Background No previous study has provided evidence for the scope and frequency of ethical dilemmas for paediatric nurses. It is essential to understand this to optimise patient care and tailor ethics support for nurses. Research aim The aim of this study was to explore the scope of nurses’ ethical dilemmas in a paediatric hospital and their engagement with the hospital clinical ethics service. Research design This study used a cross-sectional survey design. Participants and research context Paediatric nursing staff in a (...) tertiary paediatric centre in Australia completed an online survey asking about their exposure to a range of ethical dilemmas and their knowledge of the clinical ethics service. Analysis used descriptive and inferential statistics. Ethical considerations Ethical approval was granted from the hospital research committee. The survey was anonymous, and no identifying details of participants were collected. Results Paediatric nurses experienced a wide range of ethical dilemmas frequently, both in the intensive care and general areas. Knowledge and use of the clinical ethics service was poor and the most frequent challenge for nurses in managing dilemmas was feeling powerless. Conclusion There is a need to recognise the moral burden of ethical dilemmas for paediatric nurses in order to foster ethical sensitivity, and to provide adequate support to improve care and mitigate nursing moral distress. (shrink)

Moral distress is prevalent within the neonatal intensive care unit (NICU) and can negatively affect clinicians. Studies have evaluated the causes of moral distress and interventions to mitigate it...

As I write this, in November 1971, people are dying in East Bengal from lack of food, shelter, and medical caxc. The suffering and death that are occurring there now axe not inevitable, 1101; unavoidable in any fatalistic sense of the term. Constant poverty, a cyclone, and a civil war have turned at least nine million people into destitute refugees; nevertheless, it is not beyond Lhe capacity of the richer nations to give enough assistance to reduce any further suffering to (...) very small proportions. The decisions arid actions of human beings can prevent this kind of suffering. Unfortunately, human beings have not made the necessary decisions. At the individual level, people have, with very few exceptions, not responded to the situation in any signihczmt way. Generally speaking, people have not given large sums to relief funds; they have not written t0 their parliamentaxy representatives demanding increased government assistance; they have not demonstrated in the streets, held symbolic fasts, or done anything else directed toward providing thc refugees with the means to satisfy their essential needs. At thc government level, no govcrmmcnt has given the sort of massive aid that would enable the refugees to survive fm: more than a few days. Britain, for instance, has given rather more than most countries. It has, to date, given £14,750,000. For comparative purposes, B1~itain’s share of thc nonreccverabla development costs of the Anglo-French Concorde project is already in excess of £275,000,000, and on present estimates will reach £440,000,¤00. The implication is that the British government values a supersonic transport more than thirty times as.. (shrink)

Clinical genetic research is often regarded as more ethically problematic than other forms of research, and in some countries is subject to specific regulation, requiring researchers to follow specialised guidelines. In this paper, an approach to enhancing the ethical conduct of genetic research is proposed, which is believed to be more effective than simply attempting to follow general guidelines. The potential concerns, likely areas of misunderstanding and negative reactions of the participant group are systematically investigated before starting a study on (...) genetics. This would constitute, in effect, an ethical pilot study, similar to a feasibility pilot study to test equipment, procedures and logistics. The findings of the ethical pilot study would be used to help in designing ethically important aspects of research protocol, such as recruitment procedures, written and other information for potential participants, informed consent processes and reporting of results including ambiguous or uncertain results. (shrink)

Dealing with situations where parents’ views about treatment for their child are strongly opposed to doctors’ views is one major area of ethical challenge in paediatric health care. The traditional approach focuses on the child’s best interests, but this is problematic for a number of reasons. The Harm Principle test is regarded by many ethicists as more appropriate than the best interests test. Despite this, use of the best interests test for intervening in parental decisions is still very common in (...) clinical settings and can lead to confusion. In this paper, I propose the Zone of Parental Discretion as a means of putting into practice the key ideas of the Harm Principle, in a clear, step-by-step process. The Zone of Parental Discretion provides a tool for ethical deliberation by clinicians and ethicists about all situations in which parents and doctors disagree about treatment of a child, whether parents are refusing medically recommended treatment, or requesting non-recommended treatment. (shrink)

