For this special issue of the Nordic Journal of Applied Ethics, we have selected four papers that address, directly or indirectly, some key issues in family ethics.

The Jewish Family Ethics Textbook guides teachers and students of all ages and backgrounds in mining classical and modern Jewish texts to inform decision making on hard choices.

_ Source: _Volume 13, Issue 6, pp 641 - 651 During the last three decades, moral philosophy has seen an increased interest in the ethics of special relationships. The relationship that has gained the most attention in recent years is the family. While there has been some progress in understanding family relationships and their ethical implications, there is still much theoretical ground to cover. In this special issue of the Journal of Moral Philosophy, we present four papers (...) that discuss new questions concerning the rights and duties that are implied by the relationship between parents and children. These include the question whether persons have a right to parent their biological offspring, or a duty to adopt a child, rather than create one; under which circumstances dependent children owe their parents gratitude for the care they provide; and how family relationships can lead to moral blackmailing and thus to moral exploitation of some of their members. (shrink)

The present article investigates what empirical research can add to family ethics. The author discusses the approach of theologian Don Browning’s family ethics, referring to empirical research about values and norms and about factual data. The author warns against oversimplifying the relationship between what ‘is’ and what ‘ought’ to be. In the next step, the author critically examines her previous research in light of the meta-question of the relevance of empirical research for ethics. Four aspects (...) are discussed: empirical research as a possible bridge between ideals and reality, empirical results on the gender related division of domestic tasks, experiences of family in relation to ethical ideas and the relationship between ethical views on family life and religious attitudes.Empirical research is considered relevant for theological family ethics because it makes researchers aware of the distance or similarities between ideals and reality, because it helps them to reflect on the relevance of their theological ethics in practice and because it demonstrates the influence of social, religious and family identity on ethical thinking. (shrink)

This paper applies a relational and familial ethic to address concerns relating to nursing home deaths and advance care planning during Covid‐19 and beyond. The deaths of our elderly in nursing homes during this pandemic have been made more complicated by the restriction of visitors even at the end of life, a time when families would normally be present. While we must be vigilant about preventing unnecessary deaths caused by coronavirus outbreaks in nursing homes, some deaths of our elders are (...) inevitable. Thus, it is essential that advanced care planning occurs in a way that upholds the familial and relational aspects of elders’ lives that often matter to them the most. We invoke concepts from feminist ethicists like Hilde Lindemann and Eva Kittay and introduce Avery Weisman and Thomas Hackett’s concept of “appropriate death” to suggest better ways of planning for those deaths of our elderly that cannot be avoided. Our hope is to allow for deaths that are as meaningful as possible for both the elderly and the family members who survive them. (shrink)

Travis Rieder's Toward a Small Family Ethic confronts the effects of population growth and addresses what individual procreative obligations might follow from it. In this review, I summarize the main arguments that Rieder deploys to defend his position that those with large ecological footprints morally ought to follow a small family ethic. I express sympathy with some of his claims and praise the book's accessibility, but its short length inevitably means that some important issues are omitted or given (...) only superficial treatment. I highlight a few of those issues at the end of the review. (shrink)

ABSTRACTIn this article, I shall briefly examine the basic characteristics of Confucian familial morality, especially of the concept of filial piety, and argue that ancient Confucians tend to be conservative on allowing breach of filial obligations although they may not entirely exclude particular considerations to exceptional situations to a certain degree. I shall then argue that this conservative aspect of the Confucian idea of filial piety accurately captures some distinctive features of familial relationships and may thus shed light on our (...) understanding of the ethical nature of human family life and our philosophical investigation of familial ethics. (shrink)

Discusses the ethics of family from a philosophical and practical perspective, engaging law, psychology, and sociology.

