Showing papers on "Nursing ethics published in 1991"

Ethics: The Heart of Health Care

Abstract: Growing Pains. Ethics Is the Key. Uncovering the Basic Questions. Problems of Practice. The Search for Morality. What Is a Person?. Theories of Ethics. Obstacles to Clear Moral Reasoning. The Background to the Ethical Grid. The Use of the Ethical Grid. Implications. References and Further Reading. Index.

Principle-oriented ethics and the ethic of care: a creative tension.

Abstract: Research to date in the field of nursing ethics has overlooked the nature of the guiding moral framework in nursing practice, while focusing primarily on the moral reasoning and moral behaviors among nurses. This research depicts two moral frameworks--a principle-oriented ethic and the ethic of care--as they are experienced by practicing critical care nurses. The interdependence of these two frameworks as they inform the moral experience of the nurse is demonstrated in the analysis of a complex nurse narrative that depicts the nurse's moral struggle.

The ethics of information.

Abstract: Information technology provides the means by which patient data can be easily accessed Countering the availability trend is the need for patient confidentiality and privacy The authors describe a simple survey aimed at investigating the improper accessing of a hospital information system The results of the study provide the catalyst for a discussion of the relationships between information systems technology and ethical nursing behavior

Historical Perspectives: Development of the Codes of Ethics in the Legal, Medical and Accounting Professions

Abstract: Members of the legal, medical and accounting professions are guided in their professional behavior by their respective codes of ethics. These codes of ethics are not static. They are ever evolving, responding to forces that are exogenous and endogenous to the professions. Specifically, changes in the ethical codes are often due to economic and social events, governmental influence, and growth and change within the professions. This paper presents an historical analysis of the major events leading to changes in the legal, medical and accounting codes of ethics.

Ethical principles for the conduct of human subject research: population-based research and ethics.

Abstract: Ethical principles for the protection of human subjects in clinical research are now well recognized,' and rooted in the inherent worth and dignity of the individual. Respect for persons recognizes people as autonomous agents and requires that their choices be observed. For persons who are not fully autonomous, the principle of respect for persons requires that they are protected from risks and adverse consequences of research, even sometimes excluded from research. Beneficence (do good) and non-maleficence (do no harm) are complementary ethical principles that impose affirmative duties on researchers to maximize any benefits for subjects and minimize any risks. Thus, researchers must go beyond mere respect for a person's choices. The researcher must be vigilant to ensure that the subject receives all possible benefits and avoids all possible harms from participating in the research. Justice requires that human beings be treated equally unless there is a strong ethical justification for treating them differently. Thus, the distribution of benefits and burdens in research should be equitable. In thinking about justice toward subjects, researchers need to consider equitable selection so that individuals are chosen on the basis of factors clearly relevant to the problems being studied. Researchers also need to consider equitable distribution of advantages to research subjects and others who could benefit from the knowledge gained by the research. These ethical principles have found expression in international guidelines for the conduct of clinical researcht, and have been codified in national statutes and regulations, particularly in the developed world.3 Ethical principles help support autonomy and selfdetermination, protect the vulnerable, and promote the welfare and equality of human beings. But traditional ethics focuses primarily on individual rights and duties, and does not always see individuals as part of wider social orders and communities. A person dominated medical ethic is insufficient for the task of setting moral and human rights boundaries around the conduct of research on populations. This paper provides a halting first step in organizing a set of ethical guidelines for the conduct of populationbased research, surveillance and practice. These principles are not distinct from, but an expansion of, traditional ethics. Research ethics, which matured significantly from the Nuremberg Code through to the Helsinki JY and the CIOMS guidelines, nourished the individual human spirit. Ethical principles should have a similarly profound impact in the development of science and the protection of human populations in the 1990s and beyond.

Ethical Issues in Social Work: Toward a Grounded Theory of Professional Ethics

Abstract: SOCIAL WORK exists because society is concerned about the vulnerable, the disenfranchised, the isolated, and the suffering. Most social services are carried out through orga nizations that structure and focus the actions of staff and that represent socie ty's concern for the needy (Jansson, 1988). The community entrusts power to social workers and others in such programs to use its resources and to implement delivery of services with caring and integrity (Leiby, 1978). Social workers are responsible for weighing the activities that should and should not be performed, deciding on the best uses of a community's limited resources, and discerning just and unjust procedures and policies to guide daily decisions (Reamer, 1982). Issues faced by social workers often involve questions of "what ought to be" in addition to "what is the case." Thus, ethical criteria and value judgments are core components of staff decision making, even if not often made ex plicit. Although facts and skills are im portant, ethical judgments cannot be dealt with on the grounds of factual in formation or professional skill alone, regardless of their scope or refinement (Rhodes, 1986). In an effort to properly handle ethical dilemmas, social workers should not ignore their own or the clients' present circumstances or worker alternatives and resources for action. However, such issues as the fair allocation of scarce resources, limitations on disclosing in formation about clients or consumers, just resolution of conflicting claims, or the appropriate role of the professional in guiding and limiting client choices are problems that are primarily ethical. Information and skill are not sufficient to solve them. These issues require thoughtful analysis in the context of participants' values and commitments. Thomas P. Holland Allie C. Kilpatrick

Ethics consultation as moral engagement.

