The aim of this thesis is to propose and defend a maxim to serve as a foundation and guideline for professional ethics in nursing. The thesis is informed by philosophical ethics and by first-hand knowledge of professional nursing practice.

Two studies analyzed the factor structure of the 8-item Multidimensional Ethics Scale (MES) (Reidenbach and Robin, 1988, 1990), a 30-item MES (the 30 items used to develop the 8-item measure), and a Perceived Moral Intensity Scale. Factor analyses supported a 3-factor structure for the 8-item MES, marginally supported a 5-factor structure (but more strongly suggested a 1-factor structure) for the 30-item MES, and supported a 3-factor structure for the Perceived Moral Intensity Scale. These scales were then used in a third study that examined the effect of manipulated and perceived moral intensity (Jones, 1991) on participants' ethical judgment of actions taken in 18 scenarios of an arguably ethical nature. A within-subject design found that manipulated moral intensity had a significant effect on ethical judgment, but perceived moral intensity did not. When ethical judgment (as measured by the three factors of the 8-item MES) was regressed on age, gender, major, perceived moral intensity factors, and interactions between age, gender, major and perceived moral intensity factors, the variance accounted for (R2) was significant for each of the three ethical judgment factors in both high and low intensity conditions using a between-subjects design, but was only significant for one of the ethical judgment factors (Moral Equity), and this only for low intensity scenarios, using a within-subject design. One explanation for the difference in effect appears to be that the means for the three perceived moral intensity factors were significantly different for the low versus high intensity condition using the between-subjects design, but the means of two of the three factors were not significantly different using the within-subject design. Three explanations for this were suggested: perceived moral intensity may not have reached a necessary threshold due to explicit referents for comparison; cognitive demand may have been greater when two versions of a single scenario were being evaluated; and, the online administration of the study may have introduced greater error variance than the in-person paper-pencil administration. Ethical judgment was found to be a more robust predictor of intention than perceived moral intensity using a within-subject design. Suggestions were made for future research. / Ph. D.

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.

Background: Insufficient resources and dynamic infection control policies during the COVID-19 pandemic created a resource-strained environment which necessitated frontline Health Care Providers (HCPs) to make ethical decisions frequently. Many of these ethical decisions included allocating scarce resources to optimally prioritize patients, resources, and clinician time. The transition from usual patient-centred care to care centred around infection control mandates and rationing resources forced HCPs to balance competing demands while trying to uphold high standards of care. This research aimed to understand the resource allocation decisions HCPs had to navigate during the pandemic and the ethical considerations guiding them. Methods: Using a qualitative case study approach, we aimed to document the type of ethical decision, reasoning used, and the action frontline HCPs took during the pandemic. Twenty-five semi-structured interviews were conducted with multi-disciplinary HCPs employed in a single community Intensive Care Unit (ICU) in Ontario. Resource allocation decisions were extracted from the transcripts and were analyzed using conventional content analysis. Results: Resource allocation decisions within critical care practice were ubiquitous and diverse. The constraints imposed by the pandemic and multiple provincial and organizational policies formed the context that necessitated these decisions. HCPs drew upon a range of ethical theories, notably Utilitarianism and Virtue Ethics, while prioritizing HCP safety and patient well-being. Resulting actions included prioritizing clinical tasks, establishing boundaries, and adapting practice patterns. Although these situations commonly evoked stress and frustration amongst HCPs, some positive internal responses were also described, including feelings of self-efficacy, resourcefulness, and team cohesion. Conclusion: In conclusion, analysis of resource allocation-derived decision-making illuminated a variety of challenges that HCPs faced during the COVID-19 pandemic, driven by institutional policies and pragmatic limitations. Insights from this study underscore how these ethical decisions are an inherent part of clinical practice and have the potential to foster positive professional development amidst adversity. / Thesis / Master of Health Sciences (MSc) / During the COVID-19 pandemic, Health Care Providers (HCPs) faced difficult choices due to limited resources and evolving infection control rules. HCPs had to decide how to allocate scarce resources and balance competing demands while maintaining high standards of care. This research aimed to understand the types of resource allocation decisions HCPs made and the ethical considerations guiding them. Through twenty-five interviews with HCPs from an Intensive Care Unit in Ontario, we found that such decisions were both frequent and diverse. HCPs considered ethical theories like Utilitarianism and Virtue Ethics, prioritizing patient well-being and HCP safety. They often had to adapt their practices, establish boundaries, and determine priorities. Although these decisions caused stress and frustration, they also fostered team cohesion and personal growth. Overall, this research sheds light on some challenges HCPs faced during the COVID-19 pandemic and underscores the importance of preparing learners to navigate ethical decision-making in clinical practice.

