Prenatal Genetic Screening and Potential Complicity in Abortion: Considerations for Catholic Health Care.

Prenatal genetic screening (PGS) is commonplace in the United States and in some parts of the world. The commonly held rationale for screening is to respect patient autonomy and to either allow the mother the opportunity to prepare herself to parent a child with a genetic disorder or to abort. As a result, PGS combined with prenatal diagnostic testing followed by abortion has significantly reduced the number of babies born with Down syndrome, for example, and, furthermore, has raised concerns about discrimination against persons with disabilities and eugenics. Although Catholic teaching clearly prohibits PGS and testing when undertaken with the intention of abortion, screening routinely is performed in Catholic health care, sometimes without regard to intent. This essay explores the issue of PGS in Catholic health care and suggests the development of a policy designed to support morally legitimate use of screening through an educational and informed consent process and attestation as to intent so as to prevent abortion or at least avoid complicity in it. Although the issue applies to prenatal testing as well as screening and for a variety of disorders as well as gender, this essay limits itself to a discussion of first trimester screening and a focus on Down syndrome. Objections to such a policy are discussed.

Toward a Consensus in Ethics Education for the Doctor of Nursing Practice.

The purpose of this study was to begin to develop a consensus as to the essential content and methods of ethics education for advanced practice nurses. An online Delphi technique was used to survey ethics experts to determine whether items were essential, desirable, or unnecessary to ethics education for students in doctor of nursing practice programs. Only the American Nurses Association Code of Ethics and ethics terminology were deemed essential foundational knowledge.

Confidence and knowledge regarding ethics among advanced practice nurses.

As the scope of advanced practice nursing expands and the educational requirements increase, so do the ethical responsibilities. How prepared are advanced practice nurses (APNs) to manage the ethical challenges in advanced practice? The purpose of this study was to determine APNs' ethics knowledge and perceived level of confidence in their ability to manage ethical problems in advanced practice. Assuming ethics knowledge and abilities of APNs are similar to those of medical residents, a survey instrument for medical residents was modified for use with APNs. Responses to the modified survey indicated a fairly high level of confidence but a fairly low level of knowledge. Studies show that ethics education can be effective in improving knowledge, confidence, and ethical behavior. Given the expanding role of APNs as doctors of nursing practice, research is needed to determine the ethics knowledge needs and teaching strategies to better prepare nurses for the challenges of advanced practice.

The community of nursing: moral friends, moral strangers, moral family.

Unlike bioethicists who contend that there is a morality common to all, H. Tristan Engelhardt (1996) argues that, in a pluralistic secular society, any morality that does exist is loosely connected, lacks substantive moral content, is based on the principle of permission and, thus, is a morality between moral strangers. This, says Engelhardt, stands in contrast to a substance-full morality that exists between moral friends, a morality in which moral content is based on shared beliefs and values and exists in communities that tend to be closely knit and religiously based. Of what value does Engelhardt's description of ethics as moral friends and moral strangers have for nursing? In this essay, I attempt to show how Engelhardt's description serves to illustrate how the nursing community historically had been one of moral friends but has gradually become one of moral strangers and, hence, at risk of failing to protect patients in their vulnerability and of compromising the integrity of nursing. Building on Engelhardt's concepts, I suggest we might consider modern nursing like a moral family to the extent that members might at times relate to one another as moral strangers but still possess a desire and a need to reconnect with the common thread that binds us as moral friends. Nursing is a practice discipline. Given the challenges of modern bioethics, an applied ethic is needed to give moral direction to clinicians as we strive to conduct ourselves ethically in the practice of our profession. To that end, nursing should reflect upon and seek to reconnect with the content-full morality that is historically and religiously based.

Moral problems and distress among nurse practitioners in primary care.

PURPOSE: To identify the ethical issues nurse practitioners (NPs) encounter in primary care, examine the types of moral problems that arise related to those issues, and determine the level of distress NPs experience. DATA SOURCE: Self-reported responses to an investigator-designed, anonymous, mailed survey on a convenience sample of 71 NPs practicing in primary care in one midwestern metropolitan area. CONCLUSIONS: This preliminary descriptive study identified a number and variety of ethical issues NPs encounter in primary care. The issue encountered with the greatest frequency was patient refusal of appropriate treatment. Distress was reported most often over problems of moral dilemma, followed by moral distress, and least often, moral uncertainty and moral outrage. Another type of moral problem, possibly related to conflict between patient autonomy and NP beneficence, occurred almost as often as moral dilemma. Not as many NPs reported encountering ethical issues or being distressed as the literature suggests. The reason for this is unclear but may be related to NPs' sense of moral responsibility or their ability to discern subtle ethical issues in the complex primary care environment. Regardless of moral problem, NPs felt frustrated and powerless. As a result, some changed jobs and contemplated leaving advanced practice. IMPLICATIONS FOR PRACTICE: More research is needed to clearly understand ethical issues and moral problems for NPs in primary care, how NPs identify and manage problems, and the effects on NPs and patients.