Ethics Archives - Page 54 of 81 - Protection of Conscience Project Library

The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses

Venke Sørlie, Lilian Jansson, Astrid Norberg

Abstract
Twenty female Registered Nurses who had experienced being in ethically difficult care situations in paediatric care were interviewed as part of a comprehensive investigation into the narratives of male and female nurses and physicians about being in such situations. The transcribed interview texts were subjected to phenomenological-hermeneutic interpretation. The results showed that nurses appreciated social confirmation from their colleagues, patients and parents very much. This was a conditioned confirmation that was given when they performed the tasks expected from them. The nurses, however, felt that something was missing. They missed self-confirmation from their conscience. This gave them an identity problem. They were regarded as good care providers but at the same time, their conscience reminded them of not taking care of all the ‘uninteresting’ patients. This may be understood as ethics of memory where their conscience ‘set them a test’. The emotional pain nurses felt was about remembering the children they overlooked, about bad conscience and lack of self-confirmation. Nurses felt lonely because of the lack of open dialogue about ethically difficulties, for example, between colleagues and about their feeling that the wrong things were prioritized in the clinics. In this study, problems arose when nurses complied with the unspoken rules and routines without discussing the ethical challenges in their caring culture.

Sørlie V, Jansson L, Norberg A. The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses. Scand. J. Caring Sci. 2003;17(285-292.

(Correspondence) Abortion perils debated

Linda Capperauld

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Not only is the article by David Reardon and associates1 flawed . . . but the authors, particularly the lead author, have a specific and known political bias against abortion rights. . . By publishing an article that does not adhere to high standards, we feel that CMAJ has done a disservice to our field, not to mention women and their families across the nation.

Capperauld L. (Correspondence) Abortion perils debated. Can Med Assoc J. 2003 Jul 22;169(2):101.

(Editorial) Unwanted results: the ethics of controversial research

CMAJ

Extract
. . . We are chided for publishing flawed research and told that we should be ashamed of publishing the “opinions” of self-evidently biased researchers. We are accused of doing a disservice to women, medicine and the Journal, of failing to conduct proper peer review, and of not adequately scrutinizing the credentials of the authors.

The abortion debate is so highly charged that a state of
respectful listening on either side is almost impossible to achieve. This debate is conducted publicly in religious, ideological and political terms: forms of discourse in which detachment is rare. But we do seem to have the idea in medicine that science offers us a more dispassionate means of analysis. To consider abortion as a health issue, indeed as a medical “procedure,” is to remove it from metaphysical and moral argument and to place it in a pragmatic realm where one deals in terms such as safety, equity of access, outcomes and risk–benefit ratios, and where the prevailing ethical discourse, when it is evoked, uses secular words like autonomy and patient choice. . .

CMAJ. (Editorial) Unwanted results: the ethics of controversial research. Can. Med. Assoc. J.. 2003 Jul 22;169(2):93.

The Killing of Psychiatric Patients in Nazi-Germany between 1939-1945

Michael Von Cranach

Israeli Journal of Psychiatry and Related Sciences

Abstract
Between 1939 and 1945, 180,000 psychiatric patients were killed in Nazi Germany. This paper opens with a brief discussion of the reasons for addressing this issue today; it is followed by the details of the so-called euthanasia program that entailed killing of patients by gas in special hospitals in the years 1939-1941, and in psychiatric hospitals in the years 1942-1945. In this latter period, patients were killed with lethal injections and through the introduction of a starvation diet. The fate of the Jewish patients and forced laborers, as well as the experiments conducted on the patients, are mentioned. Finally, some thoughts are presented to answer the question of why this could have happened. To me, the giving up of individual responsibility in an authoritarian system leads to the loss of the individual conscience and soul, including those of a psychiatrist.

Cranach MV. The Killing of Psychiatric Patients in Nazi-Germany between 1939-1945. Israeli J Psych & Related Sciences. 2003;40(1):8-18

A presentation by the same title with a similar abstract was presented at a meeting of the Israel Psychiatric Association, Jerusalem, 6th of December 2001.

Overcoming obstacles in confronting torture

Derrick Silove

Abstract
Television images of torture chambers in Iraq and reports of the escalating use of torture in Zimbabwe remind us that this form of state-sponsored abuse continues unabated in many parts of the world. . . It is timely, therefore, to consider the reasons for the inadequate attention given to the topic by health professionals.

Silove D. Overcoming obstacles in confronting torture. The Lancet. 2003 May 3;361(9368):1555.

Nurse supervisors’ actions in relation to their decision-making style and ethical approach to clinical supervision

Ingela Berggren, Elisabeth Severinsson

Extract
Findings. The essence of the nurse supervisors’ decision-making style is deliberations and priorities. The nurse supervisors’ willingness, preparedness, knowledge and awareness constitute and form their way of creating a relationship. The nurse supervisors’ ethical approach focused on patient situations and ethical principles. The core components of nursing supervision interventions, as demonstrated in supervision sessions, are: guilt, reconciliation, integrity, responsibility, conscience and challenge. The nurse supervisors’ interventions involved sharing knowledge and values with the supervisees and recognizing them as nurses and human beings.

