Bioethics : A Nursing Perspective

by Johnstone, Megan-Jane

• ISBN13: 9780729534031
• ISBN10: 0729534030
• Format: Paperback
• Copyright: 1999-09-01
• Publisher: Elsevier Science Health Science div
• More Book Details
• Purchase Benefits

Summary

This classic work has been instrumental in establishing nursing ethics as a legitimate and discrete field of inquiry and practice. Providing the framework for this 3rd edition is a new and comprehensive definition of nursing ethics. This long awaited third edition reflects the changes in attitude that have taken place not merely by the addition of new material but by the revision of large portions of the discussions advanced in the previous two editions. Bioethics: A Nursing Perspective 3e provides nurses with a text that covers the history and nature of mainstream bioethics and its relationship to nursing. It also stimulates critical thinking on bioethical issues as these relate to the real world of the practising nurse. The accessible writing style and the use of case exemplars brings to life ethical issues and challenges that nurses will face in their careers.

Author Biography

Megan-Jane Johnstone is currently Professor of Nursing at RMIT University, Melbourne Australia.

Table of Contents

Preface	xiii
Acknowledgments	xv
The changing moral world and its implications for the nursing profession	1	(8)
Introduction	1	(1)
The demise of traditional moral certainty	2	(1)
The rise and manifestation of moral fanaticism	2	(2)
The lessons of moral fanaticism	4	(1)
In search of solutions	4	(1)
Toward a pluralistic vision of human life	5	(1)
Moral controversies and the responsibilities of the nursing profession	6	(1)
Conclusion	7	(2)
`Be good women but do not bother with a Code of Ethics'	9	(30)
Introduction	9	(1)
The marginalisation of nursing ethics	10	(27)
Influences of the medical profession	10	(3)
The media	13	(5)
Interdisciplinary ethics seminars and conferences	18	(1)
The courts	19	(3)
A National Commission of Inquiry	22	(6)
The Nazi era	28	(3)
The Encyclopedia of bioethics	31	(6)
Conclusion	37	(2)
Ethics, bioethics and nursing ethics: some working definitions	39	(26)
Introduction	39	(1)
Understanding moral language	40	(1)
The need for a common moral language	40	(1)
What is ethics?	41	(2)
What is bioethics?	43	(2)
What is nursing ethics?	45	(3)
What ethics is not	48	(13)
Legal law	48	(3)
Codes of ethics	51	(4)
Hospital or professional etiquette	55	(2)
Hospital or institutional policy	57	(1)
Public opinion or the view of the majority	58	(2)
Following the orders of a superior	60	(1)
The task of ethics, bioethics and nursing ethics	61	(3)
Conclusion	64	(1)
Theoretical perspectives informing ethical conduct	65	(44)
Introduction	65	(1)
Moral theory and its relationship to ethical practice	65	(1)
Traditional and non-traditional theoretical perspectives	66	(3)
Modernist ethics	67	(1)
Postmodernist ethics	68	(1)
Moral theory and justification	69	(4)
Moral rules, principles and theories	71	(1)
Lived experience and individuated personal judgments	72	(1)
Theory and experience	72	(1)
The justification of justification	72	(1)
An overview of key traditional ethical theories	73	(29)
Deontological theories of ethics	73	(1)
Theological ethics	73	(2)
Rationalism	75	(1)
Emotivism	76	(2)
Intuitionism	78	(2)
Social contract theory	80	(1)
Applying deontological theory	81	(1)
Teleological theories of ethics	82	(1)
Moral duties	83	(1)
Moral obligations	83	(1)
Classical utilitarianism	84	(1)
Recent utilitarian theory	85	(1)
Applying utilitarian theory	86	(1)
Moral principles and moral rules	87	(1)
Ethical principlism	87	(1)
Autonomy	88	(1)
Non-maleficence	89	(1)
Beneficence	90	(2)
Justice	92	(1)
Justice as fairness	92	(2)
Justice as an equal distribution of benefits and burdens	94	(1)
Moral rules	95	(1)
Moral rights theory	96	(1)
Rights	96	(1)
Based on natural law and divine command	97	(1)
Based on common humanity	97	(1)
Based on rationality	97	(1)
Based on interests	98	(1)
Different types of rights	99	(1)
Inalienable rights	99	(1)
