BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for (...) people with intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level.ResultsAccording to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.ConclusionsConcretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences. (shrink)

Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally (...) at stake for nurses who undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is defined by a profound sense of responsibility, shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded. (shrink)

ABSTRACT In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of (...) the moral experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached. (shrink)

In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the (...) moral experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions?In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached. (shrink)

This book addresses a seemingly marginal and as yet sparsely discussed policy problem that turns out to open a window into longstanding debates at the very heart of normative ethics, metaethics, and practical rationality more broadly: Should we contact the last uncontacted peoples? Over the course of this book, I will explore grounds for three responses to this question: yes, no, and rejecting the question. First, I aim to show that even though the case of uncontacted people stirs up (...) some hard problems for theories of justice and well-being, they still warrant a presumption in favour of intervention: It seems that we would have similar duties towards uncontacted people as we are regularly taken to have towards contacted people similarly placed – if being contacted would be good for them. And it looks as though it would be, based on considerations of welfare more broadly and reasons of autonomy in particular. Still, intuitively there seems to be a strong presumption against intervention – or so widely accepted policies of non-intervention would suggest. I go on to explore two options for why intervention may be wrong overall: It may turn out to be harmful or impermissibly risky upon closer inspection of contingent circumstances; or it may be that extinguishing uncontacted cultures is bad independently of the interests of those living in them. Two further options challenge the viability of the question: I consider whether the case of uncontacted peoples undermines the very bases of our moral judgments, perhaps instantiating what Bernard Williams sought to capture with the idea of a relativism of distance. Lastly, I address whether the question of one’s self-interest in this matter challenges practical rationality more fundamentally by being a transformative choice or one between incomparable options. (shrink)

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 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. (shrink)

Resumen: Las cambiantes relaciones entre seres humanos y árboles en los relatos de los habitantes cordilleranos del sur de Chile invitan a revisar los límites de la comunidad moral para incluir en ella a los seres con que se convive y de los que se depende. La presencia de prácticas mapuches cordilleranas de largo aliento junto con las transformaciones experimentadas por las poblaciones madereras y los relatos de las personas que explotaron los árboles nativos se encarnan en conversaciones que (...) invitan a reformular el vínculo con la naturaleza, tomando como referencia la pluralidad de experiencias locales. Estas voces cordilleranas convergen con aquellas orientaciones filosóficas que reconocen al ser humano como parte y no como centro de un entramado vital de mayores y más complejas dimensiones, a la vez que, en un sentido práctico, con la urgencia de generar respuestas que resguarden la naturaleza y que garanticen la inclusión social y la convivencia intercultural.: The changing relations between human and trees open opportunities in the narratives of the south Andean residents to expand the moral duties towards those beings upon whom humans depend and with whom they live. The existence of long lasting Mapuche cultural practices in the mountainous areas along with the transformations of timber towns and the narratives of people who exploited the native trees in those territories prompt a reshaping of the link with nature by means of the creation of moral duties based upon the diversity of local experiences. Such an alternative coincides with those philosophical orientations that recognize humans as part and not as the center of a vital patchwork. At the same time, it relates to the need of alternatives to preserve nature while guaranteeing social inclusion and intercultural coexistence. (shrink)

