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Deception is common in dementia care, although its moral legitimacy is questionable. This paper conceptually clarifies when does dementia care involve deception and argues that care ethics is an appropriate ethical framework to guide dementia care compared with the mainstream ethical theories that emphasize abilities. From a perspective of care ethics, this paper claims that morally defensible deception is context-specific, embodied as a caring process that needs to be identified through instant, creative and interactive care procedures. According to this argument, it further analyses and concludes the moral rationality of deception in five common cases. While deception is morally justified in many situations, another concern is that it is usually not the last resort but a means of convenience. As the ability to interact, autonomy and dignity of persons with dementia (PWDs) are generally ignored; nurses need more training and education to master the essential procedures to ensure that the value of authenticity and autonomy is maintained and considered throughout dementia care.

A distinction between the “hard” and “soft” scientific disciplines is a modern commonplace, widely invoked to contrast the natural and the social sciences and to distribute value accordingly, where it was generally agreed that it was good to be “hard,” bad to be “soft.” I trace the emergence of the distinction to institutional and political circumstances in the United States in the second part of the twentieth century; I describe varying academic efforts to give the contrast coherent meaning; I note the distinction’s uses in disciplines’ reflections on their own present and possible future status; and I document the consequential circulation of the antonym in settings where resources for science were distributed. To follow the history of the “hard–soft” distinction is to open a window on changing sensibilities about what science is, what values are attached to it, and what it is for. I conclude with speculations about more recent changes in the value-schemes implicated in the “hard” and the “soft” and about pertinent changes in the place of the “soft” human sciences in governance and production. I envisage a possible future in which the commonplace distinction might wither away.

We present evidence from choice experiments on hypothetical triage decisions in a pandemic. Respondents have to decide who out of two patients gets ventilation. Patients are described in terms of attributes such as short-term survival chance, long-term life expectancy, and their current ventilation status. Attributes are derived from the ethical discourse among experts regarding triage guidelines during the COVID-19 pandemic and differ in the extent to which they are salient from a utilitarian or deontological perspective. Empirically, we find that although nonexperts agree with experts in prioritizing utilitarian attributes in triage decisions, nonexperts also consider the adherence to the norm of wearing face masks as particularly relevant. Furthermore, our study supports Greene and colleagues’ dual-process model of moral judgment; we find that utilitarian attributes are more decisive for respondents with a greater inclination toward utilitarianism and for respondents with a greater tendency toward reflection.

This theoretical paper proposes a new perspective to understand the moral distress of nurses more fully, using virtue ethics. Moral distress is a widely studied subject, especially with respect to the determination of its causes and manifestations. Increasing the theoretical depth of previous work using ethical theory, however, can create new possibilities for moral distress to be explored and analyzed. Drawing on more recent work in this field, we explicate the conceptual framework of the process of moral distress in nurses, proposed by Ramos et al., using MacIntyrean virtue ethics. Our analysis considers the experience of moral distress in the context of a practice, enabling the adaptation of this framework using virtue ethics. The adoption of virtue ethics as an ethical perspective broadens the understanding of the complexity of nurses’ experiences of moral distress, since it is impossible to create a ready model that can cover all possibilities. Specifically, we describe how identity, social context, beliefs, and tradition shape moral discomfort, uncertainty, and sensitivity and how virtues inform moral judgments. Individuals, such as nurses, who are involved in a practice have a narrative history and a purpose ( telos) that guide them in every step of the process, especially in moral judgment. It is worth emphasizing that the process described is supported by the formation of moral competence that, if blocked, can lead to moral distress and deprofessionalization. It is expected that nurses seek to achieve the internal good of their practice, which legitimizes their professional practice and supports them in moral decision-making, preventing moral distress.

Although moral dilemma judgments are influenced by a variety of situational factors, there is evidence for considerable disagreement between individuals. Using the CNI model to disentangle (a) sensitivity to consequences, (b) sensitivity to moral norms, and (c) general preference for inaction versus action in responses to moral dilemmas, the current research examined the temporal stability of individual differences along the three dimensions. Across two time points 1 month apart, sensitivity to consequences ( r = .81) and sensitivity to norms ( r = .84) showed high levels of stability that were comparable to the Big Five personality traits; general preference for inaction versus action showed lower stability ( r = .41). Exploratory analyses revealed reliable associations between the three dimensions of moral dilemma judgments and three of the Big Five (extraversion, agreeableness, openness). Together, these findings provide evidence for stable individual differences in moral dilemma judgments that are related to basic personality traits.

