Everyday Ethical Issues Research Articles

In search of epistemic justice. Dialogical reflection of researchers on situated ethics in studies with people living with language and/or cognitive impairment

BackgroundAcademics aim to understand the experiences of people living with cognitive and/or language impairment in their search for epistemic justice. Methods that do not rely solely on verbal information (e.g., interviews, focus groups) but also employ an attunement to the non-verbal - such as participant observation and creative methods, are seen as a suitable way to do justice to people's non-verbal interactions. However, in practice, researchers still experience ethical issues in everyday encounters with participants with cognitive and/or language impairment even when trying to address epistemic issues while employing such methods. This article aims to demonstrate 1) the importance of attending to the non-verbal in order to prevent epistemic injustice in research and 2) how a case-study approach and discussing ethical dilemmas with peers may help to unpack some of the ethical tensions that the researchers experience. Aim and methodsThis article focuses on ethical dilemmas the authors encountered during their research projects in the past. Three cases chosen by the authors illustrate these dilemmas. Dilemmas are presented as auto-ethnographical written accounts, which were discussed during ten retrospective dialogical sessions (60–90 min) organized by the research group consisting of six academic researchers. ResultsEthically sound research, in which older people living with cognitive and/or language impairment are engaged, entails much more than following procedures about informed consent, privacy, submitting a proposal to an ethics committee, and using suitable methods and techniques. Ethical issues in these studies relate to everyday situations in which researchers tried to do justice to the knowledge of people who have difficulties expressing themselves verbally, but were challenged by what they have initially experienced as ‘having it wrong,’ ‘not knowing,’ and ‘losing something in translation’ in their practice. Finally, we learned that the interactions the researchers encountered were complex. They had to constantly evaluate the appropriateness of their approach, balance rational and intuitive forms of interaction and interpretation, and consider ways of communicating the research findings. Discussion and conclusionApproximating epistemic justice in research with people with cognitive and/or language impairment requires extra effort in daily research routines. Sharing everyday ethical issues via case stories and reflecting on these issues encourages moral learning and brings new knowledge about the craftsmanship of researchers. Especially the collaborative and dialogical reflection helped the researchers to dig deeper and find words for intangible processes that often remain unaddressed. However, sharing stories about ethical issues requires mutual trust and safety because sharing and reflecting may bring discomfort, messiness, and uncertainty.

To conceal or reveal: ethical tensions and concerns in participatory action research-the relational adventures in a rural China village community research project

ABSTRACT The author reviewed her involvement in a participatory action research project for child protection in a rural Chinese community in this paper. Numerous observations and reflections on ethical tensions and decision-making are discussed. These discussions raise awareness about the ethical implications of a participatory action-inquiry process. Everyday ethical issues in research should be addressed collaboratively and relationally.

Ethics framework for citizen science and public and patient participation in research

BackgroundCitizen science and models for public participation in health research share normative ideals of participation, inclusion, and public and patient engagement. Academic researchers collaborate in research with members of the public involved in an issue, maximizing all involved assets, competencies, and knowledge. In citizen science new ethical issues arise, such as who decides, who participates, who is excluded, what it means to share power equally, or whose knowledge counts. This article aims to present an ethics framework that offers a lens of understanding and heuristic guidelines to deal with ethical issues in citizen science.MethodsWe conducted seven case studies between 2015 and 2021 to attune and validate the ethics framework for the context of citizen science. The cases related to studies with older adults, people with a psychiatric vulnerability, people dependent on community care, people who are unemployed or living in poverty or both, and young adults with respiratory disease.ResultsEthics in citizen science reaches beyond the ethical issues in traditional biomedical and health research. It entails more than following procedures about informed consent and privacy and submitting a proposal to a Medical Research Ethics Committee. Ethics in citizen science relates to everyday ethical issues during the study, including relational and moral complexities concerning collaboration, sharing power, and democratic decision-making. Dealing with these issues requires ethics work of researchers. This entails seeing ethically salient issues and reflecting on everyday ethical issues. Ethics work consists of seven features: framing work, role work, emotion work, identity work, reason work, relationship work, and performance work. All are relevant for researchers in citizen science.ConclusionsEthical issues in citizen science often relate to power differentials, partnership, and collaboration between academics and non-academics. The ethics framework prepares researchers for the work needed in citizen science to act responsibly and offers a heuristic guide to reflect on ethics. Reflection on ethics is a pathway towards ethical citizen science, especially if researchers collaboratively reflect in partnership with non-academics who are subject to the moral issue.

The Ethics in Long-Term Care Model: Everyday Ethics and the Unseen Moral Landscape of Assisted Living.

