2010
- Abstract: The provisions of the andalusian Law on rights and guarantees of the dignity
of
persons
in the process of death, also
known as«act of dignified
death»,
are based
on
two pillars:
The right to the
autonomy of
the patient, supported,
if it
be, in
a will
expressed
in instructions
given in
advance and
the duties
of doctors
and health
centers to give
satisfaction, to the
extent of
their potential and respecting
the law,
those demands. The core
of the
question is
to find the
point of
necessary balance
between
the
wishes of
the patient
and the
freedom and
responsibility
of
the doctor.
Together
with positive
aspects, such
as the
recognition of
the right
and the
implementation of the
palliative care, there
are other
questionable proposals, affecting
the rights of doctors: a lack
of understanding of freedom
and professional responsibility,
recognition
of the
objection of conscience and
certain ethics
duties, etc.
As expressed by the law,
remain committed
substantial rights of doctors
and might
favor, in
the
care
activity, introducing
practices of
defensive medicine.
- Abstract: Although organizational and situational
factors have been found to predict burnout, not everyone employed at the
same workplace develops it, suggesting that becoming burnt out is a complex,
multifaceted phenomenon. The aim of this study was to elucidate perceptions
of conscience, stress of conscience, moral sensitivity, social support and
resilience among two groups of health care personnel from the same
workplaces, one group on sick leave owing to medically assessed burnout (n ¼
20) and one group who showed no indications of burnout (n ¼ 20). The results
showed that higher levels of stress of conscience, a perception of
conscience as a burden, having to deaden one's conscience in order to keep
working in health care and perceiving a lack of support characterized the
burnout group. Lower levels of stress of conscience, looking on life with
forbearance, a perception of conscience as an asset and perceiving support
from organizations and those around them (social support) characterized the
nonburnout group.
- The History: After the Second World War, Japan's
national flag ("Hinomaru," meaning "rising sun") and national anthem ("Kimigayo") have
been two of the most controversial issues in Japanese politics. Leftist
groups have attacked both as symbols of the militarism that resulted in
the invasion of Japan during the war. Throughout the entire history of
post-war Japan, such groups have taken advantage of every opportunity to
protest singing the anthem or paying respect to the flag. The Japan
Teachers Union, which organizes public school teachers, once was
dominated by the Japan Communist Party and, as it has been for a long
time and continues today, is still heavily influenced by leftist
ideology. The union has been organizing protests at school events such as
entrance, graduation, and other ceremonies and union members have further
refused to pay respect to the flag or sing the national anthem. . .
- Abstract: Two areas of ethical conflict in
intercultural nursing – who needs single rooms more, and how far should
nurses go to comply with ethnic minority patients' wishes? – are discussed
from a utilitarian and commonsense morality point of view. These theories
may mirror nurses' way of thinking better than principled ethics, and both
philosophies play a significant role in shaping nurses' decision making.
Questions concerning room allocation, noisy behaviour, and demands that
nurses are unprepared or unequipped for may be hard to cope with owing to
physical restrictions and other patients' needs. Unsolvable problems may
cause stress and a bad conscience as no solution is 'right' for all the
patients concerned. Nurses experience a moral state of disequilibrium, which
occurs when they feel responsible for the outcomes of their actions in
situations that have no clear-cut solution.
- Abstract: Aim. This paper is a report of a study
of patterns of perceptions of conscience, stress of conscience and burnout
in relation to occupational belonging among Registered Nurses and nursing
assistants in municipal residential care of older people.
Background. Stress and burnout among healthcare personnel and experiences
of ethical difficulties are associated with troubled conscience. In elder
care the experience of a troubled conscience seems to be connected to
occupational role, but little is known about how Registered Nurses and
nursing assistants perceive their conscience, stress of conscience and
burnout.
Method. Results of previous analyses of data collected in 2003, where 50
Registered Nurses and 96 nursing assistants completed the Perceptions of
Conscience Questionnaire, Stress of Conscience Questionnaire and Maslach
Burnout Inventory, led to a request for further analysis. In this study
Partial Least Square Regression was used to detect statistical predictive
patterns.
Result. Perceptions of conscience and stress of conscience explained
41Æ9% of the variance in occupational belonging. A statistical predictive
pattern for Registered Nurses was stress of conscience in relation to
falling short of expectations and demands and to perception of conscience as
demanding sensitivity. A statistical predictive pattern for nursing
assistants was perceptions that conscience is an authority and an asset in
their work. Burnout did not contribute to the explained variance in
occupational belonging.