To examine the ethical duty to patients and families in the setting of the resuscitation bay, we address a case with a focus on providing optimal care and communication to family members. We present a case of nonsurvivable traumatic injury in a minor, focusing on how allowing family more time at the bedside impacts the quality of death and what duty exists to maintain an emotionally optimal environment for family grieving and acceptance. Our analysis proposes tenets for (...) patient and family-centric care that, in alignment with trauma-informed care principles, optimize the long-term well-being of the family, namely valuing family desires and sensitivity to location. (shrink)

Background: The families of brain-dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation. The principles of donation-related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation-related experience, understanding the outcomes of (...) donation appears crucial. Objective: The aim of this study was to explore the outcomes of organ donation for the families of brain-dead patients. Methods: This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants. Data analysis was performed by following the qualitative content analysis approach developed by Elo and Kyngäs. Findings: The main category of the data was “Decision to organ donation: a challenge from conflict to transcendence.” This main category consisted of 10 subcategories and 3 general categories. The general categories were “challenging outcomes,” “reassuring outcomes,” and “transcending outcomes.” Ethical considerations: The study was approved by the regional ethical review board. The ethical principles of informed consent, confidentiality, and non-identification were used. Conclusion: Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence. Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from the tragedy of significant loss, healthcare professionals need to facilitate the process of achieving confidence and transcendence by them. (shrink)

While ethicists have directed much attention to controversial biomedical issues--including euthanasia, abortion, and genetic engineering--they have largely ignored the less obvious, but more pervasive, everyday ethical problems faced by family physicians. Ethical Issues in Family Medicine addresses these problems, offering an ethics that reflects the distinctive features of family practice, and helping family physicians to appreciate the extent to which ethical issues influence their practice.

The family disrupts equality while also, think many, providing goods of unique value. In Family Values, Brighouse and Swift tackle both of these tendencies, offering a refined and distinctive liberal egalitarian account both of the value of family life, and the limits of what may be done in its name. It builds up from an account of children's specific interests to a defence of ‘familial relationship goods’ as providing the best way of satisfying those interests. Thus though (...) parenthood carries goods of its own, parental prerogatives are delimited by what is good for children. The position which emerges plays out in nuanced, sometimes surprising ways. I raise three main lines of potential criticism, concerning, respectively, the distribution of family relationship goods, their value in relation to fair equality of opportunity, and the viability of distinguishing between family-located and other contributions to the realisation of a child's interests. (shrink)

The ethical behavior prevalent in an organization often determines business success or failure. Much research in the business context has scrutinized ethical behavior, but there are still few insights into its roots; this study furthers this line of inquiry. In line with identity work theory, we examine how employees’ identification with a family business shapes internal ethical decision-making processes. Because it is individuals who engage in decision-making—be it ethical or not—our research perspective centers on the individual level. We followed (...) an inductive, qualitative approach and conducted interviews with 19 employees in seven family businesses. We found that individuals engage in identity work when they identify as individual family firm employees and when they identify with the perceived characteristics of the family firm. These processes of identification, in turn, influence how employees cope with ethical situations. Our findings contribute to ethics and family business research, as well as to identity theory. (shrink)

This book concerns the ethics of having children through adoption or technologically-assisted reproduction. Some people who choose between these methods struggle between them. Others do not agonize in this way, perhaps because they have a profound desire for a genetic link to the child(ren) they will parent and so prefer assisted reproduction, they view adoption as the only morally decent choice in an overcrowded world, or for some other reason. This book critically examines moral choices that involve each of (...) these ways of making or expanding families with children. The contributors discuss how adoption and assisted reproduction are morally distinct from one another, but also emphasize how they are morally similar, given that both are forms of family‐making. (shrink)

In spite of the considerable development of research in the fields of business ethics and family business, a comprehensive review and integration of the area where both disciplines intersect has not been undertaken so far. This paper aims at contributing to the call for more research on family business ethics by answering the following research questions: What is the status of the current research at the intersection of business ethics and family business? Why and (...) how do family firms differ from non-family firms regarding business ethics? And, what are the key directions for further research? To answer these questions, this study combines a systematic approach for the selection of articles, resulting in a sample of 31 articles over 35 years, with a narrative review to analyze the literature. This paper finds that research on family business ethics is scarce but increasing and that family firms are considerably different from non-family firms regarding ethical issues. Particular stakeholders, goals, relationships, and practices are found to be the forces behind the peculiarity of family business ethics. Ultimately, research development on family business ethics is encouraged and future research directions flowing from the key findings and reflections of this review are provided. (shrink)