Assisted living (AL) communities are long-term care settings where people live, work, and visit, and where social relationships and care, including end-of-life care, are negotiated. Assisted living is fraught with uncertainty and conflict about values, especially given residents' cognitive and physical frailty. These value-laden issues have implications for both resident and care partners' experiences. Yet, almost no research has examined ethics in this complex care environment. In this article, we draw on and synthesize existing theory, research, and practice knowledge to offer a conceptual model and discuss case examples that highlight everyday ethical issues in AL. We conceptualize the moral decision-making process and hence the moral landscape of AL, as influenced by a myriad of multi-level factors that shape interpersonal encounters and decision-making involving residents and their care partners, which ultimately shape individuals' actions and experiences in the setting. We conclude by discussing implications for research, policy, and practice.

Everyday ethics of suicide care: Survey of mental health care providers' perspectives and support needs.

Suicide occurs in people of all ages and backgrounds, which negatively affects families, communities, and the health care providers (HCPs) who care for them. The objective of this study was to better understand HCPs’ perspectives of everyday ethical issues related to caring for suicidal patients, and their perceived needs for training and/or support to address these issues. We conducted a mixed methods survey among HCPs working in mental health in Québec, Canada. Survey questions addressed their perspectives and experiences of everyday ethical challenges they encounter in their practice with people who are suicidal, and their perceived needs for training and/or support therein. 477 HCPs completed the survey. Most participants mentioned encountering ethical issues when caring for people who are suicidal. The challenges HCPs encounter in their practice with people who are suicidal are numerous, including issues related to maintaining privacy, confidentiality, freedom and the therapeutic relationship. The lack of time, resources and professional support to address these issues was emphasized. Most HCPs reported that the training or education they have received does not allow them to address everyday ethical issues related to suicide care. In sum, there is a clear reported need for better training and support for HCPs who are offering care to people who are suicidal in relation to everyday ethical issues they encounter. Implications for practice include providing greater access to training, including access to specialists in ethics to address specific issues. This additional support could alleviate morally distressing situations for HCPs.

Everyday ethical issues in Indian medical practice

Everyday ethical issues in Indian medical practice

Ethical issues in the care of people with dementia

Dementia is a syndrome characterised by cognitive decline, memory loss and progressive functional impairment. It is increasingly common, and is largely managed in the community. The nature of dementia leads to many deep philosophical problems that bear on the various ethical issues that arise for clinicians caring for these patients. This article explores these ethical issues with a focus on promoting autonomy and making best interests decisions. Everyday ethical issues including truth telling, restraint and limitations of freedom, abuse and vulnerability are considered. Ethical issues generated by the use of assistive technologies and finally confidentiality are also, briefly, considered. Although this article cannot give specific ‘right answers’ to the myriad ethical issues confronting GPs working with people with dementia, it does aim to highlight productive lines of thought in navigating such issues.

EVERYDAY ETHICS AND THE UNSEEN MORAL LANDSCAPE OF ASSISTED LIVING

Assisted living (AL) communities are increasingly popular long-term care settings where people live, work and visit, and where social relationships and care, including end-of-life care, are negotiated. In the context of daily life, residents, their family members and friends, AL care workers and other staff, external care providers, and volunteers, continually encounter one another and make choices about a range of matters. AL is fraught with uncertainty and conflict about values, especially given residents’ cognitive and physical frailty. These value-laden issues have important implications for both resident and care partners’ quality of life. Yet, almost no research has examined ethics in this dynamic and complex care environment. We seek to address this important knowledge gap by examining AL through an ethical lens. Drawing on our research and practice experiences, we present a conceptual model that situates everyday ethics within multiple multi-levels of moral decision-making factors and systems involving individuals, the care setting and surrounding community, social norms, and the broader regulatory context. We provide an overview of AL’s moral landscape and present examples of three everyday ethical issues. We first examine informed consent as it pertains to sexual encounters involving residents with dementia. Next, we consider boundary and role issues inherent in care process and relationships. Finally, we discuss resident privacy as an area for value uncertainty in everyday life within AL. We conclude by emphasizing the need for in-depth and systematic identification of ethical issues in AL and development of management strategies for applied practice.

A Pragmatic Approach to Ethical Decision-Making in Engineering Practice: Characteristics, Evaluation Criteria, and Implications for Instruction and Assessment.

