With a focus on caring ethics, the aim of this study was to see if and how experienced nurses in care for the elderly described caring and whether they included any theoretical basis to their caring acts. Questions that guided the research were: Does ethical caring theory have any relevance in nurses clinical work? How do experienced nurses describe care in general, their intentions and motives in particular? In order to enter into the meanings of caring, a reflective lifeworld research (...) approach based on phenomenology was utilized. Eleven experienced nurses were interviewed and the resulting transcripts were analysed for meaning, The findings revealed caring as a seamless integration of different levels, or embodied moments, of knowledge. In caring that is understood as a practical, aesthetical and ethical field of force, there is room for "being", "becoming" and "doing". Theory and practice can and must intertwine to enable the caring goal of health as well-being. A conclusion that may be drawn from this study is that there is a potential for connecting ethical caring concepts and theories into practical everyday care. Nurses basic intentions for a care-giving profession, as well as hidden/forgotten theory and concepts, are viewed in this study as a possibility of turning from a pre-reflective state to a more conscious level. This study gives new nuances to the understanding that existence affects caring and caring affects existence, and contributes to the more general claim that it now is high time for ethical caring science theory to be visible and make a change in care. Highlighting the experience of existential caring intentionality, and relating the experience to theoretical caring substance, this study may contribute to the development of a more consciously ethical and individualized caring culture. (shrink)

The problem of artificial intelligence and human being has always raised questions about possible interactions among them and possible effects yielded by the introduction of such un-human subject. Dreyfus deeply connects intelligence and body based on a phenomenological viewpoint. Thanks to his reading of Merleau-Ponty, he clearly stated that an intelligence must be embodied into a body to function. According to his suggestion, any AI designed to be human-like is doom to failure if there is no tight bound with a (...) human-like body. Today, we are facing the pervasive introduction of robots into our everyday life, and the problem of this co-existence raises again with new vigor since they are not mere speculations, but there are already products sold to the public. We will highlight how vulnerability has to be taken into consideration in the design of robots to create entities which are able to relate to human beings taking into consideration mainly the positions of Sartre, Habermas, Levinas, and Marleau-Ponty. A first part will focus on the vulnerability of the robots. Robots are going to be among us, but a real interaction is possible only the moment they have a “same” body of ours. Therefore, only through the realization of a “fragile” body we can achieve a cohabitation between equals. Thanks to Merleau-Ponty we will show how the vulnerability of a body is one of the most important element to found any social interaction. The second part will focus on how the robots will affect the vulnerability of the human subjects. To produce vulnerable robots is not a mere neutral introduction, but it shapes how the subjects are constituted. Thanks to Levinas, we will study how the vulnerable robots will shape the subjects. Thanks to Sartre, we will show how the creation of a different gaze in the robot changes the vulnerabilities of the human subjects. Introducing vulnerable robots is a way to shape ourselves. (shrink)

The patient–physician relationship is of primary importance for medical ethics, but it also teaches broader lessons about ethics generally. This is particularly true for the philosopher Emmanuel Levinas whose ethics is grounded in the other who “faces” the subject and whose suffering provokes responsibility. Given the pragmatic, situational character of Levinasian ethics, the “face of the other” may be elucidated by an analogy with the “face of the patient.” To do so, I draw on examples from Martin Winckler’s fictional physician (...) narratives. In addition, I explore how the standpoint of the physician conceals a related but often unacknowledged dimension of care: the obligation to nurse. For both nurse and physician, one question encapsulates Levinas’ medical ethics: “What does the patient say?” Using this as my guiding question, I examine the context within which physician, nurse, and patient meet in order to highlight their shared vulnerability and the care relationship that binds them together. (shrink)

Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforeseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence, respect for human rights and respect for autonomy through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative research interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological interview studies. (...) We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers’ premises to react to unexpected situations and act in a sound ethical manner must be enhanced, and there is a need for an increased focus on the researchers’ ethical preparation and to continually address and discuss cases from their own interviews. (shrink)