The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive ‘high tech’ medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource (...) allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals. (shrink)

We propose a solution to the problem of logical omniscience in what we take to be its fundamental version: as concerning arbitrary agents and the knowledge attitude per se. Our logic of knowledge is a spin-off from a general theory of thick content, whereby the content of a sentence has two components: an intension, taking care of truth conditions; and a topic, taking care of subject matter. We present a list of plausible logical validities and invalidities for the logic of (...) knowledge per se for arbitrary agents, and isolate three explanatory factors for them: the topic-sensitivity of content; the fragmentation of knowledge states; the defeasibility of knowledge acquisition. We then present a novel dynamic epistemic logic that yields precisely the desired validities and invalidities, for which we provide expressivity and completeness results. We contrast this with related systems and address possible objections. (shrink)

Predictive genetic testing is now routinely offered to asymptomatic adults at risk for genetic disease. However, testing of minors at risk for adult-onset conditions, where no treatment or preventive intervention exists, has evoked greater controversy and inspired a debate spanning two decades. This review aims to provide a detailed longitudinal analysis and concludes by examining the debate's current status and prospects for the future. Fifty-three relevant theoretical papers published between 1990 and December 2010 were identified, and interpretative content analysis was (...) employed to catalogue discrete arguments within these papers. Novel conclusions were drawn from this review. While the debate's first voices were raised in opposition of testing and their arguments have retained currency over many years, arguments in favour of testing, which appeared sporadically at first, have gained momentum more recently. Most arguments on both sides are testable empirical claims, so far untested, rather than abstract ethical or philosophical positions. The dispute, therein, lies not so much in whether minors should be permitted to access predictive genetic testing but whether these empirical claims on the relative benefits or harms of testing should be assessed. (shrink)

Parents who are facing decisions about life-sustaining treatment for their seriously ill or dying child are supported by their child's doctors and nurses. They also frequently seek other information sources to help them deal with the medical and ethical questions that arise. This might include written or web-based information. As part of a project involving the development of such a resource to support parents facing difficult decisions, some ethical questions emerged. Should this information be presented in a strictly neutral fashion? (...) Is it problematic if narratives, arguments or perspectives appear to favour stopping over continuing life-sustaining treatment? Similar questions might arise with written materials about decisions for adults, or for other ethically contentious decisions. This paper explores the meaning of ‘balance’ in information provision, focusing particularly on written information about life-sustaining treatment for children. We contrast the norm of non-directiveness in genetic counselling with the shared decision-making model often endorsed in end-of-life care. We review evidence that parents do not find neutrality from medical professionals helpful in discussions. We argue that balance in written information must be understood in the light of the aim of the document, the most common situation in which it will be used, and any existing biases. We conclude with four important strategies for ensuring that non-neutral information is nevertheless ethically appropriate. (shrink)

For thirty years, Peter Singer's Practical Ethics has been the classic introduction to applied ethics. For this third edition, the author has revised and updated all the chapters and added a new chapter addressing climate change, one of the most important ethical challenges of our generation. Some of the questions discussed in this book concern our daily lives. Is it ethical to buy luxuries when others do not have enough to eat? Should we buy meat from intensively reared animals? (...) Am I doing something wrong if my carbon footprint is above the global average? Other questions confront us as concerned citizens: equality and discrimination on the grounds of race or sex; abortion, the use of embryos for research and euthanasia; political violence and terrorism; and the preservation of our planet's environment. This book's lucid style and provocative arguments make it an ideal text for university courses and for anyone willing to think about how she or he ought to live. (shrink)

When healthcare professionals feel constrained from acting in a patient’s best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be “constrained” in their actions is still lacking. This paper will examine how the application of shared decision-making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized. (...) Appreciation of these dynamics may assist in cross-discipline sensitivity, enabling more constructive dialogue and collaboration. (shrink)

What is ethics? Where do moral standards come from? Are they based on emotions, reason, or some innate sense of right and wrong? For many scientists, the key lies entirely in biology---especially in Darwinian theories of evolution and self-preservation. But if evolution is a struggle for survival, why are we still capable of altruism? In his classic study The Expanding Circle, Peter Singer argues that altruism began as a genetically based drive to protect one's kin and community members but (...) has developed into a consciously chosen ethic with an expanding circle of moral concern. Drawing on philosophy and evolutionary psychology, he demonstrates that human ethics cannot be explained by biology alone. Rather, it is our capacity for reasoning that makes moral progress possible. In a new afterword, Singer takes stock of his argument in light or recent research on the evolution of morality.--Publisher's description. (shrink)

Introduction These essays have been written over a period of about ten years and have already been published separately in various places. ...

