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PubMed2000

Virtuous principles as an ethic for nursing.

A theoretical analysis of virtuous principles--beneficence, non-maleficence, autonomy and justice provides a response to the question: 'How ought ethical nursing practice be characterised?' These virtuous principles promote human flourishing and sustain and strengthen nursing practice. Beneficence, described as acting to benefit others, incorporates a balance of benefit over harm and requires nurses to take action. Non-maleficence calls nurses to refrain from inflicting harm and defines prohibitions over actions. Autonomy, defined as self-governance and self-determination, may have limitations so that absolute or perfect autonomy might be unrealistic. Finally, Justice, a problematic concept, is aligned with fairness and what a patient deserves.

Adult↗
PubMed1996

Broadening the ethical focus: a community perspective on patient autonomy.

Health care ethics has a 'cultural' bias that is patterned on the organizational culture of our health care system. The ethical issues that are identified and debated within our institutions often are shaped by this organizational culture, and as with any culture to which one has been socialized, its influences remain, to a large extent, indistinct and unrecognized. In the field of health care ethics, these influences can direct teaching, regulate common practices, and determine what is or is not considered to be an ethical issue. The movement of health care outward from the hospital into the community provides an opportunity to explore some of the unexamined assumptions that guide our ethical deliberations. By stepping outside of the hospital culture and viewing ethical issues from a community perspective, the authors examine some of the presumptions and beliefs that lie beneath the usual institutional approach to respecting patient autonomy. Two case stories provide concrete examples of how institutional traditions can direct ethical practice.

Community Health Services↗
PubMed2004

[A concept analysis of autonomy].

Holistic care is the primary focus of today's health care system. Nurses are encouraged to maintain good relationships with their patients and to be sensitive to patient autonomy. Furthermore, patients are increasingly demanding and enjoying the right to join in decision-making processes concerning their treatment plans. The importance of patient autonomy is emphasized in the nursing literature on ethics, but no articles focus on the specific situation in Taiwan. The authors review definitions of and concepts tied to autonomy in the literature, redefine the concept to incorporate additional attributes, and construct example cases. Finally, they list empirical references on the application of the concept and the development of appropriate measures.

Holistic Nursing↗
PubMed2005

Predictive factors of rate of loss of autonomy in Alzheimer's disease patients. A prospective study of the REAL.FR Cohort.

Alzheimer's disease is characterised by a progressive loss of autonomy in activities of daily living. Many patients lose this autonomy rapidly with dramatic consequences for the patients and their relatives, and for health and social services. The aim of this study was to determine, in a large French cohort of community-living Alzheimer patients (REAL.FR), the factors underpinning different rates of loss of autonomy. Six hundred and eighty seven patients were recruited to this French cohort. Autonomy in activities of daily living was estimated with the IADL scale (Lawton). Patients were divided into three groups according to loss of autonomy during the first one-year follow-up period. Patients with a decrease in the IADL score had worse ADAS-cog score (Alzheimer's Disease Assessment Scale, cognitive subscale), Mini-Mental State Examination (MMSE), and Clinical Dementia Rating Scale scores. Up to a point, a marked decrease in the IADL score was less frequent among patients with a better ADAS-cog score (p < 0.10, bilateral test). At one-year evaluation, patients with a marked decline in autonomy were characterised by a greater decrease in Mini-Mental State score, faster progression of behavioural disturbance, and more hospitalisations. Further prospective studies, using established models, are needed to isolate the factors associated with a high rate of loss of autonomy in activities of daily living in Alzheimer patients.

Activities of Daily Living↗
PubMedDate not supplied

Ethical issues in the handling of bloodborne pathogens: evaluating the Occupational Safety & Health Administration Bloodborne Pathogen Standard.

The Occupational Safety & Health Administration Bloodborne Pathogen Standard is designed to help provide protection from contamination in the workplace. Healthcare professionals must evaluate the standard and the behaviors mandated therein, according to the basic professional ethical principles of professional autonomy, beneficence, and cost-benefit considerations. The patient's wellbeing provides the focus for making such an assessment.

Beneficence↗
PubMed2002

Why the professional-client ethic is inadequate in mental health care.

