Conscientious objections (CO) can be disruptive in a variety of ways and may disadvantage patients and colleagues who must step-in to assume care. Nevertheless, nurses have a right and responsibility to object to participation in interventions that would seriously harm their sense of integrity. This is an ethical problem of balancing risks and responsibilities related to patient care. Here we explore the problem and propose a nonlinear framework for exploring the authenticity of a claim of CO from the perspective of (...) the nurse and of those who must evaluate such claims. We synthesized the framework using Rest’s Four Component Model of moral reasoning along with tenets of the International Council of Nursing’s (ICN) Code of Ethics for Nurses and insights from relevant ethics and nursing ethics literature. The resulting framework facilitates evaluating potential consequences of a given CO for all involved. We propose that the framework can also serve as an aid for nurse educators as they prepare students for practice. Gaining clarity about the sense in which the concept of conscience provides a defensible foundation for objecting to legally, or otherwise ethically, permissible actions, in any given case is critical to arriving at an ethical and reasonable plan of action. (shrink)

ABSTRACTIn November 2005, U.S. Marine Sergeant Frank Wuterich fired on and killed five unarmed Iraqi men standing by a car near the site of an improvised explosive device explosion in Haditha...

Experimental design is one aspect of a scientific method. A well-designed, properly conducted experiment aims to control variables in order to isolate and manipulate causal effects and thereby maximize internal validity, support causal inferences, and guarantee reliable results. Traditionally employed in the natural sciences, experimental design has become an important part of research in the social and behavioral sciences. Experimental methods are also endorsed as the most reliable guides to policy effectiveness. Through a discussion of some of the central concepts (...) associated with experimental design, including controlled variation and randomization, this chapter will provide a summary of key ethical issues that tend to arise in experimental contexts. In addition, by exploring assumptions about the nature of causation and by analyzing features of causal relationships, systems, and inferences in social contexts, this chapter will summarize the ways in which experimental design can undermine the integrity of not only social and behavioral research but policies implemented on the basis of such research. (shrink)

During medical training students and residents reconstruct their view of the world. Patients become bodies; both the faults and the virtues of the medical profession become exaggerated. This reconstruction has moral relevance: it is in part a moral blindness. The pain of medical training, together with its narrowness, contributes substantially to these faulty reconstructions. Possible improvements include teaching more social science, selecting chief residents and faculty for their attitudes, helping students acquire communication skills, and helping them deal with their own (...) pain. Most importantly, clearer moral vision requires time and scope for reflection. (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)

The administration of electroconvulsive therapy (ECT) to children and adolescents remains an unresolved area of clinical debate for nurses. Thus, some nurses have refused to participate in the treatment of minors with ECT, invoking codes of conduct to justify their actions. Other nurses have supported the use of ECT with children and adolescents, via provision of technical assistance to medical colleagues. A cross-national comparison of ethical codes of conduct has confirmed that nurses should take decisive action in the clinical arena (...) when the needs or rights of vulnerable minors are compromised. The provision of clinical guidelines is suggested as one method to enshrine the rights of at-risk children and adolescents. (shrink)

The purpose of this study was to describe the extent to which nurses perceive the ethical dimensions of clinical practice situations involving patients, families and health care professionals. Using the composite theory of basic moral principles and the professional standard of care established by legal custom as a framework, situations involving ethical dilemmas were gleaned from the nursing literature. They were reviewed for content validity, clarity and representativeness in a two-stage process by expert panels. The situations were presented in a (...) written format to a convenience sample of nurses (n = 125), who were primarily staff nurses (65.6%). Respondents' judgements about whether the main issue of each situation concerned ethics ranged from a low of 0.8% to a high of 40%. From analyses of the categories into which the majority of subjects placed each situation, it was concluded that these nurses generally perceived ethics as the main issue in situations that directly involve patients' autonomy. Analysis yielded unanticipated findings about the themes in ethical situations to which nurses in practice may respond. (shrink)