Child abuse within the family is a highly sensitive issue and therefore difficult to research. This article is based on our experiences of a child abuse research project in Finland. Special attention is given to ethical considerations during the initiation of the study, and in the sampling procedures, data collection and reporting. Most importantly, all those taking part in studies on sensitive issues must be guaranteed full confidentiality and anonymity. There are also other ethical considerations that go beyond the (...) usual concerns in the research process. (shrink)

Many families of patients hold the view that it is their right to be present during a loved one's resuscitation, while the majority of patients also express the comfort and support they would feel by having them there. Currently, family presence is more commonly accepted in paediatric cardiopulmonary resuscitation than adult CPR. Even though many guidelines are in favour of this practice and recognise potential benefits, healthcare professionals are hesitant to support adult family presence to the extent that (...) paediatric family presence is supported. However, in this paper, we suggest that the ethical case to justify family presence during paediatric resuscitation is weaker than the justification of family presence during adult resuscitation. We go on to support this claim using three main arguments that people use in clinical ethics to justify FPDR. These include scarcity of evidence documenting disruption, psychological benefits to family members following the incident and respect for patient autonomy. We demonstrate that these arguments actually apply more strongly to A-FPDR compared with P-FPDR, thereby questioning the common attitude of healthcare professionals of allowing the latter while mostly opposing A-FPDR. Importantly, we do not wish to suggest that P-FPDR should not be allowed. Rather, we suggest that since P-FPDR is commonly allowed, so should A-FPDR. This is because the aforementioned arguments that are used to justify FPDR in general actually make a stronger case for A-FPDR. (shrink)

ABSTRACT:The ubiquity of family dominated firms in economies worldwide suggests that inquiry into the nature of the ethical frames of these types of firms is increasingly important. In the context of a social exchange approach and the norm of reciprocity, this manuscript addresses social cohesion in a dominant family firm coalition. It is argued that the factors underlying this cohesion, direct versus indirect reciprocity, shape unique attributes of family firms such as intentions for transgenerational sustainability, the pursuit (...) of non-economic goals, and strong interpersonal ties. Exchange structures, represented by direct and indirect reciprocity, lead family and non-family firms toward development of distinctive ethical frames of reference. (shrink)

This book is the first extensive study of the role of the family in the work of Seneca. It offers a new way of reading philosophy that combines philosophical analysis with social, cultural and historical factors to bring out the ways in which Stoicism presents itself as in tune with the universe. The family serves a central role in an individual's moral development - both the family as conventionally understood, and the wider conceptual family which Stoicism (...) constructs. Innovative readings of Seneca's work bring out the importance of the family to his thought and how it interacts with other Stoic doctrines. We learn how to be virtuous from observing and imitating our family, who can be biological relatives or people we choose as our intellectual ancestors. The Ethics of the Family in Seneca will be of particular interest to researchers in Roman Stoicism, imperial culture and the history of the family. (shrink)

This essay indicates that Confucian family-based ethics is by no means a stumbling block to organ donation in China. We contend that China should not change to an opt-out consent system in order to enhance donation because a “hard” opt-out system is unethical, and a “soft” opt-out system is unhelpful. We argue that the recently-introduced familist model of motivation for organ donation in mainland China can provide a proper incentive for donation. This model, and the family priority (...) right that this model supports, is ethically justifiable in terms of Confucian family-based ethics. (shrink)