An increasingly blurred understanding of the moral significance of accurate and authentic memory reconsolidation for an adequate apprehension of self, other, and community suggests a critical need to explore the inter-relationships shared between autobiographical memory, emotional rationality, and narrative identity in light of the contemporary possibilities of neurocognitive memory manipulation, particularly as it bears on ethical decision making. Grounding its thesis in four evidential effects – namely, (i) neurocognitive memory manipulation disintegrates autobiographical memory, (ii) the disintegration of autobiographical memory degenerates emotional rationality, (iii) the degeneration of emotional rationality decays narrative identity, and (iv) the decay of narrative identity disables one to seek, identify, and act on the good – the dissertation argues that neurocognitive memory manipulation cannot be justified as a morally licit biomedical practice insofar as it disables one to seek, identify, and act on the good. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

The purpose this study was to explore the relationship between counseling mental health practitioners’ attitudes toward euthanasia and their ethical decision making levels when confronted with clients facing end-of-life concerns. A review of literature indicated a series of complex ethical, moral, and societal issues surrounding clients’ right-to-die issues. Because of the lack of research in the counseling field and the growing prevalence of right-to-die issues with clients who have a diagnosis of a terminal illness, more research in the counseling field is needed (Hadjistavropoulos, 1996; Winograd, 2012). Participants for the present study were recruited from six state divisions of the American Counseling Association; Alabama, Louisiana, North Dakota, Maryland, Vermont, and Utah. Two multiple regressions were conducted in addition to one correlation and one MANOVA. One multiple regression was conducted using EDMS-R ans the dependent variable and one multiple regression was conducted using ATE overall score as the dependent variable. The Independent variables used were years in practice, gender, state, and religion. The dependent variables used were participant EDMS-R score and participant ATE score. Variables were chosen to examine variability accounted for in ATE and EDMS-R participant scores. Findings from this small study indicated that counselors’ years in practice, gender, state, and religion accounted for more of the variability in their beliefs about euthanasia (13.5) than their ethical decision making levels (2.7). Also, counselors’ religion had the greatest effect on participants’ ATE overall scores and on their EDMS-R P index scores. Counselors’ ATE overall scores as well as their both active and passive scores were all shown to be correlated to their P index scores with their ATE active scores exhibiting the strongest correlation and their ATE passive score exhibiting the weakest correlation. Future research suggestions include assessing counselors’ religion in more depth, and focusing on the other demographic variables in the study, as well as conducting an initial qualitative study to provide insight from individual participants as opposed to assessing a large group of participants.

Since the 1990s, academic physicians have been subjected to increased requirements for disclosure in their roles as educators and researchers and for conflict of interest (COI) resolution in their financial relationships with pharmaceutical, medical device, and biotech companies, collectively referred to as industry. The requirements are the result of the convergence of federal regulations, accreditation guidelines, professional and industry codes of ethics and conduct, and institutional policies. The disclosure and COI resolution requirements are managed and resolved by a review of forms and compliance with relevant guidance documents and policies. In the context of this environmental oversight, the purpose of the qualitative study was to explore physicians’ perspectives of how they manage and resolve conflicts of interest in their academic roles of teaching, research, and patient care. Minimal evidence-based research exists in the literature from the physician’s viewpoint. The grounded theory study examined the research question by using an issue-contingent, ethical decision-making theoretical framework from the management literature. The data were collected using a general interview guide that consisted of three sections – general questions regarding purpose and demographics, discussion of three case scenarios (teaching, research, and clinical practice), and finally, general concluding questions to assess the environment that is indicative of the context of the study. The theory emerged from the interview data as a refined theory representing a four-step ethical decision-making process with emphasis on the characteristics of physicians as moral agents. The study’s findings further indicated that bias is a significant concern. The study identified reasons physicians enter into financial relationships with industry, the risks and benefits associated with those relationships, methods for avoiding bias, and the need for healthy academic-industry collaborative research.

