Background The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. Methods Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No differences in ethical reasoning between male and (...) female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. Conclusion The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity. (shrink)

Ethicists differ considerably in their reasons for using empirical data. This paper presents a brief overview of four traditional approaches to the use of empirical data: “the prescriptive applied ethicists,” “the theorists,” “the critical applied ethicists,” and “the particularists.” The main aim of this paper is to introduce a fifth approach of more recent date (i.e. “integrated empirical ethics”) and to offer some methodological directives for research in integrated empirical ethics. All five approaches are presented in a table for heuristic (...) purposes. The table consists of eight columns: “view on distinction descriptive-prescriptive sciences,” “location of moral authority,” “central goal(s),” “types of normativity,” “use of empirical data,” “method,” “interaction empirical data and moral theory,” and “cooperation with descriptive sciences.” Ethicists can use the table in order to identify their own approach. Reflection on these issues prior to starting research in empirical ethics should lead to harmonization of the different scientific disciplines and effective planning of the final research design. Integrated empirical ethics (IEE) refers to studies in which ethicists and descriptive scientists cooperate together continuously and intensively. Both disciplines try to integrate moral theory and empirical data in order to reach a normative conclusion with respect to a specific social practice. IEE is not wholly prescriptive or wholly descriptive since IEE assumes an interdepence between facts and values and between the empirical and the normative. The paper ends with three suggestions for consideration on some of the future challenges of integrated empirical ethics. (shrink)

Alisdair MacIntyre argues that the virtues necessary for good work are everywhere and always embodied by particular communities of practice. As a general surgeon, MacIntyre’s work has deeply influenced my own understanding of the practice of good surgery. The task of this essay is to describe how the guild of surgeons functions as a more-or-less coherent tradition of moral enquiry, embodying and transmitting the virtues necessary for the practice of good surgery. Beginning with an example of surgeons engaged in a (...) process of moral discernment, I describe how the practice of surgery depends on the cultivation of a certain kind of practical wisdom (phronesis) that effectively orders the techniques of surgery toward particular notions of human flourishing within the limits of what is possible with the particular body on which the surgeon operates. I then argue that one reason why surgeons train in an apprenticeship model of "residency" is to cultivate not only the technical skill but also the practical wisdom to perform good surgery. I conclude by noting that the surgical profession is enduring necessary, but unprecedented, changes in the way it practices and transmits its art; and without deliberate and sustained attention to the character formation of surgeons, the profession runs the risk of creating excellent technicians who are nonetheless ill-equipped to practice wise and good surgery. (shrink)

This thesis is about the content and concerns of each of four disciplines pertaining to the field of bioethics: medicine, philosophy, religion and law. Emphasis is put on the human values each reflects in patients' lives. A last chapter is dedicated to patients' narrative in order to bring a practical perspective to the discussions of the previous chapters. The four essential human values interconnecting among the four disciplines are: the patients' need for authority, the need for protection, the existential questioning (...) about the meaning of life, and the fear of death. (shrink)

This paper examines the moral responsibilities of physicians, toward themselves and their colleagues, their students and patients, and society, in terms of the nature and exercise of professional self-regulation. Some of the author's close encounters with cases involving research misconduct, behavioral impairment or deviance, and medical practice at the moral margin, are described to illustrate why, in Freidson's words, physicians are a delinquent community with respect to the ways they meet their responsibility to govern the competence and conduct of their (...) members. (shrink)

Social norms are an important input for ethical decisions in any business context. However, the cross-cultural discovery of extant social norms presents a special challenge to international management because norms may be inscrutable to outsiders. This article considers the contribution of Integrative Social Contracts Theory (ISCT) to the analysis of social norms in business ethics. It questions the origins and dynamics of norms from a sociological perspective, and identifies a tension between prescriptive efforts to make norms obligatory and positivist accounts (...) that describe norms as evolving and unstable. In the presence of dynamic and incomplete norms, managers can either deliberate with stakeholders to make norms flexible or codify norms to make them rigid. This essay argues that deliberation is the only reliable method for anticipating emergent norms. (shrink)

*Work on this paper was funded in part by NIH grant K01-AT00054, National Center for Complementary and Alternative Medicine. Know then thyself, presume not God to scan The proper study of mankind i...

Grady and colleagues (2008) have provided a major contribution to the field of bioethics, and their research should lend a significant hand to the oft-neglected ethics needs of professional nurses....