(1/57) The virtue of nursing: the covenant of care.

It is argued that the current confusion about the role and purpose of the British nurse is a consequence of the modern rejection and consequent fragmentation of the inherited nursing tradition. The nature of this tradition, in which nurses were inducted into the moral virtues of care, is examined and its relevance to patient welfare is demonstrated. Practical suggestions are made as to how this moral tradition might be reappropriated and reinvigorated for modern nursing.  (+info)

(2/57) The difficult, demanding, and demented AIDS patient in long-term care.

Demented AIDS patients in long-term care present interconnected medical, ethical, and management problems. The patient's right to care must be considered in the context of the obligations owed to other residents and to staff members. A principled analysis should focus on substantive and procedural issues: the concept of autonomy must be modified by notions of accommodation to the needs of others; procedural fairness should guide discussions. A dynamic analysis should identify the various parties, their conflicting interests, and possible routes for resolving differences.  (+info)

(3/57) Doctors' and nurses' attitudes towards and experiences of voluntary euthanasia: survey of members of the Japanese Association of Palliative Medicine.

OBJECTIVE: To demonstrate Japanese doctors' and nurses' attitudes towards and practices of voluntary euthanasia (VE) and to compare their attitudes and practices in this regard. DESIGN: Postal survey, conducted between October and December 1999, using a self-administered questionnaire. PARTCIPANTS: All doctor members and nurse members of the Japanese Association of Palliative Medicine. MAIN OUTCOME MEASURE: Doctors' and nurses' attitude towards and practices of VE. RESULTS: We received 366 completed questionnaires from 642 doctors surveyed (response rate, 58%) and 145 from 217 nurses surveyed (68%). A total of 54% (95% confidence interval (CI): 49-59) of the responding doctors and 53% (CI: 45-61) of the responding nurses had been asked by patients to hasten death, of whom 5% (CI: 2-8) of the former and none of the latter had taken active steps to bring about death. Although 88% (CI: 83-92) of the doctors and 85% (CI: 77-93) of the nurses answered that a patient's request to hasten death can sometimes be rational, only 33% (CI: 28-38) and 23% (CI: 16-30) respectively regarded VE as ethically right and 22% (CI: 18-36) and 15% (CI: 8-20) respectively would practise VE if it were legal. Logistic regression model analysis showed that the respondents' profession was not a statistically independent factor predicting his or her response to any question regarding attitudes towards VE. CONCLUSIONS: A minority of responding doctors and nurses thought VE was ethically or legally acceptable. There seems no significant difference in attitudes towards VE between the doctors and nurses. However, only doctors had practised VE.  (+info)

(4/57) Reply to Ann Bradshaw.

My original paper suggested that an ethics of care which failed to specify how, and about what, to care would be devoid of normative and descriptive content. Bradshaw's approach provides such a specification and is, therefore, not devoid of such content. However, as all ethical approaches suggest something about the 'what' and 'how' of care, they are all 'ethics of care' in this broader sense. This reinforces rather than undermines my original conclusion. Furthermore, Bradshaw's 'ethics of care' has philosophical and historical problems which I outline.  (+info)

(5/57) Everyday ethics in an acute psychiatric unit.

The paper begins with a brief statement about the centrality of autonomy or self governance as a core ethical value in the interaction between health care worker and patient. Then there are three stories describing everyday interactions in an acute psychiatric unit. These are used to help unravel ethical issues relating to patient autonomy. Each story is analysed for its ethical components by describing the protagonists' different perspectives, and their reactions to the events. Attention is also paid to institutional policy. Suggestions are made for small changes in both staff behaviour and institutional procedures. Such changes could enhance rather than diminish patient autonomy.  (+info)

(6/57) A note on nursing ethics in the USA.

In this note on nursing ethics, Mr Martin Bunzl, a philosopher who is involved in seminars on medical ethics at his university, describes the ethical dilemmas of the nurse in the USA. He sets out the arguments to support the view that a nurse ought always to follow the orders of the physician and critically evaluates them both from an ethical and a legal standpoint. The practical implications of the view that a nurse's responsibility is to do what is in the best interests of patients are also discussed.  (+info)

(7/57) Gilligan: a voice for nursing?

The current reform of nursing education is resulting in major changes in the curricula of colleges of nursing. For the first time, ethical and moral issues are being seen as an important theme underpinning the entire course. The moral theorist with whose work most nurse teachers are acquainted is Kohlberg. In this paper, it is suggested that his work, and the conventions of morality which he exemplifies, may not be the most appropriate from which to address the moral issues facing the nurse. The author suggests that the work of Carol Gilligan of Harvard university is of great significance, not only for nurses involved in the teaching of ethics, but for all nurses. Gilligan's emphasis on caring and relationships accords with the common experience of the nurse, and echoes the current revival of interest within nursing in examining, and valuing, the phenomenon of caring.  (+info)

(8/57) Nurse participation in decisions regarding limitation of treatment.

A vast literature exists on the ethical aspects of decisions to limit life-sustaining treatments, and much of it deals with the way decisions ought to be made. Little is known, however, about how decisions are made in actual clinical practice. Empirical studies have not investigated the decision-making process directly and, with one exception, have only focused on physician practices. Through the use of a case, this paper examines the nature of hospital cancer nurses' involvement in the decision-making process. Three practice domains are identified: assisting patients to reach a truly autonomous choice, helping families to understand and to cope with the realities of the situation, and communicating with and encouraging open communication among all those involved. In addition, the potential value of the in-between position of the nurse is noted, and nurse responsibilities are summarized.  (+info)