This chapter provides an introduction to higher-order metaphysics as well as to the contributions to this volume. We discuss five topics, corresponding to the five parts of this volume, and summarize the contributions to each part. First, we motivate the usefulness of higher-order quantification in metaphysics using a number of examples, and discuss the question of how such quantifiers should be interpreted. We provide a brief introduction to the most common forms of higher-order logics used in metaphysics, and indicate a (...) number of questions which can be raised in such systems using logical vocabulary alone. Using a further example, we return to applications of higher-order logics in metaphysics. We also mention key developments in the history of higher-order logic as it pertains to metaphysics. Finally, we mention certain arguments which have been raised against the use of higher-order logic, and some ways of responding to them. (shrink)

Narrative thinking -- Narrative thinking about one's past -- Grief : a case study -- Narrative thinking about one's future -- Self-forgiveness : a case study -- The narrative sense of self -- Narrative, truth, life, and fiction.

Single-premise epistemic closure is the principle that: if one is in an evidential position to know that P where P entails Q, then one is in an evidential position to know that Q. In this paper, I defend the viability of opposition to closure. A key task for such an opponent is to precisely formulate a restricted closure principle that remains true to the motivations for abandoning unrestricted closure but does not endorse particularly egregious instances of closure violation. I focus (...) on two brands of epistemic theory that naturally incorporate closure restrictions. The first type holds that the truth value of a knowledge ascription is relative to a relevant question. The second holds that the truth value of a knowledge ascription is relative to a relevant topic. For each approach, I offer a formalization of a leading theory from the literature and use this formalization to evaluate the theory’s adequacy in terms of a precise set of desiderata. I conclude that neither theory succeeds in meeting these desiderata, casting doubt on the viability of the underlying approaches. Finally, I offer a novel variant of the topic-sensitive approach that fares better. (shrink)

Since its original publication in 1975, this groundbreaking work has awakened millions of people to the existence of "speciesism"—our systematic disregard of nonhuman animals—inspiring a worldwide movement to transform our attitudes to animals and eliminate the cruelty we inflict on them. In Animal Liberation, author Peter Singer exposes the chilling realities of today’s "factory farms" and product-testing procedures—destroying the spurious justifications behind them, and offering alternatives to what has become a profound environmental and social as well as moral issue. (...) An important and persuasive appeal to conscience, fairness, decency, and justice, it is essential reading for the supporter and the skeptic alike. (shrink)

First published in 1987. Routledge is an imprint of Taylor & Francis, an informa company.

In Victoria, Australia, the law regulating abortion was reformed in 2008, and a clause was introduced requiring doctors with a conscientious objection to abortion to refer women to another provid...

Language sample analysis is an important practice for providing a culturally sensitive and accurate assessment of a child's language abilities. A child's usage of literate language devices in narrative samples has been shown to be a critical target for evaluation. While automated scoring systems have begun to appear in the field, no such system exists for conducting progress-monitoring on literate language usage within narratives. The current study aimed to develop a hard-coded scoring system called the Literate Language Use in Narrative (...) Assessment, to automatically evaluate six aspects of literate language in non-coded narrative transcripts. LLUNA was designed to individually score six literate language elements. The interrater reliability of LLUNA with an expert scorer, as well as its' reliability compared to certified undergraduate scorers was calculated using a quadratic weighted kappa. Results indicated that LLUNA met strong levels of interrater reliability with an expert scorer on all six elements. LLUNA also surpassed the reliability levels of certified, but non-expert scorers on four of the six elements and came close to matching reliability levels on the remaining two. LLUNA shows promise as means for automating the scoring of literate language in LSA and narrative samples for the purpose of assessment and progress-monitoring. (shrink)