Absolute rights	99	(1)
Prima-facie rights	99	(1)
Making rights claims	100	(1)
Correlative moral duties	100	(1)
Problems with rights claims	101	(1)
Revitalisation of other traditional perspectives on ethics	102	(6)
Virtue ethics	102	(2)
The notion of virtue	104	(1)
The virtuous person	104	(1)
Virtue ethics: alternative to or component part of traditional theories?	105	(1)
Casuistry ethics	106	(2)
Conclusion	108	(1)
A feminist perspective on ethics and bioethics	109	(32)
Introduction	109	(1)
A feminist approach to ethics	110	(1)
Gender distortions in moral philosophy	111	(1)
The contributions of women to philosphy	111	(2)
The task of feminist ethics	113	(1)
The alleged difference between male and female thinking	114	(5)
The abstract versus the real	119	(7)
Male alternatives to modernist perspectives	126	(5)
The rationality thesis and the role of emotion in moral decision-making	131	(2)
Mainstream bioethics and feminist bioethics	133	(1)
Parallels between feminist ethics and nursing ethics	133	(1)
Virtue theory, an ethic of care, and nursing ethics	134	(4)
Conclusion	138	(3)
A transcultural perspective on ethics and bioethics	141	(20)
Introduction	141	(1)
Culture and its relationship to ethics	142	(2)
The nature and implications of a transcultural approach to ethics	144	(7)
Moral diversity and the challenge of moral pluralism	151	(1)
Problems associated with a transcultural approach to ethics in health care	152	(7)
Transcultural ethics and the case of female genital mutilation	156	(3)
Conclusion	159	(2)
Moral problems and moral decision-making in nursing	161	(38)
Introduction	161	(1)
Distinguishing moral problems from other sorts of problems	161	(2)
Identifying moral problems in nursing	163	(20)
Moral unpreparedness	163	(3)
Moral blindness	166	(3)
Moral indifference	169	(2)
Amoralism	171	(1)
Immoralism	172	(1)
Moral complacency	173	(1)
Moral fanaticism	174	(1)
Moral disagreements and controversies	174	(1)
Internal moral disagreement	175	(1)
Radical moral disagreement	176	(1)
Moral dilemmas	177	(5)
Moral stress, moral distress and moral perplexity	182	(1)
Moral decision-making---a systematic approach	183	(7)
A moral decision-making model	184	(1)
Assessing the situation	184	(3)
Diagnosing or identifying the moral problem(s)	187	(1)
Setting moral goals and planning an appropriate moral course of action	188	(1)
Implementing the plan of moral action	189	(1)
Evaluating the moral outcomes of the action implemented	189	(1)
Moral decision-making---an experiential approach	190	(4)
A calculus of experience as a guide to moral conduct	190	(4)
Should nurses study moral decision-making?	194	(2)
Conclusion	196	(3)
Patients' rights to and in health care	199	(50)
Introduction	199	(1)
The issue of patients' rights	200	(2)
What are patients' rights?	202	(44)
The right to health care	203	(1)
The right to equal access to health care	204	(3)
The right to have access to appropriate care	207	(1)
The right to quality of care	208	(1)
Challenges posed by the right to health care	208	(1)
The right to make informed decisions	209	(1)
What is informed consent?	210	(7)
Informed consent and the soverignty of the individual	217	(1)
Informed consent and ethical principlism	218	(1)
The elements of an informed and valid consent	218	(7)
The problem of rational competency	225	(6)
Paternalism and informed consent	231	(2)
Is paternalism justified?	233	(1)
Pro-paternalism (always justified)	233	(1)
Anti-paternalism (never justified)	234	(1)
Prima-facie paternalism (sometimes justified)	234	(1)
Applying the `Paternalistic Principle' in health care	234	(1)
Informed consent and nurses	235	(1)
The right to confidentiality	236	(2)
Confidentiality as a prima-facie principle	238	(2)
The right to dignity and dying with dignity	240	(1)
Can dignity be defined?	241	(2)
Implications for nurses	243	(1)
The right to be treated with respect	243	(3)
Conclusion	246	(3)
Human rights and the mentally ill	249	(10)
Introduction	249	(1)
Discrimination against the mentally ill	249	(1)
The moral responsibilities of nurses in mental health care	250	(1)
