Background: In the globalizing world, nurses often meet humans from different cultures and values. This fact has led them to make ethical decisions, which do not comply with their own moral jurisdictions at care setting.
Objectives: The objective of the study was to investigate the relationships between moral development levels of the nurses and their scores of nursing principled thinking and practical consideration during decision making for ethical dilemmas.
Methods: This was a descriptive correlational study. Nursing Dilemma Test, Moral Development Scale for Professionals and socio-demographic form were used. Study was conducted with 227 nurses.Ethical considerations: An institutional authorization, an ethics approval from non-interventional ethics committee of the respective university, permission from the authors of the scales used and informed consents from the nurses were obtained in order to conduct the study.
Results: In this study, nurses were found to be at post-conventional level according to Kohlberg's moral development theory. Sociodemographic and working characteristics of the nurses have not affected their scores of moral development level and their scores of nursing principled thinking, practical consideration and familiarity (p?>?0.05). Nurses take attention for moral principles during decision making although not at a desirable level, and they are relatively affected by environmental factors.
Conclusion: Although nurses are familiar with ethical problems at scenarios including ethical dilemmas, they cannot make decisions in accordance with their moral development levels during decision making for ethical dilemmas. Nurses should be instructed and supported for ethical decision making by recognizing factors that may be effective on their decision making.
This book examines the ethics of end of life care, focusing on the kinds of decisions that are commonly made in clinical practice. Specific attention is paid to the intensification of treatment for terminal symptoms, particularly pain relief, and the withdrawal and withholding of care, particularly life-saving or life-prolonging medical care. The book is structured into three sections. The first section contains essays examining end of life care from the perspective of moral theory and theology. The second sets out various conceptual terms and distinctions relevant to decision-making at the end of life. The third section contains chapters that focus on substantive ethical issues. This format not only provides for a comprehensive analysis of the ethical issues that arise in the context of end of life care but allows readers to effectively trace the philosophical, theological and conceptual underpinnings that inform their specific interests. This work will be of interest to scholars working in the area as well as clinicians, specialists and healthcare professionals who encounter these issues in the course of their practice.
This insightful study examines the deeply personal and heart-wrenching tensions among financial considerations, emotional attachments, and moral arguments that motivate end-of-life decisions.
America’s health care system was built on the principle that life should be prolonged whenever possible, regardless of the costs. This commitment has often meant that patients spend their last days suffering from heroic interventions that extend their life by only weeks or months. Increasingly, this approach to end-of-life care is coming under scrutiny, from a moral as well as a financial perspective. Sociologist Roi Livne documents the rise and effectiveness of hospice and palliative care, and growing acceptance of the idea that a life consumed by suffering may not be worth living.
Values at the End of Life combines an in-depth historical analysis with an extensive study conducted in three hospitals, where Livne observed terminally ill patients, their families, and caregivers negotiating treatment. Livne describes the ambivalent, conflicted moments when people articulate and act on their moral intuitions about dying. Interviews with medical staff allowed him to isolate the strategies clinicians use to help families understand their options. As Livne discovered, clinicians are advancing the idea that invasive, expensive hospital procedures often compound a patient’s suffering. Affluent, educated families were more readily persuaded by this moral calculus than those of less means.
Once defiant of death—or even in denial—many American families and professionals in the health care system are beginning to embrace the notion that less treatment in the end may be better treatment.
L'ouvrage aborde des problèmes majeurs de l'éthique médicale actuelle. Il constate que dans le cadre de la santé, pour régler les conflits, on a besoin de recourir à une diplomatie : respectueuse de la loi, l'éthique ne se réfère pas, comme les morales et les religions, à des valeurs transcendantes. S'appuyant sur divers exemples - le sang, les machines - l'auteur montre comment l'éthique médicale affronte des situations dans lesquelles la rationalité ne peut que composer avec des éléments d'ordre symbolique.
Sont abordés également quelques problèmes posés par la robotique et l'informatique : loin de les proscrire, on cherche à leur trouver une juste place à l'intérieur d'un nouvel humanisme.
This paper argues that healthcare aims at the good of health, that this pursuit of the good necessitates conscience, and that conscience is required in every practical judgement, including clinical judgment. Conscientious objection in healthcare is usually restricted to a handful of controversial ends (e.g. abortion, euthanasia, contraception), yet the necessity of conscience in all clinical judgements implies the possibility of conscientious objection to means. The distinction between conscientious objection to means and ends is explored and its implications considered. Based on this, it is suggested that conscientious objection, whether to means or ends, occurs when a proposed course of action comes into irreconcilable conflict with the moral principle 'do no harm'. It is, therefore, concluded that conscientious objection in healthcare can be conceived as a requirement of the moral imperative to do no harm, the right to refuse to harm in regard to health.
