Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones

2017 ◽  
Vol 26 (2) ◽  
pp. 480-495 ◽  
Author(s):  
Kristina Lundberg ◽  
Sofia Kjellström ◽  
Lars Sandman
Keyword(s):  
Registered Nurses ◽  
Healthcare Personnel ◽  
Humanitarian Law ◽  
Military Operations ◽  
Ethical Considerations ◽  
Common View ◽  
Ethical Problems ◽  
Ethical Codes ◽  
Individual Interviews ◽  
Nurses And Physicians

Background: When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively. Aim: This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones. Design: Abductive qualitative design. Participants and research context: Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali. Ethical considerations: The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014). Findings: Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties. Discussion/conclusion: These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

Ethics rounds

2014 ◽  
Vol 23 (2) ◽  
pp. 203-213 ◽  
Author(s):  
Marit Silén ◽  
Mia Ramklint ◽  
Mats G Hansson ◽  
Kristina Haglund
Keyword(s):  
Ethical Climate ◽  
Ethical Issues ◽  
Healthcare Personnel ◽  
Ethical Review ◽  
Ethical Considerations ◽  
Daily Work ◽  
Individual Interviews ◽  
Ethics Rounds ◽  
Difficult Situations ◽  
Insight Into

Background: Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection. Aim: The aim of this study was to gain a deeper understanding of how the ethics rounds were experienced and why the intervention in the form of ethics rounds did not succeed in improving the ethical climate for the staff. Research design: An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews. Participants and research context: A total of 11 healthcare personnel, working in two different psychiatry outpatient clinics and with experience of participating in ethics rounds, were interviewed. Ethical considerations: The study was based on informed consent and was approved by one of the Swedish Regional Ethical Review Boards. Findings: The participants were generally positive about the ethics rounds. They had experienced changes by participating in the ethics rounds in the form of being able to see things from different perspectives as well as by gaining insight into ethical issues. However, these changes had not affected daily work. Discussion: A crucial question is whether or not increased reflection ability among the participants is a good enough outcome of ethics rounds and whether this result could have been measured in patient-related outcomes. Ethics rounds might foster cooperation among the staff and this, in turn, could influence patient care. Conclusion: By listening to others during ethics rounds, a person can learn to see things from a new angle. Participation in ethics rounds can also lead to better insight concerning ethical issues.

Distrust and patients in intercultural healthcare: A qualitative interview study

2016 ◽  
Vol 25 (3) ◽  
pp. 313-323 ◽  
Author(s):  
Lise-Merete Alpers
Keyword(s):  
Cultural Competence ◽  
Ethnic Minority ◽  
Belief Systems ◽  
Healthcare Personnel ◽  
Ethical Considerations ◽  
Informed Consent Form ◽  
Qualitative Interview Study ◽  
Nurses And Physicians ◽  
Depth Interviews ◽  
Minority Ethnic

Background: The importance of trust between patients and healthcare personnel is emphasised in nurses’ and physicians’ ethical codes. Trust is crucial for an effective healthcare personnel–patient relationship and thus for treatment and treatment outcomes. Cultural and linguistic differences may make building a trusting and positive relationship with ethnic minority patients particularly challenging. Although there is a great deal of research on cultural competence, there is a conspicuous lack of focus on the concepts of trust and distrust concerning ethnic minority patients, particularly in relation to the concept of ‘othering’. Aim: To study which factors help build trust or create distrust in encounters between healthcare professionals and hospitalised ethnic minority patients, as well as study the dynamic complexities inherent within the process of ‘othering’. Research design: Qualitative design, in-depth interviews and hermeneutic analysis. Participants and research context: The interviewees were 10 immigrant patients (six women and four men – eight Asians, two Africans – ages 32–85 years) recruited from a south-eastern Norwegian hospital. Ethical considerations: Study approval was obtained from the hospital’s Privacy Ombudsman for Research and the hospital’s leadership. Participation was voluntary and participants signed an informed consent form. Conclusion: Distrust and othering may be caused by differences in belief systems, values, perceptions, expectations, and style of expression and behaviour. Othering is a reciprocal phenomenon in minority ethnic patient–healthcare personnel encounters, and it influences trust building negatively. Besides demonstrating general professional skill and competence, healthcare personnel require cultural competence to create trust.

