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Book Details
Abstract
An essential resource for both undergraduate and postgraduate students and registered nurses to develop new insights and moral wisdom around ethical issues they will face in clinical practice.
Bioethics: A Nursing Perspective, 6th Edition continues to set the standard for bioethical issues in nursing practice. As with previous editions, this highly respected text provides a comprehensive framework to assist students and registered nurses to understand the ethical challenges, obligations and responsibilities they will encounter in daily practice.
- Greater depth on ethical issues, particularly those concerned with ethical conduct, unprofessional conduct and professional misconduct and ‘morality politics’
- Case scenarios and critical questions to encourage students and registered nurses to reflect on key issues that relate to their own practice
- NEW chapters: - Ethics, dehumanisation and vulnerable populations - Professional obligations to report harmful behaviours with a focus on impaired practitioners, child abuse and elder abuse
- Introduces a new concept: ‘cultural humility’
- Content on ‘needs versus wants’, ‘the right not to be informed’, palliative sedation, preventing ethical conflicts, the relationship between professional judgment and moral decision-making in nursing and health care contexts, and future ethical difficulties concerned with climate change, peak oil, pandemic influenza, antimicrobial resistance and health inequalities
- All chapters and references have been updated to reflect contemporary nursing practice, locally and globally
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Half title page | i | ||
| Dedication | ii | ||
| Bioethics | iii | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface | xiii | ||
| Acknowledgments | xv | ||
| Permissions acknowledgments | xv | ||
| List of reviewers | xvi | ||
| List of abbreviations | xvii | ||
| 1 Professional standards and the requirement to be ethical | 1 | ||
| Keywords | 1 | ||
| Learning Objectives | 1 | ||
| Introduction | 1 | ||
| The requirement to uphold exemplary standards of conduct | 2 | ||
| Unprofessional conduct and professional misconduct | 4 | ||
| Ethical professional conduct | 4 | ||
| Unprofessional conduct | 4 | ||
| Professional misconduct | 5 | ||
| Unethical professional conduct | 5 | ||
| Questioning the requirement to be morally exemplary | 5 | ||
| Nursing as a moral project | 6 | ||
| Conclusion | 6 | ||
| 2 Ethics, bioethics and nursing ethics: | 9 | ||
| Keywords | 9 | ||
| Learning Objectives | 9 | ||
| Introduction | 9 | ||
| The importance of understanding ethics terms and concepts | 10 | ||
| The need for a critical inquiry into ethical professional practice | 11 | ||
| Understanding moral language | 11 | ||
| What is ethics? | 12 | ||
| What is bioethics? | 13 | ||
| What is nursing ethics? | 15 | ||
| What ethics is not | 16 | ||
| Law | 17 | ||
| Codes of ethics | 20 | ||
| Hospital or professional etiquette | 23 | ||
| Hospital or institutional policy | 24 | ||
| Public opinion or the view of the majority | 24 | ||
| Ideology | 27 | ||
| Following the orders of a supervisor or manager | 28 | ||
| The task of ethics, bioethics and nursing ethics | 29 | ||
| Conclusion | 31 | ||
| Endnotes | 32 | ||
| 3 Moral theory and the ethical practice of nursing | 33 | ||
| Keywords | 33 | ||
| Learning Objectives | 33 | ||
| Introduction | 33 | ||
| Moral justification | 34 | ||
| Theoretical perspectives informing ethical practice | 36 | ||
| Ethical principlism | 36 | ||
| What are ethical principles? | 36 | ||
| Autonomy | 37 | ||
| Non-maleficence | 38 | ||
| Beneficence | 39 | ||
| Justice | 40 | ||
| Justice as fairness and impartiality (equity) | 41 | ||
| Justice as an equal distribution of benefits and burdens | 42 | ||
| Justice as reconciliation and reparation | 43 | ||
| Moral rules | 44 | ||
| Problems with ethical principles | 45 | ||
| Moral rights theory | 46 | ||
| Moral rights | 46 | ||
| Moral rights based on natural law and divine command | 46 | ||