BackgroundSerious ethical problems have been anecdotally identified in the care of children with osteogenesis imperfecta (OI), which may negatively impact their moral experiences, defined as their sense of fulfillment towards personal values and beliefs.Research aimsTo explore children’s actual and desired participation in discussions, decisions, and actions in an OI hospital setting and their community using art-making to facilitate their self-expression.Research designA focused ethnography was conducted using the moral experiences framework with data from key informant interviews; participant (...) observations, semi-structured interviews, and practice-based research (art-making) with 10 children with OI; and local documents.Participants and research contextThe study was conducted at a pediatric, orthopedic hospital.Ethical considerationsThis study was approved by McGill University Institutional Review Board.Findings/resultsChildren expressed desires to participate in their care, but sometimes lacked the necessary resources and encouragement from healthcare providers. Art-making facilitated children’s voice and participation in health-related discussions.ConclusionsHealthcare providers are recommended to consider the benefits of art-making and educational resources to reduce discrepancies between children’s actual and desired participation in care and promote positive moral experiences. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Bad, the Ugly, and the Need for a Position by PsychiatryLloyd A. Wells (bio)Keywordsvice, psychiatric education, psychiatry-law interface, medicalizationSadler’s paper is thought provoking and will resonate with many psychiatrists who deal with the interface of vice and psychiatric syndromes. This interface and the dilemmas it poses are perhaps most discussed by residents, who are dealing with the issue for the first time and who often debate what is (...) “psychiatric” about these cases. Many residents have their own informal systems of classifying vice, often with a divide between the criminal population and those perceived as avoiding work and responsibility. These unofficial classifications are usually judgmental and often pejorative, but the residents rarely get much help from faculty in this area. Indeed, many of the faculty have equally judgmental and pejorative views, which are neither systematized nor subject to systematic analysis.By clarifying the importance of the issue of the vice–mental disorder relationship (VMDR) to psychiatry, Sadler may move this topic to one that receives Socratic discourse in our training programs and serious consideration in the training of psychiatrists rather than an idiosyncratic lumping of these patients into the broad category of “patients I don’t like.”Sadler asks for comments in several categories: historical intractability, goals of psychiatry, taxonomy, implications for the criminal justice system, implications for the law, and ethical/political implications.Issues of historical intractability are long standing. In A Tour of the Whole Island of Great Britain, written in the early eighteenth century, Daniel Defoe (1724–1727) describes many asylums, often with the comment, “as it is a madhouse, so is it also a house of correction.” Some of the great public hospitals of the seventeenth and eighteenth centuries were built at least as much to get antisocial and homeless people off the streets as to provide care for the mentally ill. The moral treatment of France and Great Britain, which added much to the practice of psychiatry, clearly had punitive “treatments” for patients with vice-laden behaviors, and this was very explicit in the American moral model of treatment of the late nineteenth century with its obsessive need to prevent patients from masturbating. In the nineteenth and early twentieth centuries, there was great debate about the inclusion of Pritchard’s “moral insanity”—now sanitized into “personality disorders”—into the psychiatric domain, and Kraepelin referred to this group as “enemies of society.”Sadler next asks us to consider the goals of psychiatry in regard to “a proper VMDR.” He wonders [End Page 43] whether a strict medicalization account can be defended. I think it is clear from a large literature and from clinical experience that it cannot be defended —now. But it may become defensible in this century, which will pose enormous challenges to psychiatry, lawmakers, and the courts (vide infra). A strict moralization model is defended by many in society, including some psychiatrists, but has severe limitations and seems illogical. It is hard to make a case (though juries have done so) that, for example, a very delusional young woman with postpartum psychosis who murders her children because of the belief that far worse things than death will happen to them imminently if they live, fits the moralization approach. The Dahmer case is especially instructive. Although there was enormous “vice” (and perhaps “evil”), it is hard to make a case that a sane man would make temples out of the body parts of victims and would attempt to commune with the dead through them.He wonders whether a “mixed” version of medicalization/moralization can be developed and defended. I would argue for both a mixed approach and a “shared” approach. A middle adolescent with bipolar disorder burned his house to the ground. (Fortunately, he and family members were injured but not killed.) He was wildly manic at the time and set the fire because he wanted to prove that he was immortal and totally impervious to flames. He was delusional, extraordinarily impulsive, and completely without judgment, and it would be extraordinarily difficult to exclude the medical frame in any consideration of the vice involved. The vice, indeed, may be more involved in his decision while euthymic to stop taking... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Instinct of Nature: Natural Law, Synderesis, and the Moral SenseRobert A. Greene“Instinct is a great matter.”—Sir John FalstaffThis essay traces the evolution of the meaning of the expression instinctus naturae in the discussion of the natural law from Justinian’s Digest through its association with synderesis to Francis Hutcheson’s theory of the moral sense. The introduction of instinctus naturae into Ulpian’s definition of the natural law by Isidore (...) of Seville in the seventh century posed a problem of definition for medieval commentators. Some said that it meant a universal and providential natura naturans; some defined it as the urge to self and species preservation in animals, degenerating in man into sensual and shameful impulses; some advanced the humanistic and paradoxical notion that it referred to a unique exercise of human reason in coming to know the natural law. The contemporaneous revival in the twelfth century of St. Jerome’s puzzling new term “synderesis,” and its gradual definition as the immediate apprehension of the first practical moral principles of the natural law, brought the two terms into proximity and loose association.A half-century later St. Bonaventure made explicit what had remained latent in the thinking of Thomas Aquinas by relocating synderesis in the affective rather than the intellectual part of man’s nature. Accordingly the moral discoveries of synderesis came to be spoken of as not only non-discursive but instinctive in nature—apprehensions for which no reason could be given, apprehensions somehow rooted in affective human experience. During the bilingual early modern period an increasingly secularized, internalized, and reified instinctus [End Page 173] naturae, together with its abbreviated vernacular cognate, “instinct,” came to serve as a substitute and synonym for the obsolescent synderesis. Edward Herbert’s attention to instinctus naturae in his De Veritate (1624), Sir Matthew Hale’s speculations about the place of rational instinct in the natural law, and Francis Hutcheson’s theory of a moral sense all exemplify this semantic legacy.The first entry in Justinian’s Digest has had a disproportionate influence on later speculation about the natural law. It begins a chapter that gives pride of place to general definitions of justice, law, jus naturale and jus gentium, and it is drawn from the writings of the Roman jurisconsult Domitius Ulpianus (d. 223), whose work constitutes forty percent of the Digest. Ulpian defines the natural law, with insistent repetition, as that which nature has taught to, or is common to, all animals:Jus naturale is that which nature has taught to all animals; for it is not a law specific to mankind but is common to all animals—land animals, sea animals, and the birds as well. Out of this comes the union of man and woman [male and female] which we call marriage, and the procreation of children, and their rearing. So we can see that the other animals, wild beasts included, are rightly understood to be acquainted with this law. Jus gentium, the law of the nations, is that which all human peoples observe. That it is not coextensive with natural law can be grasped easily, since this latter is common to all animals whereas jus gentium is common only to human beings among themselves. 1Justinian’s compilers gave Ulpian’s definition striking prominence at the beginning of the Digest and then in the same short chapter quoted the incompatible and more traditional definitions of his contemporaries Gaius and Paulus. They confined the operation of the natural law to mankind and spoke of reason as its source. 2 The compilers had been charged to eliminate just such conflicts; yet here at the very outset they set a conundrum that perplexed commentators [End Page 174] and invited explanation from Isidore of Seville to Hugo Grotius. Their selection of quotations suggests that as lawyers they regarded such general definitions as “for legal purposes no more than ornament to discussion.” 3 For those of a more speculative bent, however, the dilemmas could not have been more fundamental. How was the natural law to be defined in relation to those appetitive and self-preservative urges that man seemed to share with animals? Or did the term law apply only... (shrink)

The authors’ aim is to bring to the attention of readers the inadequacies of care for people in Hungary who are terminally ill. They believe that both objective and subjective factors cause these inadequacies. Most of these factors arise from moral dilemmas that could be eased or even solved if ethics education had a much more prominent place in the nursing curriculum. Even if nurses would not become automatically better persons morally, a much wider knowledge of medical/nursing ethics (...) could significantly improve nursing care both before and at the end of life. Although the article is also critical of the nursing care provided, it is not its purpose to make any generalizations. The study utilized selected passages from essays written by 76 practicing nurses on their personal experience of ethical dilemmas in their work environment, and a questionnaire administered to 250 students (registered nurses and health care students) studying for a college degree. This article is written by two authors who have formed an unusal alliance: a registered nurse with 29 years’ experience of bedside nursing, but who is currently a teacher of nursing ethics at a local health college, and a lawyer turned bioethicist. (shrink)

There has been an increase in recent years in the use of empirical methods in healthcare ethics. Appeals to empirical data cannot answer moral questions, but insights into the knowledge, attitudes, experience, preferences and practice of interested parties can play an important part in the development of healthcare ethics. In particular, while we may establish a general ethical principle to provide explanatory and normative guidance for healthcare professionals, the interpretation and application of such general principles to actual (...) class='Hi'>practice still requires interpretation and judgement. And many situations in healthcare practice are complex and may involve a variety of principles, each of which may conflict with the others. Simple surveys or interview studies may not be sufficient if we wish to develop a nuanced approach to ethical practice that can be set out in guidelines, codes or directives. We do not resolve moral questions by plebiscite. In this paper, the authors argue for the use of consensus methods to develop shared understanding of ethical practice, and they argue further for the combination of the Delphi method with the use of vignettes to illustrate the kind of situations that may occur in practice. They develop their argument in part by reference to their experience of using this approach in their recent research. (shrink)

