The objectives are to examine the tension between the ethics of care and the ethics of justice, offer critical analysis and develop an amalgam of key elements from both. A more sufficient framework for moral decision-making will be proposed and its validity assessed. Part One investigates the ethics of care, beginning with a critical analysis of Carol Gilligan's approach to the ethics of care and justice, leading to an exploration of the nature and content of care from key authors in the debate. By focusing on nursing the tensions surrounding care are highlighted. Critical analysis draws out key themes from care including persons, relationships, context and responsibilities. Part Two examines the ethics of justice, concentrating on the substantive theories of John Rawls and Alasdair MacIntyre. Through critical analysis the need for minimum standards of protection for the vulnerable in society is highlighted. The thesis emphasises and argues for justice as equality, fairness and equity, the importance of persons, community, rationality, justification, fittingness, morality, duties and obligations. Part Three argues for an amalgam of key themes from both the ethics of care and justice. This model consists of the crucial role of context, persons and relationships, responsibilities, justice and appropriateness in moral decision-making as a framework for a middle way. After arguing for its sufficiency in theory, it is tested in practice by application to the Child B case. The thesis argues a middle way model is more adequate than either the ethics of care or justice alone for critically examining the decisions and justifications offered in this case. In conclusion, critical reflection on the theory and practice of a middle way model is offered, and its potential for further application and development regarding moral decision-making and training for the caring professions explored.

This thesis is set in the context of social science’s interest in the generation of expectations, the news media, and neurotechnologies. It is a qualitative case study that examines the nature and impact of news media reporting of some pioneering research, which used functional magnetic resonance imaging in an attempt to diagnose and communicate with severely brain-injured individuals. Previous news media studies exploring neurotechnologies have been quantitative, or have tended to focus on how or why the news media represents neurotechnologies and/or the impact of the reporting, but rarely all three together. My thesis looks at all three aspects of the news media reporting of my case study. I draw on three sets of empirical data. First, those related to the production of the media - the press releases which reported the research; ten semi-structured interviews with science press officers; and the relevant expert comments posted on the Science Media Centre’s website. Second, 51 newspaper articles reporting the research. Third, five semi-structured interviews with relatives of severely brain-injured patients. I show that the mood of excitement and ‘breakthrough’ present in the press release reporting of this research was closely echoed in the news coverage. This excitement influenced the views and beliefs of only some of the relatives I interviewed. I then examine the nature of hype and by drawing on Haraway’s concept of ‘situated knowledges’ (1988) I argue that individuals view hype differently depending on their profession, industry and/or socio-cultural background. Finally, I show how whilst both the news media and the scholarly literature portrayed this research as ethically contentious, the issues most prominently discussed by scholars and/or journalists do not necessarily equate with relatives’ concerns. My findings aim to contribute to the sociology of expectations, media theory, the sociology of bioethics and the public understanding of science.

Internet technologies are increasingly advocated as a means for transforming health care and improving people’s health. In the field of e-health questions on the health implications of internet use are typically approached through attempts at measuring the effect of internet use on health outcomes. In this, information is usually conceptualised as a form of knowledge/power and online information practices are enrolled in discourses on patient empowerment. Taking the different meanings ascribed to information in these approaches as my point of departure, in this thesis I rethink the implications of internet use on health through an empirical exploration of alternative conceptualisations of the relationship between information and health in the context of contemporary HIV treatment and care. I do this through two analytical moves. First, drawing on the concept of performativity, a concern with what effect internet use has on health is turned into one of how internet use enacts health. Second, rather than treating information as knowledge/power, through an analysis of how a specific group of women ‘living with HIV’ in the UK use the internet, I reconfigure the connections between internet use and health through a conceptualisation of information as care. Drawing on a range of empirical materials – including forty-seven in-depth interviews with patients and internet content providers, non-participant observations, document and website analysis – three areas of health-related internet use are analysed in detail: the seeking out of health-related and specifically biomedical information; the seeking out and sharing of experiential knowledge and narratives about living with HIV; meeting prospective partners and dating. However, rather than studying these areas of internet use in order to interrogate what they can tell us about the internet, I analyse them as part of the ethical regime of ‘living with HIV’, in which the virus, previously thought of as ‘terminal’, becomes, through info and bio technologies, normalised as ‘chronic’. From this perspective, enacting health not only entails working on and with one’s body, but also always invokes its distribution across bodies, to other areas and relations, including internet technologies and the networks of relations established via these technologies.