Many real-world dilemmas involve disagreement about whether decisions should follow moral norms in an unconditional manner ( deontology) or be based on the consequences for the greater good ( utilitarianism). To examine how political ideology may account for some of these disagreements, the current research used a formal modeling approach to investigate the associations between political ideology and (a) sensitivity to consequences, (b) sensitivity to moral norms, and (c) general preference for inaction versus action in responses to moral dilemmas. Across three studies ( N = 996) with samples from the United States (Studies 1 and 3) and the United Kingdom (Study 2), conservatives were less influenced by overall consequences for the greater good in comparison with liberals. Political ideology was not significantly associated with sensitivity to moral norms and general action tendencies. The findings provide more nuanced insights into how political ideology may contribute to disagreements on real-world moral dilemmas.

Rates of crime for Blacks in the United States in the post-slavery era have always been high relative to Whites. But explaining, or minimizing, this fact faces a major problem: individual excuses for bad acts point to deficiencies, in the agent, which are perhaps forgivable, such as mental deficiency or a deprived childhood, but at the price of treating the agent as less than a full member of the moral community. Collectivizing excuses risks implying group inferiority. The history of attempts to provide an explanation of crime that mitigates blame without undermining full participation to the moral community is long and convoluted, leading to the presently widespread claim that crime is itself a product of victimization through pervasive racism. Three basic strategies – rejection of comparison, attribution to racially invariant causes and explanation by reference to uniquely Black conditions, such as subculture or extreme stigmatization – are identified and their ethical implications distinguished.

We use network psychometrics to map a subsection of moral belief systems predicted by moral foundations theory (MFT). This approach conceptualizes moral systems as networks, with moral beliefs represented as nodes connected by direct relations. As such, it advances a novel test of MFT’s claim that liberals and conservatives have different systems of foundational moral values, which we test in three large datasets ( NSample1= 854; NSample2= 679; NSample3= 2,572), from two countries (the United States and New Zealand). Results supported our first hypothesis that liberals’ moral systems show more segregation between individualizing and binding foundations than conservatives. Results showed only weak support for our second hypothesis, that this pattern would be more typical of higher educated than less educated liberals/conservatives. Findings support a systems approach to MFT and show the value of modeling moral belief systems as networks.

Sacrificial moral dilemmas, in which opting to kill one person will save multiple others, are definitionally suboptimal: Someone dies either way. Decision-makers, then, may experience regret about these decisions. Past research distinguishes affective regret, negative feelings about a decision, from cognitive regret, thoughts about how a decision might have gone differently. Classic dual-process models of moral judgment suggest that affective processing drives characteristically deontological decisions to reject outcome-maximizing harm, whereas cognitive deliberation drives characteristically utilitarian decisions to endorse outcome-maximizing harm. Consistent with this model, we found that people who made or imagined making sacrificial utilitarian judgments reliably expressed relatively more affective regret and sometimes expressed relatively less cognitive regret than those who made or imagined making deontological dilemma judgments. In other words, people who endorsed causing harm to save lives generally felt more distressed about their decision, yet less inclined to change it, than people who rejected outcome-maximizing harm.

Research on moral decision making usually focuses on two ethical principles: the principle of utilitarianism (= morality of an action is determined by its consequences) and the principle of deontology (= morality of an action is valued according to the adherence to moral norms regardless of the consequences). Criticism on traditional moral dilemma research includes the reproach that consequences and norms are confounded in standard paradigms. As a remedy, a multinomial model (the CNI model) was developed to disentangle and measure sensitivity to consequences ( C), sensitivity to moral norms ( N), and general preference for inaction versus action ( I). In two studies, we examined the link of basic personality traits to moral judgments by fitting a hierarchical Bayesian version of the CNI model. As predicted, high Honesty–Humility was selectively associated with sensitivity for norms, whereas high Emotionality was selectively associated with sensitivity for consequences. However, Conscientiousness was not associated with a preference for inaction.