Background: In Israel, caring for people with end-stage dementia confined to home is mainly done by home care units, and in some cases by home hospice units, an alternative palliative-care service. Because life expectancy is relatively unknown, and the patient’s decision-making ability is poor, caring for this unique population raises ethical dilemmas regarding when to define the disease as having reached a terminal stage, as well as choosing between palliative and life-prolonging-oriented care. Objectives: Exploring and describing differences and similarities of (...) professional staff members’ (PSMs’) and family caregivers’ perceptions of caring for people with end-stage dementia in two different settings. Design: Qualitative research, using semi-structured interviews analyzed through a thematic content–analysis approach. Participants: Sixty-four interviews were conducted (24 PSMs and 40 family caregivers) in two care-settings—home hospice unit and home care unit. Ethical considerations: The study was approved by the Ethics Committee (BBL00118-17). Findings: We found dilemmas regarding palliative care to be the main theme, including definition of the disease as terminal, choosing “comfort” over “life-prolonging,” clarifying patients’ wishes and deciding whether or not to use artificial feeding. Discussion: Both PSMs and family caregivers deal with ethical dilemmas and have reached different conclusions, both legitimate. Comprehending dementia as a terminal disease influenced participants’ perceptions of the relevancy of palliative care for people with end-stage dementia. Discrepancies between PSMs and family caregivers in caring for people with end-stage dementia were found in both home hospice unit and home care unit environments, raising potential conflicts regarding decisions for end-of-life care. Conclusions: Communication between PSMs and family caregivers is crucial for the discussion about the discrepancies regarding the unique dilemmas of caring for people with end-stage dementia and bridging the gap between them. Lack of communication and resources can hamper the provision of an acceptable solution for quality and equality of care in the best interest of people with end-stage dementia. (shrink)

End-of-life issues have become an urgent problem in Japan, where people are among the longest lived in the world and most of them die while connected to high-technology medical equipment. This study examines a sensitive end-of-life ethical issue that concerns patients, families and nurses: the withdrawal of artificial food and fluid from terminally ill patients. A sample of 160 Japanese nurses, who completed a questionnaire that included forced-choice and open-ended questions, supported this act under only two specific conditions: if the (...) patient requested it, and if it relieved the patient’s suffering. They considered that the doctor’s orders, the family’s request, or the patient’s advanced age did not ethically justify this act. A small number of people who had recently lost a relative took part in semistructured interviews focusing on their experiences of their terminally ill relatives being given artificial food and fluid. Ethical, social and cultural factors surrounding this issue are discussed. (shrink)

Medical ethical thought, imbued with the idealism of traditional medicine, has always grappled with the problem of translating abstract principles into actions that do not violate the sensibilities of the patient or the physician. The problem of translation is minimal for the family physician engaged in routine conversations with patients and their family members. This conversation — staying with details, maintaining the union of values and facts, reflecting without detaching or distancing — suggests a model of ethical reasoning (...) and problem-solving that warrants serious attention. (shrink)

Background In current Western medical ethics, patient-centered medicine is considered the norm. However, the cultural background of collectivism in East Asia often leads to family-centered decision-making. In Japan, prior studies have reported that family-centered decision-making is more likely to be preferred in situations of disease notification and end-of-life decision-making. Nonetheless, there has been a recent shift from collectivism to individualism due to changes in the social structure. Various personal factors have also been reported to influence moral decision-making. (...) Therefore, this study examined whether the current trend in attitudes of healthcare decision-making in Japan is family-centered or patient-centered among the general public and physicians. In addition, the personal factors that influence this tendency were examined.Methods Three vignettes on disease notification and two vignettes on decision-making during end-of-life care were created, and 457 members of the public and 284 physicians were asked about their attitudes (behavioral intentions) regarding these vignettes.Results Approximately, 95% of physicians were patient-centered in explaining the patient’s severe medical condition. However, approximately 80% of physicians emphasized the wishes of the family over patient wishes when making life-sustaining decisions. Nearly half the general public emphasized the patient’s wishes in the explanation of a severe medical condition and in life-sustaining decisions. In both the public and physician groups, personal factors, particularly the presence or absence of a disease under treatment and prior caregiving experience, influenced ethical attitudes toward medical treatment decisions.Conclusions In relatively low-conflict situations, such as the announcement of a patient’s medical condition, physicians tended to be patient-centered, while they tended to be family-centered in situations of strong conflict in withholding life-sustaining treatment. The fact that personal factors influenced the family-centered response in situations of strong conflict highlights the importance of not only acquiring knowledge of medical ethics but also learning to fairly apply this knowledge in practice. (shrink)

