This book is an investigation into the descriptive task of moral philosophy. Nora Hämäläinen explores the challenge of providing rich and accurate pictures of the moral conditions, values, virtues, and norms under which people live and have lived, along with relevant knowledge about the human animal and human nature. While modern moral philosophy has focused its energies on normative and metaethical theory, the task of describing, uncovering, and inquiring into moral frameworks and moral practices has mainly been left to (...) social scientists and historians. Nora Hämäläinen argues that this division of labour has detrimental consequences for moral philosophy and that a reorientation toward descriptive work is needed in moral philosophy. She traces resources for a descriptive philosophical ethics in the work of four prominent philosophers of the twentieth century: John Dewey, Ludwig Wittgenstein, Michel Foucault, and Charles Taylor, while also calling on thinkers inspired by them. (shrink)

The role of ethicists is to provide a genuine ethical theory to help non-ethicists interpret and solve moral dilemmas, to define what is right or wrong, and, finally, to clarify moral values. Therefore, ethicists are taught to address morality with rational procedures, to set aside their moral intuitions and emotions. Sometimes, professional ethicists are prone to falling into the archangel delusion – the belief that they are beyond the influence of their own emotions. This can lead to ousting moral intuitions (...) from the space of ethical reflection, thus making ethicists unaware of them. They may treat intuitive beliefs about morality as an expression of primal moral feelings. The main question pursued in this article, is how those feelings may influence moral theories, which should be developed by professional ethicists. Ethicists may provide an ethical theory which is merely a rationalisation and justification for their own suppressed moral emotions, rather than the effect of genuine, rational moral reasoning. To help ethicists cope with this delusion, a model of cooperation between descriptive and normative ethics is proposed. Ethicists should therefore use the research tools of descriptive ethics to determine their own intuitions, and the moral emotions in which these intuitions are grounded. --------------- Received: 09/06/2021. Reviewed: 23/07/2021. Accepted: 13/08/2021. (shrink)

ABSTRACT Objective: To describe how local research ethics committees (LRECs) consider and apply research ethics in the evaluation of biomedical research proposals. Design: A qualitative study was conducted using purposeful sampling, focus groups and a grounded theory approach to generate data and to analyse the work of the LRECs. Setting and participants: 11 LRECs of the Mexican Institute of Social Security (IMSS). Results: LRECs considered ethics to be implicit in all types of research, but that ethics (...) reviews were only necessary for projects that included the direct participation of human beings. The LRECs appeared to understand the importance of consent, as in the completion of a consent form, but did not emphasise the importance of the process of acquiring ‘informed’ consent. The committees considered their main roles or functions to be: (a) to improve the methodological quality of research and to verify – if applicable – the ethical aspects; (b) to encourage personnel to undergo research training; (c) to follow‐up research to oversee the adherence to norms and compliance with a specified research timetable. Conclusions: This study provides a valuable insight into how these LRECs understand the ethical review process. The emphasis of the committees was on rules, regulations, improving research methodology and research training, rather than a focus on efforts to protect the rights and well being of research subjects. The results encourage further normative and descriptive lines of investigation concerning education and the development of LRECs. (shrink)

In the last twenty years, there has been an enormous growth of scientific research concerning the process of human moral reasoning and moral intuitions. In contemporary descriptive ethics, three dominant approaches can be found – heuristic approach, dual-process theory, and universal moral grammar. Each of these accounts is based on similar empirical evidence combining findings from evolutionary biology, moral psychology, and neuroethics. Nevertheless, they come to different conclusions about the reliability of moral intuitions. The aim of this paper (...) is to critically investigate each of these approaches and compare them with recent scientific findings. Last chapter addresses implications of these findings for moral epistemology and normative ethics. The aim is to show that despite different interpretations of available data, we can reach a satisfying pragmatical conclusion which would be in compliance with the empirical evidence, yet it would not necessarily depend on it. (shrink)

Research question and aim Clinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020, a CEC was established in an Oncology Research Hospital in the North of Italy. This paper describes the development process and the activities performed 20 months from the CEC’s implementation, to increase knowledge about CEC’s implementation strategy. Research design We collected quantitative data related to number and characteristics of CEC activities carried (...) out from October 2020 to June 2022 using the CEC internal database. Data were reported descriptively and compared with data from the literature to provide a complete overview of the CEC’s development and implementation process. Participants and research context The study has been conducted at the local health authority (LHA) of Reggio Emilia. It is a report of the activities provided by the CEC, where no HPs or patients were involved. Ethical Considerations The report is part of a larger study named EVAluating a Clinical Ethics Committee implementation process (EvaCEC), which has been approved by the Local Ethics Committee (AUSLRE Protocollo n° 2022/0026554 of 24/02/2022). EvaCEC is also the first author's PhD project. Findings In total, the CEC performed 7 ethics consultations (EC), published three policies related to particular ethical questions of clinical and organizational practice, provided one educational online course on ethics consultation targeting employed HPs, and promoted a specific dissemination process among the different departments of the LHA. According to our results, the CEC widely fulfilled the standard threefold set of clinical ethics support services tasks (namely, ethics consultation, ethics education, and policy development), but further investigations are needed to evaluate the CEC’s impact on clinical practice. Conclusion Our findings may increase knowledge regarding the composition, role, and tasks of a CEC in an Italian setting, informing future strategies and efforts to regulate these institutions officially. (shrink)