The question of how we decide that someone else has done something wrong is at the heart of moral psychology. Little work has been done to investigate whether people believe that others’ moral judgment differs from their own in moral dilemmas. We conducted four experiments using various measures and diverse samples to demonstrate the self–other discrepancy in moral judgment. We found that (a) people were more deontological when they made moral judgments themselves than when they judged a stranger (Studies 1-4) and (b) a protected values (PVs) account outperformed an emotion account and a construal-level theory account in explaining this self–other discrepancy (Studies 3 and 4). We argued that the self–other discrepancy in moral judgment may serve as a protective mechanism co-evolving alongside the social exchange mechanism and may contribute to better understanding the obstacles preventing people from cooperation.

The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. We propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles.

The purpose of these studies was to examine the principles people engage in when thinking about punishment, using a new measure (the Punishment Orientation Questionnaire [POQ]). Although traditional conceptualizations of punishment divide it into utilitarianism (e.g., deterrence) and retributivism (“eye for an eye”), we argue that a more useful metric of lay attitudes concerns orientation toward or away from punishment. After pilot testing and factor analysis, we used item response theory to assess four scales: prohibitive utilitarianism (limiting punishment based on utility), prohibitive retributivism (aversion to punishing innocent people), permissive utilitarianism (willingness to give strict punishment based on the benefits thereof), and permissive retributivism (desire for just deserts). The POQ showed good predictive validity for capital jury eligibility and sentencing recommendation in response to a death penalty trial stimulus. This study provides a better understanding of how classic punishment philosophies manifest among laypersons and contributes data outside of classical test theory.

We investigated whether the responses of 68 ethics committee members and staff to trolley dilemmas could predict their responses to research ethics problems concerning vaccine trials. Trolley dilemmas deal with the issue of sacrificing some for the benefit of many, which is also a core issue in the vaccination trial dilemmas. The subjects’ responses to trolley dilemmas showed no statistically significant correlation with their responses to our vaccination trial dilemmas. We concluded that, if there is a component of transferable intuition between the contexts, it must be small and dominated by other factors. Furthermore, the willingness to sacrifice some for many was larger in the trolley context, despite a more favorable risk/reward ratio and the voluntary participation of the subjects at risk in the vaccination situations. We conclude that one’s general willingness to trade lives in the trolley context may be an artifact that is due to its unrealistic setting.

Regardless the specific theoretical perspective, all ethical formulations for criminal justice practice in some way construct the ontological character of the offender, which, in turn, situates both epistemology and method. How this ethical process ultimately constructs the offender will likely help to establish the degree of ethical worth such an individual is deemed worthy to receive. Whether based upon the seriousness of the crime or based upon the specific configuration of the architecture of incarceration, the very possibility of legitimate ethical practice is greatly compromised. Such results can be better avoided when the ethical import of the individual is ontologically situated within the very definition of what it means to be human.1By situating this discussion within the context of the analytic psychology of Carl Jung and his concept of the shadow and the originary ethics of Martin Heidegger found in Being and Time, a more ontologically configured possibility for a criminal justice ethics can be recognized.

Morality is inherently social, yet much extant work in moral psychology ignores the central role of social processes in moral phenomena. To partly address this, this article examined the content of persuasive moral communication—the way people justify their moral attitudes in persuasive contexts. Across two studies, we explored variation in justification content (deontological, consequentialist, or emotive) as a function of moral foundations. Using justification selection techniques (Study 1) and open-ended justification production (Study 2), results demonstrate a preference (a) for deontological appeals in justifications for the sanctity foundation, (b) for consequentialist appeals for the individualizing foundations (care and fairness), and (c) for emotive appeals in justifications for the binding foundations (loyalty, authority and sanctity). The present research questions the generality of inferences about the primacy of emotions/intuition in moral psychology research and highlights the important role of reasons in persuasive moral communication.

Recognition has grown that moral behavior (e.g., generosity) plays a role in status attainment, yet it remains unclear how, why, and when demonstrating moral characteristics enhances status. Drawing on philosophy, anthropology, psychology, and organizational behavior, I critically review a third route to attaining status: virtue, and propose a moral virtue theory of status attainment to provide a generalized account of the role of morality in status attainment. The moral virtue theory posits that acts of virtue elicit feelings of warmth and admiration (for virtue), and willing deference, toward the virtuous actor. I further consider how the scope and priority of moralities and virtues endorsed by a moral community are bound by culture and social class to affect which moral characteristics enhance status. I end by outlining an agenda for future research into the role of virtue in status attainment.