For many years questions have been posed about the way ethics is taught in accounting education. The teaching of ethics is often criticized for emphasizing the legal dimension to the detriment of the moral one, among other reasons. This case study focuses on an accounting course intended to develop and stimulate students’ critical thinking on accounting and its role in daily life. The investigation is based on an empirical study that took place in the 2015–2016 academic year, when the first (...) author undertook non-participant observation and examined the final term assignment (a short essay) of the great majority of the 120 students enrolled in this course. One of the course’s main features was to expose the students to critical thinking, through analyses and discussions of the roles of accounting and accountants in organizations and society—using research articles as a backdrop to stimulate analysis and discussion. Our investigation suggests that the course is able to sensitize students to professional ethics and responsibilities. Our argument, broadly supported by an empirical case analysis, is that a course centered on a dialogical approach and critical thinking on the role of accounting and accountants in society may impact the development of ethical sensitivity in future accounting practitioners. (shrink)

Moral sensitivity is known to be the starting point for moral competence and even is a core concept in the curricula for bachelor’s-level nursing students in the Netherlands. While the development of moral sensitivity in nursing is commonly agreed to be important, there is no clear understanding of how to develop moral sensitivity through nursing education and what components of nursing education contribute to moral sensitivity. Studies on educational interventions could build knowledge about what works in developing moral sensitivity and (...) how to achieve this outcome. Therefore, the aim of this study is to explore if and how educational interventions contribute to the development of moral sensitivity in nursing students. A scoping review was conducted. Four electronic databases were searched: CINAHL, PubMed, MEDLINE and SpringerLink. Articles that were not about formal or initial nursing education and that had no link to moral development or moral sensitivity were excluded. After the final selection on educational interventions, 10 articles out of the initial 964 resources were included in the review. Three different but related dimensions of moral sensitivity emerged from the literature: (1) raising moral awareness, (2) providing the ability to frame and name ethical issues and (3) improving moral reasoning ability. Half of the studies used quantitative measures to evaluate the educational intervention, in particular the Moral Sensitivity Questionnaire; the other half used diverse qualitative evaluation methods. None of the studies presented teaching methods that included all three dimensions of moral sensitivity. Moral awareness of self appears to be more loosely connected to the other two dimensions, which raises the question of whether it can be seen as a prerequisite for them. To encompass all dimensions of moral sensitivity, a mix of quantitative and qualitative measures seems most appropriate to study that topic. (shrink)

ABSTRACT This cross-sectional study compared the moral reasoning of first-year and third-year doctoral students in clinical psychology. Nineteen first-year and 20 third-year students were recruited from 17 doctoral training programs in the UK. Most adopted a sophisticated approach to moral judgments, as assessed by the Defining Issues Test, although, surprisingly, more experienced students had significantly less sophisticated schemata. In their moral judgments, less experienced students relied more heavily on their personal, and more experienced students on their professional, constructs, as assessed (...) by repertory grid technique. Integration between personal and professional constructs was higher in more experienced students. (shrink)

Common understandings of neuroethics, i.e., of its distinctive nature, are premised on two distinct sets of claims: (1) neuroscience can change views about the nature of ethics itself and neuroethics is dedicated to reaping such an understanding of ethics; (2) neuroscience poses challenges distinct from other areas of medicine and science and neuroethics tackles those issues. Critiques have rightfully challenged both claims, stressing how the first may lead to problematic forms of reductionism while the second relies on debatable assumptions about (...) the nature of bioethics specialization and development. Informed by philosophical pragmatism and our experience in neuroethics, we argue that these claims are ill-founded and should give way to pragmatist reconstructions. Namely, neuroscience, much like other areas of empirical research on morality, can provide useful information about the nature of morally problematic situations but it does not need to promise radical and sweeping changes to ethics based on neuroscientism. Furthermore, the rationale for the development of neuroethics as a specialized field need not to be premised on the distinctive nature of the issues it tackles or of neurotechnologies. Rather, it can espouse an understanding of neuroethics as both a scholarly and a practical endeavor dedicated to resolving a series of problematic situations raised by neurological and psychiatric conditions. (shrink)