In this paper, we put forward the view that emotions have a legitimate and important role in health professional ethics education. This paper draws upon our experience of running a narrative ethics education programme for ethics educators from a range of healthcare disciplines. It describes the way in which emotions may be elicited in narrative ethics teaching and considers the appropriate role of emotions in ethics education for health professionals. We argue there is a need for a pedagogical framework to (...) productively incorporate the role of emotions in health professional ethics teaching. We suggest a theoretical basis for an ethics pedagogy that integrates health professional emotions in both the experience and the analysis of ethical practice, and identify a range of strategies to support the educator to incorporate emotion within their ethics teaching. (shrink)

I lay out the framework for my theory of sensory imagination in “Imagining as a guide to possibility.” Sensory imagining involves mental imagery , and crucially, in describing the content of imagining, I distinguish between qualitative content and assigned content. Qualitative content derives from the mental image itself; for visual imaginings, it is what is “pictured.” For example, visually imagine the Philadelphia Eagles defeating the Pittsburgh Steelers to win their first Super Bowl. You picture the greenness of the field and (...) the football’s brown oblong shape. Some of what you imagine isn’t explicitly pictured, however. That it is Sunday, that it is the Super Bowl: these facts are assigned. (shrink)

Political decisions have the potential to greatly impact our lives. Think of decisions in relation to abortion or climate change, for example. This makes political legitimacy an important normative concern. But what makes political decisions legitimate? Are they legitimate in virtue of having support from the citizens? Democratic conceptions of political legitimacy answer in the affirmative. Such conceptions righly highlight that legitimate political decision-making must be sensitive to disagreements among the citizens. But what if democratic decisions fail to track what (...) there is most reason to do? What if a democratically elected government fails to take measures necessary to protect its population from threats related to climate change? Peter argues that the legitimacy of political decisions doesn't just depend on respect for the citizens' will; and defends a novel hybrid conception of political legitimacy, called the Epistemic Accountability conception. According to this conception, political legitimacy also depends on how political decision-making responds to evidence for what there is most reason to do. Grounds for Political Legitmacy starts with an overview of the main ways in which philosophers have thought about political legitimacy, and identifies the epistemic accountability conception as an overlooked alternative. It then develops the epistemic accountability conception of political legitimacy and discusses its implications for legitimate political decision-making. Considering the norms that should govern political debate, it examines the role of experts in politics, and probes the responsibilities of democratically elected political leaders and as well as of citizens. (shrink)

In the Western world it is usually taken as given that we all want happiness, and our educational arrangements tacitly acknowledge this. Happiness, Hope, and Despair argues, however, that education has an important role to play in deepening our understanding of suffering and despair as well as happiness and joy. Education can be uncomfortable, unpredictable, and unsettling; it can lead to greater uncertainty and unhappiness. Drawing on the work of Søren Kierkegaard, Miguel de Unamuno, Fyodor Dostoevsky, Simone Weil, Paulo Freire, (...) and others, Peter Roberts shows why these features of educational life need not be feared; to the contrary, they can be seen as a source of hope and human fulfilment. After years of negotiating an education system dominated by the language of competition, performance, and economic advancement, students and teachers often long for something different; they seek not just measurable success but also opportunities to ask searching questions of themselves and the world they encounter. Happiness, Hope, and Despair makes an important contribution toward meeting this need. It fosters a rethinking of the nature, purpose, and value of education, and opens up possibilities for further scholarly and professional inquiry. (shrink)

Our topic is the theory of topics. My goal is to clarify and evaluate three competing traditions: what I call the way-based approach, the atom-based approach, and the subject-predicate approach. I develop criteria for adequacy using robust linguistic intuitions that feature prominently in the literature. Then I evaluate the extent to which various existing theories satisfy these constraints. I conclude that recent theories due to Parry, Perry, Lewis, and Yablo do not meet the constraints in total. I then introduce the (...) issue-based theory—a novel and natural entry in the atom-based tradition that meets our constraints. In a coda, I categorize a recent theory from Fine as atom-based, and contrast it to the issue-based theory, concluding that they are evenly matched, relative to our main criteria of adequacy. I offer tentative reasons to nevertheless favour the issue-based theory. (shrink)

This volume explores the use of higher-order logics in metaphysics. Seventeen original essays trace the development of higher-order metaphysics, discuss different ways in which higher-order languages and logics may be used, and consider their application to various central topics of metaphysics.

