To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". Practitioners accept the relevance of concepts widely disparaged (...) by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

We live in a liberal, democratic, multicultural society where ideally the values of personal liberty and autonomy are paramount. In such a society the state, through the law, should not be concerned with telling people how they should live their lives. In spite of this, many of the ethical stances taken in liberal societies are paternalistic and authoritarian. This readable and balanced book is an original discussion of contemporary issues in bioethics. Max Charlesworth argues that as there can be no (...) public consensus on a set of core values – liberal societies accept a variety of religious, non-religious, political and moral stances - there should be a plurality of ethical stances as well. On this basis he discusses issues such as the ending of human life, the new reproductive technologies and ethical distribution of limited health-care resources, particularly hospital care. (shrink)

Ethics has been discussed largely in the language of the father, Nel Noddings believes: in principles and propostions, in terms such as _justification,_ _fairness,_ and _equity._ The mother's voice has been silent. The view of ethics Noddings offers in this book is a feminine view. "This does not imply," she writes, "that all women will accept it or that most men will reject it; indeed there is no reason why men should not embrace it. It is feminine in the deep (...) classical sense—rooted in receptivity, relatedness, and responsiveness. It does not imply either that logic is to be discarded or that logic is alien to women. It represents an aternative to present views, one that begins with the moral attitude or longing for goodness and not with moral reasoning." What is at the basis of moral action? An altruism acquired by the application of rule and principle? Or, as Noddings asserts, caring and the memory of being cared for? With numerous examples to supplement her rich theoretical discussion, Noddings builds a compelling philosophical argument for an ethics based on natural caring, as in the care of a mother for her child. The ethical behavior that grows out of natural caring has at its core as care-filled receptivity to those involved in any moral situation, and leaves behind the rigidity of rule and principle to focus on what is particular and unique in human relations. "The hand that steadied us as we learned to ride our first bicycle did not provide propositional knowledge, but it guided and supported us all the same, and we finished up 'knowing how.'" Noddings's discussion is far-ranging, as she considers whether organizations, which operate at a remove from the caring relationship, can truly be called ethical. She discusses the extent to which we may truly care for plants, animals, or ideas. Finally, she proposes a realignment of education to encourage and reward not just rationality and trained intelligence, but also enhanced sensitivity in moral matters. (shrink)

What is at the basis of moral action? An altruism acquired by the application of rule and principle? Or, as Noddings asserts, caring and the memory of being cared for? With numerous examples to supplement her rich theoretical discussion, Noddings builds a compelling philosophical argument for an ethics based on natural caring, as in the care of a mother for her child. The ethical behavior that grows out of natural caring, and has as its core care-filled receptivity to those involved (...) in any moral situation, leaves behind the rigidity of rule and principle to focus on what is particular and unique in human relations. Noddings's discussion is wide-ranging, as she considers whether organizations, which operate at a remove from the caring relationship, can truly be called ethical. She discusses the extent to which we may truly care for plants, animals, or ideas. Finally, she proposes a realignment of education to encourage and reward not just rationality and trained intelligence, but also enhanced sensitivity in moral matters. (shrink)

Researching Lived Experience introduces an approach to qualitative research methodology in education and related fields that is distinct from traditional approaches derived from the behavioral or natural sciences—an approach rooted in the “everyday lived experience” of human beings in educational situations. Rather than relying on abstract generalizations and theories, van Manen offers an alternative that taps the unique nature of each human situation. The book offers detailed methodological explications and practical examples of hermeneutic-phenomenological inquiry. It shows how to orient oneself (...) to human experience in education and how to construct a textual question which evokes a fundamental sense of wonder, and it provides a broad and systematic set of approaches for gaining experiential material that forms the basis for textual reflections. Van Manen also discusses the part played by language in educational research, and the importance of pursuing human science research critically as a semiotic writing practice. He focuses on the methodological function of anecdotal narrative in human science research, and offers methods for structuring the research text in relation to the particular kinds of questions being studied. Finally, van Manen argues that the choice of research method is itself a pedagogic commitment and that it shows how one stands in life as an educator. (shrink)

ACKNOWLEDGMENTS. Among Those Who helped greatly in the initial stages of this project by making constructive suggestions on my first "caring" papers are Nick Burbules, William Doll, Bruce Fuller, Brian Hill, William Pinar, Mary Anne ...

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

Introduction: Morality in Modern and Postmodern Perspective Shattered beings are best represented by bits and pieces. Rainer Maria Rilke As signalled in its ...

In a Different Voice is the little book that started a revolution, making women's voices heard, in their own right and with their own integrity, for virtually the first time in social scientific theorizing about women. Its impact was immediate and continues to this day, in the academic world and beyond.

Abstract:In this paper we highlight the emergence of organizational ethics issues in health care as an important outcome of the changing structure of health care delivery. We emphasize three core themes related to business ethics and health care ethics: integrity, responsibility, and choice. These themes are brought together in a discussion of the process of Mission Discernment as it has been developed and implemented within an integrated health care system. Through this discussion we highlight how processes of institutional reflection, such (...) as Mission Discernment, can help health care organizations, as well as corporations, make critical choices in turbulent environments that further the core mission and values and fulfill institutional responsibilities to a broad range of stakeholders. (shrink)

A. ON THE MEANING OF PHENOMENOLOGY 1. "PHENOMENOLOGY" * "Phenomenology" is, in the 20th century, mainly the name for a philosophical movement whose primary ...