This article offers a discussion of the relevance of empirical studies to normative ethics focusing on the new trend in bioethics called empirical bioethics. The author sees this trend as an answer to a call made by anthropologists decades ago that ethicists should be more aware of the situatedness of the moral institution of life. Through a discussion of two opposing views expressed in the final publications of the EU-funded EMPIRE-project, the middle way is sought between the misconception of (...) bioethics as pure philosophy on one side and the misconception of bioethics as sociology on the other. The author argues that empirical studies may be of relevance to the normative enterprise in at least three ways as illustrated in the EMPIRE-material. First, there is the relevance of empirical facts as descriptive premises in ethical arguments. Second, there is the relevance of empirical studies as means of mapping moral opinion and moral experience which ought to serve as one of two poles between which one oscillates in moral decision making – the other being the normative ethical theories. Third, there is the relevance of empirical studies of the capacity and function of the human mind, which may tell us something about the range of normative principles and rules.Keywords: Ethics, normative ethics, descriptive ethics, empirical bioethics. (shrink)

BackgroundClinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital.MethodsSemi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May (...) 31, 2020. All documents were analysed by two researchers independently.ResultsTwenty-four CECCs were requested within the study period, of which most (n = 22; 92%) had been initiated by physicians of the department. The patients were an average of 79 years old (R: 43–96), and 14 (58%) patients were female. The median length of stay prior to request was 12.5 days (R: 1–65 days). The most frequent diagnoses (several diagnoses possible) were cardiology-related (n = 29), followed by sepsis (n = 11) and cancer (n = 6). Twenty patients lacked decisional capacity. The main reason for a CECC request was uncertainty about the balancing of potential benefit and harm related to the medically indicated treatment (n = 18). Further reasons included differing views regarding the best individual treatment option between health professionals and patients (n = 3) or between different team members (n = 3). Consensus between participants could be reached in 18 (75%) consultations. The implementation of a disease specific treatment intervention was recommended in five cases. Palliative care and limitation of further disease specific interventions was recommended in 12 cases.ConclusionsTo the best of our knowledge, this is the first in-depth evaluation of a CECC service set up for an academic department of cardiology and intensive medical care. Patient characteristics and the issues deliberated during CECC provide a starting point for the development and testing of more tailored clinical ethics support services and research on CECC outcomes. (shrink)

Evidence shows that during birth women frequently experience unconsented care, coercion, and a loss of autonomy. For many countries, this contradicts both the law and medical ethics guidelines, which emphasize that competent and fully informed women’s autonomy must always be respected. To better understand this discordance, we empirically describe perinatal maternity care providers’ and women’s moral deliberation surrounding coercive measures during birth. Data were obtained from 1-on-1 interviews with providers (N = 15) and women (N = 14), and a (...) survey of women (N = 118). Analyses focused on an in-depth exploration of responses to a question on the permissibility of coercion in birth whose wording was borrowed from a Swiss medical-ethical guideline. Reasons for and against a principle permissibility of coercive measures in birth were grouped into clusters of reasons to build a coherent explanatory framework. Factors considered morally relevant when deliberating on coercion included women’s decisional capacity, beneficence/non-maleficence, authority through knowledge on the part of providers, flaws of the medical system, or the imperative to protect the most vulnerable. Also, we identified various misconceptions, such as the conviction that a pathological birth can justify coercion or that fetal rights can justifiably infringe on women’s autonomy. Information and education on the issue of coercion in birth are urgently needed to enable women to fully exercise their reproductive autonomy, to prevent long-term adverse health outcomes of women and children, and to reconcile the medical vigilance which has lead to a reduction of perinatal morbidity and mortality with women’s enfranchisement in their own care. (shrink)

In common with much of theEnglish-speaking world, New Zealandersgenerally oppose the use of animalexperimentation where there is no demonstrableand immediate benefit for human, animal, orenvironmental health. Intrusive experiments onsheep internal and external parasites publishedbetween 1996 and 2000 are reviewed, anddiscussed in relation to these publicsensibilities. A total of 16 publishedexperiments on sheep parasites involvedsurgical manipulations or other intrusiveprocedures. Some of these experiments had noshort-term application, or the only applicationwas in increasing animal production. Otherscould have been modified at some extra expenseso (...) that they were less intrusive. Still otherswere duplications of previous work. All thesemanipulations would be unacceptable accordingto the orthodox morality of the general public.Breeding programs, rotation of grazing,``low-tech'' vaccination, and in vitromodels of sheep can provide insights intopreventing parasite infestation withoutintrusive experiments. Such research protocolsshould take priority over existing programs.The results also confirm earlier reports thatanimal ethics committees are not fulfillingtheir mandated objective of acting as watchdogsfor the public. Possible changes in New Zealandanimal welfare legislation and itsinterpretation by Animal Ethics Committees arediscussed. (shrink)

This article presents a descriptive, interpretive theory of ethical responsibility in public health nursing. The theory is based on qualitative empirical studies, a purposeful literature review and meta-ethnography of public health nurses’ experiences of ethical responsibility, interpreted within a philosophical framework. Levianasian philosophy provides the main direction for the authors’ interpretations. The path for theory development consists of three phases: an inspirational phase, an explorative phase and the third phase ‘ joining the dots’. The theory illustrates that ethical responsibility (...) in public health nursing is related to the life existentials of temporality and human relationships. Due to blurred boundaries in these essential life structures, public health nurses can experience a sense of satisfaction but also worries, uncertainties and loneliness. The study reveals paradoxical connections between fear and courage, and between freedom, autonomy and a sense of entrapment in responsible relationships. The authors purport that the results of this study are relevant for education and practice and can provide direction for further studies on developing theories of ethical responsibility in other nursing specialities. (shrink)

