As in many other fields of practical ethics, virtue ethics is increasingly of interest within nursing ethics. Nevertheless, the virtue ethics literature in nursing ethics remains relatively small and underdeveloped. This article aims to categorize which broad theoretical approaches to virtue have been taken, to undertake some initial comparative assessment of their relative merits given the peculiar ethical dilemmas facing nurse practitioners, and to highlight the prob- lem areas for virtue ethics in (...) the nursing context. We find the most common approaches fall into care approaches grounded in sentimentalist or feminist ethics, eudaimonist approaches grounded in neo-Aristotelianism, and those grounded in MacIntyre’s practice theory. Our initial assessment is that the eudaimonist approach fares best in terms of merit and relative to criticisms of virtue ethics. But an outstanding issue concerns the motivational psychology of virtuous nursing and whether virtue ethical accounts of right action are self-effacing, i.e. justify an act on grounds that cannot function as the agent’s reason for doing it if she is to act well. One of us, Newham, believes that a virtue consequentialist approach is the best response to these issues. Some form of pluralistic theory, such as Christine Swanton’s, may be needed to explain the many competing values and goods involved in ethical nursing. (shrink)

Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. The authors focus on the individual nurse’s responsibilities, as well as considering the wider issues affecting patients, colleagues and society as a whole. This third edition is fully updated, and takes into account recent changes in ICN position statements, WHO documents, as well (...) as addressing current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes. (shrink)

Aims and Objectives The purpose of this paper was to clarify the concept of ethical conflict in nursing and highlight the importance of tackling this issue. -/- Background Ethical conflict is on the rise in the nursing context. It is associated with the compromise of nurses' well-being and patient care. However, there is no thorough conceptual understanding of this concept. -/- Design Concept analysis. -/- Methods Databases (PubMed, PsycINFO, CINAHL, Scopus, Embase, Web of Science and SocINDEX) were searched (...) for studies between 1984 and 2021. Both quantitative and qualitative studies related to ethical conflict in nursing were included. Walker and Avant's method of concept analysis was used to identify the defining attributes, antecedents and consequences of the concept of ethical conflict in nursing. We followed the PRISMA-ScR checklist to report the study. -/- Results Thirty studies were included for conceptualization. Defining attributes were divided into four categories: (1) emotional responses, (2) incompatible values, (3) competing interests and (4) ambiguous obligations. The antecedents were (1) ethical sensitivity, (2) negative ethical climate, (3) insufficient authority, (4) unrealistic expectations, (5) poor collaboration and (6) inadequate resources. The consequences were identified as (1) moral residue, (2) loss of identity, (3) professional burnout and (4) poor patient care. -/- Conclusions A unified conceptual model of ethical conflict in nursing shed light on the ethical issues nurses might come across in practice. Despite the fact that ethical conflict is inherently negative, we conceptualised this concept as a neutral fact and an opportunity for nursing action. The construct identification provides basis for both the development of practice and the development of staff support and education. (shrink)

Starting from two observations regarding nursing ethics research in the past two decades, namely, the dominant influence of both the empirical methods and the principles approach, we present the cornerstones of a foundational argument-based nursing ethics framework. First, we briefly outline the general philosophical–ethical background from which we develop our framework. This is based on three aspects: lived experience, interpretative dialogue, and normative standard. Against this background, we identify and explore three key concepts—vulnerability, care, and dignity—that (...) must be observed in an ethical approach to nursing. Based on these concepts, we argue that the ethical essence of nursing is the provision of care in response to the vulnerability of a human being in order to maintain, protect, and promote his or her dignity as much as possible. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

For a long time discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. However, a narrow focus on medical resources prevents us from seeing that there are many cases-- perhaps the majority-- in which less dramatic but equally important issues of rationing occur. The allocation of nurses' time is one such issue.

The paper explores the potential of using narrative centered pedagogies in Engineering Ethics Education (EEE), drawing insights from their successful application in nursing and business ethics education. While traditional methods in EEE focus on fostering moral reasoning through case study analysis and teaching ethical theories, increasingly, there is a need for fostering soft ethical skills, such as moral sensitivity and creativity, which, in turn, demand new teaching approaches. Initially developed for nursing ethics, narrative pedagogy emphasises (...) understanding experiences through storytelling and dialogue, contrasting with the decision oriented focus of EEE. While narrative pedagogy allows for understanding stakeholders’ motivations, there is a gap in translating this understanding into ethical decisions, which engineering students must make. Drawing from a literature survey of the existing research in ethics education, the paper describes three kinds of narrative pedagogy to be used for EEE. Despite its theoretical potential, narrative pedagogy has not been deployed in EEE due to a lack of systematic research on its effectiveness. The paper calls for more experimentation and documented case studies in teaching to explore the potential narrative pedagogy in EEE. Without such experiments, the theoretical potential of narrative pedagogy in EEE may remain unproven. (shrink)

