The role of conscience and virtue: contrasting two models of medicine.

Today's medical ethics involve two different viewpoints based on how we understand the role of conscience in medicine and the purpose of healthcare. The first view, called the health-directed model, sees medicine as a way to improve health and promote healing, while also respecting the values of both patients and doctors. In this model, doctors need some discretionary space to decide how to achieve the best health outcomes in their practice. On the other hand, the service-provider model sees the main goal of medicine as providing a service, especially healthcare, with a strong focus on protecting patient autonomy. In this view, doctors are required to provide care even when it goes against their personal beliefs.The goal of this article is to explore the foundations and arguments of these two medical models. Understanding the key ideas behind these models is important for deciding whether to support or oppose conscientious objection in medical ethics. Additionally, the article aims to figure out which model makes a stronger case and to offer advice on how to engage with the opposing view from a virtue ethics perspective.

Choosing to Provide: Early Medical Abortion and Clinician Conscience in Ireland.

Providers are essential to the delivery of abortion care. Yet, they often occupy an ambiguous space in political discourse around abortion. The introduction of a new abortion service in Ireland invites us to look afresh at providers. Since the Health (Regulation of Termination of Pregnancy) Act 2018 came into force, by far the most common form of abortion care has been early medical abortion (EMA). This is typically provided by General Practitioners (GPs), with approximately 10% of GPs having chosen to provide EMA. This article draws on an empirical study of providers to investigate their motivations for, and experiences of, provision and their views on colleagues who have not chosen to provide. The study shows that for many providers, the choice to provide was grounded in a moral commitment to protecting women's rights to autonomy and health and ensuring that the harms of the past were not repeated. The article argues that notwithstanding increased normalisation of EMA in Ireland, conscience still has a role to play in abortion care provision and it is important to reflect on the various aspects of this role.

Nurses' and Midwives' Stress of Conscience and Its Correlation With Selected Sociodemographic and Work-Related Variables.

AIM: To assess the level of stress of conscience experienced by Polish nurses and midwives and its determinants. DESIGN: Descriptive cross-sectional study. METHODS: The study was conducted from March 2019 to December 2020 and included convenience sampling of nurses and midwives working in hospitals in south-eastern Poland. An adapted version of the stress of the conscience questionnaire was used. RESULTS: A total of 476 nurses and midwives completed the survey. The stress of conscience mean value was 67.57. There were no differences in stress of conscience between nurses and midwives. There were five predictors of stress of conscience for nurses: additional job, place of residence, care for patients over 65 years of age, satisfaction with one's salary and having specialised courses, for midwives: social status, work mode and postgraduate studies. CONCLUSION: With the knowledge of predictors of stress of conscience, educational institutions, policymakers and hospital managers should focus their interventions on the factors that lead to a higher level of stress of conscience. It is essential to provide psychological support, building positive relationships between colleagues and focusing on organisational conditions. IMPLICT: Further research in this area is therefore encouraged, along with pre- and postgraduate training in coping with challenging situations such as the death of a patient and caring for elderly patients with dementia or multiple diseases. The study identifies predictors of stress of conscience and problems that can influence their appearance. Factors that increase the stress of conscience, such as organisational conditions and caring after patients are over age 65, should receive special attention in clinical education and result in the provision of an increased level of support from supervisors. Policymakers should also direct their future actions towards the ageing population, staff shortages, the resignation from the profession by improving working conditions and reducing the stress of conscience. REPORTING METHOD: STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Burnout in healthcare workers: The effect of stress of conscience.

PURPOSE: The stress of conscience occurs in stressful situations that are often encountered in healthcare, leading to an uncomfortable conscience in healthcare workers. They may not be able to control their emotions and feel burnout. Therefore, the aim of this study is to evaluate the effect of stress of conscience on burnout in healthcare workers. METHODS: This cross-sectional study was performed with 602 healthcare workers between November 2020 and January 2021 in Turkey. Data were collected using a sociodemographic form, Stress of Conscience Scale, and Maslach Burnout Inventory. RESULTS: A positive and high-level relationship was found between the stress of conscience and burnout (r = 0.603, p < 0.001). The stress of conscience accounted for 36% of burnout. Also, female healthcare workers have high stress of conscience and burnout scores. CONCLUSION: This study is important in terms of realising the stress and burnout of healthcare workers and for health managers to recognise the stress types of their workers. The increase in the level of burnout of healthcare workers is associated with their stress of conscience. Using the results of this study, national and international consensus can be obtained to reduce the impact of the stress of conscience on healthcare workers.