Thesis advisor: James Keenan / Environmental conservation is a pressing issue for modern humans. Health care systems and the consumption of medical goods should therefore be assessed in light of environmental sustainability. While the primary focus of environmental bioethics has been hospitals and health care facilities, ethicists must also address the offerings of the medical industry going forward. My dissertation proposes four principles to assess the environmental sustainability of current and future medical developments, techniques, and procedures. The four principles of green bioethics are: 1. General allocation of resources should precede special interest access: distributive justice 2. Current human needs over current human wants: environmental conservation 3. Simplicity before complexity: reducing dependence on medical intervention 4. The common good should drive health care instead of financial profit: ethical economics. The four principles of green bioethics will move environmental bioethics into the 21st century in a responsible and sustainable manner. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Theology.

<p>The intimate connection between autonomy and decision-making in applied health care, especially in various kinds of consent and refusal has taken center stage in medical ethics since the Salgo decision in 1957. Prior to that time, the physician’s supposedly moral duty to provide appropriate medical care typically surpassed the legal obligation to respect patient’s autonomy. The Salgo decision concluded that physicians have a legal duty to provide facts necessary for the patient to make an informed decision. "The doctor knows best" long ago was replaced with "The doctor proposes; the patient disposes." There is no legal obligation for the patient’s choice to be palatable to anyone, other than that patient himself/herself. Although Beauchamp and Childress justified the obligation to solicit decisions from patients and potential research subjects by the principle of respect for autonomy, they however, acknowledged that the principle’s precise demands remain unsettled and open to interpretations and specification. This thesis addresses a current debate in the bioethical community on the four-principle approach. Using Tom Beauchamp and James Childress as case study, to discuss mainly the principle of respect for autonomy, I go on to explain their central arguments concerning this principle in relation to decision making in health care ethics. Rather than focus on their respective weaknesses, which many theorist and health care professionals do, I emphasis instead on the contribution the principle of respect for autonomy can make in the process of ethical decision making in health care situation.</p>

The intimate connection between autonomy and decision-making in applied health care, especially in various kinds of consent and refusal has taken center stage in medical ethics since the Salgo decision in 1957. Prior to that time, the physician’s supposedly moral duty to provide appropriate medical care typically surpassed the legal obligation to respect patient’s autonomy. The Salgo decision concluded that physicians have a legal duty to provide facts necessary for the patient to make an informed decision. "The doctor knows best" long ago was replaced with "The doctor proposes; the patient disposes." There is no legal obligation for the patient’s choice to be palatable to anyone, other than that patient himself/herself. Although Beauchamp and Childress justified the obligation to solicit decisions from patients and potential research subjects by the principle of respect for autonomy, they however, acknowledged that the principle’s precise demands remain unsettled and open to interpretations and specification. This thesis addresses a current debate in the bioethical community on the four-principle approach. Using Tom Beauchamp and James Childress as case study, to discuss mainly the principle of respect for autonomy, I go on to explain their central arguments concerning this principle in relation to decision making in health care ethics. Rather than focus on their respective weaknesses, which many theorist and health care professionals do, I emphasis instead on the contribution the principle of respect for autonomy can make in the process of ethical decision making in health care situation.

Proefschrift Radboud Universiteit Nijmegen.

Assent, currently defined as “a child’s affirmative agreement”, is a way in which some children are included in the decision-making process regarding their participation in clinical research. Current guidelines for paediatric research do not provide clear directions for how assent should be handled, resulting in confusion among researchers. The goal of this research project was two-fold: to examine the ethical arguments for assent with a view to developing concrete moral justification for its being required, and to develop a framework of significant issues for an investigator to consider when deciding whether to gain assent from an individual child. After an in-depth analysis, it was determined that the ethical justification for assent arises from the researcher’s dual obligations to the child and his parents. A child’s parents are responsible for determining when and how he will develop his decision-making ability. The researcher has an obligation to engage with the child in a manner that complements their pedagogical style, while also treating the child as a being of moral worth. As a child’s family context has an influence on his participation in medical decision-making, further research on children’s daily decision-making within their families is needed. To this end, a three-phase research agenda was designed: a qualitative focus group study, a quantitative questionnaire study, and a discussion panel with paediatric experts. The children in these studies clearly desired to make decisions but did not express an interest in having complete control. They expected their parents to provide them with decision-making guidance in most aspects of their lives. Data collected from parents illustrated that they often tried to involve their children in decisions by providing them with limited options from which to choose and encouraging family discussion. Participants in the discussion panel stated that they did not expect children to make an independent decision regarding medical care, but they might attempt to give children smaller decisions, such as the arm used to provide a blood sample. These results indicate that the definition of assent should be revised, emphasising the child’s involvement in the overall decision making process, without an expectation of an “affirmative agreement”, likely mimicking a familiar decision-making setting from his family context. This could then be documented in the child’s clinical notes through a brief description of all relevant interactions and/or discussions with the child, resulting in an accurate portrayal of the entire assent process.