As feminist theory explicates its fundamental principles – justice for the oppressed – it can lose its essential focus on the situation of women. One example is the inattention to nurses within feminist bioethics. Nurses deserve attention because most are women, but also because their lack of power is paradigmatic of patriarchy. Those examining ethics consultations should discuss whether nurses are allowed to request them. But feminists also need to imagine ways in which nurses can be heard when, for (...) instance, their worklives are “redesigned.” Doing so would also allow attention to other classes of the disempowered. (shrink)

Abstract: Background: Coronary artery disease remains the leading cause of morbidity and mortality Worldwide. Previous reviews pointed that nursing interventions are beneficial for coronary artery patients. However, most interventions focused on education and counselling, but not consistent with the outcome set; still did not consider patient’s coronary artery disease risky characteristics. Related studies in China also difficult to find. Therefore this study was conducted to investigate kinds of nursing interventions delivered to coronary artery patients and match them with (...) patient’s risk factors of coronary artery disease. Results of this study were expected to add new knowledge that will alert nurses to consider coronary artery risk factors which in turn might enable the development of appropriate approaches to improve patient’s wellbeing hence reduce frequent coronary artery morbidity and mortality. Methods: A descriptive, cross-sectional, retrospective design using clinical case notes was employed. Study was undertaken in coronary care wards at the teaching hospital in China from November 2017 to September 2018. Structured-literature supported self-designed questionnaire was utilized for data collection. Chi square (χ2) test and multivariate logistic regression for adjusted odds ratio with 95% confidence interval were used to compare the relationship among independent (patient’s risk coronary artery disease factors) and dependent (nursing interventions) categorical variables. Ethical permission was granted accordingly. Results: A total of 300 coronary artery patients’ case notes were audited with mean age 63±11.2 years. Of these 175 (58.3%) were males. 126(42%) were smoking and 224(74.7%) were hypertensive. More evidence based nursing interventions than education and counselling were found to be delivered to these patients. “Administer coronary artery disease medication and their instructions” was mostly delivered to many patients 291(97%) while “counsel to cope with stress” was the least one 60 (20.0%). Three of eight nursing interventions delivered significantly matched with three or all of these patient’s coronary artery risk variables (age, smoking, hypertension and diabetes) (p < 0.05 and/or < 0.01) with Adjusted odds ratio (95% CI) within their significant ranges. Conclusion: This study delivers valuable insight that, nurses in the studied teaching hospital delivered beneficial evidence based nursing interventions to patients with coronary artery disease which significantly matched with their risk factors of coronary artery illness. However, care for stress was low hence needs improvement. Furthermore, research is needed to get consistency of nursing interventions with patient’s end point clinical outcomes for further appraisal of nursing efforts in caring CAD patients . (shrink)

This article will explore and summarise the four main ethical theories that have relevance for healthcare assistants. These are utilitarianism, deontology, virtue ethics, and principlism. Understanding different ethical theories can have a number of significant benefits, which have the potential to shape and inform the care of patients, challenge bad practice and lead staff to become better informed about areas of moral disagreement.

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ (...) evidence and the other pillars of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

Ebola is a deadly disease with no cure; there is no vaccine developed yet. Many died during the 2014 outbreak in West Africa, and many healthcare professionals went to the virus infected area to treat the patients while placing their lives in danger. Not every medical professional placed in the field is a fully trained specialist, and sometimes one or two under-trained doctors are in charge of the entire clinic with some nurses and operating technicians. When unexpected outbreaks of the (...) virus occur in the places, the doctor(s) would encounter medical and ethical dilemmas. Should they leave or stay? In fact, this dilemma is not confined to the Ebola pandemic but relevant to all similar cases. In this paper, three authors, a medical resident, a clinical bioethicist, and a theoretical bioethicist respond to the dilemma. (shrink)

The claim is made in the book, Applied Ethics, published under the auspices of the Australian Association for Professional and Applied Ethics (AAPAE), that it can strengthen ethical behaviour. That claim, embodied in the subtitle, is based on more than a half dozen practices set out in the book. In total, they are drawn from an examination of ethical practices across fourteen different disciplines. The purpose of this paper is to outline and support that claim, drawing primarily on (...) chapters of the book, but also drawing on a small amount of additional information. The research on the ethical issues in each of these disciplines, and the writing of the chapters, were undertaken by members and associates of AAPAE. The fourteen disciplines were Marketing, Business, Accounting, Pharmacy, Nursing, Medicine, Veterinary & Animal Ethics, Engineering, Information and Communications Technology (ICT), Journalism, Policing, Politics, the Law and the Sciences. The findings have significance for the teaching of ethics by moral philosophers, for not all ethics classes follow the practices suggested by these findings. A few of the practices are even rejected by some moral philosophers. That the practices will improve ethical behaviour is the principal position taken by this paper. -/- . (shrink)