Patients who are subject to compulsory care constitute a substantial proportion of the work-load of mental health professionals, particularly psychiatric nurses. This article examines the traditional 'beneficence-autonomy' approach to ethics in compulsory psychiatric care and evaluates it against the reality of daily practice. Risk to the public has always been an important but often unacknowledged consideration. Inequalities exist among ethnic and socio-economic groups and there is a lack of agreement on what constitutes mental disorder. Two major changes in compulsory psychiatric care--community orders and care for patients with untreatable severe personality disorders--further challenge the traditional ethical approach. There are also important human rights implications. The simple patient-health professional relationship no longer provides an adequate framework for mental health professionals on which to base their ethical decisions. The public and organizations may have different perspectives and their interests are becoming increasingly important. Mental health professionals, particularly psychiatric nurses, may face ethical dilemmas because of these different perspectives.

Ethics, Nursing↗
PubMed2005

In defense of paternalism.

This paper argues that we have wrongly and not for the patient's benefit made a form of stark autonomy our highest value which allows physicians to slip out from under their basic duty which has always been to pursue a particular patient's good. In general - I shall argue - it is the patient's right to select his or her own goals and the physician's duty to inform the patient of the feasibility of that goal and of the means needed to attain it. If the goal is not one that is possible, the patient, with the physician and family, must select a feasible goal and then discuss the costs/benefits of various approaches. The physician should take a leading role in helping the patient select the goal. I argue that to simply present a laundry list of means and insist that patients choose for themselves is not only abandoning patients to their autonomy but is, in fact, a crass form of violating the patient's autonomy. Freely choosing not to choose is a choice a patient with decisional capacity is entitled to make and one that needs to be respected.

Beneficence↗
PubMed2005

A comparison of the psychometric properties of the hooked on nicotine checklist and the modified Fagerström tolerance questionnaire.

We compared the psychometric properties of the Hooked on Nicotine Checklist (HONC) and the Modified Fagerström Tolerance Questionnaire (MFTQ). Adolescent current smokers (n = 215) completed both instruments three times, at baseline and 6- and 12-month follow-up. Internal consistency of the HONC was high (alpha = 0.92), as was its stability over the follow-up interval (intraclass correlation (ICC) = 0.93 over 6 months and 0.91 over 1 year). Internal consistency of the MFTQ was acceptable (alpha = 0.83), and its stability over the follow-up interval was similar to that reported previously (ICC = 0.79 at 6 months and 0.76 at 1 year). The HONC predicted smoking at both follow-up points, while the MFTQ did so only at 6 months. The HONC compared favorably with the MFTQ in all respects. The most important advantage of the HONC is that it is measuring a clearly defined concept, diminished autonomy over tobacco, which begins when the sequelae of tobacco use present a barrier to quitting.

Adolescent↗
PubMed1989

Advance directives in emergency medicine: medical, legal, and ethical implications.

Emergency physicians often encounter clinical situations in which medical resuscitation may not coincide with patient expectations. These situations present complicated medical, legal, and ethical dilemmas. The history of the patient's right to refuse treatment as it applies to resuscitative medical care is reviewed. Medical recognition of patient autonomy and legal precedents affirming it are discussed, as are the various types of advance directives, including the living will and durable power of attorney and their clinical uses.

Emergencies↗
PubMed2002

Whose autonomy? Which choice? A study of GPs' attitudes towards patient autonomy in the management of low back pain.

BACKGROUND: Respect for patient autonomy is an important ethical principle for medical practitioners; however, previous investigators have reported inconsistent attitudes amongst practitioners towards respect for patient autonomy. This study in empirical ethics used qualitative methods to investigate GPs' attitudes towards respect for patient autonomy in consultations for low back pain. OBJECTIVES: The aim of this study was to explore GPs' attitudes towards respect for patient autonomy by analysing attitudes towards four issues in the management of low back pain which raise ethical and practical dilemmas. METHODS: Participants were 21 GPs selected from general practice in South Australia by stratified, purposive sampling aimed at maximizing diversity. Semi-structured interviews were tape-recorded, transcribed and analysed using codes developed from the transcripts, with additional theoretical codes. In the analysis, attitudes towards patient autonomy in the four issues were characterized as autonomy-respecting, intermediate or controlling. RESULTS: The results showed individual inconsistencies in GPs' attitudes towards respect for patient autonomy. For example, the majority of GPs accepted patient autonomy in the use of complementary therapies, but were controlling with regard to the use of analgesics. Attitudes to duration of time off work were spread evenly, whilst controlling attitudes towards use of X-rays were modified by patient requests for X-rays. CONCLUSIONS: These results suggest that GP attitudes towards patient autonomy are modified by ethical and pragmatic factors, and vary depending upon the nature of the issue in question.

