No / The challenges associated with patient-based research in palliative care are well documented. This paper focuses on the ethical challenges and discusses them in the context of a pilot study to explore the palliative-care needs of patients with moderate and severe chronic obstructive pulmonary disease. The main ethical challenge encountered related to problems surrounding the use of terminology, specifically the terms ‘palliative care’ and ‘chronic obstructive pulmonary disease’. The approving ethics committee specified that these terms be removed from all patient materials in order to protect patients from undue distress. The impact of this ethical advice on patients’ ability to give fully informed consent is discussed. This paper highlights a requirement for appropriately resourced and well-managed studies in palliative care, and identifies a need for the development of appropriate strategies in order to ensure the informed participation of patients with non-cancer diagnoses in palliative-care research.

Research Doctorate - Doctor of Philosophy (PhD) / Registered nurses, while carrying out their professional roles, regularly encounter situations with ethical components. While there are research findings reporting the types of ethical challenges nurses face, their level of involvement in ethical decision-making, and reasoning processes used, how nurses actually deal with situations that challenge them personally has not been specifically explored. The purpose of this study was to investigate the psychosocial processes that can explain how registered nurses reason and make decisions when faced with ethical situations that challenge their personal values and belief systems. A grounded theory approach was used to conduct the study, allowing a substantive theory to be developed. Twenty-three nurses, currently working in metropolitan or regional areas in New South Wales, volunteered to participate in the study. Two methods of data collection were utilised, the first being semi-structured, in-depth interviews which were audio taped then transcribed. The second method used hypothetical vignettes with associated questions to which the participants were invited to anonymously return written responses. Data were managed by means of the computer program NVivo 2, while constant comparative analysis using open, axial and selective coding, as outlined by Strauss and Corbin (1998), was performed. The substantive theory which emerged from the data explains the processes used by nurses when they have to deal with ethical challenges to their personal values and beliefs. The basic psychosocial process (core category) of protecting client autonomy reveals a pattern of moral reasoning that gives priority to the client’s self-determined choices. This subsumes the key processes (subcategories) of: (1) being self-aware, (2) determining duties to other/s versus self, (3) engaging self as protector, and (4) restoring self from tension or anguish, which link to each other and to the core category to explain the various sub-processes used when protecting client autonomy is considered a priority. Findings in the study revealed that nurses who give primacy to client autonomy believe they should not impose their own preferred choices on to clients. Yet the emphasis on client autonomy is also paradoxical, since it may come at the cost of compromise and even denial of the nurses’ own autonomy and their deeply held values and beliefs. When they become aware that their personal values and beliefs are being challenged, they are at times prepared to compromise their own values or beliefs, yield to constraints, or put themselves at risk in order to protect the autonomy of clients. Such actions can leave nurses experiencing ethical tension or anguish for which they need to seek support. Opportunities to find appropriate support are not always available to them in the work environment. The findings in this study have important implications for both nurses and the nursing profession. The pattern of moral reasoning shows generosity and nurses’ commitment to their caring and advocacy roles. However, when nurses are regularly prepared to compromise their own values or beliefs because they give priority to protecting client autonomy, there is a risk they may be left with a sense of loss to their personal worth and in their ability to be moral agents. Further, in some situations it may occur out of complacency because they simply accept that it is the client’s choice, absolving the nurse of further moral responsibility. Appropriate support systems need to be available to nurses to help them deal with the consequences which may occur as a result of giving preference to clients’ choices, over their own.

Unique characteristics of cluster randomized trials (CRTs) complicate the interpretation of standard research ethics guidelines. Variable interpretation by research ethics committees may further complicate review and conduct. An international web-based survey was administered to corresponding authors of 300 randomly sampled CRT publications. We investigated ethics review and consent practices, investigator experiences with ethics review, and the perceived need for CRT-specific ethics guidelines. The response rate was 64%. Ethics review and consent were under-reported in publications. Ethics approval was obtained in 91%, and consent from individual and cluster level participants in 79% and 82% of trials. Consent varied by level of experimental intervention, data collection, and cluster size. Respondents cited variability among ethics committees (46%), and negative impacts of ethics review on their studies (38%). The majority perceived a need for ethics guidelines (73%), and guidance for ethics committees (70%). CRT-specific ethics guidelines are required to ensure practices meet ethical standards.

