Background   The patient's rights to self-determine their own health care is described in Swedish legislation and guidelines. However, due to infancy, unconsciousness, severe brain damage or certain diseases, some patients might be unable to make such decisions. Ethically difficult situations do occur, not infrequently associated with culture. Since the patient is vulnerable, there is a risk that the patient in the treatment and care can not be bothered to maintain right to autonomy and that the nurse violates patient integrity. Aim                 The aim of this study was to illustrate the nurse's dilemma when the patient refuses vital caring efforts. Method           A literature review of eight scientific articles with a qualitative approach was performed. Results           The results revealed the following domains to describe the nurse's dilemma when the patient refuses vital care interventions: patients’ reasons for treatment refusal, the nurse's understanding of the patient's refusal of care and contradictory legislation Conclusion     More knowledge and discussion of the patient's decision-making competence is needed for both the nursing profession and those who make decisions on legislation.

Approved for public release; distribution in unlimited. / This study examines ethical dilemmas in the workplace and how organizational members move to resolve these challenges. Existing research was reviewed to gain insight and determine current views of ethical dilemmas experienced at work. A study was then conducted with Supply Corps Officers in the U.S. Navy to better understand the dilemmas they face in their daily work life. Officers were asked to think of a critical incident when they faced a moral challenge and how they responded. Data procured from critical incident interviews is suggestive of how officers describe ethical dilemmas, how they identify options for action, and finally how they select a course of action. The dilemmas generally involved issues with financial accountability, fairness in performance evaluations, fraternization, homosexuality in the service, employee drug and alcohol abuse, fraudulent use of government property and funds, conflict between personal and military values, and managing important relationships. This initiative, supported by the Chief of the Supply Corps, is designed to be a promising start toward creating an informed strategy, one that will ultimately lead to the design of enhanced educational programming regarding moral behavior in the military. / Lieutenant Commander, Supply Corps, United States Navy

This paper is the result of an empirical research project analysing the decision behaviour of Austrian managers in ethical dilemma situations. While neoclassical economic theory would suggest a pure economic rational basis for management decisions, the empirical study conducted by the authors put other concepts to a test, thereby analysing their importance for managerial decision making: specific notions of fairness, reciprocal altruism, and commitment. After reviewing some of the theoretical literature dealing with such notions, the paper shows the results of an online survey working with scenarios depicting ethical dilemma situations. By judging such scenarios the respondents showed their preference for the named concepts, though with different degrees of confirmation. The results (with all limitations of an online survey in mind) support the theoretical work on the named concepts: Fairness elements (including Rawlsian principles of justice and an understanding of fairness as conceived by a reference transaction) play a major part in management decisions in ethical dilemma situations. Also, commitment as a behaviour that sticks to rules even if personal welfare is negatively touched, and reciprocal altruism as a cooperative behaviour that expects a reciprocal beneficial action from other persons have been concepts used by Austrian managers when analysing ethical dilemmas. The article also tries to put the results into a comparative perspective by taking into account other studies on ethical decision factors conducted with e.g. medical doctors or journalists, and by discussing intercultural implications of business ethics.

Ethical dilemmas often reflect expected concerns – alleviating distress, protecting confidentiality, and maintaining integrity in one’s work. But forensic fringe elicits what seemingly only exists in suspense thrillers. What if you (quite literally) know where the bodies are buried? What if a high-ranking politician publicly declares your client dangerous (and they’re not)? What if your research contributes to bad legislation? Here, enter an escape room of ethical reasoning. Contemplate interesting and intricate dilemmas involving unique client considerations, competing legal and political interests, questions of personal morality, values, and public safety, and the role of science in ethical research and clinical practice.

This two-phase, sequential mixed methods study explored how student affairs professionals resolved professional ethical dilemmas. A student affairs professional was defined as an individual whose educational background and work experience are in student affairs. An ethical dilemma is defined as a situation in which two ethical principles are at odds rather than a simple matter of right versus wrong (Kitchener, 1985). A professional ethical dilemma is an ethical dilemma in the context of a person's work-related experience. The first phase of the study was a qualitative exploration of how representatives of the Council for the Advancement of Standards in Higher Education (CAS) resolve professional ethical dilemmas by interviewing the representatives. The second phase of this study was confirmatory. An online questionnaire was designed and administered to members of the National Association of Student Personnel Administrators (NASPA) who held positions similar to those held by the phase one sample. The questionnaire was designed to confirm the findings from phase one about ethical dilemma resolution. The study found that professional ethical dilemmas are very complex, involving multiple ethical principles, multiple roles of the person facing the dilemma, and multiple constituent groups involved in the dilemma. Despite this complexity, student affairs professionals use a relatively simple resolution process of serious reflection and conferring with others. Considerations of self (e.g. role in dilemma and impact on self) and the wider organization (e.g. legal implications and political implications) were used in the resolution process. The study also found that student affairs professionals' personal values helped them prioritize the vying ethical principles involved in the dilemma so that they could make a decision that they believed was ethical. / Ph. D.

