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Table of Contents


	Preface	xii
	Acknowledgments	xv
Chapter 1	Professional Standards and the Requirement to be Ethical	01
	Introduction	01
	The Requirement to be Ethical	04
	Questioning the Requirement to be Ethical	04
	Nursing as a Moral Project	05
	Conclusion	06
	Case Scenarios and Critical Questions	06
Chapter 2	Ethics, Bioethics and Nursing Ethics: Some Working Definitions	09
	Introduction	09
	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?	16
	What Ethics is Not	17
	Law	17
	Codes of Ethics	21
	Hospital or Professional Etiquette	24
	Hospital or Institutional Policy	25
	Public Opinion or the View of the Majority	27
	Following the orders of a Supervisor or Manager	28
	The Task of Ethics, Bioethics and Nursing Ethics	30
	Conclusion	32
	Case Scenarios and Critical Questions	33
Chapter 3	Moral theory and the Ethical Practice of Nursing	35
	Introduction	35
	Moral Justification	36
	Theoretical Perspectives Informing Ethical Practice	38
	Ethical Principlism	39
	What are Ethical Principles?	39
	Moral Rules	47
	Problems with Ethical Principles	48
	Moral Rights Theory	49
	Moral Rights	49
	Making Rights Claims	54
	Rights and Responsibilities	54
	Problems with Rights Claims	55
	Virtue Ethics	57
	The Notion of Virtue	58
	Virtue Ethics and Nursing	59
	Virtue Ethics and Nursing�s Ethic of Care	61
	Problems with Virtue Ethics	62
	Deontology and Teleology	63
	Deontology	63
	Teleology	64
	Moral Duties and Obligations	64
	Limitations and Weaknesses of Ethical Theory	67
	Moral Justification and Moral Theory � Some Further Thoughts	68
	Conclusion	69
	Case Scenarios and Critical Questions	69
Chapter 4	Cross-Cultural Ethics and the Ethical Practice of Nursing	71
	Introduction	71
	Cross-Cultural Ethics and Nursing	72
	Culture and its Relationship to Ethics	73
	The Nature and Implications of a Cross-Cultural Approach to Ethics	74
	Moral Diversity and the Challenge of Moral Pluralism	81
	Dealing with Problems Associated with a Cross-Cultural Approach to Ethics in Health Care	83
	Cross-Cultural Ethics and the Case of Female Genital Mutilation	87
	Conclusion	90
	Case Scenarios and Critical Questions	91
Chapter 5	Moral Problems and Moral Decision-Making in Nursing and Health Care Contexts	93
	Introduction	94
	Distinguishing Moral Problems from Other Sorts of Problems	94
	Identifying Different Kinds of Moral Problems	95
	Moral Unpreparedness	96
	Moral Blindness	98
	Moral Indifference	101
	Amoralism	102
	Immoralism	103
	Moral Complacency	104
	Moral Fanaticism	105
	Moral Disagreements and Conflicts	105
	Internal Moral Disagreements	105
	Radical Moral Disagreements	107
	Moral Dilemmas	108
	Moral Stress, Moral Distress and Moral Perplexity	113
	Making Moral Decisions	114
	Moral Decision-Making � A Working Definition	114
	Processes for Making Moral Decisions	114
	Reason and Moral Decision-Making	116
	Emotion and Moral Decision-Making	118
	Intuition and Moral Decision-Making	120
	Life Experience and Moral Decision-Making	122
	Reason, Emotion, Intuition and Life Experience � Some Further Thoughts	123
	Dealing with Moral Disagreements and Disputes	124
	Being Accepting of Different Points of View	125
	Everyday Moral Problems in Nursing	127
	Conclusion	128
	Case Scenarios and Critical Questions	128
Chapter 6	Patients� Rights to and in Health Care	131
	Introduction	132
	The Issue of Patients� Rights	133
	What Are Patients� Rights?	135
	The Right to Health and Health Care	136
	The Right to Equal Access to Health Care	138
	The Right to Have Access to Appropriate Care	139
	The Right to Quality Care	140
	The Right to Safe Care	140
	Challenges Posed by the Right to Health Care	141
	The Right to Make Informed Decisions	142
	What is Informed Consent?	143
	Informed Consent and the Sovereignty of the Individual	148
	Informed Consent and Ethical Principlism	149
	The Elements of an Informed and Valid Consent	149
	The Problem of Rational Competency	155
	Paternalism and Informed Consent	162
	Is Paternalism Justified?	164
	Applying the �Paternalistic Principle� in Health Care	165
	Informed Consent and Nurses	166
	The Right to Confidentiality	166
	Confidentiality as an Absolute Principle	168
	Confidentiality as a Prima-Facie Principle	170
	The Right to be Treated with Dignity	172
	What is Dignity?	173
	Dignity and the Right to Dignity	175