Conclusion. Both occupational groups viewed conscience as an asset and
not a burden. Registered Nurses seemed to exhibit sensitivity to
expectations and demands and nursing assistants used their conscience as a
source of guidance in their work. Structured group supervision with
personnel from different occupations is needed so that staff can gain better
understanding about their own occupational situation as well as the
situation of other occupational groups.
- Abstract: Background: In elderly care registered nurses (RNs) and nurse
assistants (NAs) face ethical challenges which may trouble their conscience.
Objective: This study aimed to illuminate meanings of RNs' and NAs' lived
experience of troubled conscience in their work in municipal residential
elderly care.
Design: Interviews with six RNs and six NAs were interpreted separately
using a phenomenological hermeneutic method.
Settings: Data was collected in 2005 among RNs and NAs working in special
types of housings for the elderly in a municipality in Sweden.
Participants: The RNs and NAs were selected for participation had
previously participated in a questionnaire study and their ratings in the
questionnaire study constituted the selection criteria for the interview
study.
Results: The RNs' lived experience of troubled conscience was formulated
in two themes. The first theme is 'being trapped in powerlessness' which
includes three sub-themes: being restrained by others' omission, being
trapped in ethically demanding situations and failing to live up to others'
expectations. The second theme is 'being inadequate' which includes two
sub-themes: lacking courage to maintain one's opinion and feeling
incompetent. The NAs' lived experience of troubled conscience was formulated
in the two themes. The first is 'being hindered by pre-determined
conditions' which includes two sub-themes: suffering from lack of focus in
one's work and being restrained by the organisation. The second theme is
'being inadequate' which includes two sub-themes: lacking the courage to
object and being negligent.
Conclusions: The RNs' lived experience of troubled conscience were
feelings of being trapped in a state of powerlessness, caught in a struggle
between responsibility and authority and a sense of inadequacy fuelled by
feelings of incompetence, a lack of courage and a fear of revealing
themselves and endangering residents' well-being. The NAs' lived experience
of troubled conscience was feelings of being hindered by pre-determined
conditions, facing a fragmented work situation hovering between norms and
rules and convictions of their conscience. To not endangering the atmosphere
in the work-team they are submissive to the norms of their co-workers. They
felt inadequate as they should be model care providers. The findings were
interpreted in the light of Fromm's authoritarian and humanistic conscience.
- Abstract: The purpose of this paper is to present the theoretical
and philosophical assumptions of the Nursing Manifesto, written by three
activist scholars whose objective was to promote emancipatory nursing
research, practice, and education within the dialogue and praxis of
social justice. Inspired by discussions with a number of nurse
philosophers at the 2008 Knowledge Conference in Boston, two of the
original Manifesto authors and two colleagues discussed the need to
explicate emancipatory knowing as it emerged from the Manifesto. Our
analysis yielded an epistemological framework based on liberation
principles to advance praxis in the discipline of nursing. This paper
adds to what is already known on this topic, as there is not an explicit
contribution to the literature of this specific Manifesto, its
significance, and utility for the discipline.While each of us have
written on emancipatory knowing and social justice in a variety of works,
it is in this article that we identify, as a unit of knowledge production
and as a direction towards praxis, a set of critical values that arose
from the emancipatory conscience-ness and intention seen in the framework
of the Nursing Manifesto.
- Introduction: Suppose a pharmacist refuses to
dispense pills that induce abortion claiming that dispensing such pills
runs counter to principles he holds dear. Indeed, the pharmacist claims
that forcing him to dispense the pills would violate his freedom of
conscience. He even claims that he would not have become a pharmacist
had he foreseen an obligation to dispense such pills at the time he
entered the profession. Should the pharmacist's job be protected if he
is making a bona fide claim of conscience? And does it matter whether
the pharmacist's objection to dispensing the pills is rooted in
religious or nonreligious reasons?
- One of the most intriguing questions in medical ethics is whether
individual physicians ought to be able to refuse conscientiously to provide
services that patients seek. The issue requires us to delve into difficult
problems, such as the extent to which physicians must subordinate their
interests to those of their current or prospective patients, and how
essential the services physicians object to are as new medical technologies
develop. Despite the difficulty that surrounds this issue, many
bioethicists - like Dan Brock and Mark Wicclair - have tried to address it in a
single journal article. But Holly Fernandez Lynch is an exception. She gives
conscientious objection in medicine (hereafter, "conscientious objection")
the book-length treatment that it deserves. . .