Child sexual exploitation and abuse has grave implications for the mental health and wellbeing of children and young people. It has been linked to a wide range of difficulties which may extend into adulthood. School-based prevention programs that aim to raise awareness are popular, however, have historically lacked robust and consistent evaluation. The purpose of the present study was therefore to explore young people’s experiences of attending a school-based theater-in-education program, and the impact this had on their (...) awareness and understanding of CSEA. Four focus groups of between four to six participants each were conducted with young people from two co-educational State schools in the United Kingdom. The approach of Template Analysis was used to analyze the data, and revealed a number of themes related to the superordinate themes of “Information and Detail Delivered” and “Format and Timing.” The results suggest that participants gained new awareness and understanding of aspects related to CSEA, including other forms of exploitation, as well as how to avoid harm and what to do “if bad things happen.” Participants further reported that the theater performance/live element of the program was particularly impactful, feeling that this was delivered to them at the right time, but suggesting that younger people would also benefit from the important messages. In addition, areas for improvement were identified in terms of the delivery of the program, and the issue of victim blaming. Findings are discussed with a view to practical implications and directions for future research. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral (...) case deliberation, healthcare professionals bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

This paper questions the assumption of the bulk of Western philosophy that reasoning in general, and moral reasoning in particular, can be undertaken without any consideration of the unique cultural experiences of those who engage in it. It proposes a communitarian alternative for thinking about subjecthood. It further contends that there is need for professional African philosophers to assist their people in the quest for solutions to current pertinent socio-economic challenges facing them.

Following the trend of sharing, and associating being on-line with being 'on-life', many people are now demanding the ownership and control of their data across all processing phases, including the erasure of their presence on the web. In Europe, recent proposals for regulation include an explicit 'Right to be Forgotten'; this right stated in the European Commission Proposal for Regulation COM 2011/12 does not emerge without controversy. It is being criticised on several grounds, including clashing with other rights, such (...) as freedom of expression, as well as setting the terrain for censorship. Besides the purely legal aspects of the proposed provisions, the chapters of this volume discuss how those legal provisions correspond in practice to worldviews and how individual and collective memory must be governed. They look into the deeper consequences of such provisions to construction of identity, culture and community formation, and how such a right affects how, what and why individuals, groups and societies remember and forget. (shrink)

In this project I claim that Dewey's version of pragmatism leads to an approach to identifying and addressing conflicts between human and nonhuman interests which help bridge the gap between practice and theory in environmental ethics. I claim that traditional arguments in environmental ethics often give little or no guidance to resolving conflicts faced by those involved with environmental practice. After describing traditional arguments in environmental ethics, I argue that Dewey's philosophy offers an alternative to those arguments which (...) gives direction to practitioners for resolving conflicts so that all parties to a conflict "grow" as a result of the conflict. ;In my examination of Dewey's philosophy I focus on the notions of inquiry, experience, growth, the idea of character in moral judgment, and Dewey's concept of the "good". I show how the focus which comes from an examination of those concepts directs us to focus on particular difficulties faced by particular people as they move around in their lives and come in conflict with different views, their own and others, about what is the "right" course of action. I also show how a Deweyan approach to environmental ethics lends support to major claims of the ecofeminists. (shrink)

This paper takes a virtuist approach to medical ethics to explore, from an empirical angle, ideas about settled ways of living a good life. Qualitative research methods were used to analyse the ways in which a group of 15 general practitioners articulated notions of good doctoring and the virtues in their work. I argue that the GPs, whose talk is analysed here, defined good general practice in terms of the ideals of accessibility, comprehensiveness, and continuity. They regarded these ideals (...) significant both for the way they dealt with morally problematic situations and for how they conducted their professional lives more generally. In addition, I argue that the GPs who articulated these ideals most clearly were able to, in part, because they shared the experience of working in rural areas. This experience helped them to develop an understanding of the nature of general practice that their urban colleagues were less able to draw on. In that sense, the structural and organisational framework of general practice in rural areas provided the context for their understanding of ideals in general practice. (shrink)

Conducting phenomenological research for dissertations can be an involved and challenging process, and writing it up is often the most challenging part. How to Write a Phenomenological Dissertation gives students practical, applied advice on how to structure and develop each chapter of the dissertation specifically for phenomenological research. Phenomenology is about personal experience and personal experience varies from researcher to researcher. However, this variation is a big source of confusion for new researchers in the social, behavioral, or health sciences. This (...) brief text is written in a simple, step-by-step fashion to account for this flexibility and variation while also providing structure necessary for a successful dissertation. Broken up into chapters that follow each chapter of the dissertation, this text logically addresses the various parts of phenomenological research, starting with ensuring phenomenology is the right method for your research, writing the literature review, going through methods and results sections to analysis and discussion. The author, using experience gleaned from supervising phenomenological dissertations for many years, gives time-tested advice on how structure the dissertation to fit into more common frameworks, using checklists and tables throughout. Each chapter includes a list of helpful resources for students to use alongside this book with specific information on methods and research. Unique to this text is a chapter on creating your own phenomenological method which allows students to expand their viewpoints and experiment in future studies after the dissertation. (shrink)

The author, head of a teaching hospital surgical unit, argues that the medical curriculum must ensure that all students are exposed to a minimum of ethical discussion and decision-making. In describing his own approach he emphasises the need to show students that it is 'an intensely practical subject'. Moreover, he reminds them that moral dilemmas in medicine--perhaps a better term than medical ethics--are unavoidable in clinical practice. Professor Johnson emphasises the need for small group teaching and discussion of (...) real cases, preferably chosen and 'worked up' by individual students. He suggests that ethical issues could profitably be introduced into written, oral and clinical examinations. (shrink)

1492. The American continent was drawing Europeans on. Some saw in it the chance of a utopia, others saw it as utopia already coming about, in its natural state. All at once two processes of domination were triggered: one supported by the force of arms, and the other by the power of ideas and beliefs. If the defenders of utopian thinking were able to create a lasting achievement, it is because they managed to make their ideas fit with the principles (...) governing the social life of the indigenous peoples: thus a substantial part of what remains from the period of Don Vasco de Quiroga had preceded it. Cultures will not be able to transcend nationalisms and rise to the level of concerns shared by the whole of humanity until they can stand up for their own particular character against ‘globalizing’ trends. (shrink)

