When people lose capacity to make a medical decision, the standard is to assess what their preferences would have been and try to honor their wishes. Dementia raises a special case in such situations, given its long, progressive trajectory during which others must make substituted judgments. The question of how to help surrogates make better‐informed decisions has led to the development of dementia‐specific advance directives, in which people are given tools to help them communicate what their preferences are while they (...) are still able. Such directives allow the perspective of the person to play a clearer role in guiding decisions about their care. Dementia directives can never serve as rigid algorithms. Rather, they can be used to help inform conversations, to help surrogates make decisions that are better aligned with the preferences the person would have had. This essay lays out the proposed utility of dementia‐specific directives and addresses some of the criticisms raised about them. (shrink)

A biblically informed guidebook for Christians facing difficult health care decisions, from the making of life (infertility, organ donation, cloning) and taking of life (abortion, euthanasia) to the technologically driven faking of life (genetic engineering, etc.).

A biblically informed guidebook for Christians facing difficult health care decisions, from the making of life (infertility, organ donation, cloning) and taking of life (abortion, euthanasia) to the technologically driven faking of life (genetic engineering, etc.).

A comprehensive analysis of ethical topics in palliative care, combining clinical experience and philosophical rigor. A broad array of topics are explored from historical, legal, clinical, and ethical perspectives, offering both the seasoned clinician and interested lay reader a thorough examination of the complex ethical issues facing patients suffering from life-threatening illness.

The purpose of this book is to assist health care professionals in understanding some of the complex contemporary issues that they confront and to provide guidance in making decisions. These issues are described and analyzed in the context of philosophical principles and methods in language that is understandable to the professional who is unfamiliar with the study of philosophy and ethics. -from Preface.

The authors draw on their extensive early years experience to provide a comprehensive and up-to-date review of the key issues in the field of early childhood care and education. In this fully updated and revised new edition, rewritten to include the new Early Years Foundation Stage, students will find that this text now meets the needs of students on Foundation degrees, Early Childhood Degrees and the new Early Years Professional qualification. Topics covered in this essential textbook include: an overview (...) of the principles of effective practice discussions on equal opportunities and children's rights an update of the latest development theories relating to brain development and how children learn and the difficulties children may face in their learning investigations into what working with parents really means consideration of the different early years systems in operation summaries of key management issues and useful information on how to address them comparison with European perspectives on early years care and education the importance of play in children's early learning. Readers of this second edition will also find the expansion of existing chapters in order to include topics such as inclusion, transitions, child protection in relation to the internet and partnerships with parents. The book covers the whole age range from birth to eight years with a special section on the birth to three years age group. Each chapter is fully referenced and has case studies or reflective practice boxes within the text. Informative and engaging, the book challenges the reader to think about how underlying theory may be reflected in practice. It will be essential reading for all students who are studying for early childhood qualifications at levels four, five and six. (shrink)

The introduction to a special issue of the journal Bioethics that we edited.

Drawing on ancient writers, from Aesop to Ovid, classicist and working farmer, Mark Usher compiles in this book an anthology of Greco-Roman passages illustrating how they thought about animals and illuminating they might help us to rethink our relationships with them. Not many contemporary readers will know, for example, the compelling arguments the second century AD Greek philosopher Porphyry makes for vegetarianism, long before a plant-based diet began to garner headlines. Plutarch's serio-comic exposition of the rationality and inherent dignity of (...) non-human creatures-put on the lips of one of Circe's pigs-is so fresh that it sounds like it was formulated just yesterday. The knowledge the poet Theognis derived from Greek sponge divers about the behavior of octopods rivals our contemporary fascination with the octopus. Aristotle's introduction to the scientific study of animal morphology and behavior remains unparalleled for its elegance and insight, and it represents one of the first forays into natural history writing. Seneca, employing an ingenious etymological pun on the word animal, endeavors to show that we humans are morally inferior to our animal cousins, who instinctively know and are satisfied with their place in Nature. The Greeks and Romans, amidst all their magnificent cultural achievements and reckless, destructive behavior, lived closer than most of us to the perils and prospects of their environments. This afforded them a sensitivity to their environments and, in particular, to their fellow creatures that can perhaps help to disabuse us of our disconnectedness from animal life. This small volume demonstrates how astoundingly relevant the ancients still are in this regard. (shrink)