Ethical guidelines for psychologists are meant to stimulate and help psychologists to act appropriately with respect to clients, colleagues, and other individuals involved in their professional relations. This paper focuses on the similarity of codes of ethics of psychologists in European countries in general, and on specific ethical dilemmas in the area of work and organizations in particular. First, an overview is given of the development of ethical guidelines in Europe and the USA. Second, the results are presented of (...) a survey by E-mail amongst members of the European Federation of Psychologists’ Associations (EFPA) to identify the differences and similarities between ethical guidelines of the affiliate members. Third, the potential dilemmas of stakeholders in work and organizational assessment are addressed. Finally, the results of a survey among Dutch selection psychologists are presented. The purpose of this study was to examine a possible tension between normative behavior and attitudes about normal behavior. It was concluded that ethical guidelines of European countries cover comparable (sub-)principles and that there are indications that individual psychologists agree with the written principles. In addition, suggestions for future research are given. (shrink)

Background Ethics consultations are established in contemporary health care. Informal ethics consultations often occur and are possibly beneficial, yet they have not been empirically studied. We sought to describe features of informal ethics consultations and to identify facilitators and disruptors of patient participation in such ethics consultations. Methods We used a mixed methods (quantitative and qualitative) evaluation design and conveniently sampled 64 sequential informal ethics consultations over a period of 3 years in two academic health (...) care centers in one city in Canada. Data were collected by the two participating ethicists. We used statistical description for the quantitative data and thematic analysis for the qualitative data. Results Patients participated in only two (3%) of the informal ethics consultations. Factors that disrupted patient participation in ethics consultations were related to patients’ issues (mental impairments), family issues (family withholding information from the patient), and team members’ issues (efficiency considerations). Conclusion Informal ethics consultations may be used for ethics capacity building of health care providers rather than for engagement with addressed patients. Further research on informal ethics consultations is required, including in different sites. (shrink)

Ludwig Wittgenstein suggested that in philosophy explanation should be replaced by description. I want to explore what this might mean in ethics. I first consider Wittgenstein and reasons to doubt that he supported a fact/value distinction as strongly or straightforwardly as is sometimes believed. Next I look at Iris Murdoch’s work as an example of what I take to be a good approach to ethics, and one that is consistent with Wittgenstein’s thought, as well as turning to recent (...) work by some Wittgensteinian or post-Wittgensteinian ethicists and what it has to say about the value and importance of description. Finally, I try to add something new to this discussion, drawing on work by Donna Haraway and some work in virtue epistemology. Specifically, I suggest that ethics and virtue epistemology are more than merely parallel, I add to the defense of Alice Crary’s Wittgensteinian notion of wider rationality, and I show description of reality to be complicated but possibly a significant tool in moral philosophy. (shrink)

Ethics of Description: The Anthropological Dispositif and French Modern Travel Writing follows the development of a minor tradition in French literature where metropolitan authors traveling abroad demonstrate their awareness of the ethical conundrums of representing world peoples. During the colonial-modern era, currents of anthropological thought and representational practice are identifiable throughout society, and across literature, the arts, and the sciences. Collectively, they can be theorized as belonging to a dispositif, the anthropological dispositif. The modernization of anthropology serves as an (...) ambivalent interlocutor for the realizations of the writers studied in this book about the difficulties of describing cultural realities that lie largely outside their ken. Anthropology motivates new literary representational strategies that are, alternatively, in keeping with scientific mandates or operate against them. Forty images are analyzed alongside literary works. A postcolonial chapter shows how the ethical awareness of the colonial-modern authors studied have impacted minority self-representation in contemporary France. (shrink)

Background: Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field. Objectives: This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis. Research design: We used qualitative content analysis. Ethical considerations: The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required. Findings: The analysis (...) shows that all 12 textbooks describe and present people who are considered as psychotic from a ‘perspective from above’. In this perspective, the readers are learning about psychosis in the professional’s language and from the author’s viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a ‘perspective from within’. Here, the readers are learning about psychosis from the patients’ own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person. Discussion and conclusion: Drawing partly on Rita Charon’s writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients’ own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness. (shrink)

To some extent, perhaps under Moore's chastening influence, eccentric philosophical denials of the existence of physical objects, other people's minds, the past, and so on, have gone out of fashion. All the same there is at least one very common philosophical conclusion which, though not as extravagant as these, is no less paradoxical. This is the dogma that ethical statements could not describe anything at all, and the collateral claim that they could not be true or false. This is, I (...) suggest, as paradoxical as traditional denials of the existence of chairs and tables, since the denial that ethical statements could be descriptive, like the denial that chairs and tables could exist, is opposed by the common observation that ethical statements do describe, just as the other is opposed by the common observation that chairs and tables do exist. I hope to make two things perfectly clear. First of all, that ethical statements do describe states of affairs; and secondly, that the reason ultimately given for saying that they could not describe anything, namely that they differ in verification from statements of fact, is only partly true, and its uncritical acceptance has led to the canonisation of the belief that ethical statements are non-descriptive and have no truth-values. (shrink)

In response to the abundance of parenting literature and a contemporary emphasis on expertise, recent scholars have suggested that how we parent should be determined by values and a family’s particular needs, a combination often referred to as practical wisdom. In this article, I build on previous calls for an ethical approach to being a parent. I argue that being able to share and cultivate one’s unique personality and have one’s aptitudes and interests recognized is a key condition of living (...) well and that parents play an important role in helping their children know and realize their gifts. I put forth an exercise for attending to children, the descriptive review of the child. In doing so, I first describe this practice, illustrate it, and then explain how it can help one live well as a parent. (shrink)