This paper begins by reviewing dominant themes in current teaching of professional ethics in engineering education. In contrast to more traditional approaches that simulate ethical practice by using ethical theories to reason through micro-level ethical dilemmas, this paper proposes a pragmatic approach to ethics that places more emphasis on the practical plausibility of ethical decision-making. In addition to the quality of ethical justification, the value of a moral action also depends on its effectiveness in solving an ethical dilemma, cultivating healthy working relationships, negotiating existing organizational cultures, and achieving contextual plausibility in everyday professional practice. This paper uses a cross-cultural ethics scenario to further elaborate how a pragmatic approach can help us rethink ethical reasoning, as well as ethics instruction and assessment. This paper is expected to be of interest to educators eager to improve the ability of engineers and other professional students to effectively and appropriately deal with the kinds of everyday ethical issues they will likely face in their careers.

Effectiveness of ethical issues teaching program on knowledge, ethical behavior and ethical stress among nurses

Background : New technology, economic constraints, scarce resources and conflicting values have set expectations for nurses’ ethical competence. Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care. The aim of the study is to examine the effect of teaching program regarding ethical issues on nurses knowledge, ethical behavior, frequency and degree of ethical stress. Subjects and methods : Research design is A Quasi-experimental design was used in the study. The study was conducted among staff nurses working at Mansoura Emergency Hospital which provides a wide spectrum of health services at Delta Region. Three tools were used for data collection namely: Ethical Issues Knowledge Questionnaire, Observational checklist for Ethical Behavior and Ethical Issues Stress scale. Results: The study findings concludes that there was a strong correlation between Knowledge of Nursing ethics and Ethical behavior after the teaching program. In addition strong correlation found between the Knowledge and frequency of ethical stress in post test. Conclusion & Recommendations: Nurses face daily ethical challenges in the provision of quality health care. Ethical issues teaching program has positive influence in improving their knowledge, reduction in the frequency and degree of stress. It is recommended that ethics training cannot take place just once in a training room, but needs on-going support at all levels of the organization. The training should include what ethics is, along with actual examples of relevant situations, and how to explore an ethical dilemma through interacting with others.

Nothing to complain about? Residents' and relatives' views on a "good life" and ethical challenges in nursing homes.

Background:Nursing home residents are a vulnerable population. Most of them suffer from multi-morbidity, while many have cognitive impairment or dementia and need care around the clock. Several ethical challenges in nursing homes have been described in the scientific literature. Most studies have used staff members as informants, some have focused on the relatives’ view, but substantial knowledge about the residents’ perspective is lacking.Objective:To study what nursing home residents and their relatives perceive as ethical challenges in Norwegian nursing homes.Research design:A qualitative design with in-depth interviews with nursing home residents, and focus-group interviews with relatives of nursing home residents. The digitally recorded interviews were transcribed verbatim. Analysis was based on Interpretive Description.Participants and research context:A total of 25 nursing home residents from nine nursing homes in Norway, and 18 relatives of nursing home residents from three of these nursing homes.Ethical considerations:This study was reported to and approved by the Regional Ethics Committee in Oslo, Norway.Findings and discussion:The main ethical challenges in Norwegian nursing homes from the residents’ and relatives’ perspective were as follows: (a) acceptance and adaptation, (b) well-being and a good life, (c) autonomy and self-determination, and (d) lack of resources. The relationship with the staff was of outmost importance and was experienced as both rewarding and problematic. None of the residents in our study mentioned ethical challenges connected to end-of-life care.Conclusion:Residents and relatives experience ethical challenges in Norwegian nursing homes, mostly connected to “everyday ethical issues.”

A Semiotic Approach to Food and Ethics in Everyday Life

The aim of this paper is to explore how food can be analyzed in terms of signs and codes of everyday life, and especially how food can be used to express ethical concerns. The paper investigates the potential of a semiotic conceptual analysis: How can the semiotic approach be used to analyze expressions of ethics and food ethics in everyday life? The intention is to explore from a theoretical point of view and with constructed cases, how semiotics can be used to analyze the role of food as an expression of ethics in everyday life among families, friends, and colleagues: How do foodstuffs function as signs of ethics in everyday life? How is food used to send signals about care and concern? How are the signs of food ethics perceived? It is concluded that analyzing ethical considerations with respect to food with the help of the semiotic model can show us perspectives that otherwise would be difficult to see and thus we can address everyday food ethical issues that otherwise might not be noted. The semiotic approach to food ethics in everyday life is a conceptual framework that can be used to draw attention to certain domains and fields of food ethical behavior that otherwise would tend to remain implicit and unspoken.

"Here's my dilemma". Moral case deliberation as a platform for discussing everyday ethics in elderly care.

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’.