Two versions of the argument that prenatal diagnosis discriminates against the disabled are distinguished and analysed. Both are shown to be inadequate, but some valid concerns about the social effects of prenatal diagnosis are highlighted.

Hospitals are places where patients are unwell, where patients and their families may be upset, confused, frustrated, in pain, and vulnerable. The likelihood of these experiences and emotions manifesting in anger and aggressive behaviour is high. In this paper, we describe the involvement of a clinical ethics service responding to a request to discuss family aggression within a rehabilitation department in a large paediatric hospital in Australia. We suggest two key advantages of involving a clinical ethics service in discussions about (...) how to respond to family aggression. First, the process of ethics deliberation provides an opportunity for clinicians to be involved in the solution by articulating their perspectives, tolerance levels, and general concerns about the effects of family aggression towards staff. Second, supporting clinicians to articulate and identify the impact of parental aggression directly counters the disadvantages of the more blunt zero-tolerance policy response, which is necessarily imposed from the top down. (shrink)

In at least some cases of justified perceptual belief, our perceptual experience itself, as opposed to beliefs about it, evidences and thereby justifies our belief. While the phenomenon is common, it is also mysterious. There are good reasons to think that perceptions cannot justify beliefs directly, and there is a significant challenge in explaining how they do. After explaining just how direct perceptual justification is mysterious, I considerMichael Huemers (Skepticism and the Veil of Perception, 2001) and Bill Brewers (Perception and (...) Reason, 1999) recent, but radically different, attempts to eliminate it. I argue that both are unsuccessful, though a consideration of their mistakes deepens our appreciation of the mystery. (shrink)

BackgroundFor children with life-limiting conditions who are unable to participate in decision-making, decisions are made for them by their parents and paediatricians. Shared decision-making is widely recommended in paediatric clinical care, with parents preferring a collaborative approach in the care of their child. Despite the increasing emphasis to adopt this approach, little is known about the roles and responsibilities taken by parents and paediatricians in this process. In this study, we describe how paediatricians approach decision-making for a child with a (...) life-limiting condition who is unable to participate in decision-making for his/herself.MethodsThis qualitative phenomenological study involved 25 purposively sampled paediatricians. Verbatim transcripts from individual semi-structured interviews, conducted between mid-2019 and mid-2020, underwent thematic analysis. Interviews were based around a case vignette matched to the clinical experience of each paediatrician.ResultsTwo key themes were identified in the exploration of paediatricians' approach to decision-making for children with life-limiting conditions: there is a spectrum of paediatricians’ roles and responsibilities in decision-making, and the specific influences on paediatricians’ choice of approach for end-of-life decisions. In relation to, analysis showed four distinct approaches: non-directed, joint, interpretative, and directed. In relation to, the common factors were: harm to the child, possible psychological harm to parents, parental preferences in decision-making, and resource allocation.ConclusionsDespite self-reporting shared decision-making practices, what paediatricians often described were physician-led decision-making approaches. Adopting these approaches was predominantly justified by paediatricians’ considerations of harm to the child and parents. Further research is needed to elucidate the issues identified in this study, particularly the communication within and parental responses to physician-led approaches. We also need to further study how parental needs are identified in family-led decision-making approaches. These nuances and complexities are needed for future practice guidance and training around paediatric decision-making.Trial registration: Not applicable. (shrink)

Bioethics, Volume 36, Issue 7, Page 765-773, September 2022.

The idea of “postponed withholding,” proposed by Syltern et al. (2022), is a provocative one, and like all good provocative ideas, provokes deeper thinking from fresh perspectives. Our attention wa...