Abstract: I will begin by presenting some doubts about what might be called the "received view" of the role of the moral expert as a health care consultant. Then I will review the literature on moral experts and moral expertise and proceed to apply the results of that review to the notion that there are some who are expert in ethical decision making in health care. I will try to show that certain conclusions that can be drawn from this rather circumscribed topic have implications for the very conception of the relationship between moral theory and clinical ethics.

Medical students' professional ethics: defining the problems and developing resources.

Abstract: An AAMC working group concluded that medical educators have paid insufficient attention to students' development of professional standards and to the immediate ethical dilemmas that students face as students. Its discussion of the primary determinants of medical students' ethical development focused on improving: (1) the evaluation of candidates for admission; (2) the medical school learning climate, including recognition of the challenges inherent in the increasing cultural diversity among students and patients; and (3) communication to students of expectations of professional behaviors and standards. An AAMC initiative is outlined that includes preparation of a resource book featuring cases illustrating common ethical dilemmas that medical students face, descriptions of effective honor systems, suggestions for faculty development, and an annotated bibliography.

Physicians' and nurses' perceptions of ethics problems on general medical services.

Abstract: Objective:To understand the kinds of clinical situations physicians and nurses regard as “ethics problems.”

Ethics Committees and Due Process: Nesting Rights in a Community of Caring

Abstract: As ethics committees have become increasingly common in health care settings, and indeed sometimes mandated by law, they have become increasingly powerful. Yet by far the most problematic activity in which committees engage is to address ethical issues in ongoing cases involving current patients. Performing this function means that a committee is consulted in active treatment disputes. When the physician and the patient or the patient's family disagree, the physician (or far more rarely, the patient or family) may well take the case to the ethics committee. What the ethics committee advises can carry decisive weight. Moreover, many disputes will never make it into court; the committee will serve as the forum of last resort. Even when a case does make it to court, the committee's prior determination may exert substantial influence. Some judges have considered the prior committee determination, and have even suggested that courts should accord such a determination some deference. Given the fact that ethics committees have been embraced by statute, regulation, and the courts, and are capable of wielding substantial power in a domain of protected rights, one might expect to see these committees according at least the rudiments of due process. That expectation, however, would be sorely disappointed. Most of these committees accord nothing resembling due process. All indications are that most fail even to give the patient notice and an opportunity to be heard, much less other tools a patient might need to participate effectively in the ethics committee's proceedings. Even more remarkably, there is no hue and cry. Instead, there is a widespread sense that ethics committees are fine as they are, without the cumbersome requirements of due process. This article explores why this is so -- the roots of that complacency. It is an argument for restructuring the ethics committee process by embracing a broad concept of due process, one grounded not only in law but also in ethics.The article begins by asking what beliefs about ethics committees have allowed them to escape the requirements of due process. The prevailing mythology about ethics committees holds that these committees are purely advisory and wield no decision making power, and that they promote the interests of patients without any need for due process. The author debunks the mythology by showing that ethics committees may wield determinative power in treatment disputes and can greatly disadvantage patients. The article explores the question of how to describe ethics committees properly, in order to ground formulation of a suitable ethics committee process. Yet ethics committees have a troubling dual character. Committees are often depicted as support mechanisms for physicians and other hospital caregivers, with ethics committee consultation likened to medical consultation of expert colleagues. This view yields a model of process that is informal, focuses on the needs of caregivers, and offers no procedural protections to the patient. On the other hand, some scholars see ethics committees as adjudicatory, with the focus on resolving disputes. In this view, ethics committee process must be more formal, the focus is on patients' rights, and the committee must afford procedural protections. Ethics committees have drawn on both models and may actually flip back and forth. This shifting duality poses real dangers, especially for patients and their families, who may not be included at all in the committee's process. This dangerous double identity reflects an ongoing struggle between traditional physician paternalism and a newer effort to recognize patients' rights. The proliferation of ethics committees has been part of an attempt to revolutionize medical relationships by shifting decisional power to the patient, but it is a revolution that so far is incomplete and swamped in ambivalence. The article pursues reconstruction. The author argues that the first step in constructing a sound process is to recognize that committees' foremost obligation is to serve and protect the patient. This mandates due process. The author urges due process not only in fulfillment of the committee's legal obligations, but also its ethical ones. The challenge is to find procedures that will protect not only the patient's rights and self-determination, but also her relationships to medical personnel and continued connection to professional and medical care-giving. To accomplish this, ethics committees not only should afford due process in their own case consultations, but should also become leading proponents of a broad value of due process in the clinical setting, catalyzing innovation and change. The idea is to domesticate due process, to make it not the lawyerly enemy of the physician, but the tool to guarantee that the patient is heard. In this way due process becomes the protector not only of rights, but of relationships. The goal is not to alienate the caregivers from their patient, but to cement them to her through a process that allows for conflict and rights. By embracing due process, ethics committees can become true advocates for patients' rights, rights that are nested in a community of care-giving.

