2.	Virtue Nursing Ethics

Virtue ethics: an approach to moral dilemmas in nursing.

Arries E.

School of Nursing, University of Johannesburg, Auckland Park. ea@edcur.rau.ac.za

Nurses are increasingly confronted with situations of moral difficulty, such as not to feed terminally ill patients, whistle blowing, or participation in termination of pregnancy. Most of these moral dilemmas are often analyzed using the principle-based approach which applies the four moral principles of justice, autonomy, beneficence, and non-malfiscience.

In some instances, consequentialism is considered, but these frameworks have their limitations. Their limitations has to do with a consideration for the interpersonal nature of clinical nursing practice on the one hand, and is not always clear on how to judge which consequences are best on the other hand. When principles are in conflict it is not always easy to decide which principle should dominate. Furthermore, these frameworks do not take into account the importance of the interpersonal and emotional element of human experience.

On the contrary, decision-making about moral issues in healthcare demands that nurses exercise rational control over emotions. This clearly focuses the attention on the nurse as moral agent and in particular their character. In this article I argue that virtue ethics as an approach, which focus of the character of a person, might provide a more holistic analysis of moral dilemmas in nursing and might facilitate more flexible and creative solutions when combined with other theories of moral decision-making. Advancing this argument, firstly, I provide the central features of virtue ethics. Secondly I describe a story in which a moral dilemma is evident. Lastly I apply virtue ethics as an approach to this moral dilemma and in particular focusing on the virtues inherent in the nurse as moral agent in the story.

PMID: 16245481 [PubMed - indexed for MEDLINE

3.	Global Nursing Ethics

Nursing Ethics-continuing education, CE, CEU Picking Out the Pieces: Ethics and Morality in Global Nurse Migration Policy.

Hayden SA, Narine L, Tong RO; AcademyHealth. Meeting (2005 : Boston, Mass.).

Abstr AcademyHealth Meet. 2005; 22: abstract no. 3501.

University of North Carolina at Charlotte, PhD Program in Public Policy , 9201 University City Boulevard, Charlotte, NC 28223 Tel. 704-687-6272 Fax 704-583-4467

RESEARCH OBJECTIVE: This study explores the extent ethical and moral arguments are considered in policy discussions about international nurse recruitment. International nurse recruitment can seem a morally neutral phenomenon but there is growing recognition that it in fact may have significant moral and ethical impacts. For developing countries, the losses of large numbers of highly skilled workers represents investment losses in human capital and have the potential to threaten their ability to establish and maintain basic public health measures. In this study we look at the ethics of a tradeoff between access to health care and freedom of movement by health care professionals; dilemmas created when one group of highly skilled professionals is treated differently than others; and the ethical and moral implications of brain drain.

STUDY DESIGN: This research is a meta-synthesis of existing studies. Studies were identified using major key search terms on Medline,

CINAHL, social science citation index, and other health care databases. Published and unpublished papers addressing ethical recruitment of nurses by national and international professional nursing organizations and major institutions were also reviewed.

POPULATION STUDIED: Previous studies on nurse immigrants, migration of medical professionals, and issues of globalization related to brain drain.

PRINCIPAL FINDINGS: Few studies on nurse recruitment have considered the ethical implications of international nurse recruitment. It is not known what effects recent ethical statements from international agencies may have as recruitment efforts are conducted by private employment agencies that are external to government and professional organizations. There are currently no mechanisms to monitor recruitment methods and approaches. Few ethical standards for nurse recruitment addressed the health care access and quality of care problems that may arise in source countries. Nor has there been explicit examination of the ethics associated with the loss of capital investment experienced by these countries.

CONCLUSIONS: Current discourse regarding international nurse recruitment fails to address the issue in terms of professional ethics and values. While they address exploitation and mistreatment of nurse immigrants, ethical statements fail to consider the financial and social exploitation of source countries. The impact of equity and efficiency tradeoffs between Northern and Southern countries remains largely unexplored. The failure to take into account ethical implications limits the policy discussion taking place about international recruitment and so may hinder attempts to fully understand what the phenomenon involves, its effects, and what might be the best options available to address the problem.

IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Elucidation of the ethical and moral dilemmas inherent in international nurse recruitment can help researchers and policy makers to identify a way to better understanding this topic as both a domestic and foreign policy issue. For healthcare administrators this new understanding provides a framework for thinking about the tradeoffs between using domestic or foreign prepared nurses. For policymakers and nurse educators, this information will assist in decision-making about increasing domestic production of professional nurses. Professional nursing organizations, professional associations, and nursing leaders can use these findings to help them better integrate professional ethics and values in their approaches to international nurse recruitment

4.
Declaration of Global Nursing Ethics

Key points for developing an international declaration on nursing, human rights, human genetics and public health policy.