| Moral rights based on common humanity | 47 | ||
| Moral rights based on rationality | 47 | ||
| Moral rights based on interests | 47 | ||
| Moral rights based on human experiences of grievous wrongs | 48 | ||
| Different types of rights | 49 | ||
| Inalienable rights | 49 | ||
| Absolute rights | 49 | ||
| Prima-facie rights | 50 | ||
| Making rights claims | 50 | ||
| Rights and responsibilities | 50 | ||
| Problems with rights claims | 51 | ||
| Virtue ethics | 53 | ||
| The notion of virtue | 54 | ||
| The virtuous person | 54 | ||
| Virtue theory, an ethic of care and nursing ethics | 55 | ||
| Virtue ethics and an ethic of care in nursing – some further thoughts | 57 | ||
| Problems with virtue ethics | 58 | ||
| Deontology and teleology | 59 | ||
| Deontology | 59 | ||
| Teleology | 60 | ||
| Moral duties and obligations | 61 | ||
| Moral duties | 61 | ||
| Moral obligations | 62 | ||
| Clarifying the difference between rights and duties | 62 | ||
| Limitations and weaknesses of ethical theory | 63 | ||
| Moral justification and moral theory – some further thoughts | 64 | ||
| Conclusion | 65 | ||
| Endnotes | 66 | ||
| 4 Cross-cultural ethics and the ethical practice of nursing | 67 | ||
| Keywords | 67 | ||
| Learning Objectives | 67 | ||
| Introduction | 67 | ||
| Cross-cultural ethics and nursing | 68 | ||
| Culture and its relationship to ethics | 69 | ||
| The nature and implications of a cross-cultural approach to ethics | 71 | ||
| Moral diversity and the challenge of moral pluralism | 77 | ||
| Dealing with problems associated with a cross-cultural approach to ethics in health care | 79 | ||
| Ethics, cultural competency, cultural safety and cultural humility | 82 | ||
| Cultural competency | 83 | ||
| Cultural safety | 84 | ||
| Cultural humility | 85 | ||
| Conclusion | 86 | ||
| Endnote | 88 | ||
| 5 Moral problems and moral decision-making in nursing and health care contexts | 89 | ||
| Keywords | 89 | ||
| Learning Objectives | 89 | ||
| Introduction | 89 | ||
| Distinguishing moral problems from other sorts of problems | 90 | ||
| Identifying different kinds of moral problems | 91 | ||
| Moral unpreparedness / moral incompetence | 92 | ||
| Moral blindness | 94 | ||
| Moral indifference and insensitivity | 96 | ||
| Amoralism | 98 | ||
| Immoralism | 98 | ||
| Moral complacency | 99 | ||
| Moral fanaticism | 99 | ||
| Moral disagreements and conflicts | 100 | ||
| Internal moral disagreement | 100 | ||
| Radical moral disagreement | 101 | ||
| Moral dilemmas | 103 | ||
| ‘Moral distress’ | 107 | ||
| Making moral decisions | 108 | ||
| Moral decision-making – a working definition | 108 | ||
| Processes for making moral decisions | 109 | ||
| Reason and moral decision-making | 110 | ||
| Emotion and moral decision-making | 111 | ||
| Intuition and moral decision-making | 114 | ||
| Life experience and moral decision-making | 116 | ||
| Reason, emotion, intuition and life experience – some further thoughts | 117 | ||
| Dealing with moral disagreements and disputes | 117 | ||
| Being accepting of different points of view | 117 | ||
| Everyday moral problems in nursing | 120 | ||
| Conclusion | 121 | ||
| Endnotes | 122 | ||
| 6 Ethics, dehumanisation and vulnerable populations | 123 | ||
| Keywords | 123 | ||
| Learning Objectives | 123 | ||
| Introduction | 123 | ||
| Vulnerability | 124 | ||
| Identifying vulnerable populations | 124 | ||
| Vulnerability as a guide to action | 125 | ||
| Vulnerability and nursing ethics | 125 | ||
| Humanness, dehumanisation and vulnerability | 126 | ||
| Humanness | 126 | ||
| Dehumanisation | 127 | ||
| Forms of dehumanisation | 127 | ||
| Explicit and subtle expressions of dehumanisation | 128 | ||
| Why dehumanisation occurs | 129 | ||
| Consequences of dehumanisation | 130 | ||
| Deterring dehumanisation | 131 | ||
| Addressing the root causes of dehumanisation | 131 | ||
| Fostering moral inclusion | 132 | ||
| Detecting and exposing instances of dehumanisation and moral exclusion | 132 | ||
| Energising dissent | 133 | ||
| Stigma | 134 | ||
| Prejudice and discrimination | 135 | ||