Background: An ongoing challenge for clinical ethics consultation is learning how colleagues in other healthcare professions understand, make use of, and evaluate clinical ethics consultation services. Aim: In pursuing such knowledge as part of clinical ethics consultation service quality assessment, clinical ethics consultation services can learn important information about the issues and concerns that prompt colleagues to request ethics consultation. Such knowledge allows for greater outreach, education, and responsiveness by clinical ethics consultation services to (...) the concerns of clinician colleagues. Design: This quality assessment project explores consultation requests and follow-up questionnaire responses voluntarily submitted from nurses who requested clinical ethics consultation. We present qualitative data analyzed using content analysis and constant comparison methods to identify key concerns that prompted requests as well as common themes among nurse requestors’ evaluations of what was most important in clinical ethics consultations. Participants and context: A total of 41 nurses requesting clinical ethics consultation and 15 who returned the follow-up questionnaire. Ethical considerations: Our Office of Research Compliance and Quality Improvement determined that our project was not considered human subjects research and so did not require institutional review board approval or exemption. However, efforts were made to avoid any sense of coercion and all data were de-identified prior to analysis. Findings: Our analysis revealed six main categories of issues that prompted nurses’ requests for ethics consultation, as well as unifying themes around nurses’ experiences, advocacy, and family support while caring for patients in the intersections of patients, families, and physicians. Discussion: The insights gained from analyzing nurses’ requests for and responses to clinical ethics consultation may serve as a resource for clinical ethics consultation services seeking to identify, respond to, and educate regarding issues of importance to nurse colleagues and may be a resource for nursing administrators and leadership seeking to identify and address common ethical issues nurses face. Conclusion: Ongoing work on clinical ethics consultation service quality improvement and engagement with our nursing colleagues about their concerns prompting—and their evaluations of—clinical ethics consultation are necessary. (shrink)

The inclusion of morally binding values such as religious—or in a broader sense, spiritual—values fundamentally alter organizational decision-making and ethical behavior. Family firms, being a particularly value-driven type of organization, provide ample room for religious beliefs to affect family, business, and individual decisions. The influence that the owning family is able to exert on value formation and preservation in the family business makes religious family firms an incubator for value-driven and faith-led decision-making and behavior. They (...) represent a particularly rich and relevant context to re-assess the relationship between ethical beliefs, decision-making processes and behaviors in business organizations at the interface between family and professional logics. This Special Issue is dedicated to deepening our understanding of the role religious values and spirituality play in the formation of organizational ethical practices in faith-led family firms and resulting organizational and family-related outcomes. In this editorial, we introduce the 10 papers included in this Special Issue, which investigate the relationship between religion or spirituality and family firm ethical behavior in various geographical, cultural and religious contexts, using a multitude of qualitative and quantitative methodologies. By focusing on the effects of religious or spiritual orientations on both the business and the family, as well as on the values, norms and goals present in the family business system, further research can gain a more nuanced understanding of the relationship between religious and spiritual believes, and sustainable ethical behavior in family firms. (shrink)

Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and family members who do not wish them to attempt cardiopulmonary resuscitation. We examine the professional guidance and the protection provided to clinicians, which is not matched by guidance to protect family members. We look at the legal framework in which these scenarios are taking place, and the ethical issues which are presented. We consider the (...) interaction between ethics, clinical practice and the law, and offer suggested changes to policy and guidance which we believe will protect ambulance clinicians, relatives and the patient. (shrink)

Offers an innovative theological look at what family might mean that cuts deeper than current, mostly polarised debates. The book taps literary, artistic and biblical sources and brings them into conversation with family studies from humanities and social science to understand why family is currently a controversial topic.

