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1800 results in Nursing

Page 70 of 90

  • 14 - Autonomy and consent

  • Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
  • Book:
    Foundations of Healthcare Ethics
    Published online:
    21 June 2018
    Print publication:
    08 April 2015, pp 228-245

  • Summary

    One the most vexed questions in healthcare involves patient autonomy, and the extent to which patients are able to make decisions about their healthcare. It may not always be the case that patients will be able to understand the information that they have been given and decide what advice regarding their treatment they should follow. The question of autonomy and the extent to which patients are able to give informed consent to the treatment being recommended to them becomes more difficult as their health deteriorates. These issues will be explored in this chapter.

    The idea that patients need to be asked to consent to the medical and healthcare treatment that is being proposed to them is reasonably modern. After all, the healthcare practitioner is the professional, the person with the expertise to decide what treatments are needed by the patient in order to return to health. If a patient needs an operation to remove a tumour, they are expected to accept the surgeon’s advice and have the operation. The Hippocratic Oath states nothing about asking patients for their informed consent before the physician prescribes medication or performs surgery. Despite this, it has generally become accepted that, because patients are autonomous, self-determining human persons, they need to be fully informed of the treatment options available to them, and to decide, having assessed the available information and taken appropriate advice, what treatments they will undertake. This is the recognition that a pathway to health will involve the active participation of patients – that is, it is not simply a matter of patients passively receiving treatment. The whole person needs to be involved in recovery to full health.

  • 15 - The ‘dead donor rule’ and organ donation

    • By Brigid McKenna, Office of Life, Marriage and Family in the Archdiocese of Hobart, Tasmania
  • Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
  • Book:
    Foundations of Healthcare Ethics
    Published online:
    21 June 2018
    Print publication:
    08 April 2015, pp 246-262

  • Summary

    The transplantation of tissues and organs from deceased donors is well established in Australia, beginning with the first corneal transplant in 1941 and the first kidney transplants in the early 1960s (NHMRC, 2007). In 2013, a total of 391 deceased organ donors gave 1122 Australians a new chance in life after they received an organ transplant (Donate Life, 2014). Transplantation medicine is clearly one of the most dramatic success stories of modern medicine. It is, however, also one of the most ethically controversial, with significant personal, interpersonal and societal dimensions to consider. The practice of donation after death is a source of many of these controversies, especially when the demand for organs far exceeds their supply: around 1500 people are on Australian organ transplant waiting lists at any one time (Donate Life, 2014).

    Transplantation medicine has always been guided by the primary ethical requirement that patients must be declared dead before any vital organs can be procured. However, the definition of death is not as straightforward as it once seemed. Whereas patients were once understood to be dead when they ceased to have evidence of circulation, respiration and brain functioning, with the loss of any one of these functions leading to the loss of the other two over a short period of time, the development of modern intensive-care medicine now allows the continuation of circulation and respiration in the absence of detectable brain function. This has made the question ‘When is a person dead?’ far more complicated (Truog & Robinson, 2003) and the ethical and legal requirements for organ donation far more controversial. This chapter critically examines the clinical and philosophical basis for the determination of death by neurological criteria (‘brain death’) and provides ethical analysis of emerging proposals for the ethical transplantation of vital organs.

  • 12 - Is there a right to life and a right to die?

  • Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
  • Book:
    Foundations of Healthcare Ethics
    Published online:
    21 June 2018
    Print publication:
    08 April 2015, pp 193-212