Unique characteristics of cluster randomized trials (CRTs) complicate the interpretation of standard research ethics guidelines. Variable interpretation by research ethics committees may further complicate review and conduct. An international web-based survey was administered to corresponding authors of 300 randomly sampled CRT publications. We investigated ethics review and consent practices, investigator experiences with ethics review, and the perceived need for CRT-specific ethics guidelines. The response rate was 64%. Ethics review and consent were under-reported in publications. Ethics approval was obtained in 91%, and consent from individual and cluster level participants in 79% and 82% of trials. Consent varied by level of experimental intervention, data collection, and cluster size. Respondents cited variability among ethics committees (46%), and negative impacts of ethics review on their studies (38%). The majority perceived a need for ethics guidelines (73%), and guidance for ethics committees (70%). CRT-specific ethics guidelines are required to ensure practices meet ethical standards.

Unique characteristics of cluster randomized trials (CRTs) complicate the interpretation of standard research ethics guidelines. Variable interpretation by research ethics committees may further complicate review and conduct. An international web-based survey was administered to corresponding authors of 300 randomly sampled CRT publications. We investigated ethics review and consent practices, investigator experiences with ethics review, and the perceived need for CRT-specific ethics guidelines. The response rate was 64%. Ethics review and consent were under-reported in publications. Ethics approval was obtained in 91%, and consent from individual and cluster level participants in 79% and 82% of trials. Consent varied by level of experimental intervention, data collection, and cluster size. Respondents cited variability among ethics committees (46%), and negative impacts of ethics review on their studies (38%). The majority perceived a need for ethics guidelines (73%), and guidance for ethics committees (70%). CRT-specific ethics guidelines are required to ensure practices meet ethical standards.

This study examines the convoluted challenges of different professions and their duty to report to Social Services if suspicion or knowledge of a child being in physical or mental danger occurs. In Sweden this is regulated by the law 14:1 SoL that requires personnel in their work with minors to report the slightest concern of danger without any circumstances. Previous research studies have found that there are noticeable lack of reports within the professions covered by this law. The degree of reporting differs between the professional groups that have a reporting obligation, but what all have in common is that the reporting rate is low in all. Therefore, the aim of this study has been to examine different professionals’ experiences of being in the process of reporting concern of a child, with focus on possible contexts that put professionals in ethically difficult situations. To answer these questions we’ve performed semi-structured interviews with six different professionals from four different organisations in Malmö. The analysis is based on two theories which are professional ethics and normative ethics. The final conclusions were that these theories combined with the empirical data generated in three different themes that causes difficulties within the process of reporting to Social Services. These themes were: relationships and trust, policies and guidelines, and norms and values. In decision-making, an internal ranking arises between norms, values ​​and obligations in relation to the policies and guidelines that are relevant in the workplace. In the event of disruptions within these factors, it can be difficult to maintain a good and a legally safe work ethic which could lead to a lack of reports to Social Services.