- Introduction: Even in the dire circumstances of rape, incest, or
medical emergency, certain federal and state provisions allow health care
professionals to ignore the needs of women on the basis of ethical and
moral qualms, also known as conscientious refusal. Conscience has been
defined as the private, constant, ethically attuned part of the human
character. It operates as an internal sanction that comes into play through
critical reflection about a certain action or inaction.' With the protection
of certain federal and state regulations, doctors, who vow under the
Hippocratic Oath to do no harm, may turn their patients away
withoutreferrals to other doctors willing to perform abortions. This legal
protection of conscience extends beyond doctors, and also exculpates
pharmacists from liability when they refuse to fill prescriptions for birth
control pills or Plan B emergency contraceptives. This paper seeks to
analyze the basis of the laws protecting conscientious objection in
healthcare and to examine how the legal protection of this behavior
conflicts with the rights and welfare of women. . .
- Abstract: Healthcare professionals often face
complex ethical dilemmas in the workplace. Some professionals confront
the ethical issues directly while others turn away. Moral courage helps
individuals to address ethical issues and take action when doing the
right thing is not easy. In this article the author defines moral
courage, describes ongoing discussions related to moral courage,
explains how to recognize moral courage, and offers strategies for
developing and demonstrating moral courage when faced
with ethical challenges.
- Abstract: This issue's "Legal Briefing" column covers legal
developments pertaining to conscience clauses and conscientious refusal.
Not only has this topic been the subject of recent articles in this journal,
but it has also been the subject of numerous public and professional
discussions. Over the past several months, conscientious refusal disputes
have had an unusually high profile not only in courthouses, but also in
legislative and regulatory halls across the United States. Healthcare
providers' own moral beliefs have been obstructing and are expected to
increasingly obstruct patients' access to medical services. For example,
some providers, on ethical or moral grounds, have denied: (1) sterilization
procedures to pregnant patients, (2) pain medications in end-of-life
situations, and (3) information about emergency contraception to rape
victims. On the other hand, many healthcare providers have been forced to
provide medical treatment that is inconsistent with their moral beliefs. There are two fundamental types of conscientious objection laws. First,
there are laws that permit healthcare workers to refuse providing - on
ethical, moral, or religious grounds healthcare services that they might
otherwise have a legal or employer-mandated obligation to provide.
Second, there are laws directed at forcing healthcare workers to provide
services to which they might have ethical, moral, or religious objections.
Both types of laws are rarely comprehensive, but instead target: (1)
certain types of healthcare providers, (2) specific categories of healthcare
services, (3) specific patient circumstances, and (4) certain conditions
under which a right or obligation is triggered. For the sake of clarity, I
have grouped recent legal developments concerning conscientious refusal into
eight categories:
1. Abortion: right to refuse
2. Abortion: duty to provide
3.
Contraception: right to refuse
4. Contraception: duty to provide
5.
Sterilization: right to refuse
6. Fertility, HIV, vaccines, counseling
7. End-of-life measures: right to refuse
8. Comprehensive laws: right to
refuse.
- Abstract: Their nursing experience and/or training
may lead students preparing for the nursing profession to have less moral distress and more
favorable attitudes towards a hastened death compared with those preparing
for other fields of study. To ascertain if this was true, 66
undergraduates (54 women, 9 men, 3 not stated) in southeastern USA
completed measures of moral distress and attitudes towards hastening death.
Unexpectedly, the results from nursing and non-nursing majors were not
significantly different. All the present students reported moderate moral
distress and strong resistance to any efforts to hasten death but these
factors were not significantly correlated. However, in the small sample of
nurses in training, the results suggest that hastened death situations
may not be a prime reason for moral distress.
- Abstract: This research was conducted to examine
experiences of nursing students in administering medication in the clinical
setting. Grounded theory was utilized, involving in-depth interviews with 28
final-year students. In this article, we examine the importance participants
attached to conforming to the prevailing culture, and their responses when
offered what they considered inadequate supervision. Three main categories
emerged: norming for the survival of self, conforming and adapting for
benefit of self and others; and performing with absolute conscience.
Subsequently, the model of contingent reasoning was developed to explain the
actions of students. Contingent reasoning was influenced by the relationship
with the registered nurse and individual characteristics of the students.
Contingent reasoning was validated by participants and is discussed in
relation to Kohlberg's theory of moral reasoning and other relevant nursing
literature. This model has the potential to enhance understanding of how
students make decisions, and ultimately to positively influence this
process.
Slovinska S.
Comparative
legal analysis of conscientious objections in health care. LL.M.
Short Thesis. Course: Patient's Rights in the Twenty First Century.
Professor: Judit Marcella Sándor. Central European University,
Budapest, Hungary. 29 March, 2010
- The purpose of this thesis is
to demonstrate what would be an appropriate model of the regulation of
conscientious objections in health care. These objections are regulated in many
countries' national legislations, however, some of them fail to provide
safeguards which would secure proper balance between the two conflicting
interests - the health care professional's right to act in accordance with his
conscience and individual's right to access health care.
