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Our society, in general, and health care, in particular, faces notable challenges due to the emergence of innovative digital technologies. The use of socially assistive robots in aged care is a particular digital application that provokes ethical reflection. The answers we give to the ethical questions associated with socially assistive robots are framed by ontological and anthropological considerations of what constitutes human beings and how the meaning of being human relates to how these robots are conceived. Religious beliefs and secular worldviews, each of which may participate fully in pluralist societies, have an important responsibility in this foundational debate, as anthropological theories can be inspired by religious and secular viewpoints. This article identifies seven anthropological considerations grounded in the synthesis of biblical scriptures, Roman Catholic documents, and recent research literature. We highlight the inspirational quality of these anthropological considerations when dealing with ethical issues regarding the development and use of socially assistive robots in aged care. With this contribution, we aim to foster a global and inclusive dialogue on digitalization in aged care that deeply challenges our basic understanding of what constitutes a human being and how this notion relates to machine artefacts. [ABSTRACT FROM AUTHOR]

Therefore, it is important that guidelines using GA thresholds specify that exceptions should be considered at any GA, based on other prognostic factors and parents' wishes. However, some ethicists have criticised GA thresholds as clinically and ethically inappropriate and proposed an individualised decision-making process based on prognosis.[2] Between September 2019 and October 2020, we conducted a nationwide study to understand the ethical reasons that guided Belgian neonatologists when they made decisions about whether to resuscitate infants born in EPT. Abbreviations EPT infants, extremely preterm infants GA gestational age NICU neonatal intensive care unit Extremely preterm (EPT) infants are born below 28 weeks of gestational age (GA).[1] They generally need resuscitation at birth, but deciding whether to provide this can be difficult.[1] There is considerable clinical uncertainty on treatment outcomes, which raises ethical questions about whether we should we prioritise quantity or quality of life?. [Extracted from the article]

REFERENCES 1 Sriraman S, Demirhan M, Golombek S. Beyond the numbers: unpacking the complexity of resuscitation thresholds in periviable infants. We read with interest Sriraman et al's (2023)[1] response to our article 'Resuscitation thresholds were seen as guidance by Belgian neonatologists and other relevant factors were included in decision-making'.[2] We appreciate that other institutions use an integrative approach to resuscitation decisions for extremely premature infants, one that takes into proper account other prognostic factors as well as parents' opinion. [Extracted from the article]

Consent is generally required for research and sharing rich individual‐level data but presents additional ethical and legal challenges where participants have diminished decision‐making capacity. We formed a multi‐disciplinary team to develop best practices for consent in data‐intensive dementia research. We recommend that consent processes for research and data sharing support decision‐making by persons with dementia, protect them from exploitation, and promote the common good. Broad consent designed to endure beyond a loss of capacity and combined with ongoing oversight can best achieve these goals. Persons with dementia should be supported to make decisions and enabled to express their will and preferences about participation in advance of a loss of capacity. Regulatory frameworks should clarify who can act as a representative for research decisions. By promoting harmonization of consent practices across institutions, sectors, and countries, we hope to facilitate data sharing to accelerate progress in dementia research, care, and prevention. [ABSTRACT FROM AUTHOR]

In the era of deinstitutionalisation of psychiatric patients, steady or even increasing rates of compulsory commitment to care (CCC) are an intriguing phenomenon to analyse. From a clinical, legal and ethical perspective, CCC continues to be a controversial practice in psychiatry, and perhaps even more so when applied to patients with severe substance use disorder (SUD). Several reasons make it controversial. The lack of consensus about the benefits of CCC and professional disagreement about what mental illness and autonomy mean in the case of SUD make it difficult to apply ethically sound clinical decision‐making in CCC. Also, the medico‐legal framework underlying CCC use sometimes appears to foster the use of reductionist clinical evaluation. Layered on top of these issues is how stakeholders view coercion. There is a discrepancy between clinicians’ and patients’ perception of coercion, which leads to clinician–patient differences on whether CCC is necessary. Moreover, the way in which the evaluation is typically carried out influences patients’ perception of coercion and subsequently their motivation for participating fully in treatment. In this article, we explore the value of care ethics, often applied to care practices such as nursing, when applied to more procedural medical practices, such as decision‐making regarding CCC. The care‐ethical approach views decision‐making as part of a dynamic care process, within which the lived experience, interpretative dialogue and promotion of dignity are core features. Embracing this new framework means a paradigm shift in when the therapeutic relationship begins, namely, investing in it occurs while conducting an evaluation for a possible CCC procedure. Unlike in current typical evaluations, early cultivation of the therapeutic relationship enables the patient to participate in the definition of his needs, reduces perceived coercion and negative emotions and enhances treatment motivation. Finally, implications of this novel approach for clinical practice are formulated and discussed. [ABSTRACT FROM AUTHOR]