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effectDesign, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on “Decisions near the End of Life”.Results–Practitioners accept the relevance of concepts widely (...) disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment.Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

This edition continues the debate on bioethical issues in nursing and health care. Revised chapters include discussions on transcultural ethics in nursing practice, and homophobia and the moral entitlement of AIDS and HIV-positive patients.

The field of bioethics has deployed different models of justification for particular moral judgments. The best known models are those of deductivism, casuistry, and principlism (under one, rather limited interpretation). Each of these models, however, has significant difficulties that are explored in this essay. An alternative model, suggested by the work of Henry Richardson, is presented. It is argued that specified principlism is the most promising model of justification in bioethics. Keywords: casuistry, deductivism, ethical theories, intuition principlism, specified principlism, specification (...) CiteULike Connotea Del.icio.us What's this? (shrink)

Abstract:In this paper we highlight the emergence of organizational ethics issues in health care as an important outcome of the changing structure of health care delivery. We emphasize three core themes related to business ethics and health care ethics: integrity, responsibility, and choice. These themes are brought together in a discussion of the process of Mission Discernment as it has been developed and implemented within an integrated health care system. Through this discussion we highlight how processes of institutional reflection, such (...) as Mission Discernment, can help health care organizations, as well as corporations, make critical choices in turbulent environments that further the core mission and values and fulfill institutional responsibilities to a broad range of stakeholders. (shrink)

In recent years there has been an increasing critique of the philosophically based reasoning in bioethics which is known as principlism. This article seeks to make a postmodern contribution to this emerging debate by using notions of power and discourse to highlight the limits and superficiality of this , rationalistic mode of reflection. The focus of the discussion will be on the principle of autonomy. Recent doctoral research on a hospice organization (Karuna Hospice Service) will be used to contextualize the (...) debate to end-of life ethical dilemmas. The conclusion will be reached that the discursive richness of this organization's notion of autonomy or choice, which incorporates a holistic respect for the individual and the active creation of alternatives, can provide important insights to our understanding of autonomy in bioethics. The concern is raised that if autonomy is reified as a principle outside of the context of discourse, it may only complement the hegemonic power of biomedicine. (shrink)

Nel Noddings argues that hers is not an ethics of agape. I want to argue, on the contrary, that it is, and that this is a problem. My central thesis is that the unidirectional nature of the analysis of one-caring reinforces oppressive institutions.

The question of corporate moral responsibility – of whether it makes sense to hold an organisation corporately morally responsible for its actions,rather than holding responsible the individuals who contributed to that action – has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom(UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care (...) context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially a moral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish. (shrink)

Crucial to discussions in organisational ethics is an evaluation of the metaphors and models we use to understand the organisations we are discussing. I briefly defend this contention and evaluate three possible models: the current corporate model, an orchestrator model which puts hospitals in the same class as malls and airports, and a community model. I argue that the corporate and orchestrator model push to the background some important organisational ethics issues and bias us inappropriately towards certain solutions. Furthermore, I (...) argue that the community model allows these to be more easily brought up. I also respond to the likely challenge that hospitals really are corporations by arguing that this is not relevant to evaluations of the appropriateness of the corporate model. (shrink)

Objectives—While clinical practice is complicated by many ethical dilemmas, clinicians do not often request ethics consultations. We therefore investigated what triggers clinicians' requests for ethics consultation. Design—Cross-sectional telephone survey.Setting—Internal medicine practices throughout the United States.Participants—Randomly selected physicians practising in internal medicine, oncology and critical care.Main measurements—Socio-demographic characteristics, training in medicine and ethics, and practice characteristics; types of ethical problems that prompt requests for consultation, and factors triggering consultation requests. Results—One hundred and ninety of 344 responding physicians (55%) reported requesting ethics (...) consultations. Physicians most commonly reported requesting ethics consultations for ethical dilemmas related to end-of-life decision making, patient autonomy issues, and conflict. The most common triggers that led to consultation requests were: 1) wanting help resolving a conflict; 2) wanting assistance interacting with a difficult family, patient, or surrogate; 3) wanting help making a decision or planning care, and 4) emotional triggers. Physicians who were ethnically in the minority, practised in communities under 500,000 population, or who were trained in the US were more likely to request consultations prompted by conflict. Conclusions—Conflicts and other emotionally charged concerns trigger consultation requests more commonly than other cognitively based concerns. Ethicists need to be prepared to mediate conflicts and handle sometimes difficult emotional situations when consulting. The data suggest that ethics consultants might serve clinicians well by consulting on a more proactive basis to avoid conflicts and by educating clinicians to develop mediation skills. (shrink)

First published in 1997, this book contributes to our understanding of the way our society responds to issues of death and dying. The trans-disciplinary research which informs this discussion is situated in the disciplines of bioethics and palliative care. Postmodern notions of discourse and power are used to explore the organizational approach of one hospice to working with the dying. In modern, Western technological societies, biomedicine is the dominant discourse which underpins our care of the terminally ill. Bioethics has recently (...) emerged as a discipline concerned with resolving the many ethical dilemmas arising from such a physiological, technologized approach to death. Rather than add to such studies, this research looks into the direction of alternative ways of responding to the dying in our community. KHS was chosen for this research as it presented the possibility of a holistic and spiritual alternative to the positivist, reductionist hegemony of scientific medicine. The research focus is on establishing and describing this difference, and exploring how such an organization could maintain resistance to mainstream medicine. The research findings are shared with the intent of using the material and insights gained to explore important issues presently arising in bioethics and palliative care, for example the recent critique of Principalism in bioethics and the methodological difficulties restricting research into spirituality for palliative care. (shrink)