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PubMed1983

The American Nurses' Association's position statement on nursing and social policy: philosophical and ethical dimensions.

This article analyses the American Nurses' Association's position statement on nursing and social policy. Specifically, its purpose is to highlight three themes suggested within the position statement: nursing as duty, nursing as moral art and nursing as autonomous profession. Questions are raised about the nature and significance of these themes as they relate to philosophical and ethical dimensions within nursing.

American Nurses' Association↗
PubMed1991

Sociological issues in the conceptualization of mental illness.

This paper explores the conceptual knowledge base underpinning 'mental illness type behaviour' and offers a sociological and philosophical perspective. The role of values in concepts of health and illness is presented as widespread not only within psychiatry, but also in regard to general/physical health. The controversial nature of the psychiatric enterprise is believed to be due to the lack of consensus regarding notions of mental health and mental illness. Psychiatry is presented as a form of social control, akin to the legal system, dictated by moral norms. These are presented as value-loaded and maintained in accordance with the dictates of particular interest groups. Social control concepts are explored and Freud's psychodynamic model is presented as a legitimate model that incorporates a meaningful concept of 'illness'. No theory, though, is presented as value-free. Psychiatry is thus presented as being socially and politically constructed. The implication for health care professionals is presented as that of trying to liberate professional work from the narrow responsibility of the 'individual', whilst also trying to create a more democratic enterprise.

Attitude↗
PubMed1992

The drama of nursing.

This exploratory paper considers a few possibilities for conceiving nursing as a form of aesthetic praxis. More specifically, drawing on the works of Erving Goffman on dramaturgy, and Elizabeth Burns on theatre, it makes some suggestions concerning nursing as a form of dramatic performance, and briefly attempts to relate this to concepts of praxis drawn from the writings of Hannah Arendt and critical social theorists. In contrast to Goffman's dramaturgy, which stresses the artifice of social relations and suggests a cynical view of human interactions, a critical theory of dramatic praxis introduces a normative dimension in which performance may become self-realizing and emancipatory as it aspires to the status of aesthetic praxis. Conceived in such terms, nursing practice becomes a powerful form of self-expression which has the potential to become liberating for the nurse and the patient.

Art↗
PubMed1995

Offending by adults with learning disabilities and the attitudes of staff to offending behaviour: implications for service development.

The aims of this study were: (I) to identify all adults with learning disabilities living in residential homes or attending day services in the Cambridge Health District in contact with the criminal justice system during 1992; (2) to evaluate the responses of services involved; and (3) to investigate the attitudes of staff and the policies of the services to 'offending behaviour'. Details of offences committed and the response of the police, health and social services, and other agencies were obtained by direct interview with the senior staff and through examination of case records. The attitudes of staff to offending behaviour was investigated by the use of a semi-structured questionnaire. Seven (2%) out of 358 adults with learning disabilities were reported to have had contact with the police during 1992. The eight offences allegedly committed by the seven people were two acquisitive offences, two sexual offences, one assault, one wasting of police time, one offence against the Public Order Act and one traffic offence. One offender was cautioned after the Crown Prosecution Service discontinued the case because of lack of evidence, while the other alleged offenders received informal warnings. None of the seven alleged offenders were prosecuted. Three alleged offenders lived in hostel accommodation, yet hostel accommodation only accounts for 7.8% of adults with learning disabilities living in the Cambridge Health District. Because of a lack of operational policies on offending behaviour, there were no existing referral structures for people who might need specialist health service support. Referrals tended to be inconsistent, with a considerable time-lag between offence and referral. Tolerance levels towards offending behaviour were extremely high in the two hostels, 20 group homes and day centres which were included in this study. Theft and criminal damage was hardly ever reported. Thirty establishments were visited during the course of this study. Of these establishments, staff in 12 said they would always report a major assault. In only three would a sexual assault or indecent exposure always be reported if it was to occur. Staff at one residential establishment said they would hesitate to report rape and the staff in another two would consider the circumstances before reporting it to the police.

Adult↗
PubMed2006

Limit setting in mental health: historical factors and suggestions as to its rationale.