  • Summary

    The legal and moral dimensions of rights talk

    The person who asks, ‘Is there a right to life or a right to die?’ may be looking for a legal answer or a moral one. The inquirer looking for a legal answer may be wanting to know what are their present legal entitlements or obligations: ‘What must I do to avoid trouble with the law?’ or ‘What can I avoid doing without running into trouble with the law?’ For example, the nurse may want to know whether she has a duty to assist with an abortion or the duty to assist a patient to commit suicide. The patient may want to know whether they can terminate a pregnancy without fear of criminal sanction or involve their spouse in assisting with their death, confident that their partner will not face prosecution after the peaceful death which would come more quickly than if the patient simply accepted good palliative care. The questioner looking for a moral answer is not so much interested in the present way of dealing with life at either end of the life-cycle, but rather with pondering how best we and our society might in future deal with people in such situations. The moral questioner is concerned with asking, ‘What ought we do? In a more ideal world, what ought we do? Even in a messy and broken world, what ought we do? How could laws and policies best be formulated to regulate, guide and determine how people respond and act when confronting life at either end of the life-cycle?’ When speaking of the right to die, we are usually wrestling with the moral dilemma of how best to order the doctor–patient relationship, how best to provide legal underpinning for the decisions made by patients and their next of kin, and how best to allow a patient to decide their options for life or death. If there is a right to die, it is a right to die at the time and in the manner of one’s choosing?

  • 8 - Natural law and the sanctity of human life

  • Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
  • Book:
    Foundations of Healthcare Ethics
    Published online:
    21 June 2018
    Print publication:
    08 April 2015, pp 120-137

  • Summary

    The concept of natural law has a venerable past in the Western world, having its beginnings in ancient Greece. For example, in the Theban plays, Sophocles illustrates how human actions have to conform to the laws governing human beings that have been ordained by the gods. Natural law theory holds that an understanding of human nature reveals that there are basic human goods, which all human beings need in order to flourish and be fulfilled. Although there are differing views about what is to be included in the list of basic human goods, the broadest list includes life, work and play, beauty, truth, friendship, self-integration, peace of conscience, marriage and religion. Natural law holds that these goods are incommensurable, and one cannot be preferred over another – although some goods may be dominant in particular lives. Crucially, whether some goods dominate or not, we need to share in all the goods to some extent. This leads to some potential problems in terms of ethical decision-making.

    The idea of a law

    The idea of the natural law is very broad, and not only encompasses views about natural science and the laws governing natural phenomena, but also extends across a number of disciplines, such as law, politics, theology and, of course, ethics. In some respects, all of these areas in the natural law tradition intersect with one another, and arguably the natural law that lies at the base of all of these disciplines is the same natural law. It is claimed that it is the natural law that justifies our intuitions about what is morally right. It is morally right to do our best to heal our patients, for example, because one of the basic human goods is life and health. It is one we all need to lead flourishing lives. We shall provide a brief account of what we might understand by a natural law or law of nature, and then outline how the idea can be applied to develop a normative ethical theory with universal application.

  • 9 - Obligations, duties and rights

  • Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
  • Book:
    Foundations of Healthcare Ethics
    Published online:
    21 June 2018
    Print publication:
    08 April 2015, pp 138-154

  • Summary

    In the last decade, there has been a resurgence of utilising a Kantian theoretical approach in healthcare ethical reasoning. Kant (1909, 1991, 1997) argues that morality does not depend on how one feels about a particular action, but rather on whether one approaches the action with a good will. Kant believes that the moral life is based purely and simply on duty or obligation, and not on a utilitarian calculation of the best consequences or on a natural law respect for the basic human goods. So Kant holds a deontological view of ethics – an ethics of duty or obligation. Kant says that the most important thing is to will to do what is rational to do, and what reason commands. He says that the principle according to which we should act is to do what we would want to be a universal law – that is, we would want everyone to act in the same way. In healthcare ethics, this means that duties and rights are taken into account in our ethical decision-making.

