Book reviewed in this article: Protecting The Vulnerable: A Reanalysis of Our Social Responsibilities. By Robert E. Goodin. Chicago: University of Chicago Press.

Health-care professionals in end-of-life care are frequently confronted with patients who seem to be ‘ambivalent’ about treatment decisions, especially if they express a wish to die. This article investigates this phenomenon by analysing two case stories based on narrative interviews with two patients and their caregivers. First, we argue that a respectful approach to patients requires acknowledging that coexistence of opposing wishes can be part of authentic, multi-layered experiences and moral understandings at the end of life. Second, caregivers need to (...) understand when contradictory statements point to tensions in a patient’s moral experience that require support. Third, caregivers should be careful not to negatively label or even pathologize seemingly contradictory patient statements. (shrink)

The aim of this study was to explore and describe how Flemish nurses experience their involvement in the care of hospitalized patients with dementia, particularly in relation to artificial nutrition or hydration (ANH). We interviewed 21 hospital nurses who were carefully selected from nine hospitals in different regions of Flanders. ‘Being touched by the vulnerability of the demented patient’ was the central experience of the nurses, having great impact on them professionally as well as personally. This feeling can be described (...) as encompassing the various stages of the care process: the nurses' initial meeting with the vulnerable patient; the intense decision‐making process, during which the nurses experienced several intense emotions influenced by supporting or hindering contextual factors; and the final coping process, a time when nurses came to terms with this challenging experience. From our examination of this care process, it is obvious that nurses' involvement in ANH decision‐making processes that concern patients with dementia is a difficult and ethically sensitive experience. On the one hand, the feeling of ‘being touched’ can imply strength, as it demonstrates that nurses are willing to provide good care. On the other hand, the feeling of ‘being touched’ can also imply weakness, as it makes nurses vulnerable to moral distress stemming from contextual influences. Therefore, nurses have to be supported as they carry out this ethically sensitive assignment. Practical implications are given. (shrink)

Objectives: The objective of this research is to analyse the evolution and nature of published empirical research in the fields of medical ethics and bioethics.Design: Retrospective quantitative study of nine peer reviewed journals in the field of bioethics and medical ethics .Results: In total, 4029 articles published between 1990 and 2003 were retrieved from the journals studied. Over this period, 435 studies used an empirical design. The highest percentage of empirical research articles appeared in Nursing Ethics , followed by the (...) Journal of Medical Ethics and the Journal of Clinical Ethics . These three journals account for 84.1% of all empirical research in bioethics published in this period. The results of the χ2 test for two independent samples for the entire dataset indicate that the period 1997–2003 presented a higher number of empirical studies than did the period 1990–1996 . This increase is statistically significant . Most empirical studies employed a quantitative paradigm . The main topic of research was prolongation of life and euthanasia .Conclusions: We conclude that the proportion of empirical research in the nine journals increased steadily from 5.4% in 1990 to 15.4% in 2003. It is likely that the importance of empirical methods in medical ethics and bioethics will continue to increase. (shrink)

The Belgian Act on Euthanasia came into force on 23 September 2002, making Belgium the second country—after the Netherlands—to decriminalize euthanasia under certain due-care conditions. Since then, Belgian nurses have been increasingly involved in euthanasia care. In this paper, we report a qualitative study based on in-depth interviews with 18 nurses from Flanders (the Dutch-speaking part of Belgium) who have had experience in caring for patients requesting euthanasia since May 2002 (the approval of the Act). We found that the care (...) process for patients requesting euthanasia is a complex and dynamic process, consisting of several stages, starting from the period preceding the euthanasia request and ending with the aftercare stage. When asked after the way in which they experience their involvement in the euthanasia care process, all nurses described it as a grave and difficult process, not only on an organizational and practical level, but also on an emotional level. “Intense” is the dominant feeling experienced by nurses. This is compounded by the presence of other feelings such as great concern and responsibility on the one hand, being content in truly helping the patient to die serenely, and doing everything in one’s power to contribute to this; but also feeling unreal and ambivalent on the other hand, because death is arranged. Nurses feel a discrepancy, because although it is a nice death, which happens in dignity and with respect, it is also an unnatural death. The clinical ethical implications of these findings are discussed. (shrink)