Background: Care ethical theories provide an excellent opening for evaluation of healthcare practices since searching for (moments of) good care from a moral perspective is central to care ethics. However, a fruitful way to translate care ethical insights into measurable criteria and how to measure these criteria has as yet been unexplored: this study describes one of the first attempts. Objective: To investigate whether the emotional touchpoint method is suitable for evaluating care from a care ethical perspective. Research design: An adapted version of the emotional touchpoint interview method was used. Touchpoints represent the key moments to the experience of receiving care, where the patient recalls being touched emotionally or cognitively. Participants and research context: Interviews were conducted at three different care settings: a hospital, mental healthcare institution and care facility for older people. A total of 31 participants (29 patients and 2 relatives) took part in the study. Ethical considerations: The research was found not to be subject to the (Dutch) Medical Research Involving Human Subjects Act. Findings: A three-step care ethical evaluation model was developed and described using two touchpoints as examples. A focus group meeting showed that the method was considered of great value for partaking institutions in comparison with existing methods. Reflection and discussion: Considering existing methods to evaluate quality of care, the touchpoint method belongs to the category of instruments which evaluate the patient experience. The touchpoint method distinguishes itself because no pre-defined categories are used but the values of patients are followed, which is an essential issue from a care ethical perspective. The method portrays the insider perspective of patients and thereby contributes to humanizing care. Conclusion: The touchpoint method is a valuable instrument for evaluating care; it generates evaluation data about the core care ethical principle of responsiveness.

The principle of deontology states that the morality of an action depends on its consistency with moral norms; the principle of utilitarianism implies that the morality of an action depends on its consequences. Previous research suggests that deontological judgments are shaped by affective processes, whereas utilitarian judgments are guided by cognitive processes. The current research used process dissociation (PD) to independently assess deontological and utilitarian inclinations in women and men. A meta-analytic re-analysis of 40 studies with 6,100 participants indicated that men showed a stronger preference for utilitarian over deontological judgments than women when the two principles implied conflicting decisions ( d = 0.52). PD further revealed that women exhibited stronger deontological inclinations than men ( d = 0.57), while men exhibited only slightly stronger utilitarian inclinations than women ( d = 0.10). The findings suggest that gender differences in moral dilemma judgments are due to differences in affective responses to harm rather than cognitive evaluations of outcomes.

Does shame have a limited moral role because it is associated with a loss of self-respect or is it an important emotional support for socially beneficial behaviours? Aristotle supports the latter position. In his ethical theory, he famously claims that shame is a semi-virtue essential in the habituation of moral norms. He clarifies this role in the Rhetoric’s lesser-known distinction between true and conventional shame, which implies human beings make subjective evaluations of those appropriated cultural norms. Importantly, he locates this potential for ethical assessment in friendship and not in public discourse, as he thinks it would be shameless to publicly evaluate moral rules. The article ends by exploring potential critiques to his position and argues that Aristotle’s approach makes shame indispensable for moral progress, even though we might want to consider some limited role for shameless public protest.

The aim of this study was to uncover and critically examine hidden assumptions that underpin the findings of nurses’ unethical conduct arising from inquiries conducted by the Nurses Tribunal in New South Wales. This was a qualitative study located within a post-structural theoretical framework. Transcripts of five inquiries conducted between 1998 and 2003 were analysed using critical discourse analysis. The findings revealed two dominant discourses that were drawn upon in the inquiries to construct nurses’ conduct as unethical. These were discourses of trust and accountability. The way the nurses were spoken about during the inquiries was shaped by normalising judgements that were used to discursively position the nurse through narrative.

This study identified and described ethical problems encountered by physiotherapists in their practice and physiotherapists’ moral sensitivity in ethical situations. A questionnaire-based survey was constructed to identify ethical problems, and the Moral Sensitivity Questionnaire Revised version was used to measure moral sensitivity. Physiotherapists (n = 116) working in public health services responded to the questionnaire. Based on the results, most of the physiotherapists encounter ethical problems weekly. They concern mainly financial considerations, equality and justice, professionalism, unethical conduct of physiotherapists or other professions and patients’ self-determination. The dimension of moral strength was emphasised in physiotherapists’ self-evaluations of their moral sensitivity. As a conclusion, ethical problems do occur not only at individual level but also at organisational and society level. Physiotherapists seem to have moral strength for speaking on behalf of the patient. Scarce resources make them feel insufficient but much could still be done to provide quality care in co-operation with other health-care professionals.