Ethical Gaps in Ophthalmology in the United States.

Purpose: To highlight gaps in the professional ethics of ophthalmology. Design: Perspective. Methods: Presentation of problematic cases in ophthalmologic ethics with juxtaposition of ethical, legal, and conscientious viewpoints informed by relevant literature. Results: What is legal, ethical, and conscientious overlap but are not identical. Professional ethical guidelines, when they exist, are stricter than what the law requires, but are silent on several contemporary controversies. Conscientious guidelines can vary from loosest to strictest as they apply to individuals with wide variability. The relationship of ophthalmology to society changes, and ethical guidelines lag for some of the interactions. Conclusion: The rules of ethics for ophthalmology need to be updated and evidence of activity and oversight made public. Failure to do so invites greater external regulation.

A Study on the Views and Thoughts of Dog Owners in Türkiye on Animal Welfare.

INTRODUCTION: The aim of the present study was to determine the views and thoughts of dog owners in Türkiye on animal welfare. The research material consisted of data obtained from face-to-face surveys with 172 randomly selected dog owners. Half of the dog owners (54,7 %) were aware of the concept of animal welfare, and almost two-thirds (61,6 %) organized their dogs' living spaces according to animal welfare principles. Participants most associated the concept of animal welfare with the concept of animal quality of life (47,7 %). Gender (p.

INTRODUCTION: L'objectif de cette étude était de déterminer les opinions et les réflexions des propriétaires de chiens en Turquie quant au bien-être des animaux. Le matériel de recherche se compose de données obtenues à partir d'enquêtes en face-à-face avec 172 propriétaires de chiens sélectionnés au hasard. La moitié des propriétaires de chiens (54,7 %) connaissaient le concept de bien-être animal et près des deux tiers (61,6 %) organisaient l'espace de vie de leur chien selon les principes du bien-être animal. Les participants associaient le plus souvent le concept de bien-être animal à celui de qualité de vie des animaux (47,7 %). Le sexe (p.

[The nursing role in psychedelic-assisted psychotherapy]. / Le rôle infirmier lors de la psychothérapie assistée par psychédéliques.

In this article, we aim to highlight the specific role of nurses in the interdisciplinary model of psychedelic-assisted psychotherapy. We argue that the plural competencies of our profession are at the heart of future issues in psychiatry and the use of psychedelics.

Conscience, Caricatures, and Catholic Identities.

Catholic health care is often viewed as antithetical to secular conceptions of autonomy. This view can engender calls to protect "choice" in Catholic facilities. However, this view is built on a fundamental misunderstanding of the Ethical and Religious Directives for Catholic Health Care Services (ERDs). This commentary, which responds to "Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience," by Abram Brummett et al., seeks to demonstrate the nuance of the ERDs as well as to address some of the challenges various Catholic identities have when interpreting and living out the ERDs so that all patients receive high-quality, compassionate care. By highlighting the Church's desire to protect all people at every stage, I hope to dispel the caricatures that often result from misunderstandings by Catholics and non-Catholics alike.

Vaccine Science Diplomacy and "The Phenomenon of Man".

The central tenets of international scientific collaborations leading to the development, testing, and the equitable distribution vaccines to combat poliomyelitis, smallpox, COVID-19, and other devasting infections, first accelerated in the mid-twentieth century. The genesis of vaccine science diplomacy also coincides with the publication of Le Phénomène Humain (The Phenomenon of Man) shortly after the death of its author, the French Jesuit priest and scientist, Dr. Teilhard de Jardin. Several tenets of Teilhard's posthumous essay, including our collective consciousness, and the "conjugated faces" of science and religion, are relevant to a modern vaccine diplomacy framework, even if Teilhard may not have specifically addressed vaccines in his writings. This could also include the potential for arriving at an "omega point" through international scientific collaboration and joint vaccine development, while simultaneously avoiding the destructive forces of anti-vaccine or anti-science activism. Collaborations between the Vatican, Catholic research universities and institutions; and leaders of the Catholic-majority nations in Africa, Asia, and Latin America in an integrated framework might accelerate these activities as they apply to both pandemic threats and neglected diseases of poverty.