    Kant’s deontological approach to ethics

    Kant’s main discussion of ethics can be found in Groundwork for the Metaphysics of Morals (1997), The Critique of Practical Reason (1909) and The Metaphysics of Morals ((1991). The first of these is generally taken to encapsulate Kant’s novel contribution to the discussion of ethics. Throughout his work on ethics, Kant takes a contrary view to those who claim that we can determine what is morally good by an appeal to the good, which he claims we cannot know, as well as those – such as virtue ethicists – who claim that the end of ethical behaviour is happiness. The latter, he thinks, cannot adequately be established. Kant provides us with a view of ethics that he believes is based on reason, the distinguishing mark of a human being. He distrusts emotion, holding that doing what is good is an imperative of reason: the recognition of doing what is right and the will to do this, irrespective of how one feels about what one has to do.

  • 3 - Ethical principlism

  • Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
  • Book:
    Foundations of Healthcare Ethics
    Published online:
    21 June 2018
    Print publication:
    08 April 2015, pp 33-50

  • Summary

    Ethical principlism is a popular ethical theory in healthcare ethics. It is based around four principles: beneficence, non-maleficence, autonomy and justice. Some codes of ethics, which try to provide guidance in healthcare, make use of these principles. This chapter will first explore what each of these principles involves, consider some examples of the principles in action and look at some of the difficulties and limitations of principlism. Principlism is at its best when the four principles work together to provide a framework for moral action, and at its worst when principles come into conflict. For example, showing respect for patient autonomy may not always lead to treatment that would be in a patient’s best interests, and so could conflict with the principle of beneficence.

    It is no surprise that when we discuss standards of moral conduct or seek guidance in moral decision-making that we appeal to moral principles that help us make decisions about how we should act. Different normative moral theories have different starting points, so we can arrive at different views about what is good and what is morally right. Different theories, starting from different principles, result in different moral rules. This suggests that where there are challenging moral issues in the healthcare area, there will be considerable difficulty in finding agreement about what course of action is morally appropriate. Ethical principlism is a possible way forward: it proposes that, despite differences among ethical theories, there is a common core morality, and invites us to consider our moral decision-making within a framework of four moral principles. That is, it is claimed that whatever our starting point in moral theory might be – whether it is utilitarianism, virtue ethics, deontology or natural law – if we begin from the framework of ethical principlism, then the more likely we are to reach an agreed decision on a moral question. The appeal of ethical principlism is that it will help us to make justifiable moral decisions rather than establish what is objectively morally right. Principlism assumes that because there will be an overlap among the various moral rules enunciated by different normative theories which yield a common core morality, there will be acceptance of the four principles that form the framework within which moral questions are considered.

Ward Ethics
  • Dilemmas for Medical Students and Doctors in Training
  • Edited by Thomasine K. Kushner, David C. Thomasma
  • Published online:
    05 February 2015
    Print publication:
    07 June 2001
  • The existing literature in medical ethics does not serve the practical needs of medical students and trainees very well, as the dilemmas posed are generally beyond their direct control, and being a student or junior doctor brings its own set of ethical concerns. The editors have addressed this need by compiling a series of case studies from around the world and inviting an international team of leading ethicists and clinicians to comment on them. Over 80 actual cases cover the range of possible problems a medical trainee may encounter on the ward, from drug and alcohol abuse, whistleblowing and improper sexual conduct to performing procedures, handling authority, disclosure, blaming, personal responses to patients, and misrepresentation of research. The book will be an essential guide on how to cope with the ethical dilemmas of those embarking on medical careers.

  • 6 - Indigeneity and health

  • Toni Schofield, University of Sydney
  • Book:
    A Sociological Approach to Health Determinants
    Published online:
    06 August 2018
    Print publication:
    03 February 2015, pp 99-122

  • Summary

    Overview

  • What are the main health effects of indigeneity?

  • How might ‘indigeneity’ refer to a social process? How is ‘coercive alienation’ central to understanding it?

  • What is the relationship between colonisation and global division in relation to indigeneity? How does it work?

  • How do the health experiences of Indigenous Australians illuminate the dynamics of indigeneity?