Das Dissertationsvorhaben greift zu Beginn einen Praxisfall im Krankenhaus auf und verdeutlicht exemplarisch, dass der Krankenhausarzt in einen Konflikt zwischen ökonomischen und ethischen Anforderungen gerät. Um die Frage beantworten zu können, wie die soziale Praxis der Krankenhausärzte gelingen kann, wird das Problem im ersten Schritt rekonstruiert. Nach der Diskussion verschiedener Lösungsansätze für das Problem im zweiten Schritt, werden im dritten Schritt Anregungen für die Praxis abgeleitet.

Made available in DSpace on 2016-04-27T13:10:21Z (GMT). No. of bitstreams: 1 Marcelo Marques Ferreira.pdf: 1136535 bytes, checksum: 3c653d7eaddb2859712b6d72d5995c0d (MD5) Previous issue date: 2013-06-12 / The Community Health Workers (CHW) show themselves to be intriguing actors in what concerns the dialogue between the common knowledge and practice with the medical and scientifical knowledge. By the very nature of their work, they deal with an ethical and humane practice, which is connected to the very exercise of citizenship. However, neither do they possess a Code of Professional Ethics that endorses them, nor are they trained to solve ethical problems related to their daily life. Hence, the goal of this dissertation submitted as a requirement for the Master's degree was to show the perception of the inherently ethical aspects of the CHW who work in the Family Health Teams (FHT) in the city of Rolândia, state of Paraná, Brazil, by the means of a study that was both quantitative and qualitative and of descriptive ethics, hence non-normative. The subjects of said study were 52 (fifty two) female CHW out of the 72 (seventy two) CHW who work in the twelve FHT in that city. For the acquiring of systematic data, two steps were taken: 1) A sociologic and economic questionnaire was applied, followed by 2) a semi-structured interview, in which all CHW were exposed to three theoretical situations that are common in their daily practice, concerning: Systemic hypertension (SH), human immunodeficiency virus (HIV) and taking care of teenagers. All of their interviews were read and analyzed by the "content analysis" method. Eight thematic axes were identified, allowing their perceptions on daily ethical issues to be comprehended. Even though the participants don't have a code of deontology, they tend to guide their conduct by their own moral principles and did present answers that were considered, most of the times, to be correct. However, every single one of them stated that they believe the existence of such code to be necessary, in example of other professional categories. The interviews revealed the ethical dilemmas that spring from such a close relation to the community and also how these women perceived the complexity of these, otherwise, simple hypothetical situations. The proposed educational measure of intervention is the contextualized training of the CHW that work in Rolândia, which will certainly enhance their capability to take action / Os Agentes Comunitários de Saúde (ACS) revelam-se atores intrigantes no que se refere ao diálogo entre os saberes e práticas populares com o conhecimento médico-científico. Pela natureza do seu trabalho, lidam com uma prática ética, humana e vinculada ao exercício da cidadania. No entanto, não possuem um Código de Ética Profissional que os respaldem ou são capacitados para solucionar questões éticas relacionadas ao seu cotidiano. Nesse sentido, o objetivo dessa dissertação de mestrado foi revelar a percepção dos aspectos éticos inerentes ao processo de trabalho dos ACS que atuam na ESF do município de Rolândia, do estado do Paraná, por meio de estudo, quantitativo e qualitativo, de ética descritiva, portanto, de cunho não normativo. Os sujeitos do estudo foram 52 (cinquenta e dois) ACS do sexo feminino dos 72 (setenta e dois) que trabalham nas 12 (doze) equipes da Estratégia de Saúde da Família (ESF) de Rolândia, Paraná. Para coleta sistemática dos dados foi aplicado um questionário para obtenção dos dados sociodemográficos (primeira etapa) seguido de entrevista semi-estruturada (segunda etapa), onde as ACS foram expostas a três situações hipotéticas comuns em sua vivência profissional sobre: Hipertensão Arterial Sistêmica (HAS), Vírus da Imunodeficiência Humana (HIV) e atendimento com adolescentes. Os discursos foram lidos e analisados pelo método da análise de conteúdo . Oito eixos temáticos foram identificados permitindo a compreensão da percepção das ACS quanto a questões éticas cotidianas. Apesar das participantes desta pesquisa não terem o referencial de um código de deontologia, balizam sua conduta em preceitos morais e apresentaram respostas que foram consideradas em sua maioria corretas. No entanto, todas as ACS declararam que acham importante a existência de legislação específica, à semelhança de outras profissões. As entrevistas revelaram os dilemas éticos oriundos deste relacionamento próximo com a comunidade e como elas percebem os casos apresentados, que são triviais, mas complexos. A medida de intervenção educativa proposta é a capacitação contextualizada das ACS de Rolândia, o que certamente potencializará suas ações