In this paper I ask whether either theology or religious practice actually contribute to ethical theory or ethical practice. I rehearse well-known Humean arguments that they do not. I then reflect on the idea from Professor O’Donovan’s paper that it is virtuous for us to entertain hopes for redemption or for fulfilment and suggest that a careful weighing of these words may indicate otherwise.

The use of Nasogastric (NG) feeding in the provision of artificial nutrition and hydration at the end of life has, for the most part, been regarded as futile by the medical community. This position has been led chiefly by prevailing medical data. In Singapore, however, there has been an increase in its utilization supported primarily by social, religious and cultural factors expressly to prolong life of the terminally ill patient. Here this article will seek to review the ethical and clinical impact of this treatment and provide some understanding for such decisions in the light of the Duty of Palliative Care [DoPC]. Complemented by virtue ethics theory, the DoPC highlights and seeks to realize the individual case specific goals of care that maximize comfort and quality of life of the patient in the face of rapid attenuation of treatment options and the eminence of the final outcome by considering each of these factors individually in order to provide the best outcome for the patient and the family.

In the history of city planning, the dichotomy between the aesthetic aspirations of the City Beautiful and City Practical movements is overstated. The aesthetic impulse did not disappear but persisted as an important thread through the development of comprehensive planning approaches into the 1920s. The nexus between beauty and utility was negotiated and expressed across four main discourses: broad social improvement, aesthetic functionality, economic rationality, and holistic design. Ultimately, beauty became wedded to utility within the very nature of the comprehensive city plan itself. The work of the leading city planner John Nolen is central to an understanding of these historic continuities and informed the early evolution of city planning theory and practice. Nolen’s challenge to the City Beautiful paradigm, while still retaining an artistic sensibility, reaestheticizes scholars’ appreciation of the City Practical.

This article aims to deepen the understanding of courage through a theoretical analysis of classical philosophers’ work and a review of published and unpublished empirical research on courage in nursing. The authors sought answers to questions regarding how courage is understood from a philosophical viewpoint and how it is expressed in nursing actions. Four aspects were identified as relevant to a deeper understanding of courage in nursing practice: courage as an ontological concept, a moral virtue, a property of an ethical act, and a creative capacity. The literature review shed light on the complexity of the concept of courage and revealed some lack of clarity in its use. Consequently, if courage is to be used consciously to influence nurses’ ethical actions it seems important to recognize its specific features. The results suggest it is imperative to foster courage among nurses and student nurses to prepare them for ethical, creative action and further the development of professional nursing practices.

The willingness to view risk as part of daily life has vanished. A risk-averse mindset among environmental regulators engenders confusion between the ethics of intention and the ethics of consequence, leading to the elevation of the precautionary principle with unintended and often unfortunate outcomes. Environmental risk assessment is conservative, but the actual level of conservatism cannot be determined. High-end exposure assumptions and current toxicity criteria from the USEPA, based on linear extrapolation for carcinogens and default uncertainty factors for systemic toxicants, obscure the degree of conservatism in risk assessments. Ideally, one could choose a percentile of the target population to include within environmental standards, but this choice is complicated by the food, pharmaceutical and advertising industries, whose activities, inadvertent or not, often promote maladaptive and unhealthy lifestyle choices. There has lately been much discussion about background exposures and disease processes and their potential to increase the risk from environmental chemicals. Should these background exposures or disease processes, especially those associated with maladaptive individual choices, be included as part of a regulatory risk evaluation? A significant ethical question is whether environmental regulation should protect those pursuing a self-destructive lifestyle that may add to or synergize with otherwise innocuous environmental exposures. Choosing a target percentile of protection would provide an increased level of transparency and the flexibility to choose a higher or lower percentile if such a choice is warranted. Transparency and flexibility will lead to more responsive environmental regulation that balances protection of public health and the stewardship of societal resources.

In the UK, community care has led to more complex relationships for mental health nurses. They need to respect the rights of service users to confidentiality while also respecting the rights of family caregivers to information that directly affects them. An unsatisfactory situation has arisen in which utilitarian and legally driven motives have seen family caregivers’ interests become subsidiary to those of service users and providers. An ethical case is made for sharing information with family caregivers, even against the wishes of service users. Through the use of a conceptual framework based on elements proposed by Thiroux — value of life, goodness or rightness, justice or fairness, truth-telling or honesty, and individual freedom — the article concludes that there is an ethical argument for sharing some information with family caregivers and that nurses should respect caregivers’ rights through their actions. Nurses’ actions are a commitment to seeking what is ‘good’ by making judgements based on what matters. It is argued that people and their relationships matter more than strict adherence to laws and codes.