Background The high public demand for healthcare services during the COVID-19 pandemic and strict infection control measures, coupled with threat of severe illness and death, and limited resources, led to many healthcare workers (HCWs) experiencing ethically challenging situations (ECSs). Objective To systematically explore first-hand accounts of ECS-evoking moral distress among HCWs during this public health emergency. Research design This was an open cohort study. All participants were asked whether they had been in ECS-evoking moral distress during the pandemic. Those who (...) had were asked to describe these situations. Answers were systematically analyzed according to three levels of root causes for ECSs, using thematic analysis. Participants and research context In January 2022, 977 HCWs from four Norwegian university hospitals participated. Ethical considerations The study received ethical approval from the Norwegian Ethical Review Authority (No. 130944). Results In total, 508 participants (52%) reported that they had experienced ECS-evoking moral distress during the pandemic, whereof 323 provided a qualitative description. We found that while a few reported ECSs caused at the patient level, and some described situations at the unit/team level, the vast majority reported situations caused at the system level, predominantly related to resource scarcity, particularly poor staffing. Conclusion Our findings strongly indicate that efforts to mitigate moral distress among HCWs should be targeted at the system level. More specifically, the study findings highlight resource limitations, particularly poor staffing, as a major cause of moral distress during the pandemic. (shrink)

The contemporary sociology of morality is a form of descriptive ethics that shrinks away from any sort of prescriptive ethics. Building on the moral philosophies of John Dewey, and also of Alasdair MacIntyre and Paul Ricoeur, and in dialogue with recent work by Stefan Bargheer, this article proposes a more ambitious program of critical social ethics that connects concerns with character and the common good but tempers them with attention to alienation and oppression.

To address the current lack of knowledge about clinical ethics fellowship programs (CEFPs), we surveyed all 36 programs in the U.S. and Canada. The number of CEFPs has grown exponentially over the last 40 years and far exceeds previous estimates. Commonalities among CEFPs include: 88.8% require an advanced degree or rarely accept applicants without one; 91.7% of programs do not restrict applicants to a specific background such as medicine or philosophy; and 88.9% of programs compensate fellows. CEFPs vary widely (...) on numbers of fellows trained in the last 3 years (1–111), numbers of consultations performed by each fellow (0–450), and salaries paid ($0-$95,000). Less than half of programs meet CEFP standards established by ABPD. Nonpaying programs and larger programs tend to have lower admission standards and lower expectations for fellows. We hope these data will help inform CEFP standards that promote quality and consistency without stifling desirable diversity and innovation. (shrink)

Background During the COVID-19 pandemic, virtual visiting technologies were rapidly integrated into the care offered by intensive care units (ICUs) in the UK and across the globe. Today, these technologies offer a necessary adjunct to in-person visits for those with ICU access limited by geography, work/caregiving commitments, or frailty. However, few empirical studies explore the ethical issues associated with virtual visiting. This study aimed to explore the anticipated or unanticipated ethical issues raised by using virtual visiting in the ICU, such (...) that healthcare professionals can be informed about how to carry out virtual visits ethically, safely and productively. Methods We used a descriptive exploratory qualitative research approach recruiting a convenience sample of newly-graduated junior doctors facilitating ICU virtual visits in a tertiary academic centre. Eight newly graduated junior doctors, seven female and one male, aged 23–27, participated in semi-structured interviews. We analysed transcripts using an inductive coding approach. Results Five overarching themes emerged. Two of the themes namely, ‘fulfilling a moral instinct to connect families’ and ‘promoting autonomy’, arose from participants’ descriptions of how virtual visits aligned with healthcare standards and practices they considered ethical. Three further themes, ‘preserving dignity and privacy’, ‘managing emotional distress’, and ‘providing equitable access’ to virtual visiting technologies, highlight how virtual visits might exacerbate ethical issues related to family communications. Conclusion Virtual visiting may potentially both ameliorate and exacerbate aspects of ethical healthcare delivery for ICU patients and family members. ICU team members should consider unique ethical considerations related to using virtual visiting. We recommend virtual communications skills training for staff and advocate for the use of easily accessible educational resources for families who wish to visit critically unwell patients remotely. (shrink)

IN this note I propose to make some general remarks concerning the analytical forays carried out into moral discourse by some leading figures in the modern ‘linguistic’ tradition. The philosophers I am going to speak of, may all be said to be attempting some sort of ‘descriptive’ analysis, but my thesis is that philosophers such as Toulmin and Baier are attempting something that is significantly different from what a philosopher such as Nowell-Smith is attempting. I will suggest, in the (...) following section, that the expression—‘the logic of moral discourse’—seems to be understood by these two groups of linguistic philosophers in two different ways and that one of these ways involves a more ambitious claim, than does the other, on behalf of the philosopher embarking upon a conceptual analysis of moral discourse. The manner in which, it seems to me, Toulmin and Baier understand this expression is the one that involves the more ambitious claim. In the final section of this paper I suggest that the more ambitious claim involves overloading the so-called Linguistic method to force it do a job that it seems at least not suited to perform. (shrink)

