This article questions the commonly held view that professional ethics is grounded in general ethical principles, in particular, respect for client (or patient) autonomy and beneficence in the treatment of clients (or patients). Although these are admirable as general ethical principles, we argue that there is considerable logical difficulty in applying them to the professional-client relationship. The transition from general principles to professional ethics cannot be made because the intended conclusion applies differently to each of the parties involved, whereas the (...) premise is a general principle that applies equally to both parties. It is widely accepted that professionals are required to recognize that clients or patients possess rights to autonomy that are more than the general rights to personal autonomy accepted in ordinary social life, and that professionals are expected to display beneficence toward their clients that is more than the beneficence expected of anyone in ordinary social life. The comparative component of professional ethics is an intrinsic feature of the professional situation, and thus it cannot be bypassed in working out a proper professional ethics. Thus, we contend, the proper professional treatment of clients or patients has not been explained by appeal to general ethical principles. (shrink)

This paper scrutinizes the tension between individuals’ rights and paternalism. I will argue that no normative account that includes rights of individuals can justify hard paternalism since the infringement of a right can only be justified with the right or interest of another person, which is never the case in hard paternalism. Justifications of hard paternalistic actions generally include a deviation from the very idea of having rights. The paper first introduces Tom Beauchamp as the most famous contemporary hard paternalist (...) by outlining his moral theory (principlism) and showing why it, as it stands, has to allow for hard paternalism. Secondly, the paper focuses on the notion of rights within principlism. I will employ traditional theories of rights to make sense of rights in principlism. Unfortunately, this attempt fails. In the third part, then, I claim that rights can only be limited with reference to the rights or interests of others. This structure is the very point of rights, it is their bite. I will argue for this claim and show its implications. The most important implication is that not only principlism, but every normative theory that includes rights of individuals, has to abolish hard paternalism. (shrink)

As the use of artificial intelligence (AI) technologies, particularly generative AI (Gen AI), becomes increasingly prevalent in nursing education, it is paramount to address the ethical implications of their implementation. This article explores the realm of cyberethics (a field of applied ethics that focuses on the ethical, legal, and social implications of cybertechnology), highlighting the ethical principles of autonomy, nonmaleficence, beneficence, justice, and explicability as a roadmap for facilitating AI integration into nursing education. Research findings suggest that ethical dilemmas that (...) challenge these five principles can emerge within the context of nursing education; however, adherence to these very principles, which is essential to improving patient care, can offer solutions to these dilemmas. To ensure the ethical and responsible use of Gen AI in nursing education, these principles must be woven into the fabric of curricula, and appropriate guidelines must be developed. Nurse educators have a pivotal role in strategizing comprehensive approaches for ethical AI integration, establishing clear guidelines, and instilling critical thinking among students. Fostering lifelong learning and adaptability is key to ensuring that future nurses can successfully navigate the constantly evolving landscape of health care technology. Future research should investigate the long-term impacts of AI utilization on learning outcomes and ethical decision-making. (shrink)

Bioethicists have typically disdained where they did not simply ignore the Hippocratic tradition in medicine. Its exclusivity—an oath of and for physicians—seemed contrary to the perspective that bioethicists have attempted to invoke. Robert M. Veatch recently articulated this rejection of the Hippocratic tradition, and of a professional ethic of medicine in general, in a volume based on his Gifford lectures. Here that argument is critiqued. The strengths of the Hippocratic tradition as a flexible and ethical social doctrine are offered in (...) its stead. (shrink)

For years now, autonomy has been discussed as one of the central values in health care. Understood as self-realization, it is opposed to paternalism which is conceived as an intolerable occurrence of heteronomy. Although different concepts have been developed to nuance this opposition, when it comes to health care discourse, heteronomy is still the enemy of autonomy. In our article, we defend the thesis that autonomy is only achievable as heteronomy. We are not arguing for an expansion of the meaning (...) of autonomy, but are attempting to conduct an analysis which lays bare the ‘disrupting’ attendance of heteronomy within the principle of autonomy. Autonomy does not begin where heteronomy ends, but can only begin if heteronomy is already involved. To emphasize this, we prefer to elaborate a new concept: ‘oughtonomy’. This concept is inspired by Jacques Derrida’s distinction between ‘difference’ and ‘differance’. We will develop the concept of oughtonomy from a deconstructive reading of Kant’s idea of autonomy, inspired by philosophers such as Jacob Rogozinski, Jean-Luc Nancy and others. In addition to a first exploration of this concept, this article also discusses the possible consequences of oughtonomy for current debates concerning health care. Our quest for a new understanding of autonomy is motivated by the concern that, although the accent on autonomy as self-realization and independence has many advantages, we should also bear in mind the countless disadvantages. (shrink)

In this paper I investigate the theory-practice relationship in ethics by using the lens of theorist-practitioner relationships. In particular I discuss the contrasts between theorist-practitioner relationship inside and outside the classroom, the ‘extra-mural’ expertise of theorists, and the ethical issues which arise when theorists act as co-practitioners. I argue that understanding these social and ethical issues is essential to understanding the relationship between theory and practice in ethics, and shows the need for more emphasis on practice-oriented forms of ethical theorising.

Background: Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the “Guide on the decision-making process regarding medical treatment in end-of-life situations”, aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. Objectives: To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are (...) consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses’ current end-of-life care practices. Design: Qualitative secondary analysis. Participants/context: Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. Ethical consideration: Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética. Ethical procedures are thoroughly described. Findings: All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. Discussion: Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients’ preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. Conclusion: While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses’ involvement and practices in end-of-life decision-making. (shrink)

W artykule w trojaki sposób dowodzę odrębności profesjonalnej etyki lekarskiej, mianowicie: 1. ukazując różnice pozycji normatywnej obowiązków w etyce profesjonalnej i ogólnej, 2. uzasadniając przynależność lekarskiej etyki profesjonalnej do modelu zapożyczenia jako typu etyki aplikacyjnej, 3. podając racje za profesjonalizmem historycznym jako etyką właściwą dla stanu lekarskiego. Odrębność profesjonalnej etyki lekarskiej stanowi ważny argument za jej umieszczeniem w planie edukacji etycznej studentów medycyny i lekarzy. W końcowej części pracy rekonstruuję rzeczywiste i postulowane relacje między etyką profesjonalną a profesjonalizmem, bioetyką akademicką (...) i bioetyką publiczną. Celem rekonstrukcji jest wskazanie optymalnego dla edukacji etycznej miejsca etyki profesjonalnej w systemie kształcenia etycznego profesjonalistów. (shrink)