| Disadvantage | 135 | ||
| Identifying vulnerable individuals and groups | 136 | ||
| Older people | 136 | ||
| People with mental health disorders | 139 | ||
| Immigrants and ethnic minorities | 141 | ||
| Refugees, asylum seekers, displaced people and stateless people | 144 | ||
| People with disabilities | 146 | ||
| Indigenous peoples | 148 | ||
| Health status of Australia’s Indigenous peoples | 149 | ||
| Heath status of New Zealand Māori | 150 | ||
| Global call to redress Indigenous health disparities | 150 | ||
| Prisoners and detainees | 151 | ||
| Homeless people | 154 | ||
| What is homelessness? | 155 | ||
| Causes of homelessness | 156 | ||
| Homelessness and the right to health | 156 | ||
| Sexual minorities (LGBTI people) | 157 | ||
| Conclusion | 160 | ||
| Endnotes | 161 | ||
| 7 Patients’ rights to and in health care | 163 | ||
| Keywords | 163 | ||
| Learning Objectives | 163 | ||
| Introduction | 164 | ||
| What are patients’ rights? | 165 | ||
| The right to health and health care | 166 | ||
| The right to equal access to health care | 168 | ||
| The right to have access to appropriate care | 169 | ||
| The right to quality care | 169 | ||
| The right to safe care | 170 | ||
| Challenges posed by the right to health and health care | 170 | ||
| The right to make informed decisions | 171 | ||
| What is informed consent? | 171 | ||
| The analytic components and elements of an informed consent | 173 | ||
| Informed consent and ethical principlism | 173 | ||
| The right not to know | 174 | ||
| Informed consent and the sovereignty of the individual | 175 | ||
| Paternalism and informed consent | 176 | ||
| Is paternalism justified? | 178 | ||
| Pro-paternalism (always justified) | 178 | ||
| Anti-paternalism (never justified) | 178 | ||
| Prima-facie paternalism (sometimes justified) | 178 | ||
| Applying the ‘paternalistic principle’ in health care | 179 | ||
| Informed consent and nursing care | 180 | ||
| The right to confidentiality | 180 | ||
| Confidentiality as an absolute principle | 181 | ||
| Confidentiality as a prima-facie principle | 183 | ||
| The right to be treated with dignity | 185 | ||
| What is dignity? | 185 | ||
| Dignity and the right to dignity | 187 | ||
| Dignity violations | 187 | ||
| The right to be treated with respect | 188 | ||
| The right to cultural liberty | 190 | ||
| Conclusion | 191 | ||
| Endnote | 192 | ||
| 8 Ethical issues in mental health care | 193 | ||
| Keywords | 193 | ||
| Learning Objectives | 193 | ||
| Introduction | 194 | ||
| Vulnerability, human rights and the mentally ill | 195 | ||
| Competency to decide | 197 | ||
| Psychiatric advance directives | 205 | ||
| Striking a balance between promoting autonomy and preventing harm | 205 | ||
| Origin, rationale and purpose of psychiatric advance directives | 206 | ||
| Forms and function of psychiatric advance directives | 206 | ||
| Risk and benefits of psychiatric advance directives | 207 | ||
| Anticipated risks of psychiatric advance directives | 208 | ||
| Current trends in the legal regulation of psychiatric advance directives | 209 | ||
| Ethical issues in suicide and parasuicide | 210 | ||
| Scope of the problem | 210 | ||
| Cybersuicide | 211 | ||
| The moral challenge of suicide | 211 | ||
| Defining suicide | 213 | ||
| Distinguishing suicide from euthanasia | 217 | ||
| Ethical dimensions of suicide | 217 | ||
| Autonomy and the right to suicide | 217 | ||
| The ethics of suicide prevention: some further considerations | 221 | ||
| Conclusion | 223 | ||
| Endnote | 224 | ||
| 9 Ethical issues in end-of-life care | 225 | ||
| Keywords | 225 | ||
| Learning Objectives | 225 | ||
| Introduction | 226 | ||
| Not For Treatment (NFT) directives | 227 | ||
| The problem of treatment in ‘medically hopeless’ cases | 227 | ||
| Who decides? | 228 | ||
| Not For Resuscitation (NFR) / Do Not Resuscitate (DNR) directives | 229 | ||
| Raising the issues | 230 | ||
| Problems concerning NFR / DNR decision-making criteria, guidelines and procedures | 231 | ||
| Criteria and guidelines used | 231 | ||
| The exclusion of patients from decision-making | 232 | ||