    • Northern Queensland, Australia, 1870s

    This morning in the predawn dark, his eyes accustomed to darkness, Bidiggi could see the white men’s own totemic circle of saddles and packs stacked to make a bora ring. Behind that little wall he knew, and his father and uncles and brothers knew, the white man lay in wait…

    [H]e raced forward with his spear . . . Then the shouting sticks began to bark . . .

    His brother crumpled like a broken tree . . .

    [H]e could see as the dark thinned that more and more of his tribe had fallen . . . He shook with fear . . .

    The remnants of the tribe were in l ight . . .The world was a madness of shouts and the drumming of the animals, the screams of the running men.

    Two old men . . . had been left behind, and their wives. The other women had been shot as they l ed. The old women wailed and were silenced . .

    Bidiggi was only twelve, and although he didn’t measure by white time but by black, he knew he was a man. There had been the ceremony. His father was dead. His brother. His uncles . . . His head i lled with pictures of the men on the big animals beating the tribe like wild pigs along the reedy rim of the water where they fished and swam. The pictures were blotted with blood and he could still hear the men screaming back when the shouting sticks spoke to them and see the running women and children trampled into the morning grass. ( Astley 1987 : 39–41 )

  • 5 - Ethnicity and health

  • Toni Schofield, University of Sydney
  • Book:
    A Sociological Approach to Health Determinants
    Published online:
    06 August 2018
    Print publication:
    03 February 2015, pp 83-98

  • Summary

    Overview

  • What does the evidence tell us about ethnic disparities in health on a global basis?

  • What is ‘race’? What does a racist explanation of, or approach to, ethnic disparities in health involve?

  • What does it mean to say that ethnicity and ethnic division are social processes? What role does institutional racism play in these?

  • How does ethnicity work in the production of ethnic disparities in health?

    • New York City, approximately 1890

    The homes of the Hebrew quarter are its workshops also … You are made fully aware of it before you have travelled the length of a single block in any of these East Side streets, by the whir of a thousand sewing-machines, worked at high pressure from earliest dawn till mind and muscle give out together. Every member of the family, from the youngest to the oldest, bears a hand, shut in the qualmy rooms, where meals are cooked and clothing washed and dried besides, the livelong day. It is not unusual to find a dozen persons – men, women, and children – at work in a single small room … Typhus fever and smallpox are bred here … Filthy diseases both, they sprout naturally among the hordes that bring the germs with them from across the sea … The health officers are on constant and sharp lookout for hidden fever-nests. Considering that half of the ready-made clothes that are sold in the big stores, if not a good deal more than half, are made in these tenement rooms, this is not excessive caution. It has happened more than once that a child recovering from small-pox, and in the most contagious stage of the disease, has been found crawling among heaps of half-finished clothing that the next day would be offered for sale on the counter of a Broadway store; or that a typhus fever patient has been discovered in a room whence perhaps a hundred coats had been sent home that week, each one with the wearer’s death-warrant, unseen and unsuspected, basted in the lining (Riis 1890).

  • 8 - Health care and health

  • Toni Schofield, University of Sydney
  • Book:
    A Sociological Approach to Health Determinants
    Published online:
    06 August 2018
    Print publication:
    03 February 2015, pp 148-176

  • Summary

    Overview

  • What is the globally dominant form of health care organisation? How does it work?

  • What is the most effective form of health care in terms of advancing the health of most of the world’s peoples? How does it work?

  • What are the major social dynamics responsible for the prevailing patterns of health care both within and between countries globally?