Military doctors and nurses, working neither as pure soldiers nor as merely doctors or nurses, may face a ‘role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command’. This conflict is commonly called dual loyalty. This chapter gives an overview of the military and the medical ethic and of the resulting dual (...) loyalty problem for medical personnel working in the military. It considers how dual loyalties relate to being a professional, something medical personnel are the paradigmatic examples of, but also something military personnel claim to be. Against that background, the chapter elaborates on the medical rules of eligibility used in Afghanistan, and on the policies concerning military involvement in local healthcare, to see what the existing rules and policies are, and whose interests they serve. (shrink)

Health service consumers' satisfaction with the services they receive has been a challenge over the past decade, and this has been attributed to many factors that diverse scholars have investigated using different variables. In this study, the attitude and ethical behaviours of healthcare providers as antidotes to health service consumers' satisfaction in the Primary Health Centre at Mgbuoshimini, Port Harcourt, Nigeria, were investigated. A cross-sectional descriptive research design was used to select participants from pregnant women, nursing mothers, couples for (...) family planning, and sick patients. The data were analysed using descriptive statistical tools. The results of the grand total response values were 400 (100%) and strongly agree had 190 (47.5%), agree had 160 (40%), 390 (100%) and strongly agree had 260 (66.7%), agree had 100 (25.6%), and strongly disagree had 13 (3.3%). The overall results were strongly agreed (66.7%) and agreed (25.6%); these connote that the attitudes and ethical behaviours of the healthcare providers towards healthcare service consumers in the primary healthcare facility were poor and that healthcare providers do not execute good ethical behaviour towards health service consumers in the facility, leading to low levels of health resource consumption, low patronage image promotion, and consumers' loss of confidence in the service provider. Therefore, the government should put mechanisms in place to ensure a positive attitude and favourable ethical behaviour among healthcare providers, and individual healthcare providers should also acquire soft skills to improve their attitude and ethical behaviour. (shrink)

Business Ethics and medical ethics are in principle compatible: In particular, the tools of business ethics can be useful to those doing healthcare ethics. Health care could be conducted as a business and maintain its moral core.

In lieu of an abstract, here is a brief excerpt of the content:Affect Attunement in the Caregiver-Infant Relationship and Across SpeciesExpanding the Ethical Scope of ErosCynthia WillettCompelling glimpses into the ethical capacities of our animal kin reveal new possibilities for ethical relationships encompassing humans with other animal species. Consider the remarkable report of a female bonobo in a British zoo who assists a bird found in her cage by retrieving the fallen bird, and spreading its wings so that this fellow (...) creature might fly away to its freedom. Or the report of a cat in a nursing home who curls up around dying elderly patients, and remains steadily by their side as they, unbeknownst to the medical personnel, pass away.1 Or of a sacred moment of silence by a stream for baboons in East Africa.2 Or of the ethics that spontaneously emerges among wolves at play.3 On the basis of extensive studies, biologist Frans de Waal argues that such anecdotes are far from rare, and that some core elements of moral understanding and compassion occur among a significant range of nonhuman as well as the human animal species. Apes, monkeys, and perhaps all nonhuman animals fail to display a distinctly human capacity for abstract moral reasoning. As de Waal (2006) remarks, it is difficult to tell (173–75). But our furry and feathery kin do without a doubt demonstrate rich elements of ethical response, and they often enough extend their moral concern to creatures beyond their own species. Of course, they will also bite each other’s heads off or eat their own young as well. But this is just to say that animals are neither natural [End Page 111] innocents nor savage brutes. Like us, they belong to what post-Nietzschean philosophers might frame, somewhat ironically, as a postlapsarian world of good and evil.What kind of philosophical approach could account for these postlapsarian genealogies of ethics? Biologists, primatologists, and anthropologists are drawing upon investigations of prosocial behavior to remap the boundaries of ethics, as for example in Isabelle Stengers’s call for cosmopolitical ecologies of relationships (2010, 33). Such a cosmopolitics aims to encompass our kin and kind from diverse species within the ethical boundaries of common worlds. Donna Haraway discovers an opening for Stengers’s ecology of relationships in the intimate encounters among co-evolving species, especially those she calls companion species (2008, 83). She argues, following Derrida, that the abstract reasoning processes of Stoic and Kantian cosmopolitan ethics remain closed to the participation of nonhuman animals as anything more than dependents, failing to observe the ways in which they act as companions, if not moral subjects. But then, what normative force might bind together an ethically attuned biosocial sphere that we as humans co-inhabit with other animal species?To explore this question, this essay takes its cues from well-established research on the responsive, preverbal connection of the human infant and adult caregiver (Bateson 1979; Trevarthen 1984; Stern 1985, 2010; Gibbs 2001, 2010; Hansen 2004; Anderson 2006; Papoulias and Callard 2010; Willett 1995, 2001). To this research we can add new animal studies (Smuts 1999, 2001; Fudge 2002; de Waal 2006, 2009; Bekoff 2007; Molnar 2008; Haraway 2008). These animal studies provide a basis for extending an “ethics of eros” with roots in Luce Irigaray, Michel Foucault, Enrique Dussel, Africana feminism, Freudo-Marxist critical theory, and Plato (for discussions of this tradition, see Bergoffen 1997; Huffer 2009; Willett 2001)—but reconfigured in terms of social bonds across multiple animal species. In this tradition of ethics, the lack of a cognitive-based moral subjectivity that can translate into human terms does not consign nonhuman species to a mute moral status. On the contrary, some more primordial basis for relationship and meaning may weave thin but substantial threads of a postmoral ethics across regions of the biosphere.Given the diverse modes of subjectivity among animal species, and even the lack of what we call a moral subject altogether in many species, neither ordinary modes of empathy nor of moral understanding go very far in forging multispecies social bonds. For this reason, we turn to research on “the attunement of affects” in the infant-caregiver relationship (Stern 1985). As we shall see, this... (shrink)

