Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and (...) triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen. (shrink)

Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main (...) reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue. (shrink)

Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main (...) reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue. (shrink)

Modern moral and political philosophy is in debt with natural law theory, both in its ancient and mediaeval elaborations. While the very notion of a natural law has proved highly controversial among 20th Century scholars, the last decades have witnessed a renewed interest in it. Indeed, the threats and challenges as result of multiculturalism, plural societies and global changes have generated a renewed attention to natural law theory. Clearly, it offers solid basis as possible framework to a better understanding of (...) human goods without contradictions and partial bias. The purpose of the present volume is to provide an overview of the history of this concept (Cicero, St. Paul, Aquinas, Melanchthon, Montaigne, Descartes, Leibniz, Hume, Burke, Kant, MacIntyre, etc.) as well as a deep understanding of ongoing research, both in Europe and in America. Furthermore, the specificity of these studies will be of particular value to philosophers, law-philosophers, historians, anthropologists, sociologists and theologians, and those concerned on such issues as the relation between law and moral norm, law and practical reason, and the presence of the idea of natural law in several prominent thinkers. It includes a selected bibliography on natural law. The book also provides an excellent introduction to several of the major topics in natural law theory making it useful both as a reference text and as a sourcebook for academics alike. Natural law is a rich, complex, and highly disputed term. Since its first appearances in the history of Western civilization, it has been used both to point to God as the source of the moral order and to assert that there is an objective order of justice in nature that men and their laws ought to respect. In modern times, natural law theory gave birth to what we usually call "human rights." Unlike the meaning of the term, the importance of an ongoing debate on natural law and on the theories related to it is undisputable. This is why I welcome today this new collection of essays edited by Alejandro Nèstor Garcìa Martìnez, Mario Å ilar and Josè M. Torralba. Natural Law: Historical, Systematic and Juridical Approaches includes a wide variety of studies, covering key authors and issues in natural law theory. Younger students will appreciate the clarity of the chapters, and more trained readers the detailed and accurate bibliographical references that each of them offers. The editors's choice to go from a historical approach to contemporary theories, and then to theoretical and more practical issues is also commendable. Students in philosophy and in legal theory will greatly benefit from this book. Fulvio Di Blasi, author of God and the Natural Law: A Rereading of Thomas Aquinas. (shrink)

Leibniz, in order to avoid both determinism and indifferentism, says that knowledge inclines the agent towards the best action without necessitating it. According to his modal theory, an action is contingent if the opposite is (logically) possible. The article examines the coherence of Leibniz’s notion of «inclining but not necessitating» in the context of contemporary philosophy of action, profiting from the distinction between reasons and causes. The kind of freedom which is possible according to Leibniz philosophy depends on this question.

An analysis of the particular kind of determinism that is to be found in the moral election according to Leibniz shows the model of practical reason held in his philosophy. The hermeneutical clue used in the article is to make a parallelism between the model of rationality of God’s election to create the best possible world and that of human moral election.

Die in diesem Band versammelten Essays erörtern die Frage nach der Möglichkeit des Verstehens menschlichen Handelns ohne den Rückbezug auf moralische Werte und Normen. Obwohl die Autoren sich dieser Frage auf ganz unterschiedliche, manchmal divergierende, Weisen nähern, verbindet sie alle die Annahme, es sei nicht wünschenswert oder sogar inkohärent, das menschliche Handeln grundsätzlich unabhängig von moralischen Werten zu betrachten. Die Herausgeber haben sich um eine für Philosophen und Gesellschaftswissenschaftler gleichermaßen attraktive Beitragssammlung bemüht. Die Verknüpfung philosophischer und soziologischer Perspektiven könnte zur (...) Klärung gegenseitiger Missverständnisse beitragen, die aufgrund eines mangelhaften Dialogs zwischen der philosophischen und soziologischen Handlungstheorie erwachsen sind. In diesem Band enthalten sind Essays von Terry Pinkard, Sebastian Rödl, Dieter Schönecker, Ana Marta González, John Levi Martin, Alejandro N. García Martínez, Sophie Djigo, Teresa Enríquez und Evgenia Mylonaki. The essays in this volume address the question of whether we can understand human action without reference to moral norms or values. Although the authors approach this question in different and sometimes even incompatible ways, they are united in thinking that it is undesirable or even incoherent to treat human agency as if it were conceptually independent of value questions. The editors have attempted to invite contributions that would be interesting to both philosophers and social theorists. The conjunction of philosophic and sociological perspectives might help to overcome some of the mutual misunderstandings that have been fostered by a lack of dialogue between the philosophic and sociological action theory. The volume includes essays by Terry Pinkard, Sebastian Rödl, Dieter Schönecker, Ana Marta González, John Levi Martin, Alejandro N. García Martínez, Sophie Djigo, Teresa Enríquez, and Evgenia Mylonaki. (shrink)