The aim was to increase understanding of the ethical dilemma that assistant nurses in special accommodation for people with dementia experienc, how they handle them, and how they perceive and deal with emotional stress. We used a qualitative approach in form of semi-structured interviews and vignettes. Our selection were assistant nurses working in dementia care in southern Sweden. We found that ethical dilemmas in dementia care are many and affects different areas. The one thing they have in common was that at least two choices conflict with each other and none of them lead to any positive result for the residents. We have found three common categories for how the caregivers handle the dilemmas: attract and clamoring, white lies and the healthy. The caregivers experience and are influenced by ethical in different ways. But everyone finds it hard when plans don’t turn out the way they thought from the beginning. The assistant nurses found that external factors were most stressful because external factors are difficult to change. All the assistant nurses are affected, but in which way, and to what degree, depends on the individual. They handle the emotional stress in similar ways by taking a walk, taking a five minutes break or to consider the residents best interest. Our conclusion was that nurses deal on a daily basis with ethical dilemmas and that they experience a lot of stress because of them.

Thesis (M.Sc. (Curations)) --University of Limpopo, 2015 / The purpose of the study was to determine the experiences of professional nurses with ethical dilemmas at the Witbank hospital Nkangala district Mpumalanga province. The objectives of the study were to describe the experiences of professional nurses with ethical dilemmas in nursing practice and to determine supportive measures to help professional nurses to deal with ethical dilemmas encountered in nursing practice. The research question was: what are the ethical dilemmas that professional nurses experience in nursing practice? Kohlberg theory of moral development was used as a theoretical framework. A qualitative exploratory, descriptive and contextual research design was used to describe the experiences of professional nurses with ethical dilemmas in nursing practice. Purposive sampling was used to sample fourteen (14) professional nurses. Data was collected using semi-structured interviews. Open-coding method of data analysis was used and four themes and sub-themes emerged. The study found that professional nurses experience ethical dilemmas related to death and dying, distribution of both human and material resources, respect of patients’ autonomy and the nurses’ rights. The study recommends continuous ethics education and the inclusion of ethics in nursing curricula, creation of a supportive working environment, knowledge and understanding of the pledge of service, Inter- disciplinary teams to discuss ethical issues, availability of ethics experts and ethics mentors in the wards.

<p>Syftet med denna uppsats var att undersöka hur studie- och yrkesvägledare på Jobbtorg arbetar med de dilemman som kan uppstå kring de etiska riktlinjerna. Författarnas hypotes har varit att det är svårt att tillämpa de etiska riktlinjerna i en målstyrd verksamhet som Jobbtorg. En kvalitativ metod har används där fem slumpmässigt utvalda studie- och yrkesvägledare på Jobbtorg Stockholm har intervjuats. Resultatet visar på att studie- och yrkesvägledarna upplever dilemman kring deras yrkesetik, men har utarbetat olika strategier för att hantera dessa dilemman. Det visade sig att studie- och yrkesvägledarna hade skapat sig ett stort arbetsutrymme kring studie- och yrkesvägledningen på Jobbtorg. Dilemman som de intervjupersonerna istället belyste var bland annat ekonomiska riktlinjer inom försörjningsstöd, att förmedla objektiv information och aspiranternas önskan om expertutlåtanden.</p> / <p>The purpose of this essay was to examine how the guidance counselour on Jobbtorg Stockholm works with the dilemmas which may arise over the ethical guidelines. The authors' hypothesis has been that it is difficult to apply the ethical guidelines of a targeted activity such as Jobbtorg. A qualitative approach was used in which five randomly selected guidance counselours on Jobbtorg Stockholm were interviewed. The result shows that guidance counselours experience dilemmas about their professional ethics, but have developed different strategies to deal with these dilemmas. It turned out that the guidance counselours have created a wide space around the guidance and counseling on Jobbtorg. Dilemmas that the interviewees rather highlighted, among other was economic policies, to provide objective information and the clients desire for expert advice.</p>