The task of enforcing behavioural limits in mental health settings is widely regarded as necessary but also potentially counter-therapeutic. There has been little discussion of the ideological basis for limit setting in psychiatry, and this paper attempts to locate the progress of this ideology from the moral treatment movement to contemporary medicalized psychiatry. It is suggested that limit setting has its foundations in the Enlightenment tradition of the autonomous individual and the power of reason, and in the dual functions of psychiatry as a therapeutic and social control system. The account draws on the work of critical psychiatry, as well as on recent research concerning the discourses and practices of mental health nurses, and concludes that these dual functions are inherent to the psychiatric project.

Behavior Control↗
PubMed2006

. . . that the social order prevails: death, ritual and the 'Roman' nurse.

In this article, the importance of ritual as a collective response to death is discussed. A case example, taken from a larger ethnographic study, is used to explore the responses and reactions of a group of Italian nurses to death as it occurs within an intensive care unit in Rome, Italy. The material presented is used to analyse the significance that cultural, religious and social beliefs and quasi-beliefs can have in nursing practice. The issues highlighted in this examination of the place of ritual in death are located and discussed within their highly specific cultural context and suggest that, where emphasis remains on nurses as a collective rather than on the individual nurse, ritual acts to ensure that social and moral order prevails.

Adaptation, Psychological↗
PubMed1988

An extract from Prospects and Risks of Gene Technology: The Report of the Enquete Commission to the Bundestag of the Federal Republic of Germany.

We are pleased to publish an English translation of the crucial section on germ line gene therapy from the Report of the German Enquete Commission. This section of the Report raises basic ethical questions concerning embryo research, as well as more specific questions relating to germ line gene therapy. This form of gene therapy involves genetic modification of the germ cells. Such a modification would be passed on to any descendents of the person whose genes had been altered. The Report had previously dealt with somatic gene therapy, which does not affect the germ line and hence is not passed on to descendents.

Advisory Committees↗
PubMed1991

Whose genome project?

The human genome project is a multinational project aimed at obtaining a detailed map and a complete DNA sequence of the human genome. It will have many scientific, medical, economic, ethical, legal, and social implications. A fundamental question to ask is "Whose genome project is it?" We can answer this question from different perspectives, and this aids our thinking about the issues that arise from the project. We can think of who proposed the idea, who should fund the research, who should perform the research, whose genome is mapped and sequenced, who should own the data, who should benefit from the results, and who should make these decisions. We can also compare the answers to these ethical questions with what is occurring in practice.

Altruism↗
PubMed1992

Bayer revisited.

Bayer accuses me of wrongly claiming that he holds a negative thesis about the role that the liberal emphasis on privacy rights has had on AIDS public health policy. In his reply to my review essay, he denies holding such a thesis and, moreover, makes the stronger claim that his position is sympathetic to liberalism, or at least to some versions of it. Although I appreciate Bayer's efforts to clarify his views about liberalism and a "culture of restraint and responsibility", it is clear to me that our differences are related not to a misunderstanding on my part, but to a fundamental disagreement concerning what liberalism as a political philosophy is, and what public policy implications it entails in the case of AIDS....

Acquired Immunodeficiency Syndrome↗
PubMed1993

Human gene therapy: down the slippery slope?

The strength of a slippery slope argument is a matter of some dispute. Some see it as a reasonable argument pointing out what probably or inevitably follows from adopting some practice, others see it as essentially a fallacious argument. However, there seems to be a tendency emerging to say that in many cases, the argument is not actually fallacious, although it may be unsubstantiated. I shall not try to settle this general discussion, but merely seek to assess the strength of the slippery slope argument applied to human gene therapy. The structure of my argument will be the following. First, I shall distinguish between three different versions of the slippery slope argument; two logical versions and an empirical one. Next, I will address human gene therapy in terms of each of the three versions, partly relying on slippery slope arguments against this practice that have already surfaced in the literature. I shall argue that neither version pulls through. The logical versions fail primarily because relevant distinctions can be made between different uses of gene therapy, contrary to what the proponents of the arguments claim. The empirical version fails because there seems to be no evidence supporting the claim that we shall in fact slide down the slope if we engage in gene therapy, and because if we accepted the conclusion that we should not allow gene therapy on the basis of the empirical argument, we should have to make very far-reaching and undesirable modifications in health care in general, in order to be consistent. Or at least so I shall argue.

Altruism↗