abstract Is it permissible for a doctor or nurse to knowingly administer a placebo in a clinical setting? There is certainly something suspicious about it: placebos are typically said to be ‘sham’ treatments, with no ‘active’ properties and so giving a placebo is usually thought to involve tricking or deceiving the patient who expects a genuine treatment. Nonetheless, some physicians have recently suggested that placebo treatments are sometimes the best way to help their patients and can be administered in an (...) honest way. These physicians conclude that placebo treatments are a perfectly acceptable, and ethically unproblematic, mode of treatment. While I grant the common idea that placebos are deceptive is correct, I argue that widespread misunderstandings concerning why this is so has led proponents of placebo treatments to respond to the charge of deception in a way that misses the mark entirely. My goal in this paper, then, is to develop a precise conception of what makes something a placebo, which in turn will clarify the central charge concerning the ethics of placebo treatment, viz. that it is deceptive. (shrink)

Moral (or ethical) sensitivity is widely viewed as a foundational learning goal in engineering ethics education. We have argued in this paper is that this view of moral sensitivity cannot be readily transported from the nursing context to the engineering context on the basis of a care-analogy. The particularized care characteristic of the nursing context is decisively different from the generalized and universalized forms of care characteristic of the engineering context. Through a focus on care and maintenance, (...) the engineering student’s moral sensitivity can be refined, opening up a perceptual awakening and affectivity towards the complex nature of the engineer’s Other. This awakening is in part promoted through an understanding of the ideology of neutrality as a moment in the history engineering. Becoming aware of this ideology as an ideology can then be seen as an activity of dividing loyalties that allows for a reflexive and critical view of the biases and presuppositions inherited within the world of engineering. This process of deepening the engineering student’s moral sensitivity is perhaps as much a process of the student becoming aware of her professional world, how it shapes her understanding of herself, and what it means to be a good engineer. (shrink)

Concerns of moral distress in health care have never been more relevant. In her book, Health Care Ethics Through the Lens of Moral Distress, Kristen Jones-Bonofiglio provides a comprehensive review of the effects of moral distress on providers and health care delivery, while highlighting the complexities of making ethical decisions in practice. Jones-Bonofiglio’s thoroughness and use of interdisciplinary, historical, and cultural scholarship makes this book an excellent introductory resource on moral distress for health care providers and researchers alike.

Military doctors and nurses, employees with a compound professional identity as they are neither purely soldiers nor simply doctors or nurses, face a role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command (London et al. 2006). In the context of military medical ethics this is commonly called dual loyalty (or, (...) less commonly, mixed agency). Although other professionals in the military, for instance counsellors or lawyers, might experience similar problems of dual loyalties, it seems that the dual loyalties experienced by military medical personnel are particularly testing. (shrink)

In this chapter, we consider ethical and philosophical aspects of trust in the practice of medicine. We focus on trust within the patient-physician relationship, trust and professionalism, and trust in Western (allopathic) institutions of medicine and medical research. Philosophical approaches to trust contain important insights into medicine as an ethical and social practice. In what follows we explain several philosophical approaches and discuss their strengths and weaknesses in this context. We also highlight some relevant empirical work in the section on (...) trust in the institutions of medicine. It is hoped that the approaches discussed here can be extended to nursing and other topics in the philosophy of medicine. (shrink)

Moral distress is a well-documented phenomenon in the nursing profession, and increasingly thought to be implicated in a nation-wide nursing shortage in the US. First identified by the philosopher Andrew Jameton in 1984, moral distress has also proven resistant to various attempts to prevent its occurrence or at least mitigate its effects. While this would seem to be bad news for nurses and their patients, it is potentially good news for philosophical counselors, for whom there is both socially (...) important and philosophically interesting work to be done. In an effort to encourage such work, this paper explicates the philosophical (as opposed to more purely psychological or institutional) contours of the problem. A subsequent paper, titled 'A Philosophical Counseling Approach to Moral Distress,' will highlight ways in which such a response would differ from the strategies so far deployed within the nursing profession. (shrink)