This paper revisits Ronald Dworkin's influential position that a person's advance directive for future health care and medical treatment retains its moral authority beyond the onset of dementia, even when respecting this authority involves foreshortening the life of someone who is happy and content and who no longer remembers or identifies with instructions included within the advance directive. The analysis distils a eudaimonist perspective from Dworkin's argument and traces variations of this perspective in further arguments for the moral authority of advance directives by other authors. It then critiques a feature of the eudaimonist perspectives within these arguments-namely, the position that dementia has a retroactive negative impact on what a person has previously valued-and challenges the commonly held assumption underlying them that a person's life and well-being have relatively low value beyond the onset of dementia. Although advance directives have moral authority as a means of guiding one's future health care, accounts that dismiss the value of the lives and well-being of people living with dementia should be questioned to the extent that such accounts are used to support the moral authority of advance directives stipulating measures to foreshorten individuals' lives.
Implementing uncontrolled donation after circulatory determination of death (uDCDD) in the United States could markedly improve supply of donor lungs for patients in need of transplants. Evidence from US pilot programs suggests families support uDCDD, but only if they are asked permission for using invasive organ preservation procedures prior to initiation. However, non-invasive strategies that confine oxygenation to lungs may be applicable to the overwhelming majority of potential uDCDD donors that have airway devices in place as part of standard resuscitation. We propose an ethical framework for lung uDCDD by: (a) initiating post mortem preservation without requiring prior permission to protect the opportunity for donation until an authorized party can be found; (b) using non-invasive strategies that confine oxygenation to lungs; and (c) maintaining strict separation between the healthcare team and the organ preservation team. Attempting uDCDD in this way has great potential to obtain more transplantable lungs while respecting donor autonomy and family wishes, securing public support, and enabling authorized persons to affirm or cease preservation decisions without requiring evidence of prior organ donation intent. It ensures prioritization of life-saving, the opportunity to allow willing donors to donate, and respect for bodily integrity while adhering to current ethical norms.
L’auteur Jacques Brotchi retrace, dans un dialogue avec sa petite-nièce, l’évolution de la notion d’euthanasie et ses implications morales en Belgique et ailleurs. Avec clarté et délicatesse, il explique dans quelles circonstances chacun peut bénéficier du droit de choisir sa n de vie et partir dans l’apaisement et la dignité.
Although lay notions in normative ethics have previously been investigated within the framework of the dual-process interpretation of the terror management theory (TMT), meta-ethical beliefs (subjective vs. objective morality) have not been previously investigated within the same framework. In the present research, we primed mortality salience, shown to impair reasoning performance in previous studies, to see whether it inhibits subjectivist moral judgments in three separate experiments. In Experiment 3, we also investigated whether impaired reasoning performance indeed mediates the effect of mortality salience on subjectivism. The results of the three experiments consistently showed that people in the mortality salience group reported significantly less subjectivist responses than the control group, and impaired reasoning performance partially mediates it. Overall, the results are consistent with the dual-process interpretation of TMT and suggest that not only normative but also meta-ethical judgments can be explained by this model.
Background: The public's attitudes to conscientious objection (CO) are likely to influence political decisions about CO and trust towards healthcare systems and providers. Few studies examine the public's attitudes in an in-depth way.
Methods: Six hypotheses about public attitudes to CO were devised and a questionnaire designed in order to test them. A total of 1617 Norwegian citizens completed the online questionnaire.
Results: Support for toleration of CO was strongest in the case of ritual circumcision of infant boys, lower for assisted dying and abortion. Attitudes to the procedure itself negatively predicted attitudes to CO for the procedure. Respondents were more accepting of CO to performing abortion than of CO to referrals for abortion. There was stronger support for CO as an outcome of local pragmatic arrangements than for CO as a statutory right.
Conclusions: Instead of viewing CO as a "moral safety valve" or minority right which is due also to those with whom we disagree strongly, a portion of the public approaches the issue from the angle of what moral attitudes they deem acceptable to hold. The gap between this approach on the one hand and human rights principles on the other is likely to give rise to tensions in political processes whenever policies for CO are negotiated.