Ethical sensitivity was introduced to caring science to describe the first component of decision making in professional practice; that is, recognizing and interpreting the ethical dimension of a care situation. It has since been conceptualized in various ways by scholars of professional disciplines. While all have agreed that ethical sensitivity is vital to practice, there has been no consensus regarding its definition, its characteristics, the conditions needed for it to occur, or the outcomes to professionals and society. The purpose of (...) this article is to explore the meaning of the concept of ethical sensitivity based on a review of the professional literature of selected disciplines. Qualitative content analysis of the many descriptors found within the literature was conducted to enhance understanding of the concept and identify its essential characteristics. Ethical sensitivity is considered to be an emerging concept with potential utility in research and practice. (shrink)

Background: Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today’s hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual’s dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses’ options to act on the basis of ethical and (...) moral grounds in the individual care situation. Aim: The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. Method: The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. Ethical consideration: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. Results: The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse–patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. Conclusion: Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses’ professional decision-making and forcing them to compromise basic nursing values. (shrink)

For more than 15 years Professor Per Nortvedt has been arguing the case for moral realism in nursing and the health‐care context more generally. His arguments focus on the clinical contexts of nursing and medicine and are supplemented by a series of persuasive examples. Following a description of moral realism, and the kinds of considerations that support it, criticisms of it are developed that seem persuasive. It is argued that our moral responses are explained by our beliefs as opposed to (...) moral realities. In particular, two key arguments presented by Nortvedt are challenged: the so‐called argument from convergence and the argument from clinical sensitivity. Both of these key planks in the case for moral realism are rejected, and an alternative ‘social conditioning’ account briefly sketched, which, it is claimed, has the same explanatory power as Nortvedt's thesis but does not rest on an appeal to independently existing moral properties. (shrink)

This paper examines the concept of vulnerability in the context of social research ethics. An ambiguity is noted in use of this term: it may refer to an incapacity to provide informed consent to participate in a research project, or it may imply heightened susceptibility to the risk of harm. It is pointed out that vulnerability is a matter of degree, and that there are different sources and types of harm, which must be taken into account in any judgment about (...) whether additional precautions are required to protect particular categories of research participants. Furthermore, such judgments must be sensitive to the particular context in which research is taking place. This is one of several considerations that raise questions about the desirability of the sort of pre-emptive ethical regulation that has become institutionalized in many countries over the past few decades, a form that is more appropriate to medical rather than to social research. However, this is not to deny that a concern with the vulnerability of research participants is necessary on the part of social researchers. Furthermore, it must be recognized that researchers themselves may be vulnerable to harm in the research process. Finally, some discussion is provided of the way in which a concern with vulnerability can conflict with other considerations that researchers need to take into account in doing their work. The key point is that vulnerability is a complex and controversial concept, and it requires careful handling in thinking about social research ethics. (shrink)

This study focuses on influence that older adults, living in nursing homes, have over everyday activities. Everyday activities are key to sustain a sense of stability, predictability, and enjoyment in the local world of people's everyday and therefore a critical dimension of the person‐centeredness framework applied within gerontology. This narrative ethnographic study aimed to shed light on how influence can be situated contextually, and how it can emerge through activities as well as how it is negotiated in everyday by frail (...) older adults living in a nursing home. Residents, staff members, and significant others from one nursing home in an urban area of Sweden participated in this study. Data were gathered through fieldwork, including participant observation and formal and informal conversations during a period of 6 months. Data were analyzed through a narrative interpretative approach. The findings are presented in narrative form as exemplars. The exemplars—Craquelures as justification, Seeking a place for other life worlds and An almost perfect trip—reveal a gap between the client‐centeredness framework and lived experiences regarding older adults’ influence in everyday activities. The role of everyday activities in the context of frailty is discussed in terms of ethical and responsive engagement, and implications for health‐care practices are considered. (shrink)

Recognition theory attempts to conceptualize interpersonal relationships and their normative political implications. British social philosopher Gillian Rose developed her own version of recognition rooted in the work of Georg Hegel. This article applies Rose's theory of recognition to care, arguing that its emphasis on lack of identity, the dynamic process of recognition and the existential risks involved accurately describes the relationship between nurse and patient. Rose's version is compared to both contemporary notions of the interpersonal in healthcare literature, other forms (...) of recognition theory and Emmanuel Levinas's vision of intersubjective relationships, a traditional philosophical basis for nursing care. In each case, I will argue that Rosean recognition is a fuller, more complex and ultimately more satisfying view of the relationships involved. (shrink)