Bentley et al.--O’Brien bypass the relevance of emotions in decision-making, resulting in a possible over-simplification of behavioral types. We propose integrating emotions, both in the north-south axis (in relation to cognition) as well as in the west-east axis (in relation to social influence), by suggesting a Z axis, in charge of registering emotional depth and involvement.

Introduction: Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals’ etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups. Aim: The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and (...) guidelines. Methodology: The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols’ ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity. Ethical consideration: The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee. Results: Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test–retest reliability coefficient = 0.86, r = 0.84, α1 = 0.817, α2 = 0.824 and interclass correlation coefficient = 0.874. Discussion: Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses’ education, values and quality of care. Conclusion: Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice. (shrink)

This paper describes the development and implementation of a character education program at the University of Navarra. The Leadership as Service Program has been developed in collaboration with the Oxford Character Project, and has adapted its Global Leadership Initiative to the Spanish context. The purpose of the Leadership as Service Program is to help students develop a sense of personal purpose, and virtues that are specific to leadership, such as prudence, humility, gratitude, resilience, and service. The methodology of the program (...) follows the seven strategies of character education and includes a mentoring program. In order to adapt the Global Leadership Initiative to the Spanish context, the Leadership as Service Program was integrated as much as possible into the fabric of the University of Navarra by means of (1) facilitating a new initiative to develop workshops on purpose; (2) incorporating an existing mentoring program; (3) positioning local actors as experts, and (4) dialogue with stakeholders within the university. First results indicate that the Leadership as Service Program makes a valuable contribution to the ethical and professional development of students, which corroborates with the findings of the Oxford Global Leadership Initiative. (shrink)

Literature and Character Education in Universities presents the potential of literary and philosophical texts for character education in modern universities. The book engages with theoretical and practical aspects of character development in higher education, combining conceptual discussion of the role of literature in character education with applied case studies from university classrooms. Character education within the academic context of the university presents unique challenges and opportunities. Literature and Character Education in Universities presents perspectives from academics in Europe, the USA and (...) Asia, offering unique insights into the ways that engaged reading and discussion of core texts can promote the development of intellectual and moral virtues. Chapters draw on a wide range of texts from Confucius' Analects to J. D. Salinger's The Catcher in the Rye, focusing on themes such as truthfulness, self-knowledge, prudence, tolerance, friendship, and humility. Literature and Character Education in Universities will be of real use to researchers, academics and postgraduates in the fields of higher education, philosophy, and literature. It should be essential reading for university educators interested in character development and advocates of literary education in modern universities. (shrink)

This book explores the epistemic side of racial and sexual oppression. It elucidates how social insensitivities and imposed silences prevent members of different groups from listening to each other.