Background On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature. Research aim The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas’ (...) theory of communicative actions, after 6 months from the perspective of an inter-professional team. Research design A qualitative inductive approach was chosen, and individual interviews ( n = 13) were conducted. Interview data were analysed using qualitative content analysis. Participants The participants, 10 females and two males, represented assistant nurses, registered nurses, physicians, occupational therapists, physiotherapists, welfare officers and psychologists. Each had attended at least four IEC sessions. Ethical considerations The study was approved by the Regional Ethical Review Board in Umeå, Sweden, and it has been undertaken in accordance with the Helsinki Declaration. Findings Overall, the descriptions expressed a perceived achievement of a deepened and integrated ethical awareness that increased the participants’ awareness of ethically difficult situations as well as their own ethical thinking, actions and approaches in daily work. Perspectives were shared and the team become more welded. They carried the memories of the reflections within them, which was perceived as supportive when encountered new ethically situations. Discussion Putting words to unarticulated thoughts may stimulate repeated reflections, leading to new insights and alternative thoughts. Conclusion The outcome of IEC sessions 6 months following the last session can be described as an incorporated knowledge that enables actions in ethically difficult situations based on an ethical awareness both at a ‘We-level’ and an ‘I-level’. (shrink)

BackgroundAlthough nurses are crucial to ensure patients’ peaceful death in hospitals, many nurses experience various ethical conflicts during end-of-life care. Therefore, research on nurses’ entire ethical decision-making process is required to improve nurses’ ethical decision-making in end-of-life care. This study aimed to identify Korean nurses’ ethical decision-making process based on their moral sensitivity to end-of-life patients.MethodsIn total, 171 nurses caring for terminal patients responded to the survey questionnaire. To measure the participants’ moral sensitivity and ethical decision-making process, we used the (...) Korean version of the Moral Sensitivity Questionnaire and Nurses’ Ethical Decision-Making around End of Life Care Scale. Finally, multiple linear regression analysis was used to investigate the effect of moral sensitivity on nurses’ ethical decision-making.ResultsThe mean of moral sensitivity was 4.8 ± 0.5 (out of 7), and that of ethical decision-making was 4.6 ± 0.5 (out of 6). Among the sub-dimensions of ethical decision-making, the highest score was in perceived professional accountability (5.2 ± 0.5), and the lowest in moral reasoning and moral agency (3.9 ± 0.6); the score of moral practice was 4.4 ± 0.7. In the multiple linear regression model, moral sensitivity (β = 0.852, p <.001), clinical department (β = − 7.018, p =.035), ethics education (β = 20.450, p <.001), job satisfaction (β = 5.273, p <.001), and ethical conflict (β = − 2.260, p = 0.031) were influential ethical decision-making factors.ConclusionsThis study revealed a gap between nurses’ thoughts and practices through the ethical decision-making process. They failed to lead their thought to moral practice. It also implies that moral sensitivity could positively affect nurses’ ethical decision-making. To make nurses morally sensitive, exposing them to various clinical cases would be helpful. Additionally, ethics education and clinical ethics supporting services are valuable for improving nurses’ ethical decision-making. If nurses improved their ethical decision-making regarding end-of-life care, their patients could experience a better quality of death. (shrink)

Normative issues associated with the design and implementation of population-based lung cancer screening policies are underexamined. This study was an exposition of the ethical justification for screening and potential ethical issues and their solutions in Canadian jurisdictions. A qualitative description study was conducted. Key informants, defined as policymakers, scientists and clinicians who develop and implement lung cancer screening policies in Canada, were purposively sampled and interviewed using a semi-structured guide informed by population-based disease screening principles and ethical issues in cancer (...) screening. Interview data were analyzed using qualitative content analysis. Fifteen key informants from seven provinces were interviewed. Virtually all justified screening by beneficence, describing that population benefits outweigh individual harms if high-risk people are screened in organized programs according to disease screening principles. Equity of screening access, stigma and lung cancer primary prevention were other ethical issues identified. Key informants prioritized beneficence over concerns for group-level justice issues when making decisions about whether to implement screening policies. This prioritization, though slight, may impede the implementation of screening policies in a way that effectively addresses justice issues, a goal likely to require justice theory and critical interpretation of disease screening principles. (shrink)

This article focuses on the reasons for using physical restraints, their prevalence and nurses’ experiences of their use. The data were collected by means of a questionnaire from nurses, trained nurse’s aids and auxiliary staff ( n = 173) in seven Swiss nursing homes. The results showed that physical restraints are used in nursing units, the mean number of restrained residents in each being 3.7 (SD 3.9). However, nursing staff did not necessarily understand and consider the term ‘restraint’ as a (...) restrictive device in its negative sense. The most common reasons indicated for the use of restraint were related to the protection and safety of the residents themselves, the prevention of disturbance of other residents, and the residents’ restlessness and aggressiveness. As for the reasons related to staffing, reference was made to understaffing, a lack of competence on the part of nurses, and the demands of residents, their next of kin and doctors. It was not common practice to inform the elderly residents that they would be restrained, and therefore they were not always aware of what was happening to them and why. Twenty-nine per cent of the respondents reported that the flexibility of their work was affected by the use of physical restraint. (shrink)

Ethically challenging situations routinely arise in the course of illness and healthcare. However, very few studies have surveyed patients and family members about their experiences with ethically challenging situations. To address this gap in the literature, we surveyed patients and family members at three hospitals. We conducted a content analysis of their responses to open-ended questions about their most memorable experience with an ethical concern for them or their family member. Participants described 219 unique ethical experiences that spanned many of (...) the prevailing themes of bioethics, including the patient-physician relationship, end-of-life care, decision-making capacity, healthcare costs, and genetic testing. Participants focused on relational issues in the course of experiencing illness and receiving medical care and concerns regarding the patient-physician encounters. Many concerns arose outside of a healthcare setting. These data indicate areas for improvement for healthcare providers but some concerns may be better addressed outside of the traditional healthcare setting. (shrink)

