Arguments about the morality of the use of deception in patient care have been conducted largely in an empirical vacuum, with few data about the situations in which deception occurs. Do staff frequently deceive their patients and, if so, under what conditions? Can the consequences of deception always be foreseen? What justifications do staff use to explain their behaviour? The small-scale study reported here on the uses of deception by nurses when attempting to reassure patients provides information on these questions. (...) The results suggest that deception can have deleterious effects on trust and increase the emotional distance between patients and staff. (shrink)

This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medical ethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the central focus of health care ethics. The case is made for empirical work in health care ethics and it is suggested that a good way of setting about this (...) is to ask practising nurses about the real ethical problems they encounter. (shrink)

A patient is not always told when a student is performing a procedure for the first time. Withholding this information is a form of deception. It is justified on paternalistic grounds (it is in the patient's interest not to know), or on public policy grounds (given the choice, patients would refuse, thus compromising the training of future physicians). Using the spinal tap procedure (lumbar puncture) as a paradigm, 173 patients were surveyed to determine how they felt about first time procedures (...) by medical students, interns, and residents. The patients indicated that they would be willing to be the subject for a student's (52%), intern's (62%), or resident's (66%) first spinal tap. This paper reassesses the ethics of consent for first time procedures based on responses to this survey. (shrink)

An ethic of the fitting: a conceptual framework for nursing practiceNurses are expected to act within an ethos of care cognisant of duty, the right, and the good. Concepts of virtue theory, utilitarianism and deontology are used to outline a conceptual ethical framework for nurses in practice. This ‘Moebius’ framework aims to locate the virtues in a symbiotic relationship with the principles of utilitarianism and deontology. Under this framework, fitting ethical responses are sought. Within an ethic of the fitting, rules (...) and principles do not guarantee the most ethically justifiable outcomes. Within the Moebius approach, the nurse ought to respond with a sense of compassion that befits the moment rather than adhere to a rule at all costs. (shrink)

Through a series of semistructured interviews with 12 nurses delivering direct patient care in acute, long-term and home care settings, information was sought regarding the ethical concerns of practicing nurses. Although these nurses frequently did not specifically identify the areas of expressed concern as ethical in nature, thematic analysis of the transcribed interviews uncovered four major ethical areas of concern common to these 12 nurses. These areas are: (1) Withholding of information and truth-telling; (2) Unequal access or inequalities in care; (...) (3) Differences between business and professional values; (4) Breaking and reporting broken rules. Several reasons are offered to explain the failure of nurses accurately to identify specific practice dilemmas as ethical in nature and the sequelae of these failures. Possibilities involving ongoing education and mentored experiences in practice areas are reported. (shrink)

This article aims to identify and describe the ethical dilemmas that are involved in the care of patients with incurable cancer. The data were collected in semistructured focused interviews with 32 patients, 13 nurses and 13 doctors from two central hospitals and four community health centres. The interviews were tape-recorded and transcribed verbatim. Interpretation was based on the method of content analysis. Ethical dilemmas occurred at the time of diagnosis, in connection with telling the truth, in providing information, in the (...) treatment of pain, and in decision-making situations concerning active treatment. Dilemmas of active treatment concerned chemotherapy, intravenous infusions, blood transfusions and antibiotics. There were also problems in relationships between nursing staff and next of kin, as well as a lack of co-operation between nurses and doctors. (shrink)