    • Iraq, 1950s

    In the 1950s, archaeologists found a traumatised Neanderthal skeleton in northern Iraq in the Shanidar caves. Their examination of the remains showed that it was the skeleton of a man who had lived between 40 000 and 115 000 years ago and who had begun life with a stunted arm, a large part of it which he had lost some time later. It is likely that without the use of both arms the man had used his mouth for some tasks, such as scraping or cutting – because his teeth were very severely ground down. He had also lost two front teeth, probably in another accident. At some point in this life from thousands of millennia ago, something or somebody had delivered a sharp blow to the top of the man’s head … This was accompanied by another, harder blow that had caused the left side of his face to be shattered, most probably destroying his sight on this side as well. Somehow, he had struggled on long enough to develop severe and crippling arthritis. ‘[A]round his fortieth birthday the roof over his cave hearth collapsed, ending his saga and his troubles.’ (Wood: 1979: 22)

  • 7 - The state and health

  • Toni Schofield, University of Sydney
  • Book:
    A Sociological Approach to Health Determinants
    Published online:
    06 August 2018
    Print publication:
    03 February 2015, pp 123-147

  • Summary

    Overview

  • What is ‘the state’?

  • How did rationalised rule and governance differ from their predecessors? What role did they play in the development of democratic states?

  • What is neo-liberalism and what are the main processes by which it is played out in contemporary rule and governance? How do these affect health inequity?

  • What is the relationship between the state and other major processes of social division?

  • How do contemporary rule and governance establish barriers to and opportunities for the advancement of health equity?

    • Timor-Leste (East Timor)

    To the north of Australia lies the 21st century’s first nation state – Timor-Leste, or East Timor. After a period of brutal control by Indonesia, which had taken over the former Portuguese colony in 1975, Timor-Leste formally gained its independence in 2002. Today, Timor-Leste is one of Asia’s poorest countries, with more than 80 per cent of its 1.2 million people resident in rural areas. Yet, it has become one of the fastest-growing countries in the world, with a national budget of over US $1 billion per year. Its newfound wealth derives from vast stores of oil and gas in the Timor Sea that have been used to establish a government fund estimated to be worth close to US $12 billion dollars. Along with this wealth has emerged a major rift about what the government should spend this money on.

  • 3 - Class and health

  • Toni Schofield, University of Sydney
  • Book:
    A Sociological Approach to Health Determinants
    Published online:
    06 August 2018
    Print publication:
    03 February 2015, pp 33-59

  • Summary

    Overview

  • What is the social gradient in health? What are some of the key indicators of socio-economic status (SES) used to identify it?

  • What is the relationship between SES and social resources? What kinds of health disparities can it explain?

  • What is specific to class as a domain of social practice? What does it seek to explain in relation to health?

  • What is the division of labour and what role does it play in producing class?

  • How does the ownership and control of the resources needed for producing and distributing goods and services generate class?

  • What are representational practices and discourses? What role do they play in class dynamics?

  • How does class get into peoples’ bodies as health and illness?

    • California, United States, 2013

    As one of this year’s memorable episodes of the television program ‘Keeping Up With the Kardashians’ showed, Kim Kardashian’s pregnancy and baby appeared to be in crisis. Less than a week later, Kardashian and partner Kanye West had their first child, delivering a very happy ending to the medical drama.

    On a l ight during which Kardashian experienced unexpected distress, the reality star reported that she had ‘never experienced pain like this in her life’, and was rushed to her doctor. ‘The episode offered a behind-the-scenes look at her personal anxieties and fears for what has been a very public pregnancy’.

  • 4 - Gender and health

  • Toni Schofield, University of Sydney
  • Book:
    A Sociological Approach to Health Determinants
    Published online:
    06 August 2018
    Print publication:
    03 February 2015, pp 60-82

  • Summary

    Overview

  • What distinguishes gender from other processes of social division? What does it mean to say that gender dynamics are historically and socially variable?

  • How does a sex-differences approach to health characterise the health of men and women? What are the limitations of this approach?

  • What is a gender order and what does it mean to say that it is patriarchal?

  • What evidence is there to say that gender inequality prevails on a global scale?

  • What is gendered health? What are examples of gender dynamics involved in it?

  • What is the relationship between gender dynamics, intersectionality and health disparity?

  • How are gender inequality and patriarchy evident in health disparity?