The use of Intelligent Assistive Technology in dementia care opens the prospects of reducing the global burden of dementia and enabling novel opportunities to improve the lives of dementia patients. However, with current adoption rates being reportedly low, the potential of IATs might remain under-expressed as long as the reasons for suboptimal adoption remain unaddressed. Among these, ethical and social considerations are critical. This article reviews the spectrum of IATs for dementia and investigates the prevalence of ethical considerations in the (...) design of current IATs. Our screening shows that a significant portion of current IATs is designed in the absence of explicit ethical considerations. These results suggest that the lack of ethical consideration might be a codeterminant of current structural limitations in the translation of IATs from designing labs to bedside. Based on these data, we call for a coordinated effort to proactively incorporate ethical considerations early in the design and development of new products. (shrink)

Abstract:Most papers in this issue carefully analyze normative and empirical methodologies. I shall argue that (a) there is no purely empirical nor purely normative methodology; (b) some terms escape the division of the normative and descriptive. (c) Most importantly, dialogues such as this one point to a form of integration that allows us to reflect on what it is that each approach presupposes in its study of business ethics. Thus we have made progress in recognizing the importance of (...) each methodology, how each is dependent on the other, and how neither is singularly The Approach to business ethics. (shrink)

The construction industry is usually characterized as a fragmented system of multiple-organizational entities in which members from different technical backgrounds and moral values join together to develop a particular business or project. The greatest challenge in the construction process for the achievement of a successful practice is the development of an outstanding reputation, which is built on identifying and applying an ethical framework. This framework should reflect a common ethical ground for myriad people involved in this process to survive and (...) compete ethically in today’s turbulent construction market. This study establishes a framework for ethical judgment of behavior and actions conducted in the construction process. The framework was primarily developed based on the essential attributes of business management identified in the literature review and subsequently incorporates additional attributes identified to prevent breaches in the construction industry and common ethical values related to professional engineering. The proposed judgment framework is based primarily on the ethical dimension of professional responsibility. The Ethical Judgment Framework consists of descriptive approaches involving technical, professional, administrative, and miscellaneous terms. The framework provides the basis for judging actions as either ethical or unethical. Furthermore, the framework can be implemented as a form of preventive ethics, which would help avoid ethical dilemmas and moral allegations. The framework can be considered a decision-making model to guide actions and improve the ethical reasoning process that would help individuals think through possible implications and consequences of ethical dilemmas in the construction industry. (shrink)

The last decade has witnessed the emergence of a paradox perspective on corporate sustainability. By explicitly acknowledging tensions between different desirable, yet interdependent and conflicting sustainability objectives, a paradox perspective enables decision makers to achieve competing sustainability objectives simultaneously and creates leeway for superior business contributions to sustainable development. In stark contrast to the business case logic, a paradox perspective does not establish emphasize business considerations over concerns for environmental protection and social well-being at the societal level. In order to (...) contribute to the consolidation of this emergent field of research, we offer a definition of the paradox perspective on corporate sustainability and a framework to delineate its descriptive, instrumental, and normative aspects. This framework clarifies the paradox perspective’s contents and its implications for research and practice. We use the framework to map the contributions to this thematic symposium on paradoxes in sustainability and to propose questions for future research. (shrink)

Teleosemantics is the view that mental content depends on etiological function. Moral adaptationism is the view that human morality is an evolved adaptation. Jointly, these two views offer new venues for naturalist metaethics. Several authors have seen, in the conjunction of these views, the promise of assigning naturalistically respectable descriptive content to moral judgments. One such author is Neil Sinclair, who has offered a blueprint for how to conduct teleosemantic metaethics with the help of moral adaptationism. In this paper, (...) I argue that the prospects for assigning descriptive content to moral judgments on the basis of teleosemantics are bad. I develop my argument in dialogue with Sinclair’s paper and argue that, although Sinclair’s account of the evolution of morality is plausible, the teleosemantic account of the descriptive content of moral judgments which he bases thereon suffers from crucial shortcomings. I argue further that, given some minimal plausible assumptions about the evolution of morality made by Sinclair, no assignment of descriptive content is possible. Contrary to prevailing assumptions, the combination of moral adaptationism and teleosemantics suggests that moral judgments lack descriptive content. (shrink)

Background Ethical behavior of health workers is an important part of health services. The aim of the present study was to determine the relationship between ethics and professional commitment and its relationship with the level of respect for patient rights in medical students. Material & methods A cross-sectional descriptive study was conducted with the participation of nursing, midwifery and emergency medicine students of Ilam University of Medical Sciences. Sampling was done by stratified random method. The data was collected (...) using Demographic, Professional Commitment, Professional ethics and a researcher made questioner on compliance with patient rights questionnaires. Results 300 students were participated. The results showed that the average score of professional ethics in middle school students is high (64.07 ± 8.01), the average score of professional commitment is also high (64.07 ± 8.01) and the score of respect for patient rights is also high (10.74). ± 83.46) was obtained. The professional ethics score it showed a positive and statistically significant relationship with the patient’s rights compliance score. only professional commitment is related to gender, but the average of all three variables in different age groups and the type of residence (dormitory, private home, etc.) have meaningful statistical difference. Conclusion The findings of the study show that the level of ethics and professional commitment and respect for patient rights among nursing, midwifery and emergency medicine students was good. It is hoped that the results of this research will provide a basis for better planning for the development of knowledge and respect for patient rights among students. (shrink)