Adult↗
PubMed1983

'Quality of life' and the analogy with the Nazis.

The introduction of 'quality of life' judgments into treatment decisions is viewed as pernicious by some who claim that these presuppose the Nazi position that those who are 'devoid of value' must be exterminated. 'Quality of life' judgments are said to deny the equal value of human beings and to assume that some lives are not 'worthy to be lived'. It is argued that the analogy misconstrues the senses of 'value' and 'quality' employed by Naziism and a 'quality of life' position. This leads the analogizers incorrectly to claim that both views assimilate the value of human beings to the value of their condition. A 'quality of life' position is grounded in recognition of the logical priority of the value of human beings as self-reflective evaluators and agents, which is a matter of kind, not degree. The 'quality of life' is explicated in terms of the standards of well-being of individuals, which are derived from their basic human needs and their individual priorities and goals. The use of 'quality of life' judgments is morally required to ensure that considerations of justice and individual autonomy govern treatment decisions. The purported analogy misconstrues the views of both the Nazi position and a 'quality of life' position and so is seriously misdirected.

Ethics, Medical↗
PubMed1993

Sports medicine: some ethical issues.

The ethical aspects of sports medicine have hitherto received little scrutiny, in contrast to its legal implications, which have recently been subject to much greater discussion. However, the differences that are apparent between sports medicine and 'mainstream' areas of clinical practice can shed new light on a number of the central issues within health-care ethics. By means of hypothetical case studies, this paper seeks to examine some of these issues within a sports medicine context. Specific attention will be paid to the concepts of autonomy and paternalism, issues to do with truthfulness, and the question of conflicting professional loyalties. It is suggested that the ethics of sports medicine warrant further and more detailed examination.

Adolescent↗
PubMed2006

Finnish doctors and the realisation of patient autonomy in the context of end of life decision making.

Patient autonomy is a fundamental principle in end of life decision making. However, its realisation may take a variety of forms. Discourse analysis was conducted in a qualitative interview study of 19 physicians. The physicians made use of three different discourses, each of which contained a specific understanding of patient autonomy and a physician's proper activities in the context of end of life decision making.

Attitude of Health Personnel↗
PubMed1996

Communication with the seriously ill: physicians' attitudes in Saudi Arabia.

OBJECTIVES: To study some ethical problems created by accession of a previously nomadic and traditional society to modern invasive medicine, by assessment of physicians' attitudes towards sharing information and decision-making with patients in the setting of a serious illness. DESIGN: Self-completion questionnaire administered in 1993. SETTING: Riyadh, Jeddah, and Buraidah, three of the largest cities in Saudi Arabia. SURVEY SAMPLE: Senior and junior physicians from departments of internal medicine and critical care in six hospitals in the above cities. RESULTS: A total of 249 physicians participated in the study. Less than half (47%) indicated they provided information on diagnosis and prognosis of serious illnesses all the time. Physicians who were more senior and those who spoke Arabic fared better than other groups. The majority (75%) preferred to discuss information with close relatives rather than patients, even when the patients were mentally competent. Most of the physicians (72%) felt patients had the right to refuse a specific treatment modality, and 68% denied patients the right to demand such a treatment if considered futile. Further analysis showed that physicians' attitudes varied along a spectrum from passive (25%) to paternalistic (21%) with the largest group (47%) in a balanced position. CONCLUSIONS: In traditional societies where physicians are regarded as figures of authority and family ties are important, there is a considerable shift of access to information and decision-making from patients to their physicians and relatives in a manner that threatens patients' autonomy. Ethical principles, wider availability of invasive medical technology and a rise in public awareness dictate an attitude change.

Culture↗
PubMed1997

Existential autonomy: why patients should make their own choices.

Savulescu has recently introduced the "rational non-interventional paternalist" model of the patient-doctor relationship. This paper addresses objections to such a model from the perspective of an anaesthetist. Patients need to make their own decisions if they are to be fully autonomous. Rational non-interventional paternalism undermines the importance of patient choice and so threatens autonomy. Doctors should provide an evaluative judgment of the best medical course of action, but ought to restrict themselves to helping patients to make their own choices rather than making such choices for them.

Comprehension↗