This study examined the relationship among religiosity, morality, and fear of death. Students (n = 328, 75% women, Mage = 18.9) completed measures of fear of death, frequency of immoral behavior, discrepancy between ideal and actual religious practices, strength of religious beliefs, views of God as punishing or forgiving, and behavior efficacy (the extent to which fate in the afterlife was perceived to be determined by behavior in this life). Frequency of immoral behavior was not related to fears of death, but both strength of religious views and behavior efficacy were negatively correlated with fears of death. In contrast, perceived failure to live up to religious standards was associated with more death anxiety, especially among those with punishing views of God. These findings support the idea that some aspects of religion can help protect people from death anxiety, whereas other aspects of religion can exacerbate fears of death.
In choosing to do certain things, we appear to presuppose that we can act in the interests the dead, and that we have a duty to do so. For example, some of us go to great lengths to carry out their final wishes. Given that the dead no longer exist, however, it seems that nothing can be good or bad for them: they lack prudential interests. In that case, it is hard to see how we could owe them anything. They seem to lack moral standing altogether. In this essay, I will rebut this line of thought. I will claim that in some cases things that happen after people die are indeed good or bad for them. Their interests can still be advanced or hindered, so the dead have moral standing.This article is part of the theme issue 'Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.
There has been contentious debate over the years about whether there are morally relevant similarities and differences between the three practices of continuous deep sedation until death, physician-assisted suicide, and voluntary euthanasia. Surprisingly little academic attention has been paid to a comparison of the uses of these practices in the two types of circumstances in which they are typically performed. A comparative domains of ethics analysis methodological approach is used in the paper to compare 1) the use of the three practices in paradigm circumstances, and 2) the use of the practices in paradigm circumstances to their use in non-paradigm circumstances. The analytical outcomes suggest that a bright moral line cannot be demonstrated between any two of the practices in paradigm circumstances, and that there are significant, morally-relevant distinctions between their use in paradigm and non-paradigm circumstances. A thought experiment is employed to illustrate how these outcomes could possibly inform the decisions of hypothetical deliberators who are engaged in the collaborative development of assisted dying regulatory frameworks.
Le philosophe anglais aborde plusieurs questions éthiques à propos de la vie et de la mort des hommes notamment l'avortement, l'infanticide, le suicide, l'euthanasie. Il analyse également les conditions pouvant légitimer ces pratiques et ces choix.
The provision of medically administered nutrition and hydration (MNH) for the terminally ill patient is a controversial issue and there has been much debate in the literature concerning this sensitive subject. This article reports on a qualitative research study that explores palliative care nurses' and doctors' perceptions and attitudes to patient nutrition and hydration at the end of life. Participants were from an urban and rural palliative care service. Three main discourses were identified: carers' distress at the non-provision of MNH; palliative care doctors' and nurses' position that terminal dehydration lessened the burden of suffering for dying patients; and polarisation between the acute care setting and the palliative care setting. Overlaying these three main discourses are contesting discourses involving cure vs comfort, and acute care vs palliative care. Importantly, the findings of this study reveal that palliative doctors and nurses believe that medically assisted nutrition and hydration at the end stage of life rarely benefits patients, and as long as adequate mouth care is given, patients do not suffer. However, family members do experience emotional distress in dealing with this situation. In caring for dying people, the nurse's and doctor's role is one of education and communication, involving a team approach to manage this difficult issue.
La fin de vie est traversée d’enjeux complexes, croisant questions éthiques, relations sociales et logiques de professionnalité. Les auteurs ont rappelé l’importance des contextes de conscience de la fin de vie et la manière dont ceux-ci influaient directement sur l’état d’esprit du mourant comme sur l’ambiance collective dans les milieux de la santé. Contextes de conscience fermés, ouverts, de suspicion ou de simulacre mutuel, tous infléchissent tant la façon de vivre la mort qui s’en vient que la nature des soins et la manière de les délivrer. Les auteurs présentent, ce faisant, une conceptualisation substantielle de la conscience de la fin de vie au moyen d’une discussion théorique en élaboration conforme à leur parti pris de théorisation ancrée.
[Adapté du 4e de couv.]
La sédation palliative peut être clairement et universellement définie comme une intention d'endormir les patients dans un sommeil léger ou profond de manière temporaire et délibérée. Elle ne doit pas causer la mort délibérément avec des patients en phase terminale et avec des symptômes spécifiques réfractaires. L'auteur étudie les arguments éthiques de la sédation palliative qui posent débat telle que la définition du "symptôme réfractaire" ou les principes de l'autonomie.
ADSP consacre son dossier central à l'éthique dans l'environnement sanitaire. La réflexion des auteurs porte sur l'éthique et les pratiques médicales et sociales, d'une part et sur les enjeux pour demain, d'autre part.