The ‘Other’ can be near to us, or far from us. We are in-relation with both. Given that, we explore whether, from a moral philosophical perspective, the ‘near-other’ is in tension with the ‘far-other’. We argue that we find our relationship with the near-other through a transcendent metaphysical empathy derived from the noumenon, which is manifest in the phenomenon as compassion and justice. We then argue that perceived differences in the phenomenon mean that we do not reliably transfer this empathy (...) for the near-other, to the far-other. Further, empathic and constructive dialogue is made more difficult because of our proclivity to actively engage in ‘othering’ those not-like-us. Properly, moral decision-making is positioned in a space cognizant of the other. Near-otherness makes consensus in the decision-making process easier, while far-otherness makes consensus more difficult. In our post-modern, multicultural and multifaith era, we need to be alert to the other’s perspective, to find a way to have a meaningful dialogue and thus achieve consensus in our moral decision-making. (shrink)

The normative significance of proximity in ethics is considered, giving an overview of the contemporary debates about proximity in ethics and focusing on three main perspectives that take proximity to have normative significance. The first perspective is represented by meta-ethical positions, where a basic moral claim is said to originate from an irreducible, particular and unique otherness that shows up in human vulnerability. The second perspective presents a psychologically and philosophically based analysis of human emotions, which is taken to form (...) a basis for rudimentary moral sensitivity and care. The third version of an ethics of proximity claims that personal relationships and partiality overrride impartialist and universalist ethical considerations. On the basis of this analysis, the sources of normativity and the essence of proximity as a normative consideration are elaborated. Finally, the relevance of an ethics of proximity to professional ethics in healthcare is discussed. From an ethics of proximity, it might be argued that institutions must attempt to organise medical care and nursing care so that a certain partiality and patient-centred care might be favoured and trump distributivist considerations of justice in healthcare. (shrink)

The main question examined is: How do nurses and other healthcare professionals ensure ethical interprofessional collaboration-in-practice as an everyday practice actuality? Ethical interprofessional collaboration becomes especially relevant and necessary when interprofessional practice decisions are contested. To illustrate, two healthcare scenarios are analyzed through three ethics lenses. Biomedical ethics, relational ethics, and virtue ethics provide different ways of knowing how to be ethical and to act ethically as healthcare professionals. Biomedical ethics focuses on situated, reflective, and nonabsolute principled justification, all things (...) considered; relational ethics on intersubjective, professional, and institutional relations; and virtue ethics on prephilosophical tradition and what it means to be good and to be human embedded in social and political community. Analysis suggests that interprofessional collaboration-in-practice may be more rhetoric than actuality. Key challenges of interprofessional collaboration-in-practice and specific conditions perpetuating dissension and conflict are outlined with specific education and policy recommendations included. (shrink)

For nursing, the idea of bearing witness is of utmost importance. Nurses are present with persons who experience changes in their health and quality of life and who live intense and profound moments of struggling, questioning, and finding meaning. Nurses are also with persons from moment to moment as their lives unfold, and when joy, serenity, contentment, vulnerability, sadness, fear, and suffering are experienced. In this paper, it is proposed that bearing witness is a moral way of engaging in the (...) nurse–person relationship. Based on Levinas’s ethics of the face, it is claimed that bearing witness is enacting one’s moral responsibility, which arises from the encounter with the other. Drawing on Parse’s human becoming theory, ways of witnessing and bearing witness are defined and discussed. It is suggested that bearing witness is a human‐to‐human way of being‐relating, a mode of human coexistence. Bearing witness is being present and attentive to the truth of another’s experiences. Moreover, in this paper, the ways nurses enact their moral agency and bear witness to others placed in their care, or turn away, are explored. Nurses’ moral agency is located in the constrained moral space of contemporary health care. Hence, the creation of a moral space, which allows nurses to enact their moral responsibility of bearing witness to other persons’ experiences of health and quality of life, is called for. In doing so, it is suggested that the act of bearing witness needs a specific nursing knowledge base and a recognition that being present and being with another is a valuable nursing practice that is utterly meaningful for persons who are living through difficult times. (shrink)