Ethics for public managers

Abstract: Preface Ethics and Public Managers The Gordian Knot Still Tied: Ethics and the Public Manager Looking in the Mirror Comfortably: Personal Aspects of Ethical Dilemmas Ethics and the Law Looking at the Deeper Questions: Culture and Values Organizational Dynamics: The Manager's Environment Professions, Professionalism, and Ethics Analyzing and Resolving Ethical Dilemmas Appendix: Research Methodology and Interview Instruments Bibliography Index

Ethical Decision Making in Nursing

Abstract: ELEMENTS OF THE ETHICAL DECISION-MAKING MODEL * A Critical History of Ethics * Virtue and Its Value * The First Step of Bioethical Decision Making * The Nurse/Patient Agreement * The Contemporary Bioethical Standards * Theories and Standards * The Ethical Context * Context and Ethical Action * Apparent Conflicts Among The Bioethical Standards * Agreements Without Standards * BIOETHICS AND THE NATURE OF INDIVIDUAL AUTONOMY * Aspects of Human Nature as Elements of Ethical Knowledge * Desire and the Ethical Context * The Role of Reason in Ethical Decision Making * Life as the Precondition of All Action * The Role of Purpose: The Goals of Ethical Action * The Role of Agency: The Nature of Ethical Action * Postscript to Parts One and Two * CASE STUDY ANALYSIS * Resolution to Dilemmas * Epilogue * Glossary * Supplemental Readings

The Ethical Roots of Business Ethics

Abstract: This paper traces the historical roots of some of our current preoccupations with the ethics of business. Its central argument is that many of the contemporary criteria that we use to evaluate the ethics of business are not new; rather, they date back several centuries. This paper illustrates this thesis by comparing historical and contemporary discussions of three sets of issues: the relationship between ethics and profits, the relationship between private gain and the public good and the tension between the results of capitalism and the intentions of businessmen.The fact that these tensions are inherent in the nature of capitalism, if not in human nature itself, does not make our contemporary concerns or standards any less valid. On the contrary, it underlies their significance. Contemporary discussions of business ethics constitute part of an ongoing moral dialogue with both deep secular and religious roots.

Danger signs of unethical behavior: How to determine if your firm is at ethical risk

Abstract: This paper is designed to do three things. First, it discusses some of the key trends in business ethics in the academic and corporate communities. Initiatives like the Arthur Andersen Business Ethics Program are noted. Secondly, the paper examines certain basic misconceptions about the field and concludes that the adage that good ethics is good business is still true. Finally, the paper highlights fourteen business attitudes or practices that may put a firm at ethical risk. For example, the paper discusses the risk of using ethics as simply a public relations initiative. Man's life is not a state of unalloyed happiness. The earth is no paradise. Although this is not the fault of social institutions, people are wont to hold them responsible for it. The foundation of any and every civilization, including our own, is private ownership of the means of production. Whoever wishes to criticize modern civilization, therefore, begins with private property. It is blamed for everything that does not please the critic, especially those evils that have their origin in the fact that private property has been hampered and restrained in various respects so that its full social potentialities cannot be realized.1 Ludwig von Mises