Background: Ethical sensitivity has been identified as a foundational component of ethical action. Diminished or absent ethical sensitivity can result in ethically incongruent care, which is inconsistent with the professional obligations of nursing. As such, assessing ethical sensitivity is imperative in order to design interventions to facilitate ethical practice and to ensure nurses recognize the nature and extent of professional ethical obligations. Aim: To review and critique the state of the science of nurse ethical sensitivity and to synthesize findings across (...) studies. Research design: Whittemore and Knafl’s revised framework for integrative reviews guided the analysis. Research context and data sources: A comprehensive, computer-assisted search of literature published in Cumulative Index of Nursing and Allied Health Literature and PubMed was performed. A systematic approach was used to extract, reduce, and synthesize the data. Findings: Four major conceptualizations of ethical sensitivity emerged from the literature. A sample of 25 reports met inclusion criteria, including 17 empirical reports and 8 theoretical reports. Discussion: Despite the existence of a concept analysis and a validated tool, ethical sensitivity remains a highly theoretical concept with multiple, and at times competing, conceptualizations. Ethical sensitivity has been assessed extensively in the context of ethical dilemmas; however, little attention has been paid to the way the concept operates in day-to-day practice. Conclusion: Future research should focus on better ways to operationalize and assess the concept, with particular attention to nurse awareness of the ethical content of everyday practice. (shrink)

Rotter’s theory of internal-external locus of control evolved from Carl Jung’s work. In Psychological Types (1923), Jung defined two opposing tendencies in personality introversion and extroversion. While both tendencies are present in all individuals, one tends to dominate the other. The internal–external control construct was conceived as a generalized expectancy to perceive reinforcement either as contingent upon one’s own behaviors (internal control) or as the result of forces beyond one’s control, such as chance, fate, or powerful others (external control) (Lefcourt, (...) 1981, p. 15). Locus of control refers to those causes to which individuals attribute their successes and failures. Individuals are responsive to some external motivators (e.g. better jobs, promotions, higher salaries), but the more powerful are internal pressures (the desire for increased job satisfaction, self-esteem, and quality of life). Research indicates that an individual’s internal–external locus of control impacts their ethical behavior in an organization. Rotter’s I–E Scale (1966, Psychological Monographics 80(1), 1–28), a 29 item forced choice instrument, is the most widely used instrument to measure the degree of internality versus externality. Each respondent’s score for this scale had a potential range from 0 to 23. As there are six filler items used to mask the intent of the questionnaire a score of 23 being extremely external in nature and a score of zero being extremely internal in nature. The I Scale (Internal Scale) measures the extent to which people believe that they have control over their own lives; the E Scale (External Scale) measures the extent to which people believe that they do not have control over their own lives. This study utilized the I–E Scale. Jones (Unpublished Doctoral Dissertation) and Deflumeri (Unpublished Doctoral Dissertation) investigated the likelihood of an individual to engage in unethical behavior in an organization. This research suggests that when employees perceive that locus of control resides internally they themselves decide what is appropriate behavior, but with an external locus of control, employees will look at others to decide appropriate behavior. The researcher in this study investigated the relationship between managers’ locus of control and their moral reasoning. (shrink)

Prior research on engineering students’ understandings of ethics and social responsibility has produced mixed and sometimes conflicting results. Seeking greater clarity in this area of investigation, we conducted an exploratory, longitudinal study at four universities in the United States to better understand how engineering undergraduate students perceive ethics and social responsibility and how those perceptions change over time. Undergraduate engineering students at four U.S. universities were surveyed three times: during their 1st (Fall 2015), 5th (Fall 2017), and 8th semesters (Spring (...) 2019). The students who completed all three surveys (_n_ = 226) comprise the sample that was analyzed in this paper for changes in their scores on five instruments: Fundamentals of Engineering/Situational Judgment, Moral Disengagement, ABET Engineering Work and Practice Considerations, Macroethics, and Political and Social Involvement Scale. We found that students modestly increased their knowledge of ethics and ability to apply that knowledge in situations calling for them to exercise judgment. In addition, they consistently indicated that health and safety considerations in engineering were of highest importance. They also showed steady levels of social consciousness over time, in contrast to other studies which detected a culture of increasing disengagement in engineering students throughout the four years of their undergraduate studies. (shrink)

Nurses find themselves in a unique position - between patient and physicians, and in close proximity to the patient. Moral sensitivity can help nurses to cope with the daily turmoil of demands and opinions while delivering care in concordance with the value system of the patient. This article aims to reconsider the concept of moral sensitivity by discussing the function of emotions in morality. We turn to the ideas of historic and contemporary authors on the function of emotions in morality (...) to expand our understanding of moral sensitivity. Ancient philosophers and contemporary psychologists uphold different strategies on the orientation of morality being (a) personal growth or (b) community living, and the primordial function of (c) reason and (d) emotions in the creation of judgements about good and bad. The theoretical discussion on the function of emotions in morality shows that by focusing on reason alone, one leaves out an essential part of morality. The concept of moral sensitivity should (1) include an initial judgment of good and bad based on emotions, (2) hold the ability to reflect on the initial judgement and the associated emotions, (3) include the ability to understand other stakeholders' perspectives based on the ideal-types and (4) include a personal decision on the right course of action. (shrink)

