Respect for autonomy is well known as a core element of normative views on good care. Most often it is interpreted in a liberal way, with a focus on independence and self-determination. In this article we argue that this interpretation is too narrow in the context of care in nursing homes. With the aim of developing an alternative view on respect for autonomy in this setting we described four interpretations and investigated the moral intuitions (i.e. moral judgements) of caregivers regarding (...) these approaches. We found that these caregivers seemed to value different notions relating to respect for autonomy under different circumstances. There was no significant difference in moral judgements between men and women or between doctors and nurses. We conclude that a multidimensional understanding of this principle would best fit this context. We end this article with a description of a modest theory of respect for autonomy in nursing homes. (shrink)

Bioethical research has tended to focus on theoretical discussion of the principles on which the analysis of ethical issues in biomedicine should be based. But this discussion often seems remote from biomedical practice where researchers and physicians confront ethical problems. On the other hand, published empirical research on the ethical reasoning of health care professionals offer only descriptions of how physicians and nurses actually reason ethically. The question remains whether these descriptions have any normative implications for nurses and physicians? In (...) this article, we illustrate an approach that integrates empirical research into the formulation of normative ethical principles using the moral-philosophical method of Wide Reflective Equilibrium (WRE). The research method discussed in this article was developed in connection with the project ‘Bioethics in Theory and Practice’. The purpose of this project is to investigate ethical reasoning in biomedical practice in Denmark empirically. In this article, we take the research method as our point of departure, but we exclusively discuss the theoretical framework of the method, not its empirical results. We argue that the descriptive phenomenological hermeneutical method developed by Lindseth and Norberg (2004) and Pedersen (1999) can be combined with the theory of WRE to arrive at a decision procedure and thus a foundation for the formulation of normative ethical principles. This could provide health care professionals and biomedical researchers with normative principles about how to analyse, reason and act in ethically difficult situations in their practice. We also show how to use existing bioethical principles as inspiration for interpreting the empirical findings of qualitative studies. This may help researchers design their own empirical studies in the field of ethics. (shrink)

Research on moral judgment has been dominated by rationalist models, in which moral judgment is thought to be caused by moral reasoning. The author gives 4 reasons for considering the hypothesis that moral reasoning does not cause moral judgment; rather, moral reasoning is usually a post hoc construction, generated after a judgment has been reached. The social intuitionist model is presented as an alternative to rationalist models. The model is a social model in that it deemphasizes the private reasoning done (...) by individuals and emphasizes instead the importance of social and cultural influences. The model is an intuitionist model in that it states that moral judgment is generally the result of quick, automatic evaluations (intuitions). The model is more consistent than rationalist models with recent findings in social, cultural, evolutionary, and biological psychology, as well as in anthropology and primatology. (shrink)

��Is moral judgment accomplished by intuition or conscious reasoning? An answer demands a detailed account of the moral principles in question. We investigated three principles that guide moral judgments: (a) Harm caused by action is worse than harm caused by omission, (b) harm intended as the means to a goal is worse than harm foreseen as the side effect of a goal, and (c) harm involving physical contact with the victim is worse than harm involving no physical contact. Asking whether (...) these principles are invoked to explain moral judgments, we found that subjects generally appealed to the first and third principles in their justifications, but not to the second. This finding has significance for methods and theories of moral psychology: The moral principles used in judgment must be directly compared with those articulated in justification, and doing so shows that some moral principles are available to conscious reasoning whereas others are not. (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)

Over the last few decades, psychologists have amassed a great deal of evidence that our thinking is strongly influenced by a number of biases. This research appears to have important implications for moral methodology. It seems likely that these biases affect our thinking about moral issues, and a fuller awareness of them might help us to find ways to counteract their influence, and so to improve our moral thinking. And yet there is little or no reference to such biases in (...) the philosophical literature on many pressing, substantive moral questions. In this paper, I make a start on repairing this omission in relation to one such question, the 'Aid Question', which concerns how much, if anything, we are morally required to give to aid agencies. I begin by sketching a number of biases that seem particularly likely to affect our thinking about that question. I then go on to review the psychological research on 'debiasing' - that is, on attempts to counteract the influence of such biases. And finally I discuss and illustrate certain strategies for counteracting the influence of the biases in question on our thinking about the Aid Question. (shrink)

Moral decision procedures such as principlism or casuistry require intuition at certain junctures, as when a principle seems indeterminate, or principles conflict, or we wonder which paradigm case is most relevantly similar to the instant case. However, intuitions are widely thought to lack epistemic justification, and many ethicists urge that such decision procedures dispense with intuition in favor of forms of reasoning that provide discursive justification. I argue that discursive justification does not eliminate or minimize the need for intuition, or (...) constrain our intuitions. However, this is not a problem, for intuitions can be justified in easy or obvious cases, and decision procedures should be understood as heuristic devices for reaching judgments about harder cases that approximate the justified intuitions we would have about cases under ideal conditions, where hard cases become easy. Similarly, the forms of reasoning which provide discursive justification help decision procedures perform this heuristic function not by avoiding intuition, but by making such heuristics more accurate. Nonetheless, it is possible to demand too much justification; many clinical ethicists lack the time and philosophical training to reach the more elaborate levels of discursive justification. We should keep moral decision procedures simple and user-friendly so that they will provide what justification can be achieved under clinical conditions, rather than trying to maximize our epistemic justification out of an overstated concern about intuition. (shrink)

Nursing acts occur in thousands of instances daily, being a major component of professional health care delivery in institutions, communities and homes. It follows that the ethical practice of most nurses is put to the test on an everyday rather than an occasional basis. Hence, within nursing practice there must be a rich and deep seam of reflective interpretation and practical wisdom that is 'embedded' within the experiences of every experienced nurse. This article presents discussion on some of the main (...) findings of a recently completed study on nursing ethics in New Zealand. An interpretation of a nurse's story taken from the study is offered and suggestions are made for nursing ethics education. (shrink)

: The fifth edition of Beauchamp and Childress's Principles of Biomedical Ethics is distinguished by its emphatic embrace of common morality as the ultimate source of moral norms. This essay critically evaluates the fifth edition's discussion of common morality and, to a lesser extent, its treatment of coherence (both the model of ethical justification and the associated concept). It is argued that the book is overly accommodating of existing moral beliefs. The paper concludes with three suggestions for improving this leading (...) text. (shrink)