The Theory of Planned Behavior predicts that a combination of attitudes, perceived norms, and perceived behavioral control predict intentions, and that intentions ultimately predict behavior. Previous studies have found that the TPB can predict students’ engagement in plagiarism. Furthermore, the General Theory of Crime suggests that self-control is particularly important in predicting engagement in unethical behavior such as plagiarism. In Study 1, we incorporated self-control in a TPB model and tested whether norms, attitudes, and self-control predicted intention to plagiarize and (...) plagiarism behavior. The best statistical fit for the path-analytic model was achieved when a direct path from self-control to plagiarism engagement was specified. In Study 2, we added a measure of perceived behavioral control and split the measurement of norms into descriptive and injunctive components. This study found that both self-control and perceived-behavioral control additively contributed to the prediction of plagiarism and the path-analytic model achieved its best fit when direct paths from perceived norms to plagiarism behavior were specified. These studies suggest that setting strong anti-plagiarism norms, such as by the use of honor codes, and seeking to enhance students’ self-control may reduce engagement in plagiarism. (shrink)

There is growing interest in clinical ethics. However, we still have sparse knowledge about what is actually going on in the everyday practice of clinical ethics consultations. This paper introduces a descriptive evaluation tool to present, discuss and compare how clinical ethics case consultations are actually carried out. The tool does not aim to define ‘best practice’. Rather, it facilitates concrete comparisons and evaluative discussions of the role, function, procedures and ideals inherent in clinical ethics (...) case consultation practices. The tool was developed during meetings of the European Clinical Ethics Network. Based on written reports and participation in the network meetings, the development and the content of the tool and the results of its application in presenting and discussing 10 case consultations are summarized. The tool facilitated understanding of the details of clinical ethics case consultations across individuals and institutions with various experiences and cultures, and comparison between various practices. (shrink)

Mozambique has seen remarkable growth in biomedical research over the last decade. To meet a growing need, the National Committee for Bioethics in Health of Mozambique encouraged the development of ethical review processes at institutions that regularly conduct medical and social science research. In 2012, the Faculty of Medicine of University Eduardo Mondlane and the Maputo Central Hospital established a joint Institutional Committee on Bioethics for Health. This study examines the experience of the first 4 years of the CIBS FM (...) & MCH. This study provides a descriptive, retrospective analysis of research protocols submitted to and approved by the CIBS FM & MCH between March 1, 2013 and December 31, 2016, together with an analysis of the Committee’s respective reviews and actions. A total of 356 protocols were submitted for review during the period under analysis, with 309 protocols approved. Sixty-four percent were submitted by students, faculty, and researchers from UEM, mainly related to Master’s degree research. Descriptive cross-sectional studies were the most frequently reviewed research. The majority were prospective and used quantitative methodologies. The Departments of Internal Medicine at MCH and Community Health at the FM submitted the most protocols from their respective institutions, with 38 and 53% respectively. The CIBS’s average time to final approval for all protocols was 56 days, rising to 161 for the 40 protocols that required subsequent national-level review by the CNBS. Our results show that over its first 4 years, the CIBS FM & MCH has been successful in managing a constant demand for protocol review and that several broad quality improvement initiatives, such as investigator mentoring and an electronic protocol submission platform have improved efficiency in the review process and the overall quality of the protocols submitted. Beyond Maputo, long-term investments in training and ethical capacity building for CIBS across the country continue to be needed, as Mozambique develops greater capacity for research and makes progress toward improving the health of all its citizens. (shrink)

In this brief essay, I defend my original analysis of competition and respond to a number of recent criticisms. In this process, I extend my analysis by showing the cogency and value of the kinds of metaphysical analyses recommended by Husserl. Specifically, I discuss utility of descriptive precision related to clear thinking, improved communication, and a more robust normative appreciation of competitive acts. Of particular importance in this discussion is the distinction between literal and metaphorical uses of language.

Traditionally, the development of moral theories has been considered one of the main aims of moral philosophy. In contrast, Wittgenstein was very critical of the use of theories both in philosophy in general and in moral philosophy in particular, and philosophers inspired by his philosophy have become some of the most prominent critics of both particular, contemporary moral theories and the idea of moral theory as such. Nonetheless, this article aims to show how Wittgenstein’s later philosophy offers us resources for (...) a revised understanding of the role and status of moral theories according to which theories are neither normative nor explanatory, but are rather to be understood as generalisations of particular descriptions of various forms of moral grammar. (shrink)

This paper presents an integrative, descriptive model of ethical decision making, with special attention given to issues of measurement. After building the model, hypotheses are developed from a portion of it. These hypotheses are tested in an exploratory analysis to determine if further research and testing of this model and the measurement instruments it employs are warranted.