    • China 1911

    ‘My grandmother’s feet had been bound when she was two years old. Her mother … first wound a piece of white cloth about twenty feet long round her feet, bending all the toes except the big toe inward and under the sole. Then she placed a large stone on top to crush the arch’ (Chang 1991:31). As Jung Chang (1991: 31–2) recounts in her acclaimed personal history about her life in China, the pain from footbinding had been so agonising that her grandmother had screamed in agony, fainting over and over. The procedure had been repeated over several years, with the feet bound day and night to stop them from recovering. Though there had been no reprieve from the pain throughout the process and Jung’s grandmother had pleaded with her mother to stop, the mother could only weep, telling her daughter her life would be ruined without bound feet and that her future happiness depended on it. As Jung explains, such a practice had prevailed in China for about a thousand years. It was only in bed at night that the binding could be relaxed – rarely ever removed and rarely ever witnessed by men. Removal of the binding usually revealed rotting, stinking flesh.

  • 2 - Understanding the social

  • Toni Schofield, University of Sydney
  • Book:
    A Sociological Approach to Health Determinants
    Published online:
    06 August 2018
    Print publication:
    03 February 2015, pp 16-32

  • Summary

    Overview

  • What does it mean to say that the individual is a ‘modern’ invention?

  • In what ways were modernist ideas about the individual central to the development of 18th and 19th-century European thinking about the social?

  • What is ‘social structure’ and what contribution does it make to understanding human being and action?

    • The Atlantic Ocean, somewhere between West Africa and South Carolina, 1756

    The contractions began rolling hard and long and often, and I left it to Fanta (a slave woman) to decide when to push …

    She pushed for a long time, and then she lay back and rested . . . ‘Now,’ Fanta said. She pushed three more times. I saw hairs on a head starting to part her, but the baby wouldn’t come yet. She pushed once more, and the head came all the way out, blue and purplish and light coloured and specked with bits of whiteness and blood. Fanta pushed again, and out came the shoulders. The rest slid out quickly . . . I . . . slice[d] the cord, then I wrapped the baby and gave him to Fanta. The baby cried, and Fanta let it howl good and long before allowing it to root for her nipple. She was not a proud mother, but an angry one. I tried to settle Fanta comfortably on the bed, but she pushed me away. (Hill 2007 : 86–7)

  • 1 - The social determinants of health approach

  • Toni Schofield, University of Sydney
  • Book:
    A Sociological Approach to Health Determinants
    Published online:
    06 August 2018
    Print publication:
    03 February 2015, pp 1-15

  • Summary

    Overview

  • What are health inequities according to a social determinants of health (SDOH) approach?

  • What causes health inequities and how can they be abolished using this approach?

  • What are the limitations of the SDOH approach in addressing and redressing health inequities?

    • Nigeria, around 1970

    Jonathan Iwegbu counted himself extraordinarily lucky. ‘Happy survival!’ meant so much more to him than a current fashion of greeting old friends in the first hazy days of peace … He had come out of the war with five inestimable blessings – his head, his wife Maria’s head and the heads of three out of their four children. As a bonus he also had his old bicycle – a miracle too but naturally not to be compared to the safety of five human heads …

    … [Jonathan] made the journey to Enugu and found another miracle waiting for him. It was unbelievable . . . This newest miracle was his little house in Ogui Overside . . . Only two houses away a huge concrete edifice some wealthy contractor had put up just before the war was a mountain of rubble. And here was Jonathan’s little zinc house of no regrets built with mud blocks quite intact! Of course the doors and windows were missing and five sheets off the roof. But what was that? And anyhow he had returned to Enugu early enough to pick up bits of old zinc and wood and soggy sheets of cardboard lying around the neighbourhood before thousands more came out of their forest holes looking for the same thing. He got a destitute carpenter with one old hammer, a blunt plane and a few bent and rusty nails in his tool bag to turn this assortment of wood, paper and metal into door and window shutters for five Nigerian shillings . . .

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