Ethically difficult situations in hemodialysis care – Nurses' narratives

2014 ◽  
Vol 22 (6) ◽  
pp. 711-722 ◽  
Author(s):  
Catarina EC Fischer Grönlund ◽  
Anna IS Söderberg ◽  
Karin M Zingmark ◽  
S Mikael Sandlund ◽  
Vera Dahlqvist
Keyword(s):  
Registered Nurses ◽  
Ethical Dilemmas ◽  
Research Question ◽  
Moral Integrity ◽  
Ethical Considerations ◽  
Ethical Problems ◽  
Deliberative Dialogue ◽  
Stage Renal Disease ◽  
End Stage ◽  
Difficult Situations

Background: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose. Research question: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses’ experiences of being in ethically difficult situations that give rise to a troubled conscience. Research design: This study has a phenomenological hermeneutic approach. Participants: Narrative interviews were carried out with 10 registered nurses working in dialysis care. Ethical considerations: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University. Results: One theme, ‘Calling for a deliberative dialogue’, and six sub-themes emerged: ‘Dealing with patients’ ambiguity’, ‘Responding to patients’ reluctance’, ‘Acting against patients’ will’, ‘Acting against one’s moral convictions’, ‘Lacking involvement with patients and relatives’ and ‘Being trapped in feelings of guilt’. Discussion: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience. Conclusion: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.

Complex Battlespaces

2018 ◽  
Keyword(s):  
International Law ◽  
New Technologies ◽  
Urban Environments ◽  
Armed Conflicts ◽  
Unmanned Aerial Systems ◽  
International Human Rights Law ◽  
Humanitarian Law ◽  
Military Operations ◽  
Modern Warfare ◽  
Aerial Systems

The conduct of warfare is constantly shaped by forces beyond the battlefield. These forces create complexities in the battlespace for military operations. The ever-changing nature of how and where wars are fought creates challenges for the application of the unchanging body of international law that regulates armed conflicts. The term “complex” is often used to describe modern warfare, but what makes modern warfare complex? Is it the increasingly urbanized battlefield where wars are fought, which is cluttered with civilians and civilian objects? Is it the rise of State-like organized armed groups that leverage the governance vacuum created by failed or failing States? Is it the introduction of new technologies to military operations like autonomous weapons, cyber capabilities, and unmanned aerial systems? Or is it the application of multiple legal regimes to a single conflict? Collectively, these questions formed the basis for the Complex Battlespaces Workshop in which legal scholars and experts from the field of practice came together to discuss these complexities. During the workshop, there was a general consensus that the existing law was sufficient to regulate modern warfare. The challenge, however, arises in application of the law to new technologies, military operations in urban environments, and other issues related to applying international human rights law and international humanitarian law to non-international armed conflicts. This inaugural volume of the Lieber Book Series seeks to address many of the complexities that arise during the application of international law to modern warfare.

Organisation juive européenne, Vignoble Psagot Ltd v. Ministre de l’Économie et des Finances

2021 ◽  
Vol 191 ◽  
pp. 402-442
Keyword(s):  
European Union ◽  
International Law ◽  
West Bank ◽  
International Humanitarian Law ◽  
Humanitarian Law ◽  
The European Union ◽  
Purchasing Decisions ◽  
Ethical Considerations ◽  
Occupied Territories ◽  
East Jerusalem

Economics, trade and finance — Food imports — Import of foodstuffs originating from East Jerusalem, West Bank and Golan Heights into the European Union — Labelling of products — Whether products originating from Israeli settlements in the Occupied Territories must be labelled as such — Observance of international law — Whether foodstuffs coming from settlements established in breach of rules of international humanitarian law — Ethical considerations — Purchasing decisions of consumers — Misleading of consumers Relationship of international law and municipal law — European Union law — Treaty on European Union, 1992 — Treaty on the Functioning of the European Union, 2007 — EU Customs Code — Regulation (EU) No 1169/2011 — Consistent interpretation of EU law — Interpreting Regulation (EU) No 1169/2011 in manner consistent with international law — Notions of “State”, “territory” and “place of provenance” — Referral of questions by national court to Court of Justice of European Union Territory — Status — Occupation — Occupied Territories in which State of Israel Occupying Power — East Jerusalem, West Bank and Golan Heights — Rules of international humanitarian law — Israel having limited jurisdiction — Israeli settlements in Occupied Territories — Palestinian people of West Bank enjoying right to self-determination — Golan Heights part of territory of Syrian Arab Republic — Import of foodstuffs into European Union — Labelling of products — Whether products originating from Israeli settlements in Occupied Territories must be labelled as such — Observance of international law — Whether foodstuffs coming from settlements established in breach of rules of international humanitarian law — Ethical considerations — Purchasing decisions of consumers — Misleading of consumers War and armed conflict — International humanitarian law — Fourth Geneva Convention relative to the Protection of Civilian Persons in Time of War, 1949 — Article 49 — Obligation of States not to “deport or transfer part of its own civilian population into the territory it occupies” — Impact on labelling of products originating in Occupied Territories — Status of East Jerusalem, West Bank and Golan Heights as Occupied Territories — Whether products originating from Israeli settlements in the Occupied Territories must be labelled as such — The law of the European Union

