The Role of Moral Imagination in Patients' Decision-Making

This article reviews recent developments within a number of academic disciplines pointing toward an increasing importance of imagination for understanding morality and cognition. Using elements from hermeneutics and metaphor theory, it works toward a framework for a more context-sensitive understanding of human agency, especially focusing on moral deliberation and change. The analytic framework is used to analyze the story of a patient making tough decisions in the context of prenatal diagnosis. We show how a relatively stable outlook on the world, here called the "baseline of choice,” is challenged by unexpected events and how imaginative processes enter into the active creation of a new moral order. The ensuing interpretation is then placed within a broader philosophical landscape. John Dewey's notion of "dramatic rehearsal” is put forward as one particularly promising way of understanding moral imagination, deliberation, and decision-makin

Consultoria em Ética Clínica na Suíça

A realização de Consultorias em Ética Clínica tem sido reduzida, muitas vezes, a uma simples aplicação de um método de análise de casos baseados em princípios. A consultoria seria reduzida a uma simples avaliação de um conflito entre princípios. A proposta de uma abordagem baseada em uma Deliberação de Caso Moral pode ser uma alternativa importante, onde o consultor atua como facilitador e não tomando decisões que cabem aos profissionais de saúde

Research Ethics 2.0:New Perspectives on Norms, Values, and Integrity in Genomic Research in Times of Even Scarcer Resources

Research ethics anew gained importance due to the changing scientific landscape and increasing demands and competition in the academic field. These changes are further exaggerated because of scarce(r) resources in some countries on the one hand and advances in genomics on the other. In this paper, we will highlight the current challenges thereof to scientific integrity. To mark key developments in research ethics, we will distinguish between what we call research ethics 1.0 and research ethics 2.0. Whereas research ethics 1.0 focuses on individual integrity and informed consent, research ethics 2.0 entails social scientific integrity within a broader perspective of a research network. This research network can be regarded as a network of responsibilities in which every stakeholder involved has to jointly meet the ethical challenges posed to research. (C) 2017 S. Karger AG, Basel</p

What does coercion in intensive care mean for patients and their relatives? A thematic qualitative study

Background: The need for an ethical debate about the use of coercion in intensive care units (ICU) may not be as obvious as in other areas of medicine, such as psychiatry. Coercive measures are often necessary to treat critically ill patients in the ICU. It is nevertheless important to keep these measures to a minimum in order to respect the dignity of patients and the cohesion of the clinical team. A deeper understanding of what patients and their relatives perceive during their ICU stay will shed different light on intensive care management. Patients' experiences of loss of control, dependency and abandonment may lead to a new approach towards a broader approach to the concept of coercion in intensive care. The aim of our research is to explore the experiences of patients and relatives in the ICU and to determine when it might be possible to reduce feelings and memories of coercion. Methods: We conducted and analysed 29 semi-structured interviews with patients and relatives who had been in the ICU a few months previously. Following a coding and categorisation process in MAXQDA™, a rigorous qualitative methodology was used to identify themes relevant to our research. Results: Five main themes emerged: memory issues; interviewees' experiences of restricting measures and coercive treatment; patients' negative perception of situational and relational dependency with the risk of informal coercion; patients' perceptions of good care in a context of perceived dependency; progression from perception of coercion and dependency to respect for the person. All patients were grateful to have survived. However, coercion in the form of restraint, restriction of movement, and coercive treatment in the ICU was also acknowledged by patients and relatives. These included elements of informal coercion beyond restraints, such as a perceived negative sense of dependence, surrender, and asymmetrical interaction between the patient and health providers. Conclusions: To capture the full range of patients' experiences of coercion, it is necessary to expand the concept of coercion to include less obvious forms of informal coercion that may occur in dependency situations. This will help identify solutions to avoid or reduce negative recollections that may persist long after discharge and negatively affect the patients' quality of life. Keywords: Autonomy; Coercion; Ethics; Formal–informal; Intensive care unit; Patient experiences

Improving Practice in Supported Decision-Making and Mental Capacity Assessment

Current models of evidence-based practice are predicated on the inclusion of patients / service users in decisions about their healthcare. In the United Kingdom (UK), healthcare policy and legislation requires practitioners to provide support with decision-making and, if necessary, complete mental capacity assessments to identify if service users can make informed decisions. People with communication disabilities may have difficulties understanding, thinking and talking about decisions and may require communication support. In this paper, I discuss the current challenges associated with mental capacity assessment and supported decision-making. I propose that healthcare professionals should look beyond legal and policy imperatives to consider the ethical foundations for their practice, when they face such challenges. I compare two conceptual approaches to ethical reasoning. I describe a practical solution to the clinical challenge – the development of the MCAST, a toolkit to support multidisciplinary staff to assess mental capacity and provide support to service users with communication disabilities during the decision-making proces

Mood-Enhancement mittels Antidepressiva. Ethische Aspekte zu Authentizität und Gerechtigkeit

Mood-Enhancement mittels Antidepressiva zielt auf die pharmakologische Verbesserung der Grundstimmung bei Gesunden durch Medikamente, die ursprünglich für die Behandlung von depressiven Störungen entwickelt wurden. Insbesondere seit der Entwicklung der Selektiven Serotonin-Wiederaufnahmehemmer (SSRIs) wurde diese Medikamentengruppe zunehmend zum Zweck des Mood-Enhancements eingesetzt, obwohl deren Wirksamkeit zur Stimmungsverbesserung bei Gesunden aus empirischer Sicht bis heute nicht eindeutig geklärt ist. Unabhängig von der medizinischen Wirksamkeit sollen im vorliegenden Artikel einige Überlegungen angestellt werden, die im Kontext von Mood-Enhancement auf schwierige ethische Fragen abzielen. Was ist im Falle, dass Mood-Enhancement die Authentizität von einzelnen Individuen zu verändern vermag, ethisch zu bedenken? Zu welchen ethischen Problemen führt der Anstieg in der Anwendung von Mood-Enhancement hinsichtlich der Gerechtigkeitsvorstellungen? Die vorliegende Analyse zeigt unter anderem, dass der scheinbar rationale ethische Diskurs über Mood-Enhancement von moralischen Intuitionen oder von Misstrauen geleitet sein kann