The National Institute for Health and Care Excellence (NICE) is the UK’s primary healthcare priority-setting body, responsible for advising the National Health Service in England on which technologies to fund and which to reject. Until recently, the normative approach underlying this advice was described in a 2008 document entitled ‘Social value judgements: Principles for the development of NICE guidance’ (SVJ). In January 2020, however, NICE replaced SVJ with a new articulation of its guiding principles. Given the significant evolution of (...) NICE’s methods between 2008 and 2020, this study examines whether this new document (‘Principles’) offers a transparent account of NICE’s current normative approach. It finds that it does not, deriving much of its content directly from SVJ and failing to fully acknowledge or explain how and why NICE’s approach has since changed. In particular, Principles is found to offer a largely procedural account of NICE decision-making, despite evidence of the increasing reliance of NICE’s methods on substantive decision-rules and ‘modifiers’ that cannot be justified in purely procedural terms. Thus, while Principles tells NICE’s stakeholders much about how the organisation goes about the process of decision-making, it tells them little about the substantive grounds on which its decisions are now based. It is therefore argued that Principles does not offer a transparent account of NICE’s normative approach (either alone, or alongside other documents) and that, given NICE’s reliance on transparency as a requirement of procedural justice, NICE does not in this respect satisfy its own specification of a just decision-maker. (shrink)

Background One of the biggest challenges of practicing medicine in the age of informational technology is how to conciliate the overwhelming amount of medical-scientific information with the multiple patients’ values of modern pluralistic societies. To organize and optimize the the Decision-Making Process of seriously ill patient care, we present a framework to be used by Healthcare Providers. The objective is to align Bioethics, Evidence-based Practice and Person-centered Care. Main body The framework divides the DMP into four steps, each (...) with a different but complementary focus, goal and ethical principle. Step 1 focuses exclusively on the disease, having accuracy is its ethical principle. It aims at an accurate and probabilistic estimation of prognosis, absolute risk reduction, relative risk reduction and treatments’ burdens. Step 2 focuses on the person, using empathic communication to learn about patient values and what suffering means for the patient. Emphasis is given to learning and active listening, not taking action. Thus, instead beneficence, we trust comprehension and understanding with the suffering of others and respect for others as autonomous moral agents as the ethical principles of Step 2. Step 3 focuses on the healthcare team, having the ethics of situational awareness guiding this step. The goal is, through effective teamwork, to contextualize and link rates and probabilities related to the disease to the learned patient’s values, presenting a summary of which treatments the team considers as acceptable, recommended, potentially inappropriate and futile. Finally, Step 4 focuses on provider-patient relationship, seeking shared Goals of Care, for the best and worst scenario. Through an ethics of deliberation, it aims for a consensus that could ensure that the patient’s values will be respected as well as a scientifically acceptable medical practice will be provided. In summary: accuracy, comprehension, understanding, situational awareness and deliberation would be the ethical principles guiding each step. Conclusion Hopefully, by highlighting and naming the different perspectives of knowledge needed in clinical practice, this framework will be valuable as a practical and educational tool, guiding modern medical professionals through the many challenges of providing high quality person-centered care that is both ethical and evidence based. (shrink)

ILaw, Regulation and Ethics introduces students to the responsibilities and standards in health care derived from legal, ethical and regulatory frameworks. The text approaches ethics and law for health care in an integrated and accessible way, covering governance, professional identity, and professional responsibility whereby accountability plays an important role. The text combines examples of legal and administrative decisions with the reasoning behind decisions, to introduce students to societal expectations of institutions and persons engaged in health care. Sourced (...) from a variety of regulatory, ethics, and policy arenas, the examples equip students with the ability to identify and understand appropriate standards in order to practice safely and competently, and to recognize when a situation is problematic and deserving of greater reflection or expert advice. Practice-oriented case examples and critical-reflection questions enhance the text and encourage students to develop effective practice habits, whereby active reflection, reasoning, problem solving and mindfulness become essential components of working in the health care sector. (shrink)

Ethics of Health Care: A Guide for Clinical Practice, 3E is designed to guide health care students and practitioners through a wide variety of areas involving ethical controversies. It provides a background in value development and ethical theories, including numerous real-life examples to stimulate discussion and thought.

Despite its title, this is an extremely useful book: the first four of its five chapters expound the standard range of theories of practical reasoning more clearly and accurately than one might have thought possible. A measure of Schaubroeck’s authoritative handling of her material is her ability to navigate the peaks, troughs and crevasses of the myriad variations of ‘internalism’ and ‘externalism’ without inducing either vertigo or fury. Thus she patiently guides the reader through the stupefying obstacles along the (...) route of post-Bernard Williams usages of the terminology as well, it seems to me, as anyone could possibly do. Her specific focus, furthermore, on what she terms—albeit in my view somewhat misleadingly—Humean , Kantian and Platonic variations on a theme enables the reader to see very clearly just what is at stake in the tangled literature on practical reasoning and why it matters. As a guide for the perplexed, then, or for t .. (shrink)