This paper investigates how principals can be supported in their work as teacher leaders. My focus is on how principals can help teachers respond ethically to classroom challenges. I argue that in aiding teachers, school leaders themselves need support and ongoing development. I turn to the care of the self to conceptually explore ethical self-cultivation. I then argue that a practice, Descriptive Inquiry, serves as a way for principals to care for themselves. To make this argument, I draw on (...) a qualitative study of four long-term elementary school principals. (shrink)

Background: Concerns have been expressed regarding the adequacy of ethics review systems in developing countries. Limited data are available regarding the structural and functional status of Research Ethics Committees (RECs) in the Middle East. The purpose of this study was to survey the existing RECs in Egypt to better understand their functioning status, perceived resource needs, and challenges. Methods: We distributed a self-administered survey tool to Egyptian RECs to collect information on the following domains: general characteristics of the (...) REC, membership composition, ethics training, workload, process of ethics review, perceived challenges to effective functioning, and financial and material resources. We used basic descriptive statistics to evaluate the quantitative data. Results: We obtained responses from 67% (12/18) of the identified RECs. Most RECs (10/12) have standard operating procedures and many (7/12) have established policies to manage conflicts of interests. The average membership was 10.3 with a range from 7-19. The predominant member type was physicians (69.5% of all of the REC members) with little lay representation (13.7%). Most RECs met at least once/month and the average number of protocols reviewed per meeting was 3.8 with a range from 1-10. Almost three-quarters of the members from all of the 12 RECs indicated they received some formal training in ethics. Regarding resources, roughly half of the RECs have dedicated capital equipment (e.g., meeting room, computers, office furniture, etc); none of the RECs have a formal operating budget. Perceived challenges included the absence of national research ethics guidelines and national standards for RECs and lack of ongoing training of its members in research ethics. Conclusion: Our study documents several areas of strengths and areas for improvements in the operations of Egyptian RECs. Regarding strengths, many of the existing RECs meet frequently, have a majority of members with prior training in research ethics, and have written policies. Regarding areas for improvements, many RECs should strive for a more diverse membership and should receive more financial resources and administrative support personnel. We recommend that RECs include more individuals from the community and develop a continuing educational program for its members. Institutional officials should be aware of the resource capacity needs of their RECs. (shrink)

By a logical theory I mean a formal system together with its semantics, meta-theory, and rules for translating ordinary language into its notation. Logical theories can be used descriptively (for example, to represent particular arguments or to depict the logical form of certain sentences). Here the logician uses the usual methods of empirical science to assess the correctness of his descriptions. However, the most important applications of logical theories are normative, and here, I argue, the epistemology is that of wide (...) reflective equilibrium. The result is that logic not only assesses our inferential practice but also changes it. I tie my discussion to Thagard's views concerning the relationship between psychology and logic, arguing against him that psychology has and should have only a peripheral role in normative (and most descriptive) applications of logic. (shrink)

Background In the globalizing world, nurses often meet humans from different cultures and values. This fact has led them to make ethical decisions, which do not comply with their own moral jurisdictions at care setting. Objectives The objective of the study was to investigate the relationships between moral development levels of the nurses and their scores of nursing principled thinking and practical consideration during decision making for ethical dilemmas. Methods This was a descriptive correlational study. Nursing Dilemma Test, Moral (...) Development Scale for Professionals and socio-demographic form were used. Study was conducted with 227 nurses. Ethical considerations: An institutional authorization, an ethics approval from non-interventional ethics committee of the respective university, permission from the authors of the scales used and informed consents from the nurses were obtained in order to conduct the study. Results In this study, nurses were found to be at post-conventional level according to Kohlberg’s moral development theory. Sociodemographic and working characteristics of the nurses have not affected their scores of moral development level and their scores of nursing principled thinking, practical consideration and familiarity (p > 0.05). Nurses take attention for moral principles during decision making although not at a desirable level, and they are relatively affected by environmental factors Conclusion Although nurses are familiar with ethical problems at scenarios including ethical dilemmas, they cannot make decisions in accordance with their moral development levels during decision making for ethical dilemmas. Nurses should be instructed and supported for ethical decision making by recognizing factors that may be effective on their decision making. (shrink)

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was (...) used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study’s coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress’ biomedical ethics of respect for patients’ autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care. (shrink)

Background: Nosocomial infections represent a serious challenge for healthcare systems worldwide. Adherence to hand hygiene plays a major role in infection prevention and control. These adherence rates can be improved through behaviour tracking innovations. This requires the systems to be widely implemented and accepted. Therefore, both a systematic analysis of the normative issues related and the evaluation of technology acceptance are equally important. Objectives: To explore and describe relevant aspects regarding the acceptance of technology and ethical implications using a tracking (...) device to measure and improve adherence to hand hygiene. Research design: A quantitative study with a descriptive design was performed. Participants and research context: A total of 75 questionnaires were collected in three hospitals in Germany. Acceptance of technology was measured with n = 60 participants (n = 50 nurses; n = 9 physicians; n = 1 not disclosed) and ethical assessment with n = 15 participants (nurses only). Ethical considerations: Ethical approval for this study was obtained from the institutional review board. Findings: The acceptance of technologies improving hygiene in general was good (median = 80.5, interquartile range = 28, range: 0–100). The experience with technologies in general (median = 48.5, interquartile range = 57, range: 0–100) and the acceptance of the specific technology (mean = 82.23, standard deviation = 15.16 (range: 23–138)) was moderate. There was a significant positive correlation between the acceptance and experience of technology in general ( r = 0.217, p =.025). Ethical concerns played a minor role. The need for practical support was a key topic. Discussion: Study participants accepted technologies improving hygiene; however, the specific device implemented was only moderately accepted. This creates specific opportunities in the implementation process for higher later acceptance. More practical support and an increase in experience may create opportunities for device implementation with high acceptance and low ethical concerns. Conclusion: Study results indicate a vast potential for improving the implementation process of hand hygiene technologies. Ethical concerns in this study did not seem to be a relevant barrier for successful implementation of hand hygiene technologies. (shrink)