The Patient-Physician Relation: The Patient as Partner, Part 2

Abstract: Preface Acknowledgments Introduction Part I. The Foundations of the Patient-Physician Relation 1. Models for Ethical Medicine in a Revolutionary Age 2. Medical Ethics: Professional or Universal? 3. The Physician as Stranger: The Ethics of the Anonymous Patient-Physician Relationship 4. Values in Routine Medical Decisions 5. The Concept of OMedical IndicationsO 6. The Principles for Medical Ethics Part II. The Individual Professional-Patient Relation 7. Informed Consent: The Emergeing Norms 8. Malpractice in the Contract Mode 9. The Ethics of Generic Drug Use 10. Treatment INDs: The Right of Access to Experimental Drugs 11. Ethics of Drugs for Nonapproved Uses 12. When Should the Patient Know? The Death of the Therapeutic Privilege 13. An Unexpected Chronosome: Disclosure of Genetic Information 14. The Ethics of Dispensing Placebos 15. The PatientOs Right of Access to Medical Records 16. The Limits of Confidentiality: The Case of the Homosexual Husband 17. PatientsO Duties and PhysiciansO Rights Part III. The Social Professional-Patient Relation 18. AutonomyOs Temporary Triumph: On the Alleged Conflict between Autonomy and Justice 19. DRGs and the Ethics of Cost Containment 20. Justice and Economics: Care of the Terminally Ill, Persistently Vegetative, and Elderly 21. Voluntary Risks to Health: The Ethical Issues Part IV. Special Problem Areas 22. The Ethics of Organ Transplantation 23. The Technical Criteria Fallacy: The Case of Spina Bifida 24. Limits of Guardian Treament Refusal: A Reasonableness Standard 25. ODo Not ResuscitateO Orders: An Ethical Analysis 26. The Ethics of Institutional Ethics Committees Part V. The Future of the Partnership 27. Contemporary Bioethics and the Demise of Modern Medicine Notes Index

Lives in the Balance: The Ethics of Using Animals in Biomedical Research: The Report of a Working Party of the Institute of Medical Ethics

Abstract: This book is the result of a three-year study undertaken by a multidisciplinary working party of the Institute of Medical Ethic (UK). The group was chaired by a moral theologian, and its members included biological and ethological scientists, toxicologists, physicians, veterinary surgeons, an expert in alternatives to animal use, officers of animal welfare organizations, a Home Office Inspector, philosophers, and a lawyer. Coming from these different backgrounds, and holding a diversity of moral views, the members produced the agreed report as a result of detailed and rigorous discussions. The book sets out facts about animal experiments and about animal abilities to experience pain, distress and anxiety. There is a detailed examination of the moral claims related to the benefits likely to accrue from animal research, and of strategies for weighing these benefits against the harm caused to animals, in order to decide whether particular research projects ought or ought not to proceed. This leads to consideration of the statutory and non-statutory controls which safeguard standards in such research. The final section explores a variety of philosophical arguments about the use of animals in research, and offers a philosophical justification for the Working Party's more practical conclusions. Written in clear, nontechnical language, this book is accessible to lay people as well as to scientists. It is the first such document to emerge from a meeting of people with such widely differing views on this highly controversial subject, and represents a major Lives in t he Balance: T he Et hics of Using Animals in Biomedical Research: T he Report of a Working Part y of t he Inst it ut e of Medical Et hics    contribution towards informing and raising the quality of contemporary debate. The book is unique in drawing together material and ideas never before found in one volume. It will interest a broad spectrum of readers, from ethicists and animal rights advocates to scientific researchers and laboratory administrators, along with general readers concerned about this compelling issue.

The Future of Legal Ethics

Abstract: Dissatisfaction with lawyers is a chronic grievance,1 and inspires periodic calls for reform.2 Nevertheless, the contemporary problems of the American legal profession seem to run deeper than in the past. There are more lawyers today, both proportionately and absolutely, than at any other time in recent history.' There is much greater public consciousness of lawyers' work, which is now the subject of regular coverage in newspapers, magazines, and television

Public Relations" The Empirical Research on Practitioner Ethics

Abstract: An examination of the empirical literature on public relations ethics indicates serious doubts and concerns about the ethics of the public relations practice. Practitioners tend to perceive the ethics of their top management as higher than their own ethics, suggesting that top management (of which practitioners are a part) should be in the forefront of improving organizational and practitioner ethics.

Integrity and Compromise in Nursing Ethics

Abstract: Nurses are often caught in the middle of what appear to be intractable moral conflicts. For such times, the function and limits of moral compromise need to be explored. Compromise is compatible with moral integrity if a number of conditions are met. Among these are the sharing of a moral language, mutual respect on the part of those who differ, acknowledgement of factual and moral complexities, and recognition of limits to compromise. Nurses are in a position uniquely suited to leadership in fostering an environment that makes compromise with integrity possible.

Just Doctoring: Medical Ethics in the Liberal State

Abstract: "Just Doctoring" draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the way to a new, more aware and engaged medical ethics. The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problemsfrom informed consent to care rationing and the repercussions of the HIV epidemicand gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century."