Bakgrund: Palliativ vård definieras som hälso- och sjukvård med syfte att lindra lidande och främja livskvaliteten för patienter med progressiv, obotlig sjukdom eller skada. Palliativ vård omfattar holistiskt synsätt på patienter som inkluderar fysiska, psykiska, sociala och existentiella behov samt känslomässiga aspekter av vård och involverar både anhöriga och patienter. Palliativ vård är tidskrävande, vilket medför etiska utmaningar för sjuksköterskor och påverkar den vård som ges till patienterna.Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors upplevelser av etiska utmaningar inom palliativ vård.Metod: En litteraturstudie med kvalitativ ansats har genomförts baserade på 12 studier med totalt 221 medverkande legitimerade sjuksköterskors upplevelser av etiska utmaningar inom palliativ vård. Sökningarna gjordes i databaser CINAHL och PubMed, artiklarnas kvalitet granskades med hjälp av SBU:s granskningsmall. Resultat: I resultatet identifierades sju teman: Etiska utmaningar kring patientens autonomi och självbestämmande, Etiska utmaningar kring anhörigas involvering och stöd, Etiska utmaningar kring kommunikationen, Etiska utmaningar kring beslut om livsuppehållande åtgärder, Etiska utmaningar kring andliga och kulturella behov, Etiska utmaningar kring sjuksköterskornas känslomässiga belastning, Etiska utmaningar i samverkan med annan personal. Slutsats: Kommunikationsutmaningar och samarbetsproblem inom vårdteam påverkade också omvårdnad av palliativa patienter. Förbättrad kommunikation, tydligare riktlinjer och ökat stöd var påpekat av sjuksköterskor som behov för att säkerställa en mer patientcentrerad och etiskt hållbar palliativ vård.Nyckelord: Etiska utmaningar, komfort, kommunikation, palliativ vård, sjuksköterskors upplevelser. / Background: Palliative care is defined as health care division with the aim of alleviating suffering and promoting quality of life of patients with progressive, incurable disease or injury. Palliative care encompasses a holistic view of the patients that includes physical, psychological, social and existential needs as well as emotional aspects of care and involves both patients and their relatives. Palliative care can be time demanding, which poses ethical challenges for nurses and affects the care given to patients. Aim: This literature review aimed to illuminate nurses’ experiences concerning ethical challenges in the context of palliative care.Method: A literature study with a qualitative approach was performed based on 12 qualitative primary studies which included a total of 221 registered nurses' experiences of ethical challenges in palliative care. The searches were made in databases CINAHL and PubMed, quality checked using SBU's review template. Result: Seven main themes were identified in the results: Ethical challenges regarding the patient's autonomy and self-determination, Ethical challenges regarding the involvement and support of relatives, Ethical challenges regarding communication, Ethical challenges regarding decisions about life-sustaining measures, Ethical challenges regarding spiritual and cultural needs, Ethical challenges regarding the nurses' emotional burden, Ethical challenges in collaboration with other personal. Conclusion: Nurses in palliative care faced ethical challenges regarding patient autonomy and well-being, communication and collaboration. Communication challenges and collaboration problems within care teams also affected care of palliative patients. The nurses believed that improved communication, clearer guidelines and increased support are needed to ensure more patient-centred and ethically sustainable palliative care. Keywords: Comfort, communication, ethical challenges, nurses' experiences, palliative care.