| Misinterpretation of directives | 233 | ||
| Problems concerning the documentation and communication of NFR / DNR directives | 233 | ||
| Problems concerning the implementation of NFR / DNR directives | 234 | ||
| Improving NFR / DNR practices | 235 | ||
| Medical futility | 236 | ||
| Quality of life | 238 | ||
| Origin of the phrase | 238 | ||
| Defining quality of life | 239 | ||
| Why defining quality of life is difficult | 239 | ||
| Different conceptions of quality of life | 239 | ||
| Using quality-of-life considerations to inform treatment choices | 241 | ||
| Three senses of quality of life | 241 | ||
| Descriptive sense of quality of life | 241 | ||
| Evaluative sense of quality of life | 242 | ||
| Prescriptive sense of quality of life | 242 | ||
| Advance directives | 244 | ||
| What is an advance directive? | 244 | ||
| How do advance directives work? | 245 | ||
| Risks and benefits of advance directives | 245 | ||
| Advance care planning | 247 | ||
| Respecting patient choices | 248 | ||
| Rethinking ‘end-of-life care’ | 249 | ||
| Conclusion | 250 | ||
| Endnotes | 253 | ||
| 10 The moral politics of abortion and euthanasia | 255 | ||
| Keywords | 255 | ||
| Learning Objectives | 255 | ||
| Introduction | 256 | ||
| Morality policy | 256 | ||
| Moral politics | 257 | ||
| Abortion | 257 | ||
| What is abortion? | 259 | ||
| Arguments for and against the moral permissibility of abortion | 260 | ||
| The conservative position | 260 | ||
| The moderate position | 260 | ||
| The liberal position | 262 | ||
| Abortion and the moral rights of women, fetuses and fathers | 263 | ||
| Abortion, politics and the broader community | 267 | ||
| Euthanasia | 269 | ||
| Euthanasia and its significance for nurses | 269 | ||
| Definitions of euthanasia, assisted suicide and ‘mercy killing’ | 270 | ||
| Euthanasia | 270 | ||
| Assisted suicide | 272 | ||
| ‘Mercy killing’ | 272 | ||
| Views for and against euthanasia / assisted suicide | 272 | ||
| Views in support of euthanasia | 273 | ||
| Arguments from individual autonomy and the right to choose | 273 | ||
| Arguments from the right to dignity | 273 | ||
| Arguments from the reduction of suffering | 273 | ||
| Arguments from justice and the demand to be treated fairly | 274 | ||
| Arguments from altruism and the ‘duty to die’ | 274 | ||
| Counter-arguments to views supporting euthanasia | 274 | ||
| Autonomy and the right to choose death | 274 | ||
| Dignity and the right to die with dignity | 275 | ||
| Suffering and the demand to end it | 276 | ||
| Justice and the demand to be treated fairly | 276 | ||
| Altruism and the ‘duty to die’ | 276 | ||
| Specific arguments against euthanasia | 277 | ||
| Arguments from the sanctity-of-life doctrine | 277 | ||
| Arguments from prognostic uncertainty and misdiagnosis | 277 | ||
| Arguments from the risk of abuse | 278 | ||
| Arguments from non-necessity | 279 | ||
| Arguments from discrimination | 279 | ||
| Arguments from irrational, mistaken or imprudent choice | 279 | ||
| ‘Slippery slope’ argument | 279 | ||
| The doctrine of double effect | 282 | ||
| Palliative sedation | 283 | ||
| Definition, purpose and intention of palliative sedation | 283 | ||
| Palliative sedation in existential suffering | 285 | ||
| Nurses’ attitudes and experiences | 285 | ||
| Withholding or withdrawing artificial nutrition and hydration | 286 | ||
| Position statements and the nursing profession | 288 | ||
| Taking a partisan stance | 288 | ||
| Taking a non-partisan (neutral) stance | 288 | ||
| The need of a systematic response | 290 | ||
| ‘The quandary of uncertainty’ – one nurse’s story | 291 | ||
| Conclusion | 292 | ||
| Endnotes | 293 | ||
| 11 Professional judgment, moral quandaries and taking ‘appropriate action’ | 295 | ||
| Keywords | 295 | ||
| Learning Objectives | 295 | ||
| Introduction | 295 | ||
| Moral conflict and professional judgment | 296 | ||
| Making ‘correct’ moral judgments | 297 | ||
| Common situations involving moral conflict | 298 | ||
| Professional judgment | 298 | ||
| The nature and moral importance of professional judgment | 299 | ||