A human rights approach to and in mental health care domains	251	(4)
Problems associated with a human rights approach to mental health care ethics	255	(1)
Practical ethics in mental health	256	(1)
Future directions in mental health care ethics	257	(1)
Conclusion	258	(1)
Ethical issues associated with the reporting of child abuse	259	(22)
Introduction	259	(2)
The development of the child protection movement in North America: a brief historical overview	261	(1)
The Mary Ellen case	262	(1)
Development of the child protection movement in England and Australia	262	(2)
What makes child abuse a bona fide and significant moral issue?	264	(2)
The problem of ambivalence toward the moral entitlements of children	266	(2)
The case of Daniel Valerio	266	(1)
Is the `failure of the system' to blame?	267	(1)
The ethical implications of child abuse	268	(3)
The moral demand to report child abuse	268	(1)
The notion of harm and its link with the moral duty to prevent child abuse	269	(1)
Protecting the interests of children as children and as prospective adults	269	(2)
Considerations against the mandatory and voluntary notification of child abuse	271	(2)
The professional-client relationship	271	(1)
Parents and families	272	(1)
Abused and neglected children	272	(1)
Responding to the criticisms	273	(3)
The problem of maintaining confidentiality	273	(2)
The problem of statutory surveillance	275	(1)
Preserving the integrity of the professional-client relationship	275	(1)
Upholding the interests of parents, families and abused children	276	(1)
The importance of a supportive socio-cultural environment in child abuse prevention	276	(3)
Conclusion	279	(2)
Abortion and the nursing profession	281	(24)
Introduction	281	(1)
Nurses' experiences of abortion work: a brief historical overview	282	(7)
What is abortion?	289	(1)
Is abortion morally permissible?	289	(4)
The conservative position	290	(1)
The moderate position	291	(1)
The liberal position	292	(1)
Abortion and the moral rights of women, fetuses and fathers	293	(6)
Abortion, politics and the broader community	299	(3)
Conclusion	302	(3)
Euthanasia and assisted suicide	305	(32)
Introduction	305	(2)
Euthanasia and its significance for nurses	307	(4)
Public opinion on the euthanasia/assisted suicide issue	311	(1)
Definitions of euthanasia, assisted suicide and `mercy killing'	312	(4)
Euthanasia	312	(3)
Assisted suicide	315	(1)
`Mercy killing'	315	(1)
Views for and against euthanasia/assisted suicide	316	(8)
Views in support of euthanasia	316	(2)
Counter-arguments to views supporting euthanasia	318	(2)
Specific arguments against euthanasia	320	(1)
Arguments from the sanctity-of-life doctrine	320	(1)
Arguments from misdiagnosis and possible recovery	321	(1)
Argument from the risk of abuse	321	(1)
Arguments from non-necessity	321	(1)
Arguments from discrimination	321	(1)
Arguments from irrational, mistaken or imprudent choice	322	(1)
`Slippery slope' argument	322	(2)
The killing/letting die distinction	324	(9)
Intentional killing versus alleviating pain	326	(1)
Analgesia without death	326	(1)
Analgesia with unintentional death	327	(1)
Analgesia with intentional death	327	(1)
The doctrine of double effect	328	(1)
Implications for nurses of narcotic administration	329	(1)
`Nursing care only' directives	330	(1)
The Dr Leonard Arthur case	330	(2)
The Danville case	332	(1)
Position statements on euthanasia/assisted suicide and the nursing profession	333	(2)
Conclusion	335	(2)
Suicide and parasuicide	337	(26)
Introduction	337	(2)
Socio-cultural attitudes to suicide: a brief historical overview	339	(9)
Socio-cultural acceptance of suicide, 600 BC - 4 AD	340	(4)
Attitudes of religious prohibition against suicide	344	(2)
The criminalisation of suicide	346	(1)
The medicalisation of suicide	347	(1)
Defining suicide	348	(6)
Suicide: some moral considerations	354	(5)
Autonomy and the right to suicide	354	(5)
Suicide prevention: some further considerations	359	(1)
Conclusion	359	(4)
Quality of life, `Not For Treatment' and `Not For Resuscitation' directives	363	(30)