The importance of medical confidentiality is obvious to anyone who has ever been a patient, and protecting private information about patients is one of the key responsibilities of healthcare professionals. However, maintaining the confidentiality of patients who are incarcerated in prisons poses several ethical challenges. In this chapter we explain the importance of confidentiality in general, and the dilemmas that sometimes face doctors with regard to it, before describing some of the specific difficulties faced by prison doctors. Although healthcare professionals (...) working in prisons have the same duty to respect confidentiality as those working in the wider community, the conflicts of interest caused by their dual loyalty to prisoners and to prison authorities can make it very difficult to strike the right balance between respecting confidentiality and protecting prisoners and third parties. We illustrate some of the dilemmas facing prison doctors with a series of case discussions before providing suggestions for resolving these difficult situations. Ideally, a combination of great ethical and legal sensitivity on the part of healthcare professionals and general respect for prisoners’ rights on the part of other prison staff enables most issues to be resolved without the need to compromise patients’ confidentiality. (shrink)

Introduction : health humanities -- Patient as storyteller : determinants of health -- Unconscious bias -- Bearing witness to suffering -- Resilience and burnout -- Recognizing our interdependence -- The influence of time on meaning -- Uncertainty and decision making -- Professional identity : perspectives, roles, values, and attributes.

Nurses have traditionally been regarded as clinicians that deliver compassionate, safe, and empathetic health care (Nurses again outpace other professions for honesty & ethics, 2018). Caring is a fundamental characteristic, expectation, and moral obligation of the nursing and caregiving professions (Nursing: Scope and standards of practice, American Nurses Association, Silver Spring, MD, 2015). Along with caring, nurses are expected to undertake ever‐expanding duties and complex tasks. In part because of the growing physical, intellectual and emotional demandingness, of nursing as (...) well as technological advances, artificial intelligence (AI) and AI care robots are rapidly changing the healthcare landscape. As technology becomes more advanced, efficient, and economical, opportunities and pressure to introduce AI into nursing care will only increase. In the first part of the article, we review recent and existing applications of AI in nursing and speculate on future use. Second, situate our project within the recent literature on the ethics of nursing and AI. Third, we explore three dominant theories of caring and the two paradigmatic expressions of caring (touch and presence) and conclude that AI—at least for the foreseeable future—is incapable of caring in the sense central to nursing and caregiving ethics. We conclude that for AI to be implemented ethically, it cannot transgress the core values of nursing, usurp aspects of caring that can only meaningfully be carried out by human beings, and it must support, open, or improve opportunities for nurses to provide the uniquely human aspects of care. (shrink)

It is argued that shu involves one's identification with another person while one criticizes the latter's perspective based on one's own. A mechanism is proposed for developing this sort of critique, based on some significant Confucian values. Finally, shu is applied to the context of caring actions, and it is shown how it can help to solve some of the problems arising in caring for others.

Researchers conducting large community-based studies among underserved populations may collect data on health conditions that are little-acknowledged in the local setting, and for which there are few if any services for referral of participants who need follow-up diagnosis and care. In the design and planning of studies for such settings, investigators and research ethics committees may struggle to determine what constitutes effective referral and whether it is reasonably available. We offer a guiding framework for referral planning, informed by our (...) experiences of research in the field and of service on research ethics committees, to support evaluation of local referral resources and consideration of the benefits, burdens and risks of referral in the local setting. The framework addresses both the impact of referral on the well-being of the people who would be referred and the impact that referral of study participants would have on local people outside the study. We use a sustained discussion of three field-based case examples to illustrate the ethical concerns at issue and to demonstrate the use of the referral planning framework. (shrink)

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

Our goal was to explore self‐care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self‐care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self‐care among men, encompassing hygiene, physical contact management, mask usage, skin (...) lesion vigilance, and adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self‐care practices can be facilitated by nurses guided by Dorothea Orem's Self‐Care Theory, supported by patient‐centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self‐care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio‐cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts. (shrink)

The best framework for moral and political thought is the one that creates the best climate for good political judgments. I argue that universalistic theories of justice fall short in this regard because they cannot distinguish idealization from abstraction. After describing how an ethic of care guides judgments, I suggest the practical effects that make this approach preferable. The ethic of care includes more aspects of human life in making political judgments.

Johnson and Stricker published an opinion piece in the Journal of Medical Ethics presenting their perspective on the 2008 agreement between the Infectious Diseases Society of America (IDSA) and the Connecticut Attorney General with regard to the 2006 IDSA treatment guideline for Lyme disease. Their writings indicate that these authors hold unconventional views of a relatively common tick-transmitted bacterial infection caused by the spirochete Borrelia burgdorferi. Therefore, it should come as no surprise that their opinions would clash with the IDSA's (...) evidence-based guidelines for the diagnosis and treatment of Lyme disease. Their allegations of conflict of interest against the IDSA resemble those made against the National Institutes of Health, the Food and Drug Administration and the Centers for Disease Control and Prevention in 2000, which were found to be baseless. It is the responsibility of all physicians and medical scientists to stand up to antiscientific, baseless and unethical attacks on those who support an evidence-based approach to caring for patients. (shrink)