The exposure of doctors, nurses and other medical professionals to risks in the context of epidemics is significant. While traditional medical ethics offers the thought that these dangers may limit the extent to which a duty to care is applicable in such situations, it has less to say about what we might owe to medical professionals who are disadvantaged in these contexts. Luck egalitarianism, a responsibility-sensitive theory of distributive justice, appears to fare particularly badly in that regard. If we (...) want to maintain that medical professionals are responsible for their decisions to help, cure and care for the vulnerable, luck egalitarianism seems to imply that their claim of justice to medical attention in case of infection is weak or non-existent. The article demonstrates how a recent interpretation of luck egalitarianism offers a solution to this problem. Redefining luck egalitarianism as concerned with responsibility for creating disadvantages, rather than for incurring disadvantage as such, makes it possible to maintain that medical professionals are responsible for their choices and that those infected because of their choice to help fight epidemics have a full claim of justice to medical attention. (shrink)

Goold and Stern (2006) offer a much needed dose of insight into the weakness of medical education from the perspective of resident and nonresident physicians. One of their findings pertains not to...

Philosophers have become newly interested in the ethics of sex. One promising feature of this new discussion is that it has been broadening our moral lens to include individuals whose sexual interests have historically been denied or ignored. One such group is the elderly. Contrary to popular belief, many elderly people want to have sex and see it as a regular part of their lives. If society harbors ignorance about or prejudice against elderly sexuality, it harbors stronger views against (...) the sexual expression of elderly people with dementia. People with dementia are often prohibited by nursing‐home staff, sometimes in extreme ways, from having sex with their partners. This prohibition is at least partly motivated by the goal of protecting the vulnerable. However, cutting people with dementia off from sex has negative health effects and is a needless restriction of their autonomy. In this article, I argue that the expanding moral lens in sexual ethics should include the sexual expression of elderly individuals with dementia and that their sexual expression should be respected. Specifically, I argue that many people with dementia are competent to consent to sexual activity with their long‐term partners. (shrink)

There is a global shortage of organs for transplantation and despite many governments making significant changes to their organ donation systems, there are not enough kidneys available to meet the demand. This has led scientists and clinicians to explore alternative means of meeting this organ shortfall. One of the alternatives to human organ transplantation is xenotransplantation, which is the transplantation of organs, tissues, or cells between different species. The resurgence of interest in xenotransplantation and recent scientific breakthroughs suggest that genetically-engineered (...) pigs may soon present a realistic alternative as sources of kidneys for clinical transplantation. It is therefore important for nurses and allied health professionals to understand what is involved in xenotransplantation and its future implications for their clinical practices. First, we explore the insufficiency of different organ donation systems to meet the kidney shortage. Second, we provide a background and a summary of the progress made so far in xenotransplantation research. Third, we discuss some of the scientific, technological, ethical, and economic issues associated with xenotransplantation. Finally, we summarise the literature on the attitudes of healthcare professionals toward xenotransplantation. (shrink)

Jake Greenblum and Ryan K Hubbard argue that physicians, nurses, clinical ethicists and ethics committee members should not cite religious considerations when helping patients (or their proxies) make medical decisions. They provide two arguments for this position: The Public Reason Argument and the Fiduciary Argument. In this essay, I show that the Public Reason Argument fails. Greenblum and Hubbard may provide good reason to think that physicians should not invoke their own religious commitments as reasons for a particular medical (...) decision. But they fail to show that it is wrong for physicians to cite the patient’s own religious commitments as reasons for a particular decision. As such, if Greenblum and Hubbard’s thesis is to survive, the Fiduciary Argument (or some unmentioned argument) will have to do the bulk of the work. (shrink)

Recent bioethical issues that have emerged in the field of medicine include, but are not limited to, eugenics (artificial insemination), palliative care (end of life care), euthanasia (medical resuscitation), abortion, and the development of enhanced human body parts. These bioethical issues have raised ethical questions related to the use of modern technology and how it may affect the future of society. These questions consider issues such as: what is the identity of future children? Have human beings become a commodity exchanged (...) by those who have the ability to own them? What is the meaning of justice in medical treatment? How can physicians and nurses perform humanitarian work? -/- Discussions of these questions should begin by determining their relationships with typical social and cultural values in society, such as life and death, marriage, family, fatherhood, motherhood, relatives, and next-of-kin. -/- This paper presents a review of the important Arabic literature that has been written on these bioethical issues to show the contributions of Arab scholars in this field. Arabic studies in bioethics can be classified into three types: original Arabic writings, translated studies, and congresses held in the Arab region. (shrink)

This article is about an intervention or approach in mental health care that has been developed from hermeneutics, more specifically the hermeneutics of Ricoeur. In this intervention photography is used as a means to assist patients in a process of meaning making from experiences in their life world. It aims at empowerment and strengthening the agency of patients. It does so by facilitating storytelling. Mimesis, as interpreted by Ricoeur, was found to be a central concept with which we could explain (...) the therapeutic working of the approach and legitimize its ethical claims of empowerment and recovery. Another aspect is the concordance between narrative and action, as described by Ricoeur, which has a pendant in the goal orientation of the photography intervention. At the same time demonstrations and experiences from professional practice (nurses applying the intervention) will give us feedback on the theory and enrich it with new insights, e.g. on ‘iconic representation’. (shrink)