This book offers a reassessment of the political philosophy of the British Idealists, a group of once influential and now neglected nineteenth-century Hegelian philosophers, whose work has been much misunderstood. Peter Nicholson focuses on F. H. Bradley's idea of morality and moral philosophy; T. H. Green's theory of the Common Good, of the social nature of rights, of freedom, and of state interference; and Bernard Bosanquet's notorious theory of the General Will. By examining the arguments offered by the Idealists (...) and by their critics the author is able to penetrate the deep layers of hostile comment laid down by several generations of later writers and to show that these ideas, once properly understood, are not only defensible but interesting and important. (shrink)

In theory, HREC members should use the ethical guidelines in the National Statement on the Ethical Conduct of Research Involving Humans as the basis for their decisions, and researchers should design their research in accordance with these guidelines However, very little is known about what researchers and HREC members actually do in practice. In this paper, we report some of the key findings of the study “Human Research Ethics in Practice”, a qualitative interview-based study of health researchers and HREC members (...) in Victoria. The findings shed light on how researchers and HREC members conceptualise ethics, how they use the National Statement, and what deliberative strategies they employ to assess the ethical appropriateness of research studies. The findings also reveal differences and similarities between health researchers’ and HREC members’ perceptions of the roles of HRECs, and point to some sources of misunderstanding and tension. We examine the implications of some of these findings for the ways in which HRECs carry out their task, and research institutions support and promote ethical conduct in research amongst their staff and students. The focus of this study is on health research, but we suggest that the findings are highly relevant to all other research areas where human participants are involved. (shrink)

Epistemic defeat is standardly understood in either evidentialist or responsibilist terms. The seminal treatment of defeat is an evidentialist one, due to John Pollock, who famously distinguishes between undercutting and rebutting defeaters. More recently, an orthogonal distinction due to Jennifer Lackey has become widely endorsed, between so-called doxastic (or psychological) and normative defeaters. We think that neither doxastic nor normative defeaters, as Lackey understands them, exist. Both of Lackey’s categories of defeat derive from implausible assumptions about epistemic responsibility. Although Pollock’s (...) evidentialist view is superior, the evidentialism per se can be purged from it, leaving a general structure of defeat that can be incorporated in a reliabilist theory that is neither evidentialist nor responsibilist in any way. (shrink)

It was pointed out, first by Robert Stalnaker, then also by Andy Egan, that David Lewis’s model of centered-worlds contents has undesired consequences for communication of de se contents. The recent years have seen a number of attempts to save the model by amending it to handle de se communication. Proposals include the appeal to sequences of individuals in the centers, to ersatz classical propositions, and to operations of “re-centering”. The authors are Dilip Ninan and Stephan Torre, Sarah Moss and (...) Max Kölbel, and Alan Gibbard and Clas Weber. The present paper discusses these attempts. The conclusion is that they fail. (shrink)

Deception is a reasonably common part of daily life that society sometimes demonstrates a degree of acceptance of, and occasionally people are very willing to be deceived. But can a computer identify deception and distinguish it from that which is not deceptive? We explore deception in various guises, differentiating it from lies, and highlighting the influence of medium and message in both deception and its detection. Our investigations to date have uncovered disagreements relating to the measurements of such cues, and (...) variations in interpretations, as could be problematic in building a deception detection system. (shrink)

In the debate over fetal tissue use, an analogy is often drawn between removing organs from the body of a person who has been murdered to use for transplantation, and collecting tissue from an aborted fetus to use for the same purpose. The murder victim analogy is taken by its proponents to show that even if abortion is the moral equivalent of murder, there is still no good reason to refrain from using the fetal tissue, since as a society we (...) do not see any problem about using organs from murder victims. However, I argue that the analogy between murder victims and aborted fetuses does not hold -- the two situations are not the same in all morally relevant respects. Thus the murder victim analogy does not provide an argument in favour of fetal tissue transplant. In conclusion, I point to some of the potential pitfalls of using analogies in ethical argument. (shrink)

Explores how to identify future-proof science. Peter Vickers takes a transdisciplinary approach in his analysis of 'scientific fact' in order to defend science against potentially dangerous scepticism.

The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework (...) that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff. There are no data in this work. (shrink)