Home-based nursing: An endless journey

The aim of this study was to explore metaphors for discovering values and norms held by nurses in home-based nursing care. Ten interviews were analysed and interpreted in accordance with a metaphor analytical method. In the analysis, metaphoric linguistic expressions and two entailments emerged, grounded in the conceptual metaphor 'home-based nursing care is an endless journey', which were created in a cross-domain mapping between the two conceptual domains of home-based nursing care and travel. The metaphor exposed home-based nursing care as being in constant motion, thereby requiring nurses to adjust to circumstances that demand ethical maturity. The study focuses on the importance of developing further theories supporting nurses' expressions of their experiences of everyday ethical issues.

Gazing from the inside out during ethically heightened moments

This autoethnographic account explores the everyday ethical and emotional issues that arise throughout the research process. Represented through creative analytic practice (CAP), I examine issues related to researcher safety, encountering the unexpected and sensitive topics, empathetic responsibility, role conflict, abandonment and intellectual distance ‐ all issues that shape the type of knowledge constructed as well as the researcher’s and participant’s well‐being. Emphasis is placed on using autoethnography (as a methodology) and CAP (as a form of representation) to deepen our understanding of the complexity of leisure experiences and meanings, while confronting how we come to know and write about ‘others’.

A report on small team clinical ethics consultation programmes in Japan

Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK...

The Ethics of Everyday Practice

Traditional approaches to bioethics, that privilege impartiality and objectivity and that focus primarily on moral reasoning, are relatively silent on the moral habitability of healthcare environments. Nurses and others in "the trenches" of healthcare are increasingly voicing the need to address everyday ethical issues, interdisciplinary tensions, and systemic concerns, in addition to the ethics of high-profile medical cases. Attention to the institutional processes that shape and constrain ethical dialogue and practice is required. In this article, the call is made for a shift in thinking about ethics in healthcare.

Ethical Issues RELATED TO HEALTH CARE: The Older Adult's Perspective

Although ethical issues in health care receive much publicity, attention is rarely given to the non-dramatic, everyday ethics of health care. This American Nurses' Foundation (ANF) funded pilot study was significant because it was the first to investigate everyday ethical issues from the perspective of older adult health care consumers. The overall goals of this descriptive study were to pilot interview questions and study design, as well as collect preliminary data about the ethical issues older adults in two settings (a residential facility and a non-residential community center) encounter related to health care. A sample of 10 participants answered several open-ended questions in an audiotaped interview; the tape was subsequently transcribed verbatim and analyzed using content analysis methods. Although two open-ended questions were effective in eliciting ethically related health care issues, the addition of specific examples to those questions was suggested. Health care related ethical issues identified by the older adults were categorized as Attentiveness, Respect, Care, Finances, and Health Care Systems. Although the residential participants did not experience financial issues as did the community participants, the highest priority issues for both residential and community participants were in the Attentiveness and Respect categories. The clinical implication of these findings is that nurses best address older adult health care consumers' most important ethical issues by providing attentive, respectful care in all they do.

EVERYDAY ETHICS in Assisted Living Facilities: A Framework for Assessing Resident-Focused Issues

This article describes and illustrates a framework that may be used when assessing the moral basis of everyday issues that can affect residents of assisted living facilities. The "taxonomy of everyday ethical issues" was an outcome of ethnographic research focused on care of nursing home residents with dementia. However, in this article it is shown to be equally relevant for conceptualizing issues affecting cognitively intact as well as cognitively impaired residents across these two settings. The taxonomy is grounded in some of the more common cultural characteristics of congregate living arrangements for elderly individuals who have needs for varying levels of compensatory and therapeutic oversight by a staff of service providers.

Ethnographic analysis of everyday ethics in the care of nursing home residents with dementia: a taxonomy.

The concept of everyday ethics was used to emphasize the moral basis of ordinary issues of daily living affecting quality of life for nursing home residents with dementia. To critically examine ethical issues of daily living affecting nursing home residents with dementia and to construct a descriptive taxonomy inductively derived from ethnographic fieldwork data. Combined anthropological methods of participant observation and in-depth interviewing were used in the natural setting of a 147-bed, voluntary, not-for-profit nursing home. Experiences of 30 residents, their family members, and nursing home staff were explored. In addition, the records of 10 ethics committee cases involving residents with dementia further enlarged the database. The taxonomy of everyday ethical issues includes the following four domains: (a) learning the limits of intervention; (b) tempering the culture of surveillance and restraint; (c) preserving the integrity of the individual; and (d) defining community norms and values. Each is representative of constellations of concerns that are grounded in the cultural and moral environment of the nursing home. Results highlight the challenges of recognizing the ethical in the ordinary, and of resolving everyday issues in ways that enhance quality of life for residents with dementia and those (family and staff) who care for them.