Thesis advisor: Pamela J. Grace / As supported by extensive literature, nurses have a role to play in helping patients and families in getting their needs understood and met. This ethical responsibility includes decisions made by nurses in the context of end-of-life (EOL) care. Ethical decision-making is known to be influenced by nurses' understanding of their professional accountability and several cognitive processes that underlie moral action. Rest (1986) theorized these processes as: moral sensitivity, judgment, moral motivation, and moral character. However, few instruments have been developed to understand nurses' ethical decision-making during EOL care, and most have focused on a single dimension rather than on the multi-dimensional process. The purposes of this methodological study were: 1) to develop a scale with content domains and items capable of describing Korean nurses' ethical decision-making at EOL and 2) to evaluate the scale's psychometric properties using Korean nurses (N = 230). The criteria for participation were: Korean nurses having more than 2 years of clinical experience in the types of units where most Korean patients spend the end of their lives: critical care, general medical-surgical, and hospice units. The process followed two steps. Phase I consisted of the development of domains and items. Three domains were identified through themes derived from an integrated review of relevant literature and the findings from a preliminary qualitative study involving experts in EOL care in Korea. 95 items were generated within these three domains. Content validation was completed by a panel of six nursing ethics experts, three in Korea and three in the U.S. Next, a pilot study to test readability was conducted using three Korean nurses. During Phase II, 67 items of the NEDM-EOLCS version 3.0 were tested. After item analysis and factor analysis, a 55-item final version of the NEDM-EOLCS was established. The total scale and three subscales reported good reliability and validity. The three subscales were labeled: "perceived professional accountability," "moral reasoning and moral agency," and "moral practice at the EOL." / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Ethical decision-making is an important but challenging aspect of the role of a clinical psychologist. Little research has been conducted concerning how clinical psychologists make ethical decisions, with even less known about how trainees manage the process during professional training. The current study aimed to examine how trainees make ethical decisions, and how this process differs between more and less experienced trainees. Thirty-nine trainee clinical psychologists were recruited from a total of 17 doctoral training programmes in the United Kingdom. The sample recruited was demographically similar to the training population. A cross-sectional design was used to examine differences between first year (n = 19) and third year (n = 20) trainees. An online version of The Defining Issues Test questionnaire (DIT-2, Rest et al., 1999) was used to measure level of sophistication of ethical development, and individual face to face or Skype repertory grid interviews examined the integration of trainees’ personal and professional ethical decision-making construct subsystems. The vast majority of trainees were found to adopt a sophisticated approach to ethical decision-making, with half of all ethical decisions made from within a postconventional schematic approach. However, a small minority operated from within schemata based on maintenance of societal norms or personal interests. A deterioration in sophistication of thinking was demonstrated for more experienced trainees. Less experienced trainees were found to rely comparatively more heavily on their personal construct subsystems than more experienced trainees and vice versa. Increased integration between the subsystems over the course of training was demonstrated. The study demonstrates support for an acculturation process occurring throughout training. Implications of this and ideas for future research are discussed.

This thesis presents the results of three studies that extend understanding of ethical decision making in negotiation. First, by comparing how Chinese and Australian negotiators think about contextual variables in an interpretive study, an extended model of ethical decision making in negotiation is offered. This study suggested differences in how codes of ethics and perception of the other party were understood as well as a shared understanding of the influence of the legal environment across the two cultures. Importance of organisational goals and personal and business reputation also emerged as important variables in negotiators' ethical decision making. The next study began testing the extended model with an investigation of the interaction between culture and closeness of the relationship with the other party using the SINS scale (Robinson, Lewicki, & Donahue, 2000). It was found that Chinese negotiators generally rated ethically ambiguous negotiation tactics as more appropriate than Australians, and that Chinese differentiated more in their ratings of appropriateness according to the social context. In the test for metric equivalence of the SINS scale, this study found that the existing approach of inductively deriving types of ethically ambiguous negotiation tactics based on ratings of perceived appropriateness is flawed since patterns of ratings are likely to vary across groups of negotiators. In light of this, a new typology of ethically ambiguous negotiation tactics is offered based on an a priori identification of conceptually distinct types of tactics. This new inventory of items represents the first step in the process of producing a cross-culturally generalisable scale of ethically ambiguous negotiation tactics.