In this study, we examine the relationship between appeal to self-perceptions of moral identity, included in the teaching of ethics, and the strengthening of moral judgment among postgraduate business students. As appeal to moral identity emphasizes personal engagement in the appraisal of an ethically charged situation, it addresses critiques of abstract rule application and principle transfer leveled at traditional business ethics teaching. Eighty-one participants completed a series of reflective writing exercises throughout a twelve-week business ethics unit. Based on an instrument (...) completed at the beginning and end of the education process, our results indicate a positive shift in moral judgement intensity. We, therefore, recommend appeal to moral identity as a leverage strategy to be employed in business ethics education in order to strengthen students’ moral judgment. (shrink)

This article examines trigger warnings, particularly the call for trigger warnings on university campuses, and from a Levinasian and Kantian ethical perspective, and addresses the question: When, if ever, are trigger warnings helpful to student's learning? The nursing curriculum is developed with key stakeholders and regulatory bodies to ensure graduate nurses are competent to deliver a high standard of care to patients and clients. Practical teaching practice and published research has uncovered an increasing use of ‘Trigger Warnings’ before a topic (...) is discussed, or used as warnings on core module texts. It is appreciated that some students have personal experience of psychological or physical trauma. However, apart from identifying these students through Mitigating Circumstances committees, or when the student feels confident to share this information with a personal tutor, this information remains strictly confidential. There is the potential for covert skills such as critical analysis and skilful discussion not being attained by the student. With the assistance of Kants moral theory, an argument will develop that the insidious use of Trigger warnings and the embargo of recommended reading, requires critical discussion with the public. This would involve the rationale and pedagogical justification for the use of texts, and the necessity within nursing education to address challenging clinical topics. To support students with PTSD this may involve the research discussed on personal educational needs analysis. (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)

Aim: To determine the current state of knowledge on nursing and ethics and to assess the knowledge and experience based on the evidence in this regard. Background: Although ethics is at the center of the nursing profession and the ethical issues affecting nurses are given much importance, few studies have focused on professional ethics in nursing. In this respect, ethics has become a concept that contains controversial and ambiguous situations. Design: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guide, (...) a basic search algorithm, was taken. Data sources: Cochrane, PubMed, CINAHL Complete, PsycINFO, and ULAKBIM from 2012 to 2016. Review methods: Following a systematic search strategy, all papers were assessed in relation to inclusion criteria and type of study. When sufficient information was not available in the title and summary of the works, the necessary data were evaluated in full texts. Results: This review was completed with 27 articles meeting the research criteria. The evaluation identified six themes: (1) ethics and nursing, (2) ethical difficulties/ethical dilemmas and nursing, (3) ethical competence and nursing, (4) professional ethics and nursing, (5) ethics, education, and nursing, and (6) ethics in health research. Conclusion: As a result of the review, a synthesis of high evidence-level research relating to nursing ethics was obtained. The emphasis was on the importance of further research and education so that the ethical aspects of nursing can be better understood throughout the studies. Nursing researchers’ level of evidence on ethics and their orientation to high research design will shed light on uncertain and controversial aspects of the subject. Ethical consideration: Since this was a systematic review, no ethical approval was required. There is no conflict of interest in this literature review. (shrink)

The ethical climate is the perception of health professionals about the work environment, meaning the reflection on care practices and ethical-related decisions. There are extensive studies in the international literature about the ethical climate, but there are still theoretical gaps about it in health services. In this reflection article, the objective was to explore conceptual components about the ethical climate, proposing new elements of analysis of the construct. The starting point was the accumulated knowledge itself, the possibilities for expansion, and (...) the conceptual progress emerging from contributions from studies on nursing ethics. It was understandable that the ethical climate is considered in its procedural model and cyclically, being articulated with organizational elements, as established in the literature, and, expanding the concept, with the worker’s health and the ethical expressiveness at work. Regarding this last contribution, the suggestion is to think about the potential for work to allow, limit, or favor professionals to express their ethical and esthetic values in the most daily decisions and relationships, in care, management, and education. The conceptual framework of this study progressed by addressing the ethical climate as a process articulating several concepts and elements regarding the organizational aspect, ethics, and the workers’ well-being. (shrink)