	Dignity Violations	175
	Implications for Nurses	176
	The Right to be Treated with Respect	176
	The Right to Cultural Liberty	178
	Conclusion	179
	Case Scenarios and Critical Questions	179
Chapter 7	Human Rights and the Mentally Ill	183
	Introduction	183
	Prevalence of Mental Illness	184
	Stigma, Prejudice and Discrimination Against the Mentally Ill	184
	Stigma	184
	Prejudice and Discrimination	186
	A Human Rights Approach to Protecting the Mentally Ill	188
	Problems Associated with a Human Rights Approach to Mental Health Care Ethics	189
	Psychiatric Advance Directives (�Ulysses Contracts�) in Mental Health	192
	Striking a Balance Between Promoting Autonomy and Preventing Harm	193
	Historical Overview of the Development of Psychiatric Advance Directives (Pads)	193
	Anticipated Benefits of Pads	194
	Anticipated Risks of Pads	195
	Current Trends in the Legal Regulation of Pads	196
	The Moral Responsibilities of Nurses in Mental Health Care	196
	Future Directions in Mental Health Care Ethics	198
	Conclusion	199
	Case Scenarios and Critical Questions	199
Chapter 8	Ethical Issues Associated with the Reporting of Child Abuse	203
	Introduction	203
	What is Child Abuse?	205
	The Development of the Modern Child Protection Movement in North America	205
	The Mary Ellen Case	206
	Development of the Modern Child Protection Movement in England and Australia	207
	Child Abuse in the Cultural Context of Australia	208
	�What Makes Child Abuse a Bona Fide and Significant Moral Issue?	209
	The Problem of Ambivalence towards the Moral Entitlements of Children	210
	The Case of Daniel Valerio	211
	The Case of Cody Hutchings	211
	Is the �Failure of the System� to Blame?	212
	The Ethical Implications of Child Abuse	213
	The Moral Demand to Report Child Abuse	214
	The Notion of Harm and its Link with the Moral Duty to Prevent Child Abuse	214
	Protecting the Interests of Children as Children and as Prospective Adults	215
	Considerations Against the Mandatory and Voluntary Notification of Child Abuse	217
	The Professional-Client Relationship	217
	Parents and Families	218
	Abused and Neglected Children	218
	Responding to the Criticisms	219
	The Problem of Maintaining Confidentiality	219
	The Problem of Statutory Surveillance	220
	Preserving the Integrity of the Professional-Client Relationship	221
	Upholding the Interests of Parents, Families and Abused Children	221
	The Importance of a Supportive Socio-Cultural Environment in Child Abuse Prevention	222
	Conclusion	224
	Case Scenarios and Critical Questions	225
Chapter 9	Abortion Ethics and the Nursing Profession	227
	Introduction	227
	What is Abortion?	230
	Is Abortion Morally Permissible?	231
	The Conservative Position	232
	The Moderate Position	232
	The Liberal Position	234
	Abortion and the Moral Rights of Women, Fetuses and Fathers	235
	Abortion, Politics and the Broader Community	240
	Conclusion	244
	Case Scenarios and Critical Questions	245
Chapter 10	Euthanasia, Assisted Suicide and the Nursing Profession	247
	Introduction	248
	Euthanasia and its Significance for Nurses	252
	Public Opinion on the Euthanasia/Assisted Suicide Issue	257
	Definitions of Euthanasia, Assisted Suicide and �Mercy Killing�	258
	Euthanasia	258
	Assisted Suicide	261
	�Mercy Killing�	261
	Views for and Against Euthanasia/Assisted Suicide	262
	Views in Support of Euthanasia	262
	Arguments from Individual Autonomy and the Right to Choose	263
	Arguments from the Loss of Dignity and the Right to the Maintenance of Dignity	263
	Arguments from Reduction of Suffering	263
	Arguments from Justice and the Demand to be Treated Fairly	264
	Arguments from Altruism and the �Duty to Die�	264
	Arguments from Climate Change	265
	Counter-Arguments to Views Supporting Euthanasia	266
	Autonomy and the Right to Choose Death	266
	Dignity and the Right to Die with Dignity	267
	Suffering and the Demand to End It	267
	Justice and the Demand to be Treated Fairly	267
	Altruism and the �Duty to Die�	268
	Climate Change and the Desire to Have an �Exit Strategy�	268
	Specific Arguments Against Euthanasia	268
	Arguments from the Sanctity-of-Life Doctrine	269
	Arguments from Clinical Uncertainty, Misdiagnosis and Possible Recovery	269
	Arguments from the Risk of Abuse	270
	Arguments from Non-Necessity	271
	Arguments from Discrimination	271
	Arguments from Irrational, Mistaken or Imprudent Choice	271
