In recent years, organisational theorists have been interested in the tensions faced by healthcare organisations. In this paper, these tensions are examined using the virtue approach to ethics of Alasdair MacIntyre. It is argued that although MacIntyre's framework shares many concerns with organisational studies, it supplements the analysis with a focus on moral content and evaluation. By providing moral evaluation of the stories told in organisations, an ethical analysis compels action on a basis that organisational studies does not. Nevertheless, it (...) is the analysis of stories in organisation studies that provides the tools for taking action. The analysis presented here provides an example of how ethics and organisational studies can be brought together to provide a stronger analysis of organisational phenomena. Indeed, it provides support for Nielsen's position that organisational theory and ethics are co‐dependent and suggests that greater attention should be paid to ethical concepts in the study of organisational phenomena. (shrink)

According to Giles Scofield, ethicists can provide expert testimony in descriptive ethics and metaethics, but not normative ethics. Lawrence Schneiderman appears to disagree with this view, and presumably believes that it is appropriate for an expert witness in ethics to provide ethics testimony in all three areas. I draw this conclusion from several claims made in his commentary which aim to show that we would be contending experts if both invited to testify on a case involving claims about futile medical (...) treatment. This disagreement aside, taken together both commentaries suggest that my testimony in the case of Andrew Sawatzky is wanting.In the response that follows I do not engage in a debate about the content of my testimony. (shrink)

In an overview of the essays in this project, a number of clinical ethics issues receive emphasis. (1) One cluster concerns the ethical concerns presented within the relationship between the providers (doctor, nurse, etc.) and patient (and family), as distinct from those associated with being a clinical ethics consultant invited into a situation to assist. (2) Distinct from these are ethical issues intrinsic to the ways in which clinical encounters are variously written about (from chart notes to published articles). (3) (...) Finally, there is a set of issues connected with the major characteristics of clinical encounters, in view of which it is imperative to be specifically attentive to the fine details and complex interactions among patient, doctor, family, and others, within a specific social context. Keeping these matters in mind helps to clarify the differences between consulting (talking and listening) and writing about consultations, as well as among the various kinds of writing about clinical encounters. (shrink)

Baylis, Tomlinson, and Hoffmaster each raise a number of critiques in response to Bliton's manuscript. In response, we focus on three themes we believe run through each of their critiques. The first is the ambiguity between the role of ethics consultation within an institution and the role of the actual ethics consultant in a particular situation, as well as the resulting confusion when these roles are conflated. We explore this theme by revisiting the question of What's going on? in clinical (...) ethics consultations. Moving from those issues associated with the role of the ethics consultant to those associated with the role of inquiry within the practice of ethics consultation, we then take up the serious challenge that Bliton seems shackled by the assumptions and institutional dispositions embedded in the medical culture in which he is working. This reveals the second theme, namely that there is a risk of co-optation when acting in a role that derives its legitimacy from institutional sources. Finally, we focus on an even more problematic implication stemming from the first two, namely that the focus on institutional power as the crucial factor for determining ethical significance has the effect of distorting, and perhaps obscuring, other forms of relational, interpersonal, and moral meaning. (shrink)

Paper is divided into two parts. The first contains two philosophical discussions about comprehension of courage and the second focuses on the findings in an empirical study with care home managers about the virtue of courage. First discussion revolves around the question whether the virtue of courage is expressed a) only in life–threatening situations or is it a virtue trained and exemplified in b) everyday life settings, while the second emphasises the difference between i) courage of efficiency as a skill (...) and ii) courage of excellence as a virtue. Arguments here support a vision of courage as the virtue of excellence expressed in everyday life settings. The second part of the paper highlights a new perspective of courage with regards to the notion of care towards the aim of the courageous endeavour. The ‘courage of care’ supports the idea that the courage practised as the virtue of excellence aims to develop the moral character of the actor fundamentally outside of the life–threatening situation. Care for the self, other people, animals and intangible moral principles inspire us to do brave deeds. Thus, by accepting Alasdair MacIntyre’s statements that a) in the times of the peace managers represent moral idols and b) idea that the notion of courage should be closely related to the practice of care and compassion, the research continued with the interviews with the care home managers in Kent county in England. Conversations with care home managers released further insights into how care and compassion influence the understanding of the virtue of courage. (shrink)