This article looks at the question of sin and disease in bioethics with a spiritual-theological analysis from the book of Job. The biblical figure Job is an innocent and just man who suffered horrendously. His dialogues with others—his wife, his friends, and God—can give many valuable insights for patients who suffer and for those who interact with them. Family, friends, physicians, nurses, chaplains, and pastoral workers can learn from Job how to communicate properly with sufferers. The main question for Job (...) was how to maintain the tension between God’s justice and God’s mercy and not yield to the temptation of cursing God but to speak well of Him in moments of difficulties. (shrink)

Highlights: -/- • Breastfeeding and breastfeeding support can contribute to mitigating climate change. • Achieving global nutrition targets will save more emissions than fuel-switching. • Breastfeeding support programmes support a just transition. • This work can support the expansion of mitigation options in energy system models. -/- Abstract: -/- Renewable gas has been proposed as a solution to decarbonise industrial processes, specifically heat demand. As part of this effort, the breast-milk substitutes industry is proposing to use renewable gas as a (...) substitute for fossil natural gas. However, decarbonising the industrial processing of breast-milk substitutes can increase social license for these products, potentially undermining breastfeeding. World Health Organisation nutrition targets aim to increase exclusive breastfeeding to at least 50% globally by 2025 to improve maternal, infant, and young child health and nutrition. This target will have implications for the energy transition. A weakness of existing energy models is that demands for end-use products such as breast-milk substitutes are typically not considered explicitly. This paper develops an analytical framework for explicitly representing infant feeding methods in energy systems models. We compare the emissions saved in Ireland from decarbonising the industrial processing of breast-milk substitutes with renewable gas with the emissions saved by an increase in exclusive breastfeeding to 50% in both Ireland and a key export market, China. We demonstrate that the emissions saved from achieving the minimum global breastfeeding target are greater than when renewable gas is used to displace natural gas in the production of breast-milk substitutes in Ireland. We discuss the decarbonisation of breast-milk substitutes in relation to the principle of justice as non-maleficence, a principle based on the commitment to avoid harm, a novel application of a principle of justice. We conclude that breastfeeding support can be considered a demand-side measure for mitigating climate change by reducing the demand for energy services to produce breast-milk substitutes. A key recommendation is to position breastfeeding support as both a public health and a climate justice issue that is relevant for a just transition. The framework developed for this paper could be applied to support the inclusion of a wider range of mitigation options with social justice outcomes in energy system models. [Open access]. (shrink)

In the Terry Achane case, a birth father who was in the military was not notified when his child's birth mother put up their child for adoption. Birth fathers are often stereotyped as uninvolved and irresponsible, especially when they are not married to the birth mother. Terry Achane was married. The adoption agency made little effort to contact him, raising ethical issues about the roles played by the race, economic status, and perhaps religious beliefs of the adopting parents.

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)

In this article, we investigate how the concept of Care Biography and related concepts are understood and operationalised and describe how it can be applied to advancing our understanding and practice of holistic and person‐centred care. Walker and Avant's eight‐step concept analysis method was conducted involving multiple database searches, with potential or actual applications of Care Biography identified based on multiple discussions among all authors. Our findings demonstrate Care Biography to be a novel overarching concept derived from the conjunction of (...) multiple other concepts and applicable across multiple care settings. Concepts related to Care Biography exist but were more narrowly defined and mainly applied in intensive care, aged care, and palliative care settings. They are associated with the themes of Meaningfulness and Existential Coping, Empathy and Understanding, Promoting Positive Relationships, Social and Cultural Contexts, and Self‐Care, which we used to inform and refine our concept analysis of Care Biography. In Conclusion, the concept of Care Biography, can provide a deeper understanding of a person and their care needs, facilitate integrated and personalised care, empower people to be in control of their care throughout their life, and help promote ethical standards of care. (shrink)

The standard criticisms of Confucian ethics appear contradictory. On the one hand, Confucian ethics is deemed overly rule-bound: it is obsolete because it advocates adherence to ancient Chinese norms of proper conduct. On the other hand, Confucian ethics is perceived as situational ethics—done on the run—and not properly grounded in fundamental principles or norms. I give reasons for these disparate views of Confucian ethics. I also sketch an account of Confucian morality that focuses on moral (...) development; in this account the place of normative ethics is nominal. (shrink)

The article assumes that Lipman’s paradigm of ‘Philosophy for Children’ as a ‘Community of Inquiry’ is very useful in extending the range of philosophical practices and the benefits of philosophical community reflection to collective life as such. In particular, it examines the possible contribution of philosophy to the practical and ethical dynamics which, nowadays, seem to characterise many deliberative public contexts. Lipman’s idea of CI is an interesting interpretative key for such contexts. As a result, the article highlights the possibility (...) of understanding a CI essentially in terms of an ethics of responsibility. (shrink)

