Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and (...) distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change. (shrink)

Technologies have always been bearers of profound changes in science, society, and any other aspect of life. The latest technological revolution—the digital revolution—is no exception in this respect. This paper presents the revolution brought about by digital technologies through the lenses of a specific approach: the philosophy of information. It is argued that the adoption of an informational approach helps avoiding utopian or dystopian approaches to technology, both expressions of technological determinism. Such an approach provides a conceptual framework able to (...) address the ethical challenges that digital technologies pose, without getting stuck in the dichotomous thinking of technological determinism, and to bring together ethics, ontology, and epistemology into a coherent account. (shrink)

“The most significant outcome of effective business ethics research would be an improvement of ethical standards and ethical behaviour in organizations”. So how can such research be made effective? The author is Lecturer in Management Studies, University of Cambridge, and Fellow of Lucy Cavendish College.

In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM (...) are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship. (shrink)

This paper examines voluntary corporate social responsibility (CSR) reporting as a form of moral discourse. It explores how alternative stakeholder perspectives lead to differing perceptions of the process and content of responsible reporting. We contrast traditional stakeholder theory, which views stakeholders as external parties having a social contract with corporations, with an emerging perspective, which views interaction among corporations and constituents as relational in nature. This moves the stakeholder from an external entity to one that is integral to corporate activity. (...) We explore how these alternative stakeholder perspectives give rise to different normative demands for stakeholder engagement, managerial processes, and communication. We discuss models of CSR reporting and accountability: EMAS, the ISO 14000 series, SA8000, AA1000, the Global Reporting Initiative, and the Copenhagen Charter. We explore how these models relate to the stakeholder philosophies and find that they are largely consistent with the traditional atomistic view but fall far short of the demands for moral engagement prescribed by a relational stakeholder perspective. Adopting a relational view requires stakeholder engagement not only in prescribing reporting requirements, but also in discourse relating to core aspects of the corporation such as mission, values, and management systems. Habermas’ theory of communicative action provides guidelines for engaging stakeholders in this moral discourse. (shrink)

In this paper the claim is made that the new turn to ethics brings about a need to develop a toolbox for practical ethics that makes ethical advice amenable to quality assurance and democratic transparency. This is of great importance when ethical advice is given to policy-making bodies. The mechanism of providing ethical advice through the establishment of an ethics committee is discussed. An analysis of what would follow from conceiving of the work of such a committee as an exercise (...) in discourse ethics (just one among several ethical tools). A number of critical questions and criticisms of ethics committees are presented and discussed. The paper argues that much needs to be done to develop a toolbox for practical ethics of science and technology. If efforts in this direction are neglected, one risks basic doubts about the legitimacy of ethical advice and people will come to see ethics as a mere smokescreen or passing fashion. (shrink)

Following Alder Hey and the earlier and much more extreme practices at Nuremberg, legislation has been developed governing the practice of medical ethics and research involving human participants more generally. In the medical context, relevant legislation includes GMC guidance, which states that disclosure of identifiable patient information without consent, for research purposes, is not acceptable unless it is justified in the public interest. There is a presumption, in other words, in favour of the view that patient consent ought to be (...) obtained before any piece of research is conducted. The Data Protection Act, furthermore, requires informed consent to be given before any use of identifiable personal data is made for any purpose. Moreover, ensuring that the informed consent of participants is gained is common practice on most research ethics committees. I argue, in this paper, that applying the principle of ‘informed consent’ too mechanistically in the research ethics context risks undermining the very principle it is designed to support – the principle of autonomy. This issue has been much discussed in medical ethics but not so much, so far, in the research ethics context. It will be argued that a more discerning and a less rigid and mechanistic approach, applied by research ethics committees, may help ensure that ethical issues are properly considered. (shrink)