In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This 'empirical turn' is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the (...) moral experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self-justification and bias and can increase the credibility of the RE reached. (shrink)

This work describes the perceptions that Industrial Engineering students have regarding Colombian firms’ corporate social responsibility (CSR) practices. It also explores the incidence of gender, academic level, work experience and entrepreneurial intention on students’ vision. A survey with 70 CSR practices was designed based on previous research. Practices were grouped in ten dimensions: shareholders, customers, employees, suppliers, stakeholders, ethics, environment, legal, human rights and society. A representative sample of 142 students was used. Results show that students perceive a higher commitment (...) of Colombian companies with the shareholders dimension, while a lower with the society, ethics and environmental CSR practices. Work experience and entrepreneurial intention are the only variables affecting the identified perceptions. Thus, as they gain experience, their perceptions become more favorable. On the other hand, potential entrepreneurs have a more critical view on the companies’ commitment. Additionally, the fact that the academic level does not impact students’ perceptions constitutes a challenge for the academic program, since it is expected that this will affect the vision of future engineers. This is the first study that evaluates perceptions of Industrial Engineering students, who, given their object of study, will be responsible for designing and managing production processes in organizations of the future. Results respond to a specific context (students at a Colombian public university), therefore further research to explore the subject is recommended. (shrink)

While the movement to ensure patient’s rights to information and informed consent spreads throughout the world, patient rights of this kind have yet to be introduced in mainland China. Nonetheless, China is no different from other parts of the world in that nurses are expected to shoulder the responsibility of safeguarding patients’ best interests and at the same time to uphold their right to information. This paper expounds on the principle of protectiveness grounded in traditional Chinese medical ethics concerning the (...) practice of informed consent. Nurses in China have a moral obligation to treat patients with sincerity. This notion carries a strong sense of parental protectiveness. As far as information-giving is concerned, nurses in China are ambivalent about the notion of truthfulness. The findings of an empirical study undertaken in seven Chinese cities reveal that nurses in China experience similar difficulties related to the disclosure of information as their counterparts in other parts of the world. A nurse’s narrative, the Chan case, is used to illustrate the typical difficult situation that nurses in China often encounter in looking after vulnerable patients who would like to learn more about their therapeutic regimens. The moral tension embedded in nursing practice is analysed. It is found that most nurses would prefer to tell the truth to patients, but their primary ethical justification is not that of respect for patients’ autonomy or safeguarding patients’ right to self-determination. Rather, it is basically beneficent in nature; that is, they base their decision to reveal the truth on whether or not patients will receive more relevant treatment and better nursing care. (shrink)

This paper presents a qualitative study investigating the application of physiotherapists’ professional ethics in practice with respect to touch, intimacy, and corporeality during therapy, based on the experiences of elderly patients. As the relationship in a physiotherapy session is multidimensional, the study considered three levels: physical contact, verbal contact, and the conditions in which the therapy took place. The aim of this study was to find out what values are of importance to older people during a physiotherapy (...) session, with emphasis on the categories of touch, corporeality, and intimacy. The studied group consisted of sixteen male and female physiotherapy patients aged between sixty-six and ninety-two years. The study was conducted according to the grounded theory methodology. The research material consisted of transcriptions of free targeted interviews, which were subjected to a process of coding and analysis. As a result of data analyses, three superior categories have been identified—safety, anxiety, interpersonal relationship—and three a priori categories stemming from the characteristic features of the study area—touch, corporeality, and intimacy. The a priori categories did not appear independently in statements made by the respondents, but instead seemed to be components of superior categories. The most important values indicated by the respondents concerned the interpersonal relationship with their physiotherapist and the feeling of safety and care. In terms of touch, corporeality, and intimacy, the respondents indicated, among others, the importance of predictability, a sense of security, privacy, and acceptance of the body. (shrink)

Different notions of objectivity support different notions of what is required for a moral value or obligation to be experienced as objective. If the objectivity of a property requires that it can exist even when we fail to notice its existence, then experiencing a property as objective will require that we imagine it appearing in some way that is not presently available to us. Explaining what that imagining involves is the central task of this paper. Defending the epistemic value (...) of such imagining is a secondary aim. (shrink)

Positive Psychology has turned its attention to the study of emotions in a scientific and rigorous way. Particularly, to how emotions influence people’s health, performance, or their overall life satisfaction. Within this trend, Flow theory has established a theoretical framework that helps to promote the Flow experience. Flow state, or optimal experience, is a mental state of high concentration and enjoyment that, due to its characteristics, has been considered desirable for the development of the performing activity of performing musicians. (...) Musicians are a population prone to health problems, both psychological and physical, owing to different stressors of their training and professional activity. One of the most common problems is Musical Performance Anxiety. In this investigation, an electronic intervention program was carried out for the development of psychological self-regulation skills whose main objective was to trigger the Flow response in performing musicians and the coping mechanism for Musical Performance Anxiety. A quasi-experimental design was used with a control group in which pre- and post-measures of Flow State, Musical Performance Anxiety and, also, Social Skills were taken. Sixty-two performing musicians from different music colleges in Spain participated in the program. Results indicated that the intervention significantly improved Flow State, and Sense of Control, and decreased Music Performance Anxiety, and self-consciousness of the participants in the EG but not CG. The changes in the EG after the program showed the inverse relationship between Flow and Anxiety. Two important theoretical factors of both variables, such as worry and the feeling of lack of control, could be involved. The results are under discussion and future lines of research are proposed. (shrink)