Nurses' perception of troubled conscience in intensive care units: a qualitative study.

BACKGROUND: Troubled conscience results from the lack of attention to the voice of conscience. Regarding the fact that ICU healthcare workers are constantly faced with stressful and challenging situations, they often experience a troubled conscience. AIM: This study aimed to explain the factors leading to troubled conscience and identify the consequences of troubled conscience among ICU nurses. METHODS: Qualitative content analysis was used to answer the research question. A total of 18 ICU nurses were selected to participate in this study using purposive sampling. Data were collected using face-to-face, semi-structured interviews. FINDINGS: Four categories of "carelessness", "contextual challenges", "non-supportive and unpredictable structure" and "whirlpool of troubled conscience" were shown to constitute the main causes of troubled conscience among ICU nurses. CONCLUSION: Troubled conscience negatively impacts nurses and is associated with psychological/behavioral changes among them. The identification and explanation of troubled conscience help healthcare providers to confront it and manage its causes.

Conscientious Objection.

Physicians may under some circumstances decline to provide a clinical service that is within accepted medical standards due to a deeply held moral belief that to do so would be wrong. Conscience objection in medicine is legally protected, but ethically limited by physician obligations to put patient interests first. Accommodation to conscientious objections, when possible, recognizes the diverse moral perspectives and benefits for both the objectors and the profession as a whole. When these situations arise, physicians have obligations to respectfully resolve the distress of conscientious objectors while still honoring the primacy of patient care needs.

Concept analysis of conscience-based nursing care: a hybrid approach of Schwartz-Barcott and Kim's hybrid model.

BACKGROUND: The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care. METHODS: This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived. RESULTS: The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care. CONCLUSION: Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.

Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post-Dobbs Landscape.

Since the U.S. Supreme Court's decision in Dobbs vs. Jackson Women's Health Organization, a growing web of state laws restricts access to abortion. Here we consider how, ethically, doctors should respond when terminating a pregnancy is clinically indicated but state law imposes restrictions on doing so. We offer a typology of cases in which the dilemma emerges and a brief sketch of the current state of legal prohibitions against providing such care. We examine the issue from the standpoints of conscience, professional ethics, and civil disobedience and conclude that it is almost always morally permissible and praiseworthy to break the law and that, in a subset of cases, it is morally obligatory to do so. We further argue that health care institutions that employ or credential physicians to provide reproductive health care have an ethical duty to provide a basic suite of practical supports for them as they work to ethically resolve the dilemmas before them.

To participate or not to participate: The troublesome question of nurses' conscientious objection to abortion: A qualitative study.

AIM: To report a study investigating the implementation of the "conscience clause" by practising nurses in two National Health Service Hospital Trusts in the UK. DESIGN: A qualitative study. METHODS: Data were collected from 2018 to 2020 through qualitative face-to-face interviews with 20 nurses, transcribed verbatim and analyzed by thematic analysis. RESULTS: Major themes were developing conscience, negotiating conscience and parameters of participation. CONCLUSION: Participants had varied views on conscientious objection, reflecting a continuum from unwillingness to be near anything related to abortion to being willing to participate in the whole process. Most participants framed involvement as fulfilling their "duty of care" to their patient. Direct experience of witnessing abortion overrode faith-based foundations to shape participants' beliefs as objectors or non-objectors. Non-objectors were supportive of objecting colleagues. IMPLICATIONS FOR THE PROFESSION: The complex nature of conscience as a fundamental human right is inherently related to the cultural and social context of nursing. "Employability" raised important questions over the real world of a nurse's legal right to invoke conscientious objection without consequences. IMPACT: Problem addressed Conscientious objection to abortion continues to affect nursing. Main findings There was little knowledge of the law and a reluctance to make formal objections. Where and on whom will the research have an impact It highlights the need for delineated and implemented guidelines on conscientious objection in practice for nurses. Its findings, while local, may be applicable to other abortion services. PATIENT AND PUBLIC CONTRIBUTION: Representatives of each were key in our advisory group. REPORTING METHOD: COREQ checklist for qualitative research.

Person-centred care and the work-related health and job satisfaction of health and social care professionals: protocol for a prospective longitudinal cohort study combined with qualitative studies (the PCC@Work project).