DINÇ L and GASTMANS C. Nursing Inquiry 2012; 19: 223-237 Trust and trustworthiness in nursing: an argument-based literature review Caring requires nurses to establish trusting relationships with patients and to be trustworthy professionals. This article provides insight into the conceptual understanding of trust and trustworthiness in nursing through an argument-based literature review of 17 articles published between 1980 and 2010. Trust is characterized as an attitude relying with confidence on someone. The importance of trust relationships is considered by addressing the imbalances of power in nurse-patient relationships as they increase the vulnerability and dependency of the truster. Trust is considered as a process, and time, reliance on others, risk and fragility are identified as basic attributes of trust. However, trustworthiness is inadequately explored in the nursing ethics literature. Nurse educators have a responsibility to ensure that nurses are equipped with the attitudes and knowledge that are needed to establish trusting nurse-patient relationships. [ABSTRACT FROM AUTHOR]

ABSTRACT The aim of this study was to explore and describe how Flemish nurses experience their involvement in the care of hospitalized patients with dementia, particularly in relation to artificial nutrition or hydration (ANH). We interviewed 21 hospital nurses who were carefully selected from nine hospitals in different regions of Flanders. 'Being touched by the vulnerability of the demented patient' was the central experience of the nurses, having great impact on them professionally as well as personally. This feeling can be described as encompassing the various stages of the care process: the nurses' initial meeting with the vulnerable patient; the intense decision-making process, during which the nurses experienced several intense emotions influenced by supporting or hindering contextual factors; and the final coping process, a time when nurses came to terms with this challenging experience. From our examination of this care process, it is obvious that nurses' involvement in ANH decision-making processes that concern patients with dementia is a difficult and ethically sensitive experience. On the one hand, the feeling of 'being touched' can imply strength, as it demonstrates that nurses are willing to provide good care. On the other hand, the feeling of 'being touched' can also imply weakness, as it makes nurses vulnerable to moral distress stemming from contextual influences. Therefore, nurses have to be supported as they carry out this ethically sensitive assignment. Practical implications are given. [ABSTRACT FROM AUTHOR]

The number of people suffering from dementia will rise considerably in the years to come. This will have important implications for society. People suffering from dementia have to rely on relatives and professional caregivers when their disorder progresses. Some people want to determine for themselves their moment of death, if they should become demented. They think that the decline in personality caused by severe dementia is shocking and unacceptable. In this context, some people consider euthanasia as a way to avoid total deterioration. In this article, we discuss some practical and ethical dilemmas regarding euthanasia in persons with severe dementia based on an advance euthanasia directive. We are using a personalist approach in dealing with these ethical dilemmas. [ABSTRACT FROM AUTHOR]

A prospective, descriptive study was used to assess the diagnostic validity of the Confusion Assessment Method (CAM) administered at the bedside by nurses in daily practice. Two different scoring methods of the CAM (the specific (SPEC) and sensitive (SENS) methods) were compared with a criterion standard (CAM completed by trained research nurses). During a 5-month period, all patients consecutively admitted to an acute geriatric ward of the University Hospitals of Leuven (Belgium) were enrolled in the study. The 258 elderly inpatients who were included underwent 641 paired but independent ratings of delirium by bedside and trained research nurses. Delirium was identified in 36 of the 258 patients (14%) or in 42 of the 641 paired observations (6.5%). The SENS method of the CAM algorithm as administered by bedside nurses had the greatest diagnostic accuracy, with 66.7% sensitivity and 90.7% specificity; the SPEC method had 23.8% sensitivity and 97.7% specificity. Bedside nurses had difficulties recognizing the features of acute onset, fluctuation, and altered level of consciousness. For both scoring methods, bedside nurses had difficulties with the identification of elderly patients with delirium but succeeded in diagnosing correctly those patients without delirium in more than 90% of observations. Given these results, additional education about delirium with special attention to guided training of bedside nurses in the use of an assessment strategy such as the CAM for the recognition of delirium symptoms is warranted. [ABSTRACT FROM AUTHOR]