This thesis investigates Habermas's attempt to establish a credible form of universalism in moral and political philosophy by means of the theoretical approach which he terms "discourse ethics." The central question motivating this study is whether Habermas succeeds in this ambition. Discourse ethics specifies a procedure which purports to enable all agents involved in a conflict of interest in which issues of justice are at stake to come to a rational and cooperative resolution. It proposes a position unique (...) among contemporary approaches to justice in the strength and character of its anti-relativist stance: the plurality of human cultures and the situated character of human understanding do not, according to this theory, bar the way to arriving at a minimal form of moral universalism. Although the procedure specified in communicative ethics elucidates only a narrow range of concerns--those pertaining to justice in the strict sense--it aims to do so in a way valid across all human cultures. ;Habermas's strategy for the defence of a species-wide moral universalism is, I argue, both the key feature of his position, and the least well understood. Discussion of discourse ethics to date has focussed almost exclusively on the question of its appropriateness to the context of modern, Western pluralism. An important reason for this focus has been the intricacy of Habermas's argumentative strategy, which links the recent work on discourse ethics to his longstanding project of developing a theory of communicative action. ;The principle aim of this thesis is to clarify Habermas's position by explicating his programme of justification. In so doing, I draw attention to several problems in his approach as a mechanism for cross-cultural conflict adjudication, and endeavour to provide a more perspicuous account of the relation of Habermas's theory to its main philosophical competitors, especially Rawlsian deontology, and contextualism. (shrink)

In the center of the fifth book of the Nicomachean Ethics, Aristotle elliptically characterizes political justice as a form of reciprocal rule that exists between free and equal persons pursuing a common life directed toward self-sufficiency under the rule of law. My dissertation analyzes Aristotle's thematic treatments of political justice in the Nicomachean Ethics and Politics in order to elucidate its meaning, clarify its relationship to the other forms of justice that he also discusses, and compare it to (...) contemporary neo-Aristotelian accounts of justice. ;The first chapter examines the unclear and disputed passages of Ethics V.6--7 and explains why Aristotle discusses political justice in his ethical treatise. The second chapter makes use of Aristotle's juxtaposition of political justice to household justice on the one hand and despotic justice on the other hand in order to explicate the necessary conditions of political justice, namely, freedom, equality, commonality, self-sufficiency, and the rule of law. To make sense of these concepts, the chapter explores such topics as Aristotle's understanding of the household, his notion of the self and his political criticisms of Socrates. The third chapter examines political justice or reciprocal rule in the Politics in order to understand how political justice can be both a human virtue and an institutional arrangement of offices. The fourth chapter offers a critique of Fred Miller's reconstruction of Aristotelian natural rights. Although Miller is correct to say that Aristotle recognized and understood "rights claims," he is mistaken in claiming that they are an integral part of Aristotle's practical philosophy. Aristotle understood the problems for political compromise posed by rights conceived as "trumps," and he rejects rights as philosophically fundamental on the grounds that they are an inadequate solution to both the political problem of justice and the stability of flourishing political institutions. (shrink)

This is a paper about the methodology of normative ethics. I claim that much work in normative ethics can be interpreted as modelling, the form of inquiry familiar from science, involving idealised representations. I begin with the anti-theory debate in ethics, and note that the debate utilises the vocabulary of scientific theories without recognising the role models play in science. I characterise modelling, and show that work with these characteristics is common in ethics. This establishes the (...) plausibility of my interpretation. Taking methodological inspiration from modelling in science gives us new tools for managing idealisations, and a new perspective on pluralism. I demonstrate why this interpretation is a fruitful way of interpreting ethics, by looking at three case studies. First, I return to the anti-theory debate and argue that modelling opens up a new middle ground. Second, I argue that a modelling lens offers a new way of understanding impossibility theorems in population ethics, and their bearing on ethics as a whole. Finally, I show how viewing our work as modelling can be deployed in debates within ethics, using the debate over prioritarianism as an example. I close with further methodological suggestions for those who choose to see themselves as modellers. I discuss the role of counterexamples, our responses to moral disagreement, and the training of new ethicists. (shrink)

In their recently published book Nudge (2008) Richard H. Thaler and Cass R. Sunstein (T&S) defend a position labelled as ‘libertarian paternalism’. Their thinking appeals to both the right and the left of the political spectrum, as evidenced by the bedfellows they keep on either side of the Atlantic. In the US, they have advised Barack Obama, while, in the UK, they were welcomed with open arms by the David Cameron's camp (Chakrabortty 2008). I will consider the following questions. What (...) is Nudge? How is it different from social advertisement? Does Nudge induce genuine preference change? Does Nudge build moral character? Is there a moral difference between the use of Nudge as opposed to subliminal images to reach policy objectives? And what are the moral constraints on Nudge? (shrink)