In the context of health care system complexity, nurses need responsive leadership and organizational support to maintain intrinsic motivation, moral sensitivity and a caring stance in the delivery of patient care. The current complexity of nurses’ work environment promotes decreases in work motivation and moral satisfaction, thus creating motivational and ethical dissonance in practice. These and other work-related factors increase emotional stress and burnout for nurses, prompting both new and seasoned nurse professionals to leave their current position, or even the profession. This article presents a theoretical conceptual model for professional nurses to review and make sense of the ethical reasoning skills needed to maintain a caring stance in relation to the competing values that must coexist among nurses, health care administrators, patients and families in the context of the complex health care work environments in which nurses are expected to practice. A model, Nurses’ Ethical Reasoning Skills, is presented as a framework for nurses’ thinking through and problem solving ethical issues in clinical practice in the context of complexity in health care.

This article explains the emergence, growth, and institutional anchoring of bioethics in both policy and clinical arenas. Under the heading of principlism, bioethics developed a public language for resolving disputes that allowed it to transform disputes involving sacred matters into profane work routines. At the same time, having principlism as a common language for solving practical disputes allowed “ethics work” in health care to be separated from moral theorizing as a practical activity. Two issues—the right to die and the protection of research subjects—serve to illustrate the process through which bioethics established a large institutional footprint in health care.

In this study, we examined the perception of actual and ideal ethical climate type among 95 nurses working in the internal medicine wards of one central hospital in the state of Israel. We also examined whether nurses’ demographic characteristics influence that perception and if a relationship between perceptions of an actual and an ideal ethical climate type influences nurses’ job satisfaction. A questionnaire composed of three subquestionnaires was administered and the responses analyzed using multiple linear regressions, analysis of variance and Pearson’s correlation coefficient. The results demonstrated that demographic characteristics (such as: gender, job tenure and level of education) partially influence the perception of an ideal ethical climate. Incongruence in perceptions of ‘caring’ and ‘independence’ climate types indicated a decline in nurses’ job satisfaction, while perception of actual ‘caring’ and ‘service’ climates positively influenced all aspects of job satisfaction. We recommend constructing training programs emphasizing the ethics of nursing practice and also to help lead nurses to clarify an ethical framework and guide nursing staff in dealing with ethical dilemmas.

This article explores how ethics and religion interface in everyday life by drawing on a study examining the negotiation of religious and spiritual plurality in health care. Employing methods of critical ethnography, namely, interviews and participant observation, data were collected from patients, health care providers, administrators and spiritual care providers. The findings revealed the degree to which `lived religion' was intertwined with `lived ethics' for many participants; particularly for people from the Sikh faith. For these participants, religion was woven into everyday life, making distinctions between public and private, secular and sacred spaces improbable. Individual interactions, institutional resource allocation, and social discourses are all embedded in social relationships of power that prevent religion from being a solely personal or private matter. Strategies for the reintegration of religion into nursing ethics are: adjusting professional codes and theories of ethics to reflect the influence of religion; and the contribution of critical perspectives, such as postcolonial feminism, to the understanding of lived ethics.

This analysis presents an epistemological and moral examination of suffering. It addresses the specific questions: (1) What is suffering? (2) Can one's suffering be assessed by another? and (3) What is the moral significance of suffering? The epistemological analysis is orientated by Peter Hacker's framework for the investigation of emotions, demonstrating that suffering is an emotion. This leads to a discussion of whether suffering is a phenomenon that can be evaluated objectively by another person who is not experiencing the suffering, questioning the validity of some decisional models for limiting life-sustaining therapies with the aim of preventing suffering. This analysis highlights that understandings of suffering are value laden. It is conventionally implied that suffering is `bad' and that it should be eliminated. Suffering is commonly regarded as a moral wrong that needs to be made right by health care. This article concludes with a recommendation for a paradigm shift in how suffering can be better understood, through the practice of empathic attunement.

