act 2005 regulates the assessment of decision-making capacity in England and Wales. I will argue that there are difficulties in reconciling the Act with how people make decisions in practice. I will explore how ideas from the ethics of care and from phenomenology can be used to take better account of how capacity flows from a person's relationships as well as their individual abilities. I will conclude by discussing some of (...) the ethical issues that have arisen in my assessments of decision-making capacity and how I have tried to respond. (shrink)

Ein gelungenes Arzt-Patient-Verhältnis, das auf gegenseitigem Vertrauen und ärztlicher Verantwortung basiert, ist ein zentraler Bestandteil des Ideals der ärztlichen Profession. Aktuell wird vielfach von einem neuen „ökonomischen Paradigma“ in der Medizin gesprochen, das dieses Verhältnis vermeintlich unterminiert. Als ein wichtiges Merkmal dieses Paradigmas gilt das Verständnis vom Patienten als Kunden, der charakterisiert ist durch seine Selbstbestimmung bzw. Autonomie. Wie stellt sich die Kundenrolle nun aber bei vulnerablen Patientengruppen dar, die in ihrer Autonomie eingeschränkt sind, und was bedeutet dies wiederum für (...) das Arzt-Patient-Verhältnis? In dem vorliegenden Artikel wollen wir deshalb die Fragestellung verfolgen, ob sich ärztliche Verantwortung bzw. das Arzt-Patient-Verhältnis ändert, wenn sich der (vulnerable) Patient als Kunde begreift. Als Analysesetting dient die Palliativmedizin, da sie als Beispiel für eine besonders vulnerable Patientengruppe gelten kann. Als Basis der Argumentation werden die Ergebnisse einer qualitativen Studie herangezogen, welche die Einstellungen von Palliativpatienten zum Thema „der Patient als Kunde“ erhob sowie der Frage nachging, ob sich Palliativpatienten, speziell im Rahmen von medizinischen Entscheidungen, als selbstbestimmt begreifen. Die Studienergebnisse zeigen, dass Autonomie relational verstanden werden muss und dem Arzt eine entscheidende Rolle in der Ermöglichung von Patientenselbstbestimmung zukommt – ganz unabhängig von der Selbstattribuierung der Befragten als Kunde oder Patient. Anschließend werden diese Ergebnisse dahingehend analysiert, ob sie als Ausdruck einer Veränderung des Arzt-Patient-Verhältnisses und der ärztlichen Verantwortung gegenüber den Patienten zu werten sind. Hieraus folgernd wird nach den praktischen Implikationen für das Arzt-Patient-Verhältnis auf der Grundlage der „Ethics of Care“ gefragt sowie auf die individuelle Betreuungsnotwendigkeit, speziell von vulnerablen Patientengruppen, verwiesen. (shrink)

BackgroundMany medical emergency practices are regulated by written procedures that normally provide reliable guidelines for action. In some cases, however, the consequences of following rule-based instructions can have unintended negative consequences. The article discusses a case - described on a type level - where the consequences of following a rule formulation could have been fatal.Case presentationA weak and elderly patient has cardiac arrest, and a Do Not Resuscitate clause is written in the patient’s medical record. Paramedics at the scene cannot (...) see that the patient’s general appearance match conditions which would indicate the DNR clause, so they start cardiopulmonary resuscitation, and the patient survives. This turns out to be a crucial decision. The DNR clause is from an earlier bout with serious disease from which the patient has recovered, against all odds, and someone has forgotten to remove the clause from the medical record.AnalysisIn order to be able to interpret the validity of written guidelines, paramedics and other health workers need to develop personal skills that transcend the ability simply to follow written instructions. Within traditional virtue ethics, personal judgment is conceived of as crucial for being able to make ‘good’ autonomous decisions. Virtue ethical analyses, decision-making abilities and non-technical communication skills are important as conceptual tools when health workers need to make difficult clinical decisions.ConclusionThe case study accentuates the significance of prudent judgment in medical practice. In the case described, the consequence of trusting the written advance directive could have been fatal, but the point is general: for the purpose of achieving excellent organizational performance, it is insufficient for health workers to rely uncritically on rules and procedures. Even the clearest rule formulations must be interpreted contextually in order to determine ethically correct behavior and avoid potential negative consequences that are not in the patient’s best interests. (shrink)

Much of the literature supports the moral development theory as a justification for teachers to care, where teachers should care for their students because it contributes to their moral education as caring persons. If no causal relationship can be established, the question remains whether we would want teachers to care, preferably one that does not merely import its external normative significance into teaching. I argue that an understanding of teaching, and moreover, of good teaching already has embedded within it conceptions (...) of care. Understanding that teaching involves care would then challenge virtue/character-based conceptions of the good teacher. While these clarifications are modest in scope, taking caring seriously in teaching has implications on how we conceptualize the good teacher, which in turn affects how both teacher education and professional ethics might be understood. (shrink)

Auch in der Sozialen Arbeit stellt sich die Notwendigkeit, Entscheide ethisch legitimieren zu müssen. Nicht nur können durch ihre Interventionen hohe ethische Güter der betroffenen Person berührt sein, sondern zudem treten nicht selten auch Entscheidungssituationen auf, in denen die anstehende Entscheidung unsicher und umstritten ist. Anhand der erwachsenenschutzrechtlichen Seite der Kindes- und Erwachsenenschutzbehörde in der Schweiz werden wir in diesem Beitrag den Versuch unternehmen, John Rawls’ Überlegungsgleichgewicht in seinen Grundzügen in eine konkrete Praxis zu überführen mit dem Ziel, ethische Leitlinien (...) zur Entscheidungsfindung im Rahmen der KESB zu entwickeln. Dafür sind zunächst ein paar einleitende Bemerkungen zur KESB erforderlich, um ihre Spezifika zu skizzieren. Anschließend erfolgen einige Anmerkungen zu Herausforderungen der Entscheidungsfindung in der Praxis. Danach werden wir unser Modell in seinen Grundzügen umreißen und gesondert auf den Prozess der Deliberation eingehen, die in einem kollektiven Überlegungsgleichgewicht mündet. (shrink)