Anderson G,Rorty MV.

Medical Genetics Program, Community Hospital of the Monterey Peninsula, PO Box HH, Monterey, CA 93942, USA.

Human rights legislation pertaining to applications of human genetic science is still lacking at an international level. Three international human rights documents now serve as guidelines for countries wishing to develop such legislation. These were drafted and adopted by the United Nations Educational, Scientific and Cultural Organization, the Human Genome Organization, and the Council of Europe.

It is critically important that the international nursing community makes known its philosophy and practice-based knowledge relating to ethics and human rights, and contributes to the globalization of genetics. Nurses have particular expertise because they serve in a unique role at grass roots level to mediate between genetic science and its application to public health policies and medical interventions. As a result, nurses worldwide need to focus a constant eye on human rights ideals and interpret these within social, cultural, economic and political contexts at national and local levels.

The purpose of this article is to clarify and legitimate the need for an international declaration on nursing, human rights, human genetics and public health policy. Because nurses around the world are the professional workforce by which genetic health care services and genetic research protocols will be delivered in the twenty-first century, members of the discipline of nursing need to think globally while acting locally. Above all other disciplines involved in genetics, nursing is in a good position to articulate an expanded theory of ethics beyond the principled approach of biomedical ethics. Nursing is sensitive to cultural diversity and community values; it is sympathetic to and can introduce an ethic of caring and relational ethics that listen to and accommodate the needs of local people and their requirements for public health.

PMID: 16010919 [PubMed - indexed for MEDLINE

5.	Pluralistic Nursing Ethics

A pluralist view of nursing ethics.

McCarthy J.

Catherine MacAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, School of Nursing and Midwifery, University College Cork, Cork, Ireland. j.mccarthy@ucc.ie

This paper makes the case for a pluralist, contextualist view of nursing ethics. In defending this view, I briefly outline two current perspectives of nursing ethics - the Traditional View and the Theory View.

I argue that the Traditional View, which casts nursing ethics as a subcategory of healthcare ethics, is problematic because it (1) fails to sufficiently acknowledge the unique nature of nursing practice; and (2) applies standard ethical frameworks such as principlism to moral problems which tend to alienate or undermine nursing ethical concerns.

Alternatively, the Theory View, which aims to build an independent and comprehensive theory of nursing ethics, is also found wanting because it (1) fails to sufficiently acknowledge the heterogeneous nature of nursing practices; (2) overemphasizes the differences and undervalues the similarities between nurses and other health professionals; and (3) assumes that one ethical framework can be meaningfully applied across diverse moral problems and contexts. My alternative, is to argue that nursing ethics inquiry should take a pluralist and critical stance towards available ethical frameworks and the negotiation of the ethical realm.

On this view, the search for moral consensus or a unique ethical framework for nursing is replaced by the task of working strategically with multiple frameworks in order to expand the moral agency of nurses and empower them to positively engage with moral uncertainty as an inevitable feature of living a moral life. I conclude by indicating some of the implications that this has for the teaching of nursing ethics.

PMID: 16774602 [PubMed - indexed for MEDLINE]

6.
Viable Global Nursing Ethics

Towards a Viable and Just Global Nursing Ethics

by: Nancy J. Crigger

Nurs Ethics, Vol. 15, No. 1. (1 January 2008), pp. 17-27.

Globalization, an outgrowth of technology, while informing us about people throughout the world, also raises our awareness of the extreme economic and social disparities that exist among nations. As part of a global discipline, nurses are vitally interested in reducing and eliminating disparities so that better health is achieved for all people. Recent literature in nursing encourages our discipline to engage more actively with social justice issues. Justice in health care is a major commitment of nursing; thus questions in the larger sphere of globalization, justice and ethics, are our discipline's questions also.
Global justice, or fairness, is not an issue for some groups or institutions, but a deeper human rights issue that is a responsibility for everyone. What can we do to help reduce or eliminate the social and economic disparities that are so evident? What kind of ethical milieu is needed to address the threat that globalization imposes on justice and fairness? This article enriches the conceptualization of globalization by investigating recent work by Schweiker and Twiss.
In addition, I discuss five qualities or characteristics that will facilitate the development of a viable and just global ethic. A global ethic guides all people in their response to human rights and poverty. Technology and business, two major forces in globalization that are generally considered beneficial, are critiqued as barriers to social justice and the common good. To turn human nature into humanity and righteousness is like turning the willow into cups and bowls.
The book of Mencius 10.1177/0969733007082121