verpeet e., dierckx de casterle b., van der arend a. & gastmans c.a.e. (2005) Journal of Advanced Nursing 51(2), 188–195 Nurses’ views on ethical codes: a focus group study This paper reports a study exploring nurses’ views on the ‘potential’ content and functions of an ethical code for nurses in Belgium. The term ‘potential’ is used, because Belgian nurses do not have experience with an ethical code. Ethical codes have been developed to guide nurses’ practice and to improve their professional status. Little empirical research, however, has been undertaken to determine nurses’ views on the content and functions of these codes. The available quantitative studies merely give some information on nurses’ (lack of) knowledge and use of their ethical code. No nursing ethical code currently exists in Belgium. Qualitative research exploring nurses’ views, therefore, was needed in order to find out which functions an ethical code could fulfil and what the code's content could be. Eight focus groups were conducted with 50 nurses in different healthcare settings in Belgium. Data were generated during 2003. According to participants, an ethical code could fulfil several functions, including supporting their professional nursing identity (external function) and giving guidelines for nursing practice (internal function). In addition, some aspects of content were mentioned, including nurses’ responsibilities in a relational context: particular attention should be paid to the personality of the nurse and to the specificity of nursing as a relational activity. Most agreement was reached on the ‘ethical’ function of the code, namely guiding nurses’ professional moral practice. Regarding disciplinary use and the need for legalization of the ethical code, on the contrary, opinions were divergent. It is of utmost importance to take into account nurses’ views when developing an ethical code for their profession. This study gave a first picture of the views of nurses themselves. These initial findings should be completed with nurses’ views on the formulation, dissemination and promotion of the ethical code. Such evidence-based development of an ethical code will probably give more guarantees that the code will meet nurses’ expectations and will function optimally. [ABSTRACT FROM AUTHOR]

verpoort c., gastmans c. & dierckx de casterlé b. (2004) Journal of Advanced Nursing 47(6), 592–600 Palliative care nurses’ views on euthanasia In debates on euthanasia legalization in Belgium, the voices of nurses were scarcely heard. Yet studies have shown that nurses are involved in the caring process surrounding euthanasia. Consequently, they are in a position to offer valuable ideas about this problem. For this reason, the views of these nurses are important because of their palliative expertise and their daily confrontation with dying patients. The aim of this paper is to report a study of the views of palliative care nurses about euthanasia. A grounded theory approach was chosen, and interviews were carried out with a convenience sample of 12 palliative care nurses in Flanders (Belgium). The data were collected between December 2001 and April 2002. The majority of the nurses were not a priori for or against euthanasia, and their views were largely dependent on the situation. What counted was the degree of suffering and available palliative options. Depending on the situation, we noted both resistance and acceptance towards euthanasia. The underlying arguments for resistance included respect for life and belief in the capabilities of palliative care; arguments underlying acceptance included the quality of life and respect for patient autonomy. The nurses commented that working in palliative care had a considerable influence on one's opinion about euthanasia. In light of the worldwide debate on euthanasia, it is essential to know how nurses, who are confronted with terminally ill patients every day, think about it. Knowledge of these views can also contribute to a realistic and qualified view on euthanasia itself. This can be enlightening to the personal views of caregivers working in a diverse range of care settings. [ABSTRACT FROM AUTHOR]