	�Slippery Slope� Argument	272
	The Killing/Letting Die Distinction	274
	Intentional Killing versus Alleviating Pain	276
	Analgesia without Death	277
	Analgesia with Unintended Death	277
	Analgesia with Intended Death	278
	The Doctrine of Double Effect	278
	Implications for Nurses of Narcotic Administration	280
	�Nursing Care Only� Directives	280
	The Dr Leonard Arthur Case	281
	The Danville Case	282
	Medical Directives to withhold or withdraw Nutrition and Hydration	283
	Position Statements on Euthanasia/Assisted Suicide and the Nursing Profession	286
	Conclusion	288
	Case Scenario and Critical Questions	288
Chapter 11	Ethical Issues in Suicide and Parasuicide	291
	Introduction	291
	Socio-Cultural Attitudes to Suicide: A Brief Historical Overview	295
	Socio-Cultural Acceptance of Suicide, 600 BC-4 AD	295
	Attitudes of Religious Prohibition Against Suicide	299
	The Criminalisation of Suicide	301
	The Medicalisation of Suicide	302
	Defining Suicide	304
	Suicide: Some Moral Considerations	309
	Autonomy and the Right to Suicide	310
	Suicide Prevention: Some Further Considerations	314
	Conclusion	314
	Case Scenario and Critical Questions	316
Chapter 12	End-of-Life Decision-Making and the Nursing Profession	319
	Introduction	320
	Not for Treatment (NFT) Directives	321
	The Problem of Treatment in �Medically Hopeless� Cases	321
	Who Decides?	322
	Do Not Resuscitate (DNR) Directives	323
	Raising the Issues	324
	Case 1: Mr H	325
	Case 2: Mr X	326
	Problems Concerning DNR Decision-Making Criteria, Guidelines and Procedures	327
	Criteria and Guidelines Used	327
	The Exclusion of Patients from Decision-Making	329
	Misinterpretation of Directives and Questionable Outcomes	330
	Problems Concerning the Documentation and Communication of DNR Directives	330
	Problems Concerning the Implementation of DNR Directives	332
	Improving DNR Practices	333
	Medical Futility	334
	Quality of Life	335
	Defining Quality of Life	336
	Different Conceptions of Quality of Life	336
	Using End-of-Life Considerations to Inform Treatment Choices	337
	Advance Directives	340
	What is an Advance Directive?	341
	How Do Advance Directives Work?	341
	Risks and Benefits of Advance Directives	342
	Advance Care Planning	344
	Conclusion	345
	Case Scenarios and Critical Questions	346
Chapter 13	Taking a Stand: Conscientious Objection, Whistleblowing and Reporting Nursing Errors	349
	Introduction	349
	Conscientious Objection	350
	The Nature of Conscience Explained	352
	Conscience as Moral Reasoning	353
	Conscience as Moral Feelings	353
	Conscience as Moral Reason and Moral Feelings	353
	How Conscience Works	354
	Bogus and Genuine Claims of Conscientious Objection	355
	Conscientious Objection to the Lawful But Morally Controversial Directives of a Superior	356
	Conscientious Objection and the Problem of Conflict in Personal Values	358
	Conscientious Objection � The Fear of Contagion and Homophobia	360
	Conscientious Objection and the Problem of Unsafe Work Conditions	364
	Conscientious Objection and Policy Considerations	364
	Whistleblowing in Health Care	365
	The Moylan Case (Australia)	365
	The Pugmire Case (New Zealand)	366
	The Bardenilla Case (US)	367
	The Macarthur Health Service Case (Australia)	367
	The Bundaberg Base Hospital Case (Australia)	369
	The Notion of Whistleblowing/Whistleblowers	370
	Deciding to �Go Public�	371
	Risks of Whistleblowing	371
	Clinical Governance and Clinical Risk Management	372
	Whistleblowing as a Last Resort	373
	Reporting Nursing Errors	373
	What is a �Nursing Error�?	374
	Incidence and Impact of Nursing Errors	375
	Human Error Management	376
	Nursing Error Management	377
	The Ethics and Practical Importance of Reporting Nursing Errors	378
	The Problem of Under-Reporting Nursing Errors	379
	The Importance of Distinguishing �Nursing Errors�	380
	Implications for Nurse Education, Research and Practice	381
	The Challenge to Change	383
	Conclusion	383
	Case Scenarios and Critical Questions	383
Chapter 14	Nursing Ethics Future, Moral Activism and Meeting the Challenge to be Involved	385
	Introduction	385
	Nursing Ethics Future	385
	Nursing Activism	386
	Conclusion	389
	Case Scenario and Critical Questions	389
Chapter 15	Indigenous Perspectives	391
	Introduction	391
	Indigenous Health, Political Will and Social Responsibility	394
	Bibliography	397
	Index	461