Conceptual Issues in Nursing Ethics Research

Abstract: Empirical studies that have attempted to describe nurses' ethical practice have used conceptual frameworks derived primarily from the disciplines of bioethics and psychology. These frameworks have not incorporated important concepts developed by nursing theorists over the past two decades. This article points out flaws in the past research frameworks and proposes a synthesis of ethical theory, nursing practice contexts, and empirical research methods to enrich theoretical development in nursing ethics.

The sociology of knowledge: Toward an existential view of business ethics

Abstract: Business ethics is the study of ethics as it applies to a particular sphere of human activity. As such, business ethics presupposes a difference between an individual's experience within a business organization and his or her experience outside the organization. But how do we examine this difference? How do we discuss an individual's experience of “everyday reality”? What processes create and sustain this reality, and how does one's version of “reality” affect what is, and what is not, ethical? This paper outlines an approach to these questions based on theory from the sociology of knowledge, an approach which makes some progress towards making business ethics more existential. The sociology of knowledge, and particularly the social constructionist perspective, is concerned with how an institution creates “knowledge” and how this “knowledge” affects the cognitive processes of the individuals who make up the institution. The dialectic nature of the interdependent processes which shape both the individual and the organization are important in understanding how business ethics, as one kind of social knowledge, are enacted. Examining these processes leads to several interesting hypotheses about the nature of both the study and practice of business ethics. XXX“Only individuals have a sense of responsibility.” — Friedrich Nietzsche

The clinical ethicist at the bedside.

Abstract: In this paper we attempt to show how the goal of resolving moral problems in a patient's care can best be achieved by working at the bedside. We present and discuss three cases to illustrate the art and science of clinical ethics consultation. The sine qua non of the clinical ethics consultant is that he or she goes to the patient's bedside to obtain specific clinical and ethical information. Unlike ethics committees, which often depend on second hand information from a physician or nurse, clinical ethics consultants personally speak with and examine patients and review their laboratory data and medical records. The skills of the clinical ethics consultant include the ability to delineate and resolve ethical problems in a particular patient's case and to teach other health professionals to build their own frameworks for clinical ethical decision making. When the clinical situation requires it, clinical ethics consultants can and should assist primary physicians with case management.

Virtue ethics and maori ethics

Abstract: There has been considerable recent interest among moral philosophers in the significance of the virtues for ethics and in the possibility of establishing virtue ethics as a normative theory distinct from deontological and consequentialist theories.' The main thesis of this essay is that traditional New Zealand Maori ethics is a virtue ethics. Our argument for this thesis is composed of three distinct, though frequently intertwined, strands. Descriptively we argue that a virtue ethics model is a fruitful one for understanding the nature of Maori ethics. Comparatively we argue that Maori ethics displays important similarities (and dissimilarities) when compared with other examples of virtue ethics, such as the Aristotelian tradition. Metaethically we argue that qua instance of a virtue ethic, Maori ethics implies certain conceptions of the self as moral agent, of the nature and forms of moral education, and of the appropriate patterns of sociopolitical organization.

Business Ethics as Moral Imagination

Abstract: This chapter is from the first article that I wrote on moral imagination in the late 1980s. I originally wrote it as a commentary on a Ruffin Lecture at the Darden School of the University of Virginia. It is probably one of the earliest articles on the subject in business ethics, because it was published prior to Mark Johnson’s book, Moral Imagination: Implications of Cognitive Science for Ethics (1994) and Patricia Werhane’s Moral Imagination and Management Decision Making (1999). To write it, I mostly drew mostly from literature in philosophy. After teaching business ethics in business schools, I became interested in ways to stimulate my students’ imaginations that went beyond the usual use of case studies. I stumbled on to psychologist Bruno Bettelheim’s book on fairy tales, The Uses of Enchantment, which was really about the development of ethics in children. His discussion of fairy tales offered an enjoyable way to examine role of imagination in ethics. I later wrote several other articles that developed my views on moral imagination, including the one in the next chapter.

A Basic Unit on Ethics for Technical Communicators.

Abstract: To make informed decisions about ethical issues, technical communicators need to understand how to apply general ethical principles to the kinds of dilemmas they will face routinely, concerning such issues as plagiarism, trade secrets, and misrepresentation of text and graphics. This article reviews the controversy about the relationship between ethics and rhetoric among the Greeks, provides basic definitions of ethics, and applies the literature of business and professional ethics to the concerns of technical communicators and other professionals who communicate, showing how they must think through the conflicts of obligations to their employer, the public, and the environment. It provides a case study that can be used to reinforce a student's understanding of the relationship between technical communication and ethics.