ART and, in particular, IVF and ICSI, are essentially a laboratory experiment, but which, due to its specificity, goes beyond the disciplinary boundaries, explicitly acquiring an ethical-axiological dimension in the interaction zone of the members of a particular community involved in child-bearing. At the same time, it is noted that the activity and choice of a way to solve problems with childbirth has a characteristic severity, due to the traditions and level of civil and social maturity of a country, due, (...) among other things, to the level and achievements of technical equipment in this industry of knowledge and practice. According to foreign studies, about half of all subfertile people in developed countries are trying to overcome their infertility with the help of medicine, and research data indicate that the proportion of such individuals is growing. The most difficult problems of reproduction are associated with low quality of oocytes or low ovarian reserve ; aspermia and deep teratozoospermia, can not give hope to a couple to have genetically related offspring. However, donor programs create additional opportunities for social motherhood / paternity. Donation of oocytes is found in ART programs at least 3 times more often than donation of spermatozoa. At the moment, donation of gametes and embryos raises a number of ethical, legal, medical and socio-psychological issues that require competent support from experts of a wide range of specialists, as well as competent, non-commercial, primarily due to the interaction between donors and recipients. The analysis of possible modifications of family and kinship ties is based on the idea of transforming social relations, in which assisted reproductive technologies play a fundamental role, building a system of “new kinship and new family.” By entering into the intimate process of the birth of life and acting as a regulator of the composition of participants in this process through the stimulation of responsibility to present and future relatives, reproductive technologies affect the initial moral requirements in the community, redefining universal values based on the specific situation. Scenarios of childbearing through ART with the involvement of additional participants are possible in the context of the legal field, but legally fixed anonymity of the donor leaves many unresolved issues related to the problems of hereditary diseases, genetic abnormalities and epigenetic changes; in addition, there is a problem associated with the possibility of unintentional incest, as well as the difficulties of the child’s self-identification and the closeness of his genealogy. Solutions to these issues are postponed until later, thereby initiating future dramatic situations, ethical conflicts and dilemmas with a poorly predictable positive outcome. (shrink)

The article discusses the long-term experience of humanitarian education and the formation of moral values of the medical profession at the Volgograd State Medical University. It is considered the activities of the University for development of professional and scientific research competencies of students in the interdisciplinary field of medical and social sciences. The material of scientific research conducted by students shows the process of internalization by them of humanistic models of healing, experience of empathy and compassion, internalization of bioethics (...) and medical law. The article substantiates the conclusion that the practice of educational and scientific work in the field of bioethics, the productive collaboration of teachers of humanitarian and medical disciplines, successful publishing, active participation in all international scientific and educational events in the field of biomedical ethics and healthcare law, allows us to recommend the experience of Volgograd State Medical University as a model for the formation of the social and humanitarian space of medical education for a university s of the Ministry of Health of Russia. (shrink)

Consciousness and confidence seem intimately related. Accordingly, some researchers use confidence ratings as a measure of, or proxy for, consciousness. Rosenthal discusses the potential connections between the two, and rejects confidence as a valid measure of consciousness. He argues that there are better alternatives to get at conscious experiences such as direct subjective reports of awareness (i.e. subjects’ reports of perceiving something or of the degree of visibility of a stimulus). In this chapter, we offer a different perspective. Confidence (...) ratings in general, and metacognitive measures in particular, may offer important advantages over subjective ratings. The arguments we offer here are supported by empirical, practical and socio-strategic considerations. However, we do not suggest consciousness and confidence are interchangeable. We recognize the limitations of confidence ratings in some experimental designs and for some research questions. Nevertheless, we also address a potential conceptual link between consciousness and confidence that stems from Rosenthal’s very own work on mental quality space theory. (shrink)

Euthanasia and physician-assisted suicide are controversial issues in medical ethics and medical law. In the debate, several arguments against the moral acceptability and legal feasibility of active involvement of physicians in bringing about a patient’s death can be found.One argument refers back to the Ten Commandments: “Thou shall not kill”. Killing another human being is morally abject. According to the argument, this is certainly so for medical doctors, as can be seen in the Hippocratic Oath, which explicitly forbids abortion (...) and euthanasia. A less apodictic argument refers to the slippery slope: if euthanasia would be permitted, a downhill movement is set in motion. The end of this movement would be, on the one hand, that physicians will feel forced to assist people who ask for termination of life on whatever grounds. On the other hand, it might lead to a situation in which it becomes normal to kill people who are no longer useful for society.In the literature and in the public debate, there are also arguments in favour of euthanasia and physician-assisted suicide. One such argument invokes the right to die. According to this argument, decisions concerning life and death should be up to the individual who is concerned. In many countries, suicide is morally and legally accepted. If people are allowed to kill themselves, why should they be without rights when they are no longer able to perform the act themselves?In medical ethics and medical law, patient autonomy is a central pivot. Patients have the right to refuse treatment even if this leads to their death. Shouldn’t people also have the right to determine the moment of dying, if they are in a situation which is unbearable, and without prospect of improvement? Another argument focuses on the duty of the physician to alleviate pain and suffering. If there is no other option, the doctor, in fulfilling this duty, should be allowed to actively end the patient’s life. This argument is not based on autonomy, but on beneficence.The debate concerning euthanasia involves fundamentally different moral principles. This makes the debate interesting, if not central to medical ethics and medical law. Yet, the principles are normally presented in an abstract way. Discussants stick to very general ideas, which lack reference to specific social and historical conditions, and are not related to concrete experiences. To invoke the Ten Commandments, or plea for a right to die, implies the use of universal standards, which tend to be general and empty.From a philosophical perspective, this type of argumentation can be criticized. Following Aristotle, ethics should be based upon experience. Ethical knowledge requires participation in concrete practices. Central to ethics is a feeling for the concrete situation, which is always contingent and historical. From this perspective, it makes sense to consider how practitioners in specific situations deal with moral issues, for instance concerning euthanasia. What role do they give to notions such as autonomy and beneficence, how do they interpret them and apply them to the concrete situation?In this paper I will present the Dutch experience with euthanasia. I will focus upon the way in which during the past thirty years the arguments in favour of euthanasia have been developed, in interaction with euthanasia practice. I will show that patient autonomy has been a crucial pivot. Yet, the Dutch interpretation of autonomy is not purely liberal. It does not only involve rights, but also obligations. Next, I will make clear that the physician plays a central role, in that the moral and legal basis of euthanasia is a conflict of duties on the side of the physician.This brings in the issue of beneficence. Yet the Dutch interpretation of the duty to help is not simply paternalistic. In Dutch health care, the physician-patient relationship is based upon deliberation and mutual agreement. Therefore, my conclusion will be that the Dutch practice of euthanasia has a moral ground, which goes beyond the traditional opposition between autonomy and beneficence. (shrink)