Introduction	363	(1)
Quality of life	363	(5)
Defining quality of life	364	(4)
Not For Treatment (NFT) directives	368	(3)
The problem of treatment in `medically hopeless' cases	368	(2)
Who decides?	370	(1)
Nor For Resuscitation (NFR) directives	371	(19)
Mr H	372	(2)
Mr X	374	(1)
Raising the issues	375	(2)
Problems concerning NFR decision-making criteria, guidelines and procedures	377	(1)
Criteria and guidelines used	377	(1)
The exclusion of patients from decision-making	378	(1)
Misinterpretation of directives and questionable outcomes	379	(1)
`Go slow' codes	380	(1)
Problems concerning the documentation and communication of NFR directives	381	(4)
Problems concerning the implementation of NFR directives	385	(1)
Improving NFR practices	386	(4)
Conclusion	390	(3)
Taking a stand: conscientious objection, strike action and institutional ethics committees	393	(36)
Introduction	393	(1)
Conscientious objection	394	(13)
The nature of conscience explained	395	(1)
Conscience as moral reasoning	395	(1)
Conscience as moral feelings	395	(1)
Conscience as moral reason and moral feelings	396	(1)
How conscience works	396	(1)
Bogus and genuine claims of conscientious objection	397	(1)
Conscientious objection to the lawful but morally controversial directives of a superior	398	(3)
Conscientious objection and the problem of conflict in personal values between nurse and patient	401	(1)
Conscientious objection, the fear of contagion, and homophobia	402	(4)
Conscientious objection and the problem of unsafe work conditions	406	(1)
Conscientious objection and policy considerations	406	(1)
Strike action	407	(9)
Central issues of strike action	408	(1)
Events of the 1986 Victorian state nurses' strike	409	(3)
Philosophical and ethical questions about nurses' strikes	412	(3)
Strike action---some further considerations	415	(1)
Institutional ethics committees	416	(12)
What is an institutional ethics committee?	417	(1)
Factors influencing the rise of institutional ethics committees	418	(1)
The role and function of institutional ethics committees	419	(1)
The authority and power of institutional ethics committees	420	(1)
Composition of institutional ethics committees	421	(2)
Moral decision-making by institutional ethics committees	423	(1)
Access to institutional ethics committees	424	(1)
Can institutional ethics committees help?	425	(1)
Implications of institutional ethics committees for the nursing profession	426	(2)
Institutional ethics committees---some further considerations	428	(1)
Conclusion	428	(1)
Promoting ethical nursing practice	429	(14)
Introduction	429	(1)
Formulating and enacting meaningful standards of ethical nursing conduct	430	(2)
Nursing ethics education	432	(4)
Contents	432	(1)
Location	433	(1)
Duration	434	(1)
Remedial ethics education	435	(1)
Who should teach nursing ethics?	435	(1)
Ethical nursing management and improving the moral culture of the organisations in which nurses work	436	(2)
Nursing ethics research and scholarship	438	(1)
Political action	438	(2)
Conclusion	440	(3)
Appendixes	443	(44)
I Code for Nurses (International Council of Nurses)	443	(1)
II Consumer health rights	444	(2)
III ANCI Code of Ethics for Nurses in Australia (Australian Nursing Council)	446	(4)
IV Patients' Bill of Rights (Australian Nursing Federation, Western Australia)	450	(3)
V Patients' Bill of Rights (Australian Nursing Federation, Victoria)	453	(3)
VI Nursing care of the person who is dying (Australian Nursing Federation)	456	(2)
VII Code of Ethics (New Zealand Nurses Organisation)	458	(11)
VIII Code of Professional Conduct (United Kingdom Central Council for Nursing, Midwifery and Health Visiting)	469	(2)
IX American Nurses' Association Code for Nurses	471	(2)
X Code of Ethics for Nursing (Canadian Nurses' Association)	473	(8)
XI Position statement---ethics in nursing practice (Royal College of Nursing, Australia)	481	(2)
XII Position statement---conscientious objection (Royal College of Nursing, Australia)	483	(4)
References	487	(50)
Index	537