Conclusion. Nurse supervisors frequently reflected upon the ethical principle of autonomy and the concept and substance of integrity. The nurse supervisors used an ethical approach that focused on caring situations in order to enhance the provision of patient care. They acted as role models, shared nursing knowledge and ethical codes, and focused on patient related situations. This type of decision-making can strengthen the supervisees’ professional identity. The clinical nurse supervisors in the study were experienced and used evaluation decisions as their form of clinical decision-making activity. The findings underline the need for further research and greater knowledge in order to improve the understanding of the ethical approach to supervision.

Berggren I, Severinsson E. Nurse supervisors’ actions in relation to their decision-making style and ethical approach to clinical supervision. J Adv Nurs. 2003;41(6):615-622.

Human Rights Dynamics of Abortion Law Reform

Rebecca J Cook, Bernard M Dickens

Abstract
The legal approach to abortion is evolving from criminal prohibition towards accommodation as a life-preserving and health-preserving option, particularly in light of data on maternal mortality and morbidity. Modern momentum for liberalization comes from international adoption of the concept of reproductive health, and wider recognition that the resort to safe and digniﬁed healthcare is a major human right. Respect for women’s reproductive self-determination legitimizes abortion as a choice when family planning services have failed, been inaccessible, or been denied by rape. Recognition of women’s rights of equal citizenship with men requires that their choices for self-determination be legally respected, not criminalized.

Cook RJ, Dickens BM. Human Rights Dynamics of Abortion Law Reform. Hum Rights Quart. 2003 Feb;25(1):1-59. Available from:

Prenatal screening, autonomy and reasons: the relationship between the law of abortion and wrongful birth

Rosamund Scott

Extract
This article focuses on . . . the locus and extent of legal decision-making power as regards the disabled fetus. It does this by exploring how the relationship between the law of abortion and that of wrongful birth affects the scope of a pregnant woman’s decision-making abilities in this context. . . .In order to reflect on how the law shapes and controls a woman’s (or couple’s) autonomy in this context, the article considers both the non- rights-based English legal position on abortion and its rights-based US counterpart, in addition to exploring aspects of the law of wrongful birth in both jurisdictions. It also makes some suggestions as to the value of autonomy in this context and how extensive it should be at law, although the opportunity to do so here is limited. The discussion entails reflection on the role of the medical profession, the relationship between autonomy and reasons and the interests of people with disabilities or impairments.

Scott R. Prenatal screening, autonomy and reasons: the relationship between the law of abortion and wrongful birth. Med Law Rev. 2003 Jan 01; 11(3):265-325.

Physician-Assisted Suicide and Euthanasia: German Protestantism, Conscience, and the Limits of Purely Ethical Reflection

Peter Bartmann

Abstract
In this essay I shall describe and analyse the current debate on physician assisted suicide in contemporary German Protestant church and theology. It will be shown that the Protestant (mainly Lutheran) Church in Germany together with her Roman Catholic sister church has a specific and influential position in the public discussion: The two churches counting the majority of the population in Germany among their members tend to ‘‘organize” a social and political consensus on end-of-life questions. This cooperation is until now very successful: Speaking with one voice on end-of-life questions, the two churches function as the guardians of a moral consensus which is appreciated even by many non-believers. . .I shall argue that it will be necessary to go beyond this actual controversy to the works of Gerhard Ebeling and Karl Barth for a clear and instructive account of conscience and a theological analysis of the concepts of life and suicide. On the basis of their considerations, a conscience-related approach to physician assisted suicide is developed.

Bartmann P. Physician-Assisted Suicide and Euthanasia: German Protestantism, Conscience, and the Limits of Purely Ethical Reflection. Christ Bioet. 2003;9(3):203-225.

The Limits of Conscientious Objection to Abortion in the Developing World

Louis-Jacques Van Bogaert

Abstract
The South African Choice on Termination of Pregnancy Act 92 of 1996 gives women the right to voluntary abortion on request. The reality factor, however, is that five years later there are still more ‘technically illegal’ abortions than legal ones. Amongst other factors, one of the main obstacles to access to this constitutionally enshrined human right is the right to conscientious objection/refusal. Although the right to conscientious objection is also a basic human right, the case of refusal to provide abortion services on conscientious objection grounds should not be seen as absolute and inalienable, at least in the developing world. In the developed world, where referral to another service provider is for the most part accessible, a conscientious objector to abortion does not really put the abortion seeker’s life at risk. The same cannot be said in developing countries even when abortion is decriminalised. This is because referral procedures are fraught with major obstacles. Therefore, it is argued that the right to conscientious objection to abortion should be limited by the circumstances in which the request for abortion arises.

Bogaert L-JV. The Limits of Conscientious Objection to Abortion in the Developing World. Dev World Bioeth. 2002;2(2):131-143.