The book intends to interpret how different religions articulate their territories and manage the relationship with other religions, understanding systems and multiple everyday spaces, in a dynamic that is not only a component of contemporary reality, but is central to living it. The underlying thesis is that religion is the great geopolitical issue of our time, but an interpretation is only possible in terms of religious plurality and how ideas, symbolism, subjectivities and practices are incorporated in the daily life of (...) those who share the religious times and spaces, producing territorial identities and imaginary concrete cartographies as world projects. The volume has articles that focus on the religious space being gestated, expanded, contracted, celebrated or represented as a foundation for common life, as well as inter-religious conflicts arising in a world of diverse and differential coexistence. It is not a debate about classical geopolitics, but how geopolitical relations cross cultural-religious experience. (shrink)

In this paper, we explore the concept of bearing witness in nursing practice. We examine the description of bearing witness in the nursing literature, particularly that offered by William Cody who suggests that bearing witness results in the limited moral obligation of “true presence.” We then turn to Lorraine Code's work on testimony, drawing parallels between the concepts of testimony and bearing witness. Code suggests that receiving testimony results in a responsibility to respond, and that this is an (...) ethico‐political obligation. We discuss these ideas in relation to a Canadian exemplar of witnessing the Truth and Reconciliation Commission of Canada's work to understand and address the historical injustices done to Indigenous peoples in Canada. Here, we focus on the Commission's definition of witnessing and highlight the experience of Shelagh Rogers who served as an honorary witness. As an outcome of our analysis, we suggest that bearing witness in nursing practice is most usefully conceptualized as both a moral and a political obligation. Implications for nursing practice are suggested, including first, the need to critically examine our own understandings of power and privilege in order to authentically bear witness and avoid being complicit in injustice, and second, the concomitant responsibility to take action to challenge injustice once we have borne witness to it. (shrink)

virgilee's smile brightens the gloaming, some sunlight penetrates the low-lying clouds, but a persistent mist hides merchants from one another. She sweeps her arm around this eerie scene and conjures up the attraction of the Market. So many people learned about business here, their kids are now in business all over the City. You're free here; everybody is doing their own thing at their own pace. Folks working here want to be successful. At work you go by the other (...) guys' rules, you're free here for a few hours, like being out in the woods, you can come in the middle of the week and it's private here and people don't notice you, it's therapeutic like being in an oasis. You meet so many people it really is the melting... (shrink)

The idea of moral reform requires that morality be more than a description of what people do value, for there has to be some measure against which to assess progress. Otherwise, any change is not reform, but simply difference. Therefore, I discuss moral reform in relation to two prescriptive approaches to common morality, which I distinguish as the foundational and the pragmatic. A foundational approach to common morality (e.g., Bernard Gert’s) suggests that there is no reform of (...) morality , but of beliefs, values, customs, and practices so as to conform with an unchanging, foundational morality. If, however, there were revision in its foundation (e.g., in rationality), then reform in morality itself would be possible. On a pragmatic view, on the other hand, common morality is relative to human flourishing, and its justification consists in its effectiveness in promoting flourishing. Morality is dependent on what in fact does promote human flourishing and therefore, could be reformed. However, a pragmatic approach, which appears more open to the possibility of moral reform, would need a more robust account of norms by which reform is measured. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 25.2 (2001) 353-356 [Access article in PDF] Book Review The Metaphysical Club The Metaphysical Club, by Louis Menand; xii & 546 pp. New York: Farrar, Straus and Giroux, 2001, $27.00. "They didn't just want to keep the conversation going; they wanted to get to a better place" (p. 440). So much for the most prominent contemporary pragmatist, Richard Rorty, who remains unmentioned except in the acknowledgments. (...) That better place is participatory democracy (a phrase that does not appear in the book), which "means that everyone is equally in the game, but it also means that no one can opt out" (p. 441). The true name of the game is skeptical tolerance. There are no unquestionable duties or inalienable rights, no immutable natural laws, no absolute moral rules, no highest principles, no inherent virtues, no absolute standards, no stasis, no absolutely certain truth. There are no individual destinies, because the social comes before the individual, and the individual is embedded within and cannot exist without society. Scientific knowledge is always probabilistic, not necessarily because nature is indeterministic, but because we can never know enough to calculate its regularities if they exist. To wit, there are no Platonic Ideas or unchanging universals. All is change, nothing that happens is ever repeated, our general ideas and laws of nature are merely tools for getting along in the world. Above all, ideas do not refer to things, only to other ideas. What expedites our thinking is true. What expedites our acting is right. Whenever we act according to principle, rule, or law, we are making a bet that events will turn out the way [End Page 353] we think they will. If we keep this always in mind, we will never succumb to violence or war in the name of belief or principle. Whatever we believe, it could be otherwise. Such is a general summary of pragmatism as it has filtered down to the textbooks. It is (again befittingly) more or less accurate. The can-do American seeks out cash value in practical life.Oliver Wendell Holmes, Jr., William James, Charles Saunders Pierce, and John Dewey crafted the only indigenous philosophy that has so far been produced in America. Its roots are in Laplacean probability theory, Darwinian evolutionism, and Chauncey Wright's indeterminism. While James hoped to save a place for religion (if it works, go with it) and Pierce a place for God (he thought there had to be a designing intelligence to account for order), the pragmatic result is profoundly skeptical and secular. Neither Holmes nor Dewey thought that individuals imbedded in societies had any need of absolutes. Holmes said that people first decide on the basis of experience, then they deduce. Dewey said that people first behave commonsensically, then they rationalize.There is nothing as condensed as the above in Louis Menand's beautiful book on the ideas, personalities, and influence of Holmes, James, Pierce, and Dewey. I know of no clearer exposition of their ideas, and few biographers have made them come so alive. In particular, Menand's coverage of peripheral (but by no means insignificant) figures is very rich. He describes the development of graduate universities in America in detail from their autocratic beginnings to the institution of academic freedom as we know it today. University presidents, trustees, and administrators are presented luxuriously as the villains, and the professors gloriously as the heroes. Menand remarks with slight amazement that society bought the concept that professors were beholden to the public at large and not to the state or private university owners. He could have commented further on the fact that the concept of academic freedom has become virtually irrelevant in today's corporate research universities."It is a remarkable fact about the United States," Menand begins his book, "that it fought a civil war without undergoing a change in its form of government" (p. ix). This is a breathtaking fact, and I don't suppose Menand had any intent to explain it. "The Civil War swept away the slave civilization of the South, but it swept away almost the whole intellectual... (shrink)

Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the (...) CARE model provides a substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings. (shrink)

The picture of classical antiquity most of us learned in school is framed in certain ways -- glossing over misogyny while omitting the seeds of feminist resistance. Many of today's harmful practices, like school dress codes, exploitation of the environment, and rape culture, have their roots in the ancient world. But in Antigone Rising, classicist Helen Morales reminds us that the myths have subversive power because they are told -- and read -- in different ways. Through these stories, whether it's (...) Antigone's courageous stand against tyranny or the indestructible Caeneus, who inspires trans and gender queer people today, Morales uncovers hidden truths about solidarity, empowerment, and catharsis. Antigone Rising offers a fresh understanding of the stories we take for granted, showing how we can reclaim them to challenge the status quo, spark resistance, and rail against unjust regimes. (shrink)

The Deaf culture in the United States is a unique culture that is not widely understood. To members of the Deaf community in the United States, deafness is not viewed as a disease or pathology to be treated or cured; instead it is seen as a difference in human experience. Members of this community do not hide their deafness; instead they take great pride in their Deaf identity. The Deaf culture in the United States is very communitarian not individualistic. Mary (...) Beth and Dominic are a married couple in their late 20s who are genetically deaf. They are active members in the Deaf community and work as advocates for individuals who are deaf, family members of Deaf people and sign language interpreters who identify with the Deaf culture. Mary Beth and Dominic approach the fertility clinic with a request that they only want a child with the genetic gene for deafness. They would want the embryos that do not have the gene to be destroyed. This would entail creating a child who would have the gene for deafness. Medically and ethically, should the fertility clinic agree to the couple’s request? The authors argue that the couple's request should be denied and provide reasons for it from the perspectives of foundational and clinical ethics. (shrink)

Background:Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy.Objective:To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy.Setting:Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual disabilities.Methods:Ethnographic field study.Ethical (...) considerations:The boards representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee.Findings:Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.”Conclusion:Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Understanding and Experience of Compassion:Aquinas and the Dalai LamaJudith BaradHis Holiness the fourteenth Dalai Lama writes that the essence of Mahayana Buddhism is compassion.1 Although most people recognize compassion as one of the most admirable virtues, it is not easy to find discussions of it by Christian theologians. Instead, Christian theologians tend to discuss charity, a virtue infused by God into a person. Some of these theologians, (...) such as Cardinal Henri de Lubac,2 insist that Christian charity and Buddhist compassion are very different from each other. Are they correct? A good source to investigate this claim is in Aquinas's Summa Theologica, which contains a very developed discussion of charity. If we look at Aquinas's text and compare it to what the current Dalai Lama writes about compassion, we will recognize that they are discussing the same virtue. Moreover, by combining the insights from East and West, as expressed by the thoughts of the current Dalai Lama and St. Thomas Aquinas, we can achieve a better grasp of compassion so that we can more easily practice it in our daily lives. Though remarkably similar, the two accounts offer differing perspectives, which can be incorporated for mutual enrichment.Much of Aquinas's philosophy of compassion derives from his Christian beliefs, just as much of the Dalai Lama's teachings on compassion are based on Tibetan Buddhism. This explains some of the differences in their accounts. Unlike Christians, Buddhists neither believe in a personal God nor in a soul. Yet despite their theological differences, Aquinas and the Dalai Lama generally share a very similar view of compassion. In fact, one could well imagine Aquinas agreeing with the Dalai Lama who, after acknowledging his religious influence, writes that his goal is "to appeal for an approach to ethics based on universal rather than religious principles."3 It is appropriate, therefore, to begin by considering the similarities in their accounts of compassion, starting with their definitions of compassion. [End Page 11]DefinitionsEtymologically, the word "compassion"—compassio—comes from two Latin words: com means "with" and pati means "suffer." Literally, then, "compassion" means "to suffer with." Aquinas discusses compassion as an interior effect of charity, a theological virtue. It is interior because compassion is felt within the person who has charity. The cause of compassion, charity, Aquinas describes as the friendship between God's children and God Himself. Although Aquinas wrote prolifically on the subject of charity, someone could overlook his writing on compassion because he discusses it under the term "mercy." Diana Fritz Cates, for instance, who draws on an Aristotelian-Thomistic ethical framework to develop a theory of compassion, observes, "Aristotle and Thomas have little to say about compassion: hence, it will not be helpful to begin with their accounts."4 However, Aquinas uses the word misericordia (mercy) as a synonym of compassio (compassion). The synonymous relationship between compassion and mercy is also recognized by the Dalai Lama, who affirms, "Mercy and compassion are the same."5Aquinas defines mercy as "heartfelt sympathy for another's distress, impelling us to succor him if we can." If we experience this heartfelt sympathy, we're not discouraged if the person we try to help doesn't respond. Explicitly connecting mercy and compassion, Aquinas add that mercy, misericordia, gets its name "from denoting a person's compassionate heart (miserum cor) for another's unhappiness."6 The concept of "another's unhappiness" is important to his discussion. A necessary condition of being happy, in Aquinas's view, is that an individual must obtain what he or she wishes. Conversely, someone is unhappy when he suffers what he doesn't wish to suffer. Aquinas maintains that the suffering produced by one's frustrated desire for what he or she perceives as good is a sufficient condition for evoking mercy. In regard to the merciful response, it shouldn't matter what the suffering person perceives as good. So long as the person is suffering what he doesn't wish to suffer, this person should be treated mercifully. Suppose a teenager suffers from being unpopular with his peers. Although the compassionate person may not value popularity, she should extend compassion to the... (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are (...) dealing with professional boundary issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Intrinsic value and animal integrity are two key concepts in the debate on the ethics of the genetic engineering of laboratory animals. These concepts have, on the one hand, a theoretical origin and are, on the other hand, based on the moral beliefs of people not directly involved in the genetic modification of animals. This ‘external’ origin raises the question whether these concepts need to be adjusted or extended when confronted with the moral experiences and opinions (...) of people directly involved in the creation or use of transgenic laboratory animals. To answer this question, 35 persons from the practice of biomedical research who are directly involved in genetic engineering (scientists, biotechnicians, animal caretakers and laboratory animal scientists) were interviewed. They were asked to give their moral opinion on different aspects of the genetic engineering of animals and to react to statements about the concepts of intrinsic value and animal integrity. Analysis of the interviews showed that, contrary to what is often assumed, the respondents embraced these concepts, even those senses that (more) specifically apply to genetic engineering. And although the respondents raised some objections that go beyond issues of animal welfare, these objections could quite well be expressed in terms of the concepts of intrinsic value and animal integrity. In short, the results of the present study strongly suggest that these concepts do not have to be adjusted or extended in the light of the moral experiences and opinions from practice. (shrink)