Ethical challenges when using coercion in mental healthcare: A systematic literature review

2016 ◽  
Vol 25 (1) ◽  
pp. 92-110 ◽  
Author(s):  
Marit Helene Hem ◽  
Elisabeth Gjerberg ◽  
Tonje Lossius Husum ◽  
Reidar Pedersen
Keyword(s):  
Patient Autonomy ◽  
Moral Distress ◽  
Mental Healthcare ◽  
Healthcare Personnel ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Best Interest ◽  
Ethical Considerations ◽  
Search Terms ◽  
Healthcare It

Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according to the Vancouver Protocol. Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress.

Taking Care Against the Computer

2021 ◽  
pp. 1-27
Author(s):  
Simon McKenzie ◽  
Eve Massingham
Keyword(s):  
Artificial Intelligence ◽  
International Humanitarian Law ◽  
Electromagnetic Spectrum ◽  
Humanitarian Law ◽  
Military Operations ◽  
Modern Life ◽  
Military Installations ◽  
Digital Infrastructure ◽  
The Status ◽  
Taking Care

Abstract The obligations of international humanitarian law are not limited to the attacker; the defender is also required to take steps to protect civilians from harm. The requirement to take precautions against the effects of attack requires the defender to minimize the risk that civilians and civilian objects will be harmed by enemy military operations. At its most basic, it obliges defenders to locate military installations away from civilians. Furthermore, where appropriate, the status of objects should be clearly marked. It is – somewhat counterintuitively – about making it easier for the attacker to select lawful targets by making visible the distinction between civilian objects and military objectives. The increasing importance of digital infrastructure to modern life may make complying with these precautionary obligations more complicated. Maintaining separation between military and civilian networks is challenging as both operate using at least some of the same infrastructure, relying on the same cables, systems, and electromagnetic spectrum. In addition, the speed at which operations against digital infrastructure can occur increases the difficulty of complying with the obligation – particularly if such operations involve a degree of automation or the use of artificial intelligence (ai). This paper sets out the source and extent of the obligation to take precautions against hostile military operations and considers how they might apply to digital infrastructure. As well as clarifying the extent of the obligation, it applies the obligation to take precautions against hostile military operations to digital infrastructure, giving examples of where systems designers are taking these obligations into account, and other examples of where they must.

scholarly journals Salutary factors explaining why hospital nurses remain in work and the profession

2020 ◽  
Author(s):  
Håkan Nunstedt ◽  
Monica Eriksson ◽  
Ayman Obeid ◽  
Lisbeth Hillström ◽  
Anh Truong ◽  
...  
Keyword(s):  
Registered Nurses ◽  
Sense Of Coherence ◽  
Success Factors ◽  
Intention To Leave ◽  
Well Being ◽  
Three Dimensions ◽  
Good Work ◽  
Hospital Nurses ◽  
Individual Interviews ◽  
Interview Guide

Abstract Background: There is extensive research on how nurses experience their working conditions and environment; this research shows high job stress, job dissatisfaction and intention to leave the workplace. Objective: To explore and describe success factors explaining why hospital nurses remain in work and the profession. Methods: The salutogenic theory was used as a basis for the interview guide, which contained semi-structured, open-ended questions about factors important to explaining why nurses remain in work and the profession. Data collection took place from March to June 2018. Individual interviews with twelve registered nurses working in a hospital in western Sweden were conducted. The data were analyzed using content analysis; additionally, sense of coherence (and its three dimensions: comprehensibility, manageability, and meaningfulness) was used as a tool to structure analyses of the qualitative data. Results: The following factors emerged from the analysis: having fun at work, being acknowledged, feeling togetherness in the team, having varying tasks with a manageable workload, good interaction between colleagues and patients, doing good work, feeling committed to and pride in the professional role, and having a balance between work and leisure time.Conclusions: One precondition of improving registered nurses’ health and well-being was having clear leadership. Another precondition was having a sense of coherence in relation to both the working group and the organization. Experiencing job satisfaction and being acknowledged for one’s good work were important; acknowledgement was received not only from patients, but also from colleagues, other professionals and the nurse manager. In this way, the nurses felt acknowledged and could create a sense of meaningfulness, manageability and comprehensibility in their work.

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