The overall objective of this thesis is to examine in what way ethical theory and ethical analysis can contribute to further understanding of the ethical challenges of the multicultural classroom. Based on the fact that the world is going through a process of globalization and migration, the education-system and daily praxis of teaching is put in front of new ethical challenges. The teacher in the multicultural classroom is on a daily base confronted with various dilemmas regarding for example conflicting duties, universal and conflicting values and citizenship. Martha Nussbaum´s theory of world citizenship is used as an analytical framework for the thesis and student interviews from upper secondary school is used as a complementary perspective to Nussbaum´s theory. The research questions of the thesis are: Can the theory of World Citizenship Education, when structured and analyzed, give guidance for teaching citizenship in a multicultural classroom? Is it a plausible theory confronted with the ethical challenges of the multicultural classroom? In what way can a student perspective from a multicultural classroom try the relevance and present a complementary perspective to the theory of World citizenship education? The theory and the interviews are analyzed and structured out of the research questions and by the three ethical challenges of universal values, conflicting values and sense of belonging. The conclusion of the thesis states that, even though Nussbaum´s theory does have some constraints, it is to a large degree applicable and possible to relate to the ethical challenges of the multicultural classroom and as a guide for teachers. The theory is plausible in some aspects because it presents reasonable arguments on the necessity of educational reform in an interconnected world and because it makes educational proposals of instrumental worth of the teacher. The theory is however not plausible in other aspects because; the universal values presented are to vague and not specified which makes the theory difficult to use in practise, it does not pay enough attention to the conflicting perspective of the ethical challenges in classroom nor the pedagogical importance of social inclusion when discussing conflicting values and finally the theory demonstrates a contradiction regarding how to act as a teacher about sense of belonging and recognising identity of the students. The interviews demonstrate similar but also different responses to the ethical challenges in comparison with the theory. The students recognize the existence of universal values across cultural borders in a similar way as Nussbaum, even though the values put forward are of another character than Nussbaum´s. They do however present a sceptical view towards the idea of a world citizenship and stresses the importance of bringing up discussions about nationhood, migration and belonging without being afraid of breaking any taboos. At the end the thesis presents some practical guidelines for the teacher in the multicultural classroom that follows logical out of the conclusion. The final discussion highlight the fact that the challenges of the multicultural classroom in Sweden will likely continue, and emphasizes the potential of using ethics as an analytical tool for further developing a professional teaching approach.

Den kvalitativa studien har syftat till att undersöka handläggningen och verkställigheten av parboendegarantin i det svenska välfärdssystemet ur biståndshandläggare och enhetschefers perspektiv inom äldreomsorgen. Studien har givit en inblick i hur de yrkesverksamma med erfarenhet av parboendegarantin beskrivit samspelet mellan organisation, professionsetik och professionellt handlingsutrymme i etiska utmaningar som kan uppstå under handläggningen och verkställigheten. För att erhålla en fördjupad och nyanserad kunskap kring parboendegarantins process har åtta professionella från fem olika kommuner deltagit i intervjuer där resultatet visade att alla informanter uppfattade parboendegarantin som en mänsklig rättighet för äldre. I övrigt framkom likheter i hur etiska utmaningar hanterades gällande exempelvis besittningsrätt. Studien visade även på framträdande skillnader i verkställandet av parboendegarantin vilket gav slutsatsen att riktlinjer behövs. / The qualitative study aimed to explore the administration and execution of the cohabitation guarantee (parboendegaranti) in the Swedish welfare system through the perspective of the caseworkers and the branch heads within elderly care. The study provided the professionals perception of the interaction between organization, professional ethics and professional capacity for action regarding the ethical challenges that can occur processing the cohabitation guarantee. Acquiring the insight of the professional perspective the study was based on eight qualitative interviews with professionals from five Swedish municipalities that have experience with the cohabitation guarantee. The results showed that the professionals perceived the cohabitation guarantee as a human right for the elderly and similarities were found in methods to cope with ethical dilemmas such as the right to tenency after the death of a spouse. Significant differences in how the cohabitation guarantee was executed were found which led to the conclusion that guidelines are needed.

Given the state and social homophobias one can encounter in Cameroon, it can be rightly assumed that MSM (men who have sex with men) constitute an extraordinarily vulnerable group. Such vulnerability, besides its legal nature, encompasses a number of sexual risk behaviours and psychological distress precisely derived from criminal prosecution and social discrimination. For that reason, and following the humanitarian imperative, humanitarian actors might want to launch an operation targeting such populations. Nevertheless, various ethical challenges linked to conflicting humanitarian principles, the post-colonial socio-political positions, and the diversity of queer identities might arise. This thesis will explore such ethical challenges, in an attempt to sensitise foreign humanitarians about the most sensible, yet effective, ways to support MSM in 21st- century Cameroon. The methodology used will include primary data collection through interviews and open- ended questionnaires, secondary data collection through articles and books, and the analysis and discussion of both. The theoretical framework utilised will be a combination of the Post-colonial and Queer theories, complemented with concepts borrowed from the advocacy and humanitarian ethics field.