Background: Past debate on ethics in goal planning for rehabilitation has tended to focus on tensions that can arise between ethical principles; in particular the principles of autonomy and beneficence. When setting goals, clinicians tend to prioritize the wishes of patients, justifying this from the perspective of maximizing patient autonomy. This is tempered by consideration of what is `realistic' and what the pursuit of `unrealistic goals' might be on patient well-being. Rationale: In this paper it is argued that clinicians also have an ethical obligation to take into account the resource implications of goal planning. Utilitarianism provides one perspective on addressing such issues. A utilitarian approach to goal planning would necessitate a focus on maximizing the benefits of rehabilitation to the whole community served when negotiating goals with individual patients. Critique: Clinicians may, however, have a number of concerns about utilitarianism. One assumption is that the quality of life of people with severe disability will be judged as being intrinsically low, and therefore valued less from a utilitarian perspective. A second assumption is that for people with severe disability the large effort expended in rehabilitation to achieve small gains cannot possibly repay itself in a utilitarian equation, specifically in financial terms. Evidence from the literature however has demonstrated that in fact both of these assumptions are probably false. Conclusion: Rehabilitation professionals should not be hesitant to consider utilitarianism as an ethical framework for rehabilitation. In fact, rehabilitation may well gain if people were to use this approach.

This article analyses the use of images in the discourse of animal ethics in an attempt to see how visual cultural studies can contribute to the debate in environmental philosophy. Drawing on Derrida's critique of the utilitarian theory of animal liberation and Mitchell's analysis of iconoclasm in visual culture theories, the article argues that an iconoclastic strategy of visual representation in the discourse of animal ethics undermines the very objective of such an ethical theory. Two case studies — Peter Singer's animal liberation and J.B. Callicott's land ethic — illustrate an implacable tendency to essentialize the visual and animal identity.

Role-playing games provide a particularly fruitful environment for the development of critical, ethical reasoning skills, a core component in developing a citizenry capable of fully participating in a cosmopolitan, democratic society. In this study, ethnographic interview participants recount particularly engaging ethical situations in their own game play. Through their responses, thematic trends develop that help us identify key elements in games that provide opportunities for the development of these crucial skills.

Background: The utilitarian foundation of decision analysis limits its usefulness for many social policy decisions. In this study, the authors examine a method to incorporate competing ethical principles in a decision analysis of liver transplantation for a patient with acute liver failure (ALF). Methods. A Markov model was constructed to compare the benefit of transplantation for a patient with ALF versus the harm caused to other patients on the waiting list and to determine the lowest acceptable 5-y posttransplant survival for the ALF patient. The weighting of the ALF patient and other patients was then adjusted using a multiattribute variable incorporating utilitarianism, urgency, and other principles such as fair chances. Results. In the base-case analysis, the strategy of transplanting the ALF patient resulted in a 0.8% increase in the risk of death and a utility loss of 7.8 quality-adjusted days of life for each of the other patients on the waiting list. These harms cumulatively outweighed the benefit of transplantation for an ALF patient having a posttransplant survival of less than 48% at 5 y. However, the threshold for an acceptable posttransplant survival for the ALF patient ranged from 25% to 56% at 5 y, depending on the ethical principles involved. Discussion. The results of the decision analysis vary depending on the ethical perspective. This study demonstrates how competing ethical principles can be numerically incorporated in a decision analysis.

Moral distress has received much attention in the international nursing literature in recent years. In this article, we describe the evolution of the concept of moral distress among nursing theorists from its initial delineation by the philosopher Jameton to its subsequent deployment as an umbrella concept describing the impact of moral constraints on health professionals and the patients for whom they care. The article raises worries about the way in which the concept of moral distress has been portrayed in some nursing research and expresses concern about the fact that research, so far, has been largely confined to determining the prevalence of experiences of moral distress among nurses. We conclude by proposing a reconsideration, possible reconstruction and multidisciplinary approach to understanding the experiences of all health professionals who have to make difficult moral judgements and decisions in complex situations.

Qualitative research poses ethical issues and challenges unique to the study of human beings. In developing the interpersonal relationship that is critical to qualitative research, investigator and participant engage in a dialogic process that often evokes stories and memories that are remembered and reconstituted in ways that otherwise would not occur. Ethical issues are raised when this relationship not only provides qualitative research data, but also leads to some degree of therapeutic interaction for the participant. The purpose of this article is to examine some of the controversies inherent in the researcher's dilemma when this occurs, set within the context of a nursing caring theory (Swanson), and the International Council of Nurses Code of ethics for nurses, which provides guidance on global nursing practice.