The debate on the ethics of involuntary treatment for Anorexia Nervosa (AN) is dominated by biomedical ethics approaches to the issues. In keeping with the biomedical ethics emphasis on objectively balancing ethical principles, the debate centres on how to respect the autonomy of persons with AN who refuse treatment whilst protecting these persons from harm. Commentators discuss this at a normative ethics level. Thus, the debate does not address the moral relevance of how knowledge is constructed in the practice environment (...) and the impact this has on how professional values are applied during treatment decision making. Social work ethics highlights the need for professionals to account for the authority of professional knowledge and for patients to participate in treatment decisions. However, in the practice environment, questioning medical hegemony and supporting patient participation, empowerment and self-determination (core social work values) is complicated by a lack of treatment efficacy, the high level of risk that patients present to themselves and uncertainty around the autonomy and competence of the patient to refuse treatment. This paper argues that postmodern ethics can support practitioners in managing these issues. In doing so, this paper makes a social work contribution to the debate. (shrink)

This article describes the results of qualitative research into the moral issues faced by social work professionals working in projects targeted at teenage mothers. The research is part of the tradition of empirical and practice-driven ethics. The main questions were: How does morality become visible in the social services for teenage mothers and how do social workers deal with the moral dimension of their work? (How) can education, training and peer review offer space for moral reflection? Interviews and group meetings (...) ('focus groups') were held to answer these questions. Nineteen professionals (front-line professionals as well as professionals in executive roles) participated in the research. The findings describe the moral issues and the moral actions of professionals and the organizational context respectively. The results reveal that the everyday practice of social work professionals can raise complex issues inherent to their work and that there is often no explicit reflection on the moral dimension of these issues. The authors argue that there needs to be greater focus on the complexity of moral issues and elaborate on three dimensions of this complexity. (shrink)

Nursing ethics centres on how nurses ought to respond to the moral situations that arise in their professional contexts. Nursing ethicists invoke normative approaches from moral philosophy. Specifically, it is increasingly common for nursing ethicists to apply virtue ethics to moral problems encountered by nurses. The point of this article is to argue for scepticism about this approach. First, the research question is motivated by showing that requirements on nurses such as to be kind, do not suffice to establish virtue (...) ethics in nursing because normative rivals (such as utilitarians) can say as much; and the teleology distinctive of virtue ethics does not transpose to a professional context, such as nursing. Next, scepticism is argued for by responding to various attempts to secure a role for virtue ethics in nursing. The upshot is that virtue ethics is best left where it belongs – in personal moral life, not professional ethics – and nursing ethics is best done by taking other approaches. (shrink)

This article examines a population-based opportunistic screening practice for cognitive impairment that takes place at a hospital in Sweden. At the hospital, there is a routine in place that stipulates that all patients over the age of 65 who are admitted to the ward will be offered testing for cognitive impairment, unless they have been tested within the last six months or have been diagnosed with any form of cognitive impairment. However, our analysis shows that this routine is not universally (...) and mechanically applied. Rather, the health care professionals have developed and use an ethico-political judgment, concerning, for example,whomto test,whento offer the tests, andhowto explain and perform them. This article explores the role and practice of this form of judgment, emphasising its political and ethical nature. The analysis is based on qualitative interviews with professionals and patients, and draws on the theories of Aristotle and Hannah Arendt. (shrink)

This article represents the outcome of a dialogue between a vet and a healthcare ethicist on the theme of ‘love’ in professional life. We focus on four types or varieties of love in relation to the professional care of humans and animals. We discuss the relevance of Fromm’s core elements of love and consider the implications of these for human and animal health care practice. We present and respond to five arguments that might be waged against embracing love as a (...) professional value in veterinary and medical practice. We argue that a moderated love can and should be reclaimed as a contemporary professional value. It is most helpfully contextualised within virtue ethics or care ethics. We suggest that love is a rich starting point from which to launch an exploration of an interprofessional humanimal clinical ethics. (shrink)

This article develops a eudaimonistic account of professional virtue. Using the case of teaching, the article argues that professional virtue requires that role holders care about the ends of their work. Care is understood in terms of an investment of the self. Virtuous role holders are invested in their practice in a way that makes professional excellence part of their own good. Failure to care about the ends of professional practice reveals a lack of appreciation of the value of professional (...) work. This ‘investment view’ is contrasted with the currently popular ‘key goods view’, which claims that professional virtues require a profession-specific teleological structure. Unlike ordinary virtues, which are governed by eudaimonia or human flourishing, professional virtues are allegedly derived from professional ends, like health or education. The article argues that this delivers an unconvincing criterion for determining the merits of character traits. (shrink)

The use of the term "applied ethics" to denote a particular field of moral inquiry (distinct from but related to both normative ethics and meta-ethics) is a relatively new phenomenon. The individuation of applied ethics as a special division of moral investigation gathered momentum in the 1970s and 1980s, largely as a response to early twentieth- century moral philosophy's overwhelming concentration on moral semantics and its apparent inattention to practical moral problems that arose in the wake of significant social and (...) technological transformations. The field of applied ethics is now a well established, professional domain sustained by institutional research centers, professional academic appointments, and devoted journals. As the field of applied ethics grew and developed, its contributors predominantly advocated consequentialist and deontological approaches to the problems they address; but lately a significant number of moral philosophers have begun to bring the resources of virtue ethics to bear upon the ever-evolving subject matters of applied ethics. (shrink)