Syftet med denna uppsats var att undersöka hur studie- och yrkesvägledare på Jobbtorg arbetar med de dilemman som kan uppstå kring de etiska riktlinjerna. Författarnas hypotes har varit att det är svårt att tillämpa de etiska riktlinjerna i en målstyrd verksamhet som Jobbtorg. En kvalitativ metod har används där fem slumpmässigt utvalda studie- och yrkesvägledare på Jobbtorg Stockholm har intervjuats. Resultatet visar på att studie- och yrkesvägledarna upplever dilemman kring deras yrkesetik, men har utarbetat olika strategier för att hantera dessa dilemman. Det visade sig att studie- och yrkesvägledarna hade skapat sig ett stort arbetsutrymme kring studie- och yrkesvägledningen på Jobbtorg. Dilemman som de intervjupersonerna istället belyste var bland annat ekonomiska riktlinjer inom försörjningsstöd, att förmedla objektiv information och aspiranternas önskan om expertutlåtanden. / The purpose of this essay was to examine how the guidance counselour on Jobbtorg Stockholm works with the dilemmas which may arise over the ethical guidelines. The authors' hypothesis has been that it is difficult to apply the ethical guidelines of a targeted activity such as Jobbtorg. A qualitative approach was used in which five randomly selected guidance counselours on Jobbtorg Stockholm were interviewed. The result shows that guidance counselours experience dilemmas about their professional ethics, but have developed different strategies to deal with these dilemmas. It turned out that the guidance counselours have created a wide space around the guidance and counseling on Jobbtorg. Dilemmas that the interviewees rather highlighted, among other was economic policies, to provide objective information and the clients desire for expert advice.

SAMMANFATTNING Syftet med föreliggande studie var att undersöka dialyssjuksköterskors upplevelse i mötet med en patient som vill avsluta, eller som inte är kapabel att uttrycka sig kring, sin livsuppehållande dialysbehandling. En deskriptiv intervjustudie med kvalitativ ansats utfördes på två dialysmottagningar i Mellansverige. Innehållsanalys av intervjuerna genomfördes vilket gav fem huvudkategorier; sjuksköterskors upplevelse av bristfällig kommunikation och samarbete med läkare, sjuksköterskors upplevelse av läkares svårigheter att diskutera avslutande av dialysbehandling, sjuksköterskors upplevelse av att vårda patienter som inte är kapabla att uttrycka sig kring sin dialysbehandling, sjuksköterskors upplevelse av att vårda patienter som säger, eller på något annat sätt uttrycker, att de vill avsluta sin dialysbehandling och sjuksköterskors upplevelse av stöd och samtal i vården kring patienter som vill avsluta sin dialysbehandling. Huvudresultatet visar att dialyssjuksköterskor upplever många etiska dilemman i mötet med denna patientgrupp. Mötet med en patient som säger, eller på något annat sätt uttrycker att de vill avsluta behandlingen upplevdes positivt, dock upplevdes innebörden av uttrycken ibland vara svåra att tolka. Sjuksköterskorna upplevde det många gånger frustrerande att vårda en patient som inte är kapabel att uttrycka sin vilja om fortsatt eller avslutande dialysbehandling. Slutsatsen var att ytterligare forskning inom detta område är nödvändig för att rutiner och riktlinjer skall kunna utformas. / ABSTRACT The aim of the study was to investigate the dialysis nurses' experience of meeting with a patient who wants to end, or a patient who is not able to express itself about, its life-sustaining dialysis treatment. A descriptive interview study with qualitative approach was used on two dialysis centers in central Sweden. Content analysis of the interviews were conducted which resulted in five main categories: nurses' experience of poor communication and cooperation with physicians, nurses' experience of physician's difficulty to discuss the closure of the dialysis treatment, nurses' experience of caring for patients who are unable to express themselves about their dialysis treatment, nurses' experience of caring for patients saying, or otherwise expressing, that they want to end their dialysis treatment and nurses' experience of support and conversations in health care, around patients who want to end their dialysis treatment. The main result shows that dialysis nurses experience many ethical dilemmas facing these patients. The meeting with a patient saying, or otherwise expressing, that they want to end their dialysis treatment was perceived positively, however, could the meaning of the expression sometimes be difficult to interpret. The nurses, often times, felt frustrating to care for a patient who is unable to express themselves about their dialysis treatment. The conclusion was that further research in this area is necessary so that procedures and guidelines can be designed.