| Conscientious objection | 300 | ||
| The nature of conscience explained | 303 | ||
| Conscience as moral reasoning | 303 | ||
| Conscience as moral feelings | 303 | ||
| Conscience as moral reason and moral feelings | 304 | ||
| How conscience works | 304 | ||
| Bogus and genuine claims of conscientious objection | 305 | ||
| Conscientious objection to the lawful but morally controversial directives of a supervisor | 306 | ||
| Conscientious objection and the problem of conflict in personal values | 307 | ||
| Conscientious objection and policy considerations | 308 | ||
| Whistleblowing in health care | 309 | ||
| The Moylan case (Australia) | 311 | ||
| The Pugmire case (New Zealand) | 312 | ||
| The Bardenilla case (US) | 312 | ||
| The MacArthur Health Service case (Australia) | 313 | ||
| The Bundaberg Base Hospital case (Australia) | 314 | ||
| The notion of whistleblowing / whistleblowers | 315 | ||
| Deciding to ‘go public’ | 315 | ||
| Risks of whistleblowing | 316 | ||
| Whistleblowing and clinical risk management | 317 | ||
| Whistleblowing as a last resort | 318 | ||
| Preventing ethics conflicts | 318 | ||
| The ethics–quality linkage | 319 | ||
| Appropriate disagreement | 319 | ||
| Conclusion | 320 | ||
| Endnotes | 321 | ||
| 12 Professional obligations to report harmful behaviours: | 323 | ||
| Keywords | 323 | ||
| Learning Objectives | 323 | ||
| Introduction | 323 | ||
| Reporting notifiable and health-impaired conduct of practitioners and students | 324 | ||
| Legal requirements to report wrongdoing | 324 | ||
| Professional requirements to report wrongdoing | 327 | ||
| ‘No blame’ culture and patient safety | 331 | ||
| Attitudes and experiences of reporting patient safety concerns | 333 | ||
| Reporting child abuse and elder abuse | 336 | ||
| Child abuse and neglect | 337 | ||
| Defining child abuse | 337 | ||
| Incidence of child abuse | 338 | ||
| Redressing child abuse | 339 | ||
| Elder abuse and neglect | 339 | ||
| Defining elder abuse | 340 | ||
| Incidence of elder abuse | 342 | ||
| Redressing elder abuse | 343 | ||
| Ethical issues associated with protecting children and elderly people from abuse | 344 | ||
| Why the maltreatment of children and elderly people constitutes a moral issue | 345 | ||
| The ethical implications of maltreating children and elderly people | 346 | ||
| The moral demand to report child and elder maltreatment | 346 | ||
| The notion of harm and its link with the moral duty to prevent child and elder abuse | 346 | ||
| Considerations against reporting the maltreatment of children and elderly people | 347 | ||
| The professional–client relationship | 347 | ||
| Families | 348 | ||
| Maltreated children and elderly people | 348 | ||
| Responding to the criticisms | 349 | ||
| The problem of maintaining confidentiality | 350 | ||
| The problem of being ‘the arm of the state’ | 351 | ||
| Preserving the integrity of the professional–client relationship | 351 | ||
| Upholding the interests of families | 352 | ||
| The importance of a supportive socio-cultural environment in abuse prevention | 352 | ||
| Conclusion | 353 | ||
| Endnotes | 354 | ||
| 13 Nursing ethics futures – challenges in the 21st century | 355 | ||
| Keywords | 355 | ||
| Learning Objectives | 355 | ||
| Introduction | 355 | ||
| Climate change | 356 | ||
| Nurses’ preparedness | 357 | ||
| Peak petroleum | 358 | ||
| Nurses’ preparedness | 359 | ||
| Public health emergencies | 359 | ||
| Pandemic influenza | 360 | ||
| Antimicrobial resistance | 361 | ||
| Nurses’ preparedness | 362 | ||
| Inequalities in health and health care | 364 | ||
| Nurses’ preparedness | 368 | ||
| Conclusion | 368 | ||
| Endnotes | 370 | ||
| Bibliography | 371 | ||
| Index | 423 | ||
| A | 423 | ||
| B | 423 | ||
| C | 424 | ||
| D | 425 | ||
| E | 425 | ||
| F | 426 | ||
| G | 427 | ||
| H | 427 | ||
| I | 427 | ||
| J | 428 | ||
| K | 428 | ||
| L | 428 | ||
| M | 428 | ||
| N | 430 | ||
| O | 430 | ||
| P | 430 | ||
| Q | 431 | ||
| R | 431 | ||
| S | 432 | ||
| T | 433 | ||
| U | 433 | ||
| V | 433 | ||
| W | 433 |