Vulnerability has become a popular though controversial topic in bioethics, notably since 2000. As a result, a common body of knowledge has emerged distinguishing between different types of vulnerability, criticizing the categorization of populations as vulnerable, and questioning the practical implications. It is argued that two perspectives on vulnerability, i.e., the philosophical and political, pose challenges to contemporary bioethics discourse: they re-examine the significance of human agency, the primacy of the individual person, and the negativity of vulnerability. As a phenomenon (...) of globalization, vulnerability can only be properly addressed in a global bioethics that takes the social dimension of human existence seriously. (shrink)

The purpose of this article is to explore enduring ethical vulnerabilities of the nursing profession as illustrated in historical chapters of nursing’s past. It describes these events, then explores two ethical vulnerabilities in depth: conflicting loyalties and duties, and relationships with patients as ‘other’. The article concludes with suggestions for more ethical approaches to the other in current nursing practice. The past may be one of the most fruitful sites for examining enduring ethical vulnerabilities of the nursing profession. First of (...) all, professional identity, which includes moral identity, comes in part from knowledge of the nursing profession’s past. Second, looking to the past to understand better how events and ideologies have brought vulnerabilities to the fore raises questions about ethical nursing practice today. (shrink)

The main question examined is: How do nurses and other healthcare professionals ensure ethical interprofessional collaboration-in-practice as an everyday practice actuality? Ethical interprofessional collaboration becomes especially relevant and necessary when interprofessional practice decisions are contested. To illustrate, two healthcare scenarios are analyzed through three ethics lenses. Biomedical ethics, relational ethics, and virtue ethics provide different ways of knowing how to be ethical and to act ethically as healthcare professionals. Biomedical ethics focuses on situated, reflective, and nonabsolute principled justification, all things (...) considered; relational ethics on intersubjective, professional, and institutional relations; and virtue ethics on prephilosophical tradition and what it means to be good and to be human embedded in social and political community. Analysis suggests that interprofessional collaboration-in-practice may be more rhetoric than actuality. Key challenges of interprofessional collaboration-in-practice and specific conditions perpetuating dissension and conflict are outlined with specific education and policy recommendations included. (shrink)

This article analyses problem situations in the context of anaesthesia care. It considers what it means for nurse anaesthetists to be in problematic situations in the anaesthesia care of older patients. Benner’s interpretive phenomenological approach proved useful for this purpose. Paradigm cases are used to aid the analysis of individual nurses’ experiences. Thirty narrated problematic anaesthesia care situations derived from seven interviews were studied. These show that experienced nurse anaesthetists perceive anaesthesia care as problematic and highly demanding when involving older (...) patients. To be in problematic anaesthesia care situations means becoming morally distressed, which arises from the experience or from being prevented from acting according to one’s legal and moral duty of care. An important issue that emerged from this study was the need for an ethical forum to discuss and articulate moral issues, so that moral stress of the kind experienced by these nurse anaesthetists can be dealt with and hopefully reduced. (shrink)

Background: In research on co-creation in nursing, a caring manner can be used to create opportunities whereby the patient’s quality of life can be increased in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. To promote quality of life, nurses must be sensitive to patients’ and their relatives’ needs in care encounters. Co-creation can be defined as the joint creation of vital goals for patients through the process of shared knowledge between (...) nurses, patients and their relatives. Aim: The aim of this study was to explore nurses’ experiences of caring encounters and co-creation in palliative home care from an ethical perspective. Research design, participants, and research context: A hermeneutical approach was used. The material consisted of texts from interviews with 12 nurses in a home care context. The method was inspired by thematic analysis. Ethical considerations: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Findings: An overall theme, a main theme and four sub-themes emerged. Through ethical sensitivity and perceptivity, nurses can balance their actions in the moment and change their nursing care actions according to the patient’s wishes through co-creation in encounters. Here the time is crucial, as the time needed is unique to each patient. Discussion: The themes together can be considered prerequisites for good palliative home care. If nurses fail to be sensitive and perceptive in encounters with dying patients, good palliative home care cannot be achieved. Ethical sensitivity and perceptiveness can also be considered a part of nurses’ ethical competence. Conclusion: Patients’ dignity can be preserved through ethical sensitivity and perceptiveness, which is fundamental for good palliative care. Co-creation from patients’ perspectives should be the focus of future research. (shrink)