Therefore, this thesis analyzes regulation of the conscientious objection in the
legal systems of the USA, the UK and the Slovak Republic with respect to the
appropriateness of such regulation and major differences which they include. The
thesis suggests that the protection of conscientious objection in the USA can go
too far and be too excessive, while the UK presents much more appropriate model
of regulation of conscientious objection with certain limitations. Furthermore,
it submits that regulation of conscientious objection in Slovakia consists in
general but vague clause creating the possibilities for future controversies.
The thesis also analyses different opinions on the acceptability of
conscientious objection in health care and finally, it suggests conditions and
limitations of conscientious objection that should be met in the regulation of
national legislations in order to find appropriate balance between the competing
interests of health care professionals and patient.
Sutton EJ, Upshur RE.
Are there different spheres of conscience?
J Eval Clin
Pract. 2010 Apr;16(2): 338-43. PubMed PMID: 20367861.
- Abstract: Interest in understanding the meaning of
conscience and conscientious objection in medicine has recently emerged in
the academic literature. We would like to contribute to this debate in
four ways: (1) to underscore and challenge the existing hierarchy of
conscientious objection in health care; (2) to highlight the importance
of considering the lay public when discussing the role of conscientious
objection in medicine; (3) to critique the numerous proposals put forth
in favour of implementing review boards to assess whether appeals to
conscience are justifiable, reasonable and sincere; and (4) to introduce the
Universal Declaration of Human Rights and the Siracusa Principles into
the dialogue around conscience and suggest that perhaps conscientious
objection is a human right.
Tettelbach CA.
Practice against our beliefs. J Christ Nurs. 2010
Apr-Jun;27(2):106-9. PubMed PMID: 20364524.
- Hans's descent started gradually. Shortly after joining the Army, his
superior gave him the task of registering a group of people."For their
protection,"the sergeant told him. A few months later, the sergeant ordered
him to gather the people together and deliver them to a certain walled-in
section of the city."For their protection," he said again. Later, Hans was
part of a detail that escorted those people to waiting trains. They were
traveling to another city for work. Rumors of extermination surfaced, and
people described Jews as "vermin." By the time Hans was transferred a
concentration camp, he was hardened to the fate of the Jews. As Hans
descended into his killer role, the people in authority rewarded him for
obedience and threatened to shoot him if he protested. The soldiers who got
promoted were the most brutal and ruthless in carrying out orders. . .
von Cranach M.
Ethics in psychiatry: the lessons we learn from Nazi
psychiatry. Eur Arch Psychiatry Clin Neurosci. 2010 Nov;260 Suppl
2:S152-6. Epub
2010 Oct 20. Review. PubMed PMID: 20960004.
- Abstract: Under the Euthanasia Program of Nazi Germany, more than 200,000
psychiatric patients were killed by doctors in psychiatric institutions.
After summarising the historical facts and the slow and still going-on
process of illuminating and understanding what happened, some ethical
consequences are drawn. What can we learn from history? The following
aspects are addressed: the special situation of psychiatry in times of war,
bioethics and biopolitics, the responsibility of the psychiatrist for the
individual patient, the effects of hierarchy on personal conscience and
responsibility, the unethical "curableuncurable" distinction and the
atrocious concept that persons differ in their value.
- Bertha Alvarez Manninen's (2010) exploration of how a bodily integrity
argument might defend the abortion right even if the Supreme Court
assigned fetuses to the category of persons for purposes of
constitutional law has many strengths. As a bioethicist and a legal
scholar, I share both her desire to bridge philosophical and legal
conversations and her conclusion that the abortion right should be
preserved. In this brief commentary, I offer alternate responses to the
two factors driving her project (legislative challenges to Roe and
perceptions of the pro-choice position as "callous") and raise two
unanswered questions in her bodily integrity argument.
- Just as physicians can object to providing services due to their ethical
and/or religious beliefs, medical students can have conscience-based
objections to participating in educational activities. In 1996, the Medical
Student Section of the American Medical Association (AMA) introduced a
resolution calling on the AMA to adopt a policy in support of exemptions for
students with ethical or religious objections. In that report,
students identified abortion, sterilization, and procedures performed on
animals as examples of activities that might prompt requests for
conscience-based exemptions (CBEs). In response to the student initiative,
the Council on Medical Education recommended the adoption of seven
"principles to guide exemption of medical students from activities based on
conscience." The House of Delegates adopted these principles in their
entirety.