BackgroundMany medical emergency practices are regulated by written procedures that normally provide reliable guidelines for action. In some cases, however, the consequences of following rule-based instructions can have unintended negative consequences. The article discusses a case - described on a type level - where the consequences of following a rule formulation could have been fatal.Case presentationA weak and elderly patient has cardiac arrest, and a Do Not Resuscitate clause is written in the patient’s medical record. Paramedics at the scene cannot (...) see that the patient’s general appearance match conditions which would indicate the DNR clause, so they start cardiopulmonary resuscitation, and the patient survives. This turns out to be a crucial decision. The DNR clause is from an earlier bout with serious disease from which the patient has recovered, against all odds, and someone has forgotten to remove the clause from the medical record.AnalysisIn order to be able to interpret the validity of written guidelines, paramedics and other health workers need to develop personal skills that transcend the ability simply to follow written instructions. Within traditional virtue ethics, personal judgment is conceived of as crucial for being able to make ‘good’ autonomous decisions. Virtue ethical analyses, decision-making abilities and non-technical communication skills are important as conceptual tools when health workers need to make difficult clinical decisions.ConclusionThe case study accentuates the significance of prudent judgment in medical practice. In the case described, the consequence of trusting the written advance directive could have been fatal, but the point is general: for the purpose of achieving excellent organizational performance, it is insufficient for health workers to rely uncritically on rules and procedures. Even the clearest rule formulations must be interpreted contextually in order to determine ethically correct behavior and avoid potential negative consequences that are not in the patient’s best interests. (shrink)

I argue for compatibility between feminism and medicine by developing a model of the physician-other relationship which is essentially egalitarian. This entails rejection of (a) a paternalistic model which reinforces sex-role stereotypes, (b) a maternalistic model which exclusively emphasizes patient autonomy, and (c) a model which focuses on the physician's conscience. The model I propose (parentalism) captures the complexity and dynamism of the physician-other relationship, by stressing mutuality in respect for autonomy and regard for each other's interests.

Abstract:In this paper I explore the topic of moral compromise in institutional settings and highlight how moral compromise may affirm, rather than undermine, personal integrity. Central to this relationship between moral compromise and integrity is a view of the self that is responsive to multiple commitments and grounded in an ethic of responsibility. I elaborate a number of virtues that are related to this notion of the self and highlight how these virtues may support the development of individuals who are (...) responsive and reasonable in moral discourse and discerning in establishing moral limits on compromise. I look at how moral regret is closely connected to moral compromise and emphasize its significance for reinforcing personal integrity. The paper closes with a discussion of the relevance of these topics to the field of business ethics. (shrink)

The ethics of care still appeals to many in spite of penetrating criticisms of it which have been presented over the past 15 years or so. This paper tries to offer an explanation for this, and then to critically engage with three versions of an ethics of care. The explanation consists firstly in the close affinities between nursing and care. The three versions identified below are by Gilligan (1982 ), a second by Tronto (1993 ), and a third by Gastmans (...) (2006 ), see also Little (1998 ). Each version is described and then subjected to criticism. It is concluded that where the ethics of care is presented in a distinctive way, it is at its least plausible; where it is stated in more plausible forms, it is not sufficiently distinct from nor superior to at least one other common approach to nursing ethics, namely the much-maligned 'four principles' approach. What is added by this paper to what is already known: as the article tries to explain, in spite of its being subjected to sustained criticism the ethics of care retains its appeal to many scholars. The paper tries to explain why, partly by distinguishing three different versions of an ethics of care. It is also shown that all three versions are beset with problems the least serious of which is distinctiveness from other approaches to moral problems in health care. (shrink)

Recent work in clinical nursing ethics has been influenced by two main areas of insight associated with the challenge levelled by the women's movement to traditional thinking about morality and ethics. Broadly speaking these two realms have been distinguished as articulating ‘feminist’ socio‐political and ‘feminine’ ethic of care concerns. Often these two impulses are seen as pulling against each other, or worse, the ‘feminine’ emphasis on the ethics of care is seen as reinforcing the dynamics that elicit the ‘feminist’ concern. (...) In this paper I suggest how an expanded understanding of an ethic of care in clinical settings can provide resources for dealing with both concerns. A discussion of the way institutional relations can ride rough‐shod over the ‘feminist’ insights of ethical care, in the second part of the paper, provides evidence for my conclusion that ethical nursing care depends on recognizing that both areas of insight are imperative for its success. (shrink)

In philosophy, intelligence is less important than character, or so Wittgenstein once argued. In this paper, in a similar vein, I suggest that in health care ethics consultation character is of preeminent importance. I suggest that the activity of ethics consultation can be understood as "training in virtue," and what distinguishes the good health care ethics consultant from his/her average colleague are differences in traits of character. The underlying assumption is that one's use of knowledge and abilities are ultimately a (...) function of who one is and how one perceives and confronts situations of moral uncertainty and conflict. In discussing the original case presented by Mark Bliton, I focus on the virtues of wisdom, justice, courage, compassion and humility. (shrink)

This study was designed to explore the concept of witnessed resuscitation. This was achieved through a serial approach to conceptually based research that systematically and incrementally developed understanding of the meaning of witnessed resuscitation in the context of emergency resuscitative care for adult victims of cardiorespiratory arrest. Theoretical investigation provided a strong conceptual foundation of existing knowledge and gave direction for further inquiry. Existential investigation comprised a hermeneuticphenomenological study to explore the phenomenon of lay presence during an adult cardiopulmonary resuscitation (...) attempt. Lived-experience material was subjected to thematic analysis and was revealing of five concepts that represented the essential nature of the lived experience. The concept of exposure emerged as the essence of this phenomenon. Research findings derived during theoretical and existential investigation were compared by adapting a method of template comparison. This process culminated in a synthesised conceptualisation of the meaning of witnessed resuscitation of a higher level of abstraction. Ongoing research is needed to determine whether this ‘state of the art’ conceptualisation of witnessed resuscitation holds its boundaries when applied to alternative phenomena, contexts and disciplines. Priority should be given to exploring the application of this concept in the context of patient and family-centred end-of-life care. (shrink)