In his 1928-29 Sather Classical lectures, Paul Shorey noted that ‘there are few sentences and almost no pages of Aristotle that can be fully understood without reference to the specific passages of Plato of which he was thinking as he wrote. And as…few modern Aristotelians have the patience to know Plato intimately, Aristotelians as a class only half understand their author’ (Platonism Ancient and Modern, Berkeley: University of California Press, 1938, 6). In the 75 years since Shorey’s lament, scholarship has (...) become even more specialized, and rare is the scholar who has published regularly on both Aristotle and Plato. Thus, Plato and Aristotle’s Ethics, a collection of six papers (each with accompanying commentary) presented at a S.V. Keeling Colloquium on Ancient Philosophy in November 2001, is a welcome and worthy contribution by major scholars of ancient philosophy. The volume’s contributors examine topics in Aristotle’s ethical treatises which derive from his agreements and disagreements with Plato. The volume includes an index locorum and an introduction by R. Heinaman, but no general bibliography. Although understanding the Platonic origins of Aristotle’s discussions is helpful to any student of the Ethics, the analyses are at times extraordinarily rich and closely argued, and indeed space forces me to underscore only the main arguments and largely omit discussion of the commentators’ remarks. (shrink)

Virtue ethics has been challenged on empirical grounds by philosophical interpreters of situationist social psychology. Challenges are necessarily challenges to something or other, so it’s only possible to understand the situationist challenge to virtue ethics if we have an antecedent grasp on virtue ethics itself. To this end, I first identify the non-negotiable “hard core” of virtue ethics with the conjunction of nine claims, arguing that virtue ethics does make substantive empirical assumptions about human conduct. (...) Next, I rearticulate the situationist challenge in light of these nine claims. I then turn to a discussion of specifications of several responses typically made by defenders of virtue ethics against the situationist challenge, arguing that most of them either are unsound or give up one of the elements in the hard core. A few, however, survive this criticism, and so I conclude by suggesting ways in which the situationist challenge might be not so much resisted as co-opted. Situational influences can be used to help people simulate virtue, a phenomenon I call factitious virtue. (shrink)

What is wrong with government whistleblowing and when can it be justified? In my view, ‘government whistleblowing’, i.e., the unauthorized acquisition and disclosure of classified information about the state or government, is a form of ‘political vigilantism’, which involves transgressing the boundaries around state secrets, for the purpose of challenging the allocation or use of power. It may nonetheless be justified when it is suitably constrained and exposes some information that the public ought to know and deliberate about. Government whistleblowing (...) should then be viewed, along the lines of civil disobedience, as a collective cognition- and legitimacy-enhancing device. (shrink)

_A Relational Moral Theory_ draws on neglected resources from the Global South and especially the African philosophical tradition to provide a new answer to a perennial philosophical question: what do all morally right actions have in common as distinct from wrong ones? Metz points out that the principles of utility and of respect for autonomy, the two rivals that have dominated Western moral theory for the last two centuries, share an individualist premise. Once that common assumption is replaced by a (...) relational perspective given prominence in African ethical thought, a different comprehensive principle, one focused on harmony or friendliness, emerges. Metz argues that this principle corrects the blind spots of the Western moral principles, and has implications for a wide array of controversies in applied ethics that an international audience of moral philosophers, professional ethicists, and similar thinkers will find compelling. (shrink)

This chapter addresses the growing problem of unwanted sexual interactions in virtual environments. It reviews the available evidence regarding the prevalence and severity of this problem. It then argues that due to the potential harms of such interactions, as well as their nonconsensual nature, there is a good prima facie argument for viewing them as serious moral wrongs. Does this prima facie argument hold up to scrutiny? After considering three major objections – the ‘it’s not real’ objection; the ‘it’s just (...) a game’ objection; and the ‘unrestricted consent’ objection – this chapter argues that it does. The chapter closes by reviewing some of the policy options available to us in addressing the problem of virtual sexual assault. (shrink)

Modern philosophy recognizes two major ethical theories: deontology, which encourages adherence to rules and fulfillment of duties or obligations; and consequentialism, which evaluates morally significant actions strictly on the basis of their actual or anticipated outcomes. Both involve the systematic application of universal abstract principles, reflecting the culturally dominant paradigm of technical rationality. Professional societies promulgate codes of ethics with which engineers are expected to comply, while courts and the public generally assign liability to engineers primarily in accordance with (...) the results of their work, whether intended or unintended. A third option, prominent in ancient philosophy, has reemerged recently: virtue ethics, which recognizes that sensitivity to context and practical judgment are indispensable in particular concrete situations, and therefore rightly focuses on the person who acts, rather than the action itself. Beneficial character traits—i.e., virtues—are identified within a specific social practice in light of the internal goods that are unique to it. This paper proposes a comprehensive framework for implementing virtue ethics within engineering. (shrink)