Intrinsic value and animal integrity are two key concepts in the debate on the ethics of the genetic engineering of laboratory animals. These concepts have, on the one hand, a theoretical origin and are, on the other hand, based on the moral beliefs of people not directly involved in the genetic modification of animals. This ‘external’ origin raises the question whether these concepts need to be adjusted or extended when confronted with the moral experiences and opinions (...) of people directly involved in the creation or use of transgenic laboratory animals. To answer this question, 35 persons from the practice of biomedical research who are directly involved in genetic engineering (scientists, biotechnicians, animal caretakers and laboratory animal scientists) were interviewed. They were asked to give their moral opinion on different aspects of the genetic engineering of animals and to react to statements about the concepts of intrinsic value and animal integrity. Analysis of the interviews showed that, contrary to what is often assumed, the respondents embraced these concepts, even those senses that (more) specifically apply to genetic engineering. And although the respondents raised some objections that go beyond issues of animal welfare, these objections could quite well be expressed in terms of the concepts of intrinsic value and animal integrity. In short, the results of the present study strongly suggest that these concepts do not have to be adjusted or extended in the light of the moral experiences and opinions from practice. (shrink)

:In a recent paper in Cambridge Quarterly of Healthcare Ethics on the necessary conditions for morally responsible animal research David DeGrazia and Jeff Sebo claim that the key requirements for morally responsible animal research are an assertion of sufficient net benefit, a worthwhile-life condition, and a no-unnecessary-harm condition. With regards to the assertion of sufficient net benefit, the authors claim that morally responsible research offers unique benefits to humans that outweigh the costs and harms to humans and animals. In this (...) commentary we will raise epistemic, practical, and ethical challenges to DeGrazia and Sebo’s emphasis on benefits in the prospective assessment of research studies involving animals. We do not disagree with DeGrazia and Sebo that, at the theoretical level, the benefits of research justify our using animals. Our contribution intends to clarify, at the practical level, how we should understand benefits in the prospective assessment and moral justification of animal research. We argue that ASNB should be understood as an assessment of Expectation of Knowledge Production in the prospective assessment and justification of animal research. EKP breaks down into two further claims: that morally responsible research generates knowledge worth having and that morally responsible research is designed and executed to produce generalizable knowledge. We understand the condition called knowledge worth having as scientists’ testing a hypothesis that, whether verified or falsified, advances an important interest, and production of generalizable knowledge in terms of scientific integrity. Generalizable knowledge refers to experimental results that generalize to a larger population beyond the animals studied. Generalizable scientific knowledge is reliable, replicable, and accurately descriptive. In sum, morally responsible research will be designed and carefully executed to successfully test a hypothesis that, whether verified or falsified, advances important interests. Our formulation of EKP, crucially, does not require further showing that an experiment involving animals will produce societal benefits. (shrink)

The conventional interpretation of Thomas Aquinas's concept of "moral science" casts it as a knowledge of moral rules that are the outcome of a deductive method of theoretical reason. However, there is a practical moral science that is possessed by ordinary people who are capable of a moral wisdom that is not derived from philosophy. The doctrine concerning this moral science is found in the texts of Aquinas as he takes up and strengthens the (...) philosophy of Aristotle. This book examines how moral science, then, is not a theoretical set of conclusions imposed on the will, but it is rather the grasping of a whole set of human ends that are intellectually apprehended by a compositive method. (Series: Philosophy: Science and Research / Philosophie: Forschung und Wissenschaft - Vol. 42). (shrink)

Stem cell research. Drug company influence. Abortion. Contraception. Long-term and end-of-life care. Human participants research. Informed consent. The list of ethical issues in science, medicine, and public health is long and continually growing. These complex issues pose a daunting task for professionals in the expanding field of bioethics. But what of the practice of bioethics itself? What issues do ethicists and bioethicists confront in their efforts to facilitate sound moral reasoning and judgment in a variety of venues? Are (...) those immersed in the field capable of making the right decisions? How and why do they face moral challenge -- and even compromise -- as ethicists? What values should guide them? In The Ethics of Bioethics, Lisa A. Eckenwiler and Felicia G. Cohn tackle these questions head on, bringing together notable medical ethicists and people outside the discipline to discuss common criticisms, the field's inherent tensions, and efforts to assign values and assess success. Through twenty-five lively essays examining the field's history and trends, shortcomings and strengths, and the political and policy interplay within the bioethical realm, this comprehensive book begins a much-needed critical and constructive discussion of the moral landscape of bioethics. (shrink)

Background Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses’ experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim To analyze frontline U.S. nurses’ experiences of ethics during the COVID-19 (...) pandemic. Research design Qualitative analysis using a directed content methodology. Participants and research context The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations Participant privacy and data confidentiality were addressed. Findings Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with (...) the question: What is the contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

A recurrent issue in the vast amount of literature on reasoning models in ethics is the role and nature of moral intuitions. In this paper, we start from the view that people who work and live in a certain moral practice usually possess specific moral wisdom. If we manage to incorporate their moral intuitions in ethical reasoning, we can arrive at judgements and (modest) theories that grasp a moral experience that generally cannot be (...) found outside the practice. Reflective equilibrium (RE) provides a framework for balancing moral intuitions, ethical principles and general theories. Nevertheless, persisting problems associated with the use of intuitions need to be addressed. One is the objection that moral intuitions lack the credibility necessary to guide moral reasoning. Ethicists have tried to solve this problem by formulating criteria to separate the “bad” intuitions from the “good” ones at the beginning of the reasoning process. We call this the credible input-justified outcome strategy. An example is the appeal to the common morality by Beauchamp and Childress. We think this approach is unsuccessful. As an alternative, we outline the good reasoning-justified outcome strategy. It connects to a variant of RE in which intuitions from different sources are incorporated. We argue that the elements of RE have different levels of justificatory power at the start of reasoning. In our strategy, each element can gain or lose justificatory power when it is tested in a reasoning process that meets several criteria. (shrink)