DINÇ L and GASTMANS C. Nursing Inquiry 2012; 19: 223–237 Trust and trustworthiness in nursing: an argument‐based literature reviewCaring requires nurses to establish trusting relationships with patients and to be trustworthy professionals. This article provides insight into the conceptual understanding of trust and trustworthiness in nursing through an argument‐based literature review of 17 articles published between 1980 and 2010. Trust is characterized as an attitude relying with confidence on someone. The importance of trust relationships is considered by addressing the imbalances (...) of power in nurse–patient relationships as they increase the vulnerability and dependency of the truster. Trust is considered as a process, and time, reliance on others, risk and fragility are identified as basic attributes of trust. However, trustworthiness is inadequately explored in the nursing ethics literature. Nurse educators have a responsibility to ensure that nurses are equipped with the attitudes and knowledge that are needed to establish trusting nurse–patient relationships. (shrink)

Notwithstanding the fact that care ethics has received increased attention, it has also faced much criticism. One of the focal points of critics is the normativity of care. Only when the objective normative basis of care is sufficiently clarified can care practices be evaluated and optimized from an ethical point of view. We emphasize that two levels of normativity can be identified: the context level and the foundational anthropology level. The personalist approach to care ethics is normatively stronger, at least (...) on one level, namely the foundational anthropology level. This personalist approach to care ethics indicates in which direction action must be taken so that human action may be considered ethically sound. (shrink)

The aim of this study was to explore and describe how Flemish nurses experience their involvement in the care of hospitalized patients with dementia, particularly in relation to artificial nutrition or hydration (ANH). We interviewed 21 hospital nurses who were carefully selected from nine hospitals in different regions of Flanders. ‘Being touched by the vulnerability of the demented patient’ was the central experience of the nurses, having great impact on them professionally as well as personally. This feeling can be described (...) as encompassing the various stages of the care process: the nurses' initial meeting with the vulnerable patient; the intense decision-making process, during which the nurses experienced several intense emotions influenced by supporting or hindering contextual factors; and the final coping process, a time when nurses came to terms with this challenging experience. From our examination of this care process, it is obvious that nurses' involvement in ANH decision-making processes that concern patients with dementia is a difficult and ethically sensitive experience. On the one hand, the feeling of ‘being touched’ can imply strength, as it demonstrates that nurses are willing to provide good care. On the other hand, the feeling of ‘being touched’ can also imply weakness, as it makes nurses vulnerable to moral distress stemming from contextual influences. Therefore, nurses have to be supported as they carry out this ethically sensitive assignment. Practical implications are given. (shrink)

: Discussions of ethical approaches in nursing have been much enlivened in recent years, for instance by new developments in the theory of care. Nevertheless, many ethical concepts in nursing still need to be clarified. The purpose of this contribution is to develop a fundamental ethical view on nursing care considered as moral practice. Three main components are analyzed more deeply--i.e., the caring relationship, caring behavior as the integration of virtue and expert activity, and "good care" as the ultimate goal (...) of nursing practice. For the development of this philosophical-ethical interpretation of nursing, we have mainly drawn on the pioneering work of Anne Bishop and John Scudder, Alasdair MacIntyre, Lawrence Blum, and Louis Janssens. We will also show that the European philosophical background offers some original ideas for this endeavor. (shrink)

This article gives an overview of the nursing ethics arguments on euthanasia in general, and on nurses' involvement in euthanasia in particular, through an argument-based literature review. An in-depth study of these arguments in this literature will enable nurses to engage in the euthanasia debate. We critically appraised 41 publications published between January 1987 and June 2007. Nursing ethics arguments on (nurses' involvement in) euthanasia are guided primarily by the principles of respect for autonomy, nonmaleficence, beneficence and justice. Ethical arguments (...) related to the nursing profession are described. From a care perspective, we discuss arguments that evaluate to what degree euthanasia can be considered positively or negatively as a form of good nursing care. Most arguments in the principle-, profession- and care-orientated approaches to nursing ethics are used both pro and contra euthanasia in general, and nurses' involvement in euthanasia in particular. (shrink)