The Nurse-Family Partnership, a thirty-year program of research in the United States focused on early childhood preventive intervention, offers a powerful example of the kinds of programs and public policies that Confucian understandings of parent–child relationships and moral cultivation might recommend in contemporary societies today. NFP findings, as well as its theoretical foundations, lend empirical support to early Confucian views of the role of parent–child relationships in human moral development, the nature and possibility of moral self-cultivation, and the task (...) of creating and sustaining a good society, which gives philosophers who are interested in ethical claims that reflect and inform actual practice good reasons to take Confucian ethics seriously. Additionally, the evidence provided by the NFP and early Confucian accounts can both be used to promote social change, which highlights how the sciences and the humanities can work together in complementary ways to address societal problems. (shrink)

Families frequently act as substitute decisionmakers for their older members who suffer from diminished mental capacity to make and express their own medical choices. Substitute decisionmaking takes on particular ethical and legal urgency within the nursing home environment, especially when choices concern potential medical treatment near the end of the nursing home resident's life. This article examines current legal mechanisms in the United States that enable a family to make substitute medical decisions, the ethical underpinnings of those mechanisms, and (...) specific ethical and legal considerations implicated by their application to the nursing home setting. The article offers advice to nursing home professionals, including physicians, in working with families as substitute decisionmakers. (shrink)

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify and communicate (...) ethical obligations to family caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy. (shrink)

Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate (...) decision makers for critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: perceived or actual medical error, concerns about the medical team’s competence, miscommunication, perceived conflict of interest or commitment, or loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship. (shrink)

Background Research in children is essential for them to benefit from the outcomes of research but involvement must be weighed against potential harms. In many countries and circumstances, medical research legally requires parental consent until the age of 18 years, with poorly defined recommendations for assent prior to this. However, there is little research exploring how these decisions are made by families and the ethical implications of this. Aim To explore key ethical debates in decision-making for participation of children and (...) adolescents in a human papillomavirus (HPV) vaccine trial. Methods Semi-structured interviews were undertaken with Tanzanian girls (aged 9–16 years) who had participated in an HPV vaccine trial (n = 13), their parents or guardians (n = 12), and girls together with their parents (in paired parent-child interviews) (n = 6). The interviews were analysed using thematic analysis. Interview data came from a qualitative acceptability study undertaken as part of the Dose Reduction Immunobridging and Safety Study of Two Human Papillomavirus (HPV) Vaccines in Tanzanian Girls (DoRIS) trial. Results Girls and parents desired collaborative decision-making, with parents ultimately making the decision to consent. However, girls wanted a larger part in decision-making. Decisions to consent involved many people, including extended social networks, the trial team, media outlets and healthcare professionals and this resulted in conflicts to be negotiated. Deciding where to place trust was central in participants and parents considering decisions to consent and overcoming rumours about trial involvement. Conclusions Existing models of decision-making help to understand dynamics between parents, adolescents and researchers but neglect the important wider social impacts and the fundamental nature of trust. Children’s roles in discussions can be evaluated using the principles of consent: autonomy, freedom and information. Concepts such as relational autonomy help to explain mechanisms families use to negotiate complex consent decisions. Whilst interviewees supported the maintenance of legal parental consent, researchers must design consent processes centring the child to ensure that whole family decision-making processes are supported. (shrink)

Fiester and Yuan discuss important ethical concerns regarding the use of behavior contracts in addressing conflict with patients and families labeled as “difficult” (Fiester and Yuan 2023). We agre...