Nurses working in a newborn intensive care unit report that treatment decision disagreements for infants in their care may lead to ethical dilemmas involving all health-care providers. Applying Rest’s Four-Component Model of Moral Action as the theoretical framework, this study examined the responses of 224 newborn intensive care unit nurses to the Nurses Ethical Involvement Survey. The three most frequent actions selected were as follows: talking with other nurses, talking with doctors, and requesting a team meeting. The multiple regression analysis (...) indicates that newborn intensive care unit nurses with greater concern for the ethical aspects of clinical practice (p =.001) and an increased perception of their ability to influence ethical decision making (p =.018) were more likely to display Nurse Activism. Future research is necessary to identify other factors leading to and inhibiting Nurse Activism as these findings explained just 8.5% of the variance. (shrink)

Occupational fraud frequently involves the direct or indirect participation of professional accountants. To reduce fraud, companies often focus on the incentive/pressure and opportunity legs of the fraud triangle, perhaps believing that rationalization is beyond their control. We argue that rationalization reduction is necessary to minimize occupational fraud. We propose that educators and PA consider incorporating fences as controls to reduce rationalization. Because they focus on compliance and risk avoidance and are non-negotiable, fences appeal to accountant’s Myers Briggs personalities and conventional (...) level of moral development. Educators can teach students about the fences used in practice, and explain how they help new professionals resist pressures and temptations. By adding fences to existing professional guidance, accountants can reduce the likelihood that they will be a party to fraud. (shrink)

This paper proposes laying the groundwork for principled moral reasoning as a seminal goal of ethics interventions in higher education, and on this basis, makes a case for educating future specialists and professionals with a foundation in philosophical ethics. Identification of such a seminal goal is warranted by the progressive dissociation of scientific practice and ethical deliberation since the onset of a problematic relationship between science and ethics around the mid-19th century, and the extensive mistrust of integrating ethics in science (...) and engineering curricula beyond its “applied,” “practical,” or “professional” implications. Although calls by international scientific and educational bodies to strengthen ethics teaching in scientific education over the past quarter century have brought about a notion of combining competence in a certain field with competence in ethics, this is neither entrenched in the academic community, nor fleshed out as regards its core or instruments to realize it. The legitimate goals of ethics teaching in higher education, almost settled since the 1980s, can be subsumed under the proposed seminal goal, and the latter also would safeguard content and methods of ethics interventions against the intrusion of indoctrinative approaches. In this paper, derivation of the proposed seminal goal rests on an interpretation of the Kohlbergian cognitive-developmental conception of moral adulthood consisting in autonomous principled moral reasoning. This interpretation involves, based on Kant’s conception of the virtuous person, integrating questions about the “good life” into the domain of principled reasoning. (shrink)

BackgroundRapid advances in medical technology, changing healthcare policies, and increasing patient diversity have exacerbated the ethical challenges. As nursing students are an integral part of the future nursing workforce, ethical sensitivity has a critical impact on their future careers.PurposeThis study aims to promote research in related fields by systematically reviewing the origin and development of the concept of ethical sensitivity in nursing students, comparing currently available tools for assessing ethical sensitivity in nursing students, and exploring their applicability and reliability.MethodsA literature (...) review method was used in this study. A literature search was conducted for assessment tools published between 1995 and 2024. A total of six articles focusing on assessment tools they developed to measure ethical or moral sensitivity were included and analyzed.ResultsOur analysis revealed significant variations in the reliability and applicability of these assessment tools, particularly when used in diverse cultural settings. The study also identified a need for localized modifications of these tools to ensure their accuracy and relevance in different regions.ConclusionThe findings provide valuable guidance for nursing educators in selecting appropriate assessment tools and offer a foundation for developing new tools that are more contextually relevant. This study contributes to the advancement of ethical sensitivity education for nursing students worldwide, ultimately enhancing patient care and professional development. (shrink)

Ethical awareness enables nurses to recognize the ethical implications of all practice actions, and is an important component of safe and high quality nursing care (Milliken 2016; Milliken and Grac...

As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)