Background The Regional Committee for Africa of the World Health Organization (WHO) in 2001 expressed concern that some health-related studies undertaken in the Region were not subjected to any form of ethics review. In 2003, the study reported in this paper was conducted to determine which Member country did not have a national research ethics committee (REC) with a view to guiding the WHO Regional Office in developing practical strategies for supporting those countries. Methods This is a descriptive study. The (...) questionnaire was prepared and sent by diplomatic pouch to all the 46 Member States in the WHO African Region, through the WHO country representatives, for facilitation and follow up. The data were entered in Excel spreadsheet and subsequently exported to STATA for analysis. A Chi-Squared test (χ 2) for independence was undertaken to test the relationship between presence/absence of Research Ethics Committee (REC) and selected individual socioeconomic and health variables. Results The main findings were as follows: the response rate was 61% (28/46); 64% (18/28) confirmed the existence of RECs; 36% (10/28) of the respondent countries did not have a REC (although 80% of them reported that they had in place an ad hoc ethical review mechanism); 85% (22/26) of the countries that responded to this question indicated that ethical approval of research proposals was, in principle, required; and although 59% of the countries that had a REC expected it to meet every month, only 44% of them reported that the REC actually met on a monthly basis. In the Chi-Squared test, only the average population in the group of countries with a REC was statistically different (at 5% level of significance) from that of the group of countries without a REC. Conclusion In the current era of globalized biomedical research, good ethics stewardship demands that every country, irrespective of its level of economic development, should have in place a functional research ethics review system in order to protect the dignity, integrity and safety of its citizens who participate in research. (shrink)

The framework presented by Bayefsky and Berkman is based on having clear and accurate genetic information to offer parents, for them to either decide to prepare for birth or to terminate the...

In the era of information and communication, issues of misinformation and miscommunication are more pressing than ever. _Epistemic injustice - _one of the most important and ground-breaking subjects to have emerged in philosophy in recent years - refers to those forms of unfair treatment that relate to issues of knowledge, understanding, and participation in communicative practices. The Routledge Handbook of Epistemic Injustice is an outstanding reference source to the key topics, problems and debates in this exciting subject. The first collection (...) of its kind, it comprises over thirty chapters by a team of international contributors, divided into five parts: Core Concepts Liberatory Epistemologies and Axes of Oppression Schools of Thought and Subfields within Epistemology Socio-political, Ethical, and Psychological Dimensions of Knowing Case Studies of Epistemic Injustice. As well as fundamental topics such as testimonial and hermeneutic injustice and epistemic trust, the Handbook includes chapters on important issues such as social and virtue epistemology, objectivity and objectification, implicit bias, and gender and race. Also included are chapters on areas in applied ethics and philosophy, such as law, education, and healthcare. The Routledge Handbook of Epistemic Injustice is essential reading for students and researchers in ethics, epistemology, political philosophy, feminist theory, and philosophy of race. It will also be very useful for those in related fields, such as cultural studies, sociology, education and law. (shrink)

One field in ethics that has been developed during recent decades is virtue ethics, represented most importantly by Alasdair MacIntyre's work After Virtue. Virtue ethics is not opposed to principle-based ethics, but rather complements its task and develops it more fully. In the field of US bioethics, this option has proved to be even more fruitful, especially in the work of Edmund Pellegrino and David Thomasma. Virtue ethics is also being reappraised in relation to the ethics of organisations and business. (...) It is considered that the best way of running a company does not depend solely on a group of ethical principles or agreed criteria, but on the effective exercise of certain qualities of character. Indeed, minimal ethics do not guarantee the excellence of organisations, or even their correct development. They guarantee certain standards of coexistence, but this is not sufficient to carry forward a collective enterprise in a creative way. It is impossible to achieve the aims of an organisation without ambition, magnanimity, humility, prudence, responsibility and courage. This group of intangible elements are virtues. This article explores the process of decision-making in the light of Aristotelian ethics, in particular his work _Nicomachean Ethics_. Making decisions is a common task on the managerial agenda. The decisions of a manager affect individuals, the future of the organisation and, of course, they have consequences for the organisation and its surroundings. Aristotle dedicates Book III of the work in question to studying the art of deliberation and examining which virtues must be taken into account when reaching the best decision. Aristotle tells us that we deliberate about things that are within our power and can be done. There can be no deliberation upon exact and sufficient knowledge; however, we deliberate upon the things that are brought about by our own efforts, although not always in the same way. Leading an organisation is not a mechanical matter, but rather a process that requires creativity and responsibility. There are many different ways of doing it. Following the Aristotelian doctrine, this article aims to examine the elements that must be taken into consideration for correct decisions to be made. The following virtues play a fundamental role in this process: prudence, fortitude, justice and temperance, referred to below as called cardinal virtues. (shrink)