The family is hotly contested ideological terrain. Some defend the traditional two-parent heterosexual family while others welcome its demise. Opinions vary about how much control parents should have over their children's upbringing. Family Values provides a major new theoretical account of the morality and politics of the family, telling us why the family is valuable, who has the right to parent, and what rights parents should—and should not—have over their children. Harry Brighouse and Adam Swift (...) argue that parent-child relationships produce the "familial relationship goods" that people need to flourish. Children's healthy development depends on intimate relationships with authoritative adults, while the distinctive joys and challenges of parenting are part of a fulfilling life for adults. Yet the relationships that make these goods possible have little to do with biology, and do not require the extensive rights that parents currently enjoy. Challenging some of our most commonly held beliefs about the family, Brighouse and Swift explain why a child's interest in autonomy severely limits parents' right to shape their children's values, and why parents have no fundamental right to confer wealth or advantage on their children. Family Values reaffirms the vital importance of the family as a social institution while challenging its role in the reproduction of social inequality and carefully balancing the interests of parents and children. (shrink)

Patient families sometimes ask health professionals, ‘What would you do if this were your family member?’ The purpose of this paper is to examine appropriate responses to this Question. Health professionals may say, ‘It all depends on the patient's wishes’, or ‘I don't know what is best, because my family is different from yours in many ways’. Some may believe that the most favourable course of action is the same regardless of who the patient is and explain this (...) to the patient's family, while others may refuse to answer the Question saying it is personal, or argue that such a Question should neither be asked nor answered because it is unreasonable and unprofessional to do so. We believe that, in principle, health professionals should give an honest answer as to what they would do if the patient was their family member, recognising and empathising with the fact that the patient's family is in a difficult and vulnerable position, and that their circumstances forced them to ask such a Question. Moreover, personal and emotional views of health professionals regarding treatment options may help the patient's family make important decisions. An honest answer will help strengthen the trusting relationship between health professionals and the patient's family and support their decision-making. (shrink)

The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each other. The authors explore how medicine, through its new reproductive technologies, is altering the stucture of families, how families can participate more fully in medical decision-making, and how to understand the impact on families of medical advances to extend life but not vitality.

In a healthcare setting, a multitude of ethical and moral challenges are often present when patients and families direct uncivil behavior toward clinicians and staff. These negative interactions may elicit strong social and emotional reactions among staff, other patients, and visitors; and they may impede the normal functioning of an institution. Ethics Committees and Clinical Ethics Consultation Services (CECSs) can meaningfully contribute to organizational efforts to effectively manage incivility through two distinct, yet inter-related channels. First, given their responsibility (...) to promote a humane, respectful, and professional climate, many CECSs and Ethics Committees may assist institutional leadership in evaluating and monitoring incivility policies and procedures. Second, when confronted with individual incidents of patient/family incivility, Ethics Consultants can and often do work with all stakeholders to address and mitigate potentially deleterious impacts. This manuscript presents an overview of the multifaceted ethical implications of incivility in the healthcare environment, discusses the inherent qualifications of Ethics Consultants for assisting in the management of incivility, and proposes specific mitigating actions within the purview of CECSs and Ethics Committees. We also invite healthcare organizations to harness the skills and reputation of their CECSs and Ethics Committees in confronting incivility through comprehensive policies, procedures, and training. (shrink)

Long used as a tool for medical compliance and adhering to treatment plans, behavior contracts have made their way into the in-patient healthcare setting as a way to manage the “difficult” patient and family. The use of this tool is even being adopted by healthcare ethics consultants (HECs) in US hospitals as part of their work in navigating conflict at the bedside. Anecdotal evidence of their increasing popularity among clinical ethicists, for example, can be found at professional bioethics (...) meetings and conversations and idea-sharing among practitioners on HEC social media. While there are a handful of papers gesturing toward a bioethical critique of behavior contracts of various types, the use of behavior contracts in the context of interpersonal conflict has not been vetted by bioethicists to determine their ethical legitimacy or efficacy. In this paper, we highlight a set of ethical concerns that we believe must be addressed before continuing or widespread implementation of behavior contracts to manage the “difficult” patient or family. (shrink)