meulenbergs t., verpeet e., dchotsmans p. & gastmans c. (2004) Journal of Advanced Nursing 46(3), 331–336 Professional codes in a changing nursing context: literature review Professional codes played a definitive role during a specific period of time, when the professional context of nursing was characterized by an increasing professionalization. Today, however, this professional context has changed. This paper reports on a study which aimed to explore the meaning of professional codes in the current context of the nursing profession. A literature review on professional codes and the nursing profession was carried out. The literature was systematically investigated using the electronic databases PubMed and The Philosopher's Index, and the keywords nursing codes, professional codes in nursing, ethics codes/ethical codes, professional ethics. Due to the nursing profession's growing multidisciplinary nature, the increasing dominance of economic discourse, and the intensified legal framework in which health care professionals need to operate, the context of nursing is changing. In this changed professional context, nursing professional codes have to accommodate to the increasing ethical demands placed upon the profession. Therefore, an ethicization of these codes is desirable, and their moral objectives need to be revalued. [ABSTRACT FROM AUTHOR]

Aim Background Methods Results Conclusion Implications for nursing and health policy To describe how nurses’ moral competence can be supported from the perspective of nurses, nurse managers, researchers, educators, and nursing students.Moral competence is the capacity or ability of nurses to recognise one's own emotions of what is right or wrong, to reflect on these emotions, to make decisions, and to act in ways that bring the highest level of benefit to patients. Moral competence is part of professional competence. However, little is known about how nurses’ moral competence can be supported.A qualitative descriptive study design was applied. Stratified purposive sampling was employed and focus group discussions were conducted in Belgium, Cyprus, Finland, Greece, Ireland, and Italy in 2023. A total of 38 informants (5–8 per focus group) who were registered nurses or nursing students participated. The data were analysed using both deductive and inductive content analysis. The COnsolidated criteria for REporting Qualitative research were adhered to.Seven themes were developed following analysis, which suggested that support for nurses’ moral competence can be located at individual‐relational, organisational, and societal levels. Several approaches and/or tools were also identified to support moral competence.Nurses’ moral competence could benefit from continuous support from colleagues, those in leadership positions, organisations and society. Practical tools and approaches can also successfully support nurses’ moral competence.Support for nurses’ moral competence forms a continuum from the beginning of nursing studies throughout nursing careers. Thus, educational interventions and training programmes are needed both at basic and continuous ethics education. There is also a need for investments in and development of strategies and regulations on ethics management in health systems, national‐ and international‐level ethics indicators for health policy‐making, and implementation of existing practices, interventions, and procedures in nursing practice. [ABSTRACT FROM AUTHOR]

The ethical approach of artificial administration of food and fluids has been much enlivened in recent years. Nevertheless, the ethical implications of the day-to-day event of serving meals in nursing homes remain to be clarified. This paper has a double aim. First, I present a philosophical-ethical clarification of mealtime care in nursing homes. Second, I suggest several ethical orientations related to the nutritional problem among nursing home residents. I argue that caregivers must not only have considerable knowledge and skill in nutritional matters; it is only by integrating as much as possible an attitude of caring with the competent performance of care activities that 'good mealtime care' can be achieved. [ABSTRACT FROM AUTHOR]

Critics of Kohlberg’s moral theory today focus on the content of his theory and more specifically on its justice-orientated moral concept. This has led to the well-known ‘justice-care debate’. The purpose of this article is to critically examine the validity of Kohlberg’s moral theory for research in nursing ethics from a caring perspective (referring to the content) as well as from a cognitive-structural perspective (referring to the basic assumptions of the model). The analysis points to the usefulness and value of the cognitive-structural model to empirically study nurses’ ethical behaviour; the content of Kohlberg’s model, however, needs to be adapted by adding a caring perspective as well as some personal and situational variables. An adjusted version of Kohlberg’s model is proposed and discussed. [ABSTRACT FROM AUTHOR]

The section comments on the article "Is the Professional Code Still the Cornerstone of Clinical Nursing Practice?," by P. Esterhuizen, which appeared in the 1996 issue of the "Journal of Advanced Nursing." It asserts that the paper provided an excellent overview of the problems that confront ethical codes in nursing. It emphasizes the need for more research on nurses' awareness and knowledge of their ethical codes. It focuses on three of the insights provided by Esterhuizen.