BACKGROUND: The interplay of ethical stress, heavy workloads, and job dissatisfaction poses challenges to both the recruitment and retention of health and social care professionals. Person-centred care, rooted in ethical principles, involves collaborative care, and is expected to improve care and job satisfaction. However, prior research on the impact of person-centred care practices on professionals' work-related health and job satisfaction has yielded mixed results, and most studies emanate from residential care. Understanding how person-centred care practices influence health and social care professionals across different care settings thus requires further exploration through rigorous methodology. The overall aim of PCC@Work is to follow, describe, assess, and explore the impact of person-centred care practices in hospital wards, primary care centres and municipal care on health and social care professionals' work-related health and job satisfaction. METHODS: PCC@Work is designed as a prospective, longitudinal cohort study combined with qualitative studies. A web-based questionnaire will be distributed on five occasions within two years to health and social care professionals in the three care settings. In addition, focus groups and interviews will be conducted with a selection of health and social care professionals to explore their experiences of work-related health and job satisfaction in relation to person-centred practices. DISCUSSION: PCC@Work will highlight some of the knowledge gaps on the impact of person-centred care practices regarding work-related health and job satisfaction of health and social care professionals. The uniqueness of the project lies in the multi-method design, combining a prospective longitudinal cohort study with qualitative studies, and the involvement of various professions and settings. This means we will be able to provide a comprehensive and representative understanding of person-centred care practices as a critical component for effective change in the working conditions of health and social care.

Vaccine Mandates: Weighing the Common Good vs Personal Conscience and Autonomy.

COVID-19 is a serious illness with significant morbidity and mortality. Vaccines to immunize against it were developed in record time. Mandates followed. The question to be considered is when mandates are ethical. Mandates can be used to prevent spread of an infection, prevent overwhelming the healthcare system, or protect public safety, thereby protecting the vulnerable and allowing for full flourishing of the common good. At the same time, one must be careful about respecting autonomy by allowing those who consciences do not allow them to be vaccinated to refuse. Because COVID-19 knowledge is rapidly changing as more information is known and the virus mutates, the conditions under which mandates are ethical change as well. At present, since vaccines prevent severe infection and death in high-risk individuals with added benefit for those who are vaccinated and have a history of infection, mandates can be imposed on those individuals. With an estimated 95% of the US population believed to have been infected and prior history of infection shown to be as effective as vaccination, with immunity lasting at least 500 days, and ability to prevent spread unknown at present but limited at best in the past, the vaccines therefore cannot be ethically mandated for those who are low risk for the versions released September 2023 based on information as of October 2023.

The effect of conscience perception on job satisfaction and care behaviours in nurses.

Conscience is a force capable of making judgments about one's own moral values during individual behaviour. Conscience in nursing is a concept that is perceived as authority and an inner voice, and it positively affects nursing care. Today, according to many research results, conscience is an indicator of professionalism that affects our personal and professional lives. This research was carried out to determine the effect of nurses' perceptions of conscience on job satisfaction and care behaviours. A cross-sectional study was performed in a training and research hospital. The sample size of 338 nurses was determined by power analysis, and the participants were selected using a simple random sampling method. The data were collected between June and November 2020. A "Personal Information Form", the "Conscience Perception Scale (CPS)", the "Nurse Job Satisfaction Scale (NJSS)" and the "Caring Behaviours Scale-30 (CBS-30)" were used to collect the data. The nurses obtained a score of 63.36 ± 12.13 on the CPS, indicating a high level of conscience perception; a total of 3.41 ± 0.69 points on the NJSS, revealing a high level of job satisfaction; and a total of 150.42 ± 21.22 points on the CBS-30, implying that care perceptions were found to be high. It was determined that the nurses' perceptions of conscience had an effect on their job satisfaction and care behaviours (R = 0.398, Adjusted R2 = 0.158, p = 0.000). The nurses who participated in the study had a high perception of conscience, which positively affected their job satisfaction and care behaviours.

The Overlooked Contributors to Climate and Biodiversity Crises: Military Operations and Wars.

The military-industrial complex, military operations, and wars are major contributors to exacerbating both climate change and biodiversity crises. However, their environmental impacts are often shadowed due to national security reasons. The current paper aims to go through the devastating impacts of military operations and wars on climate change and biodiversity loss and challenges that hinder the inclusion of military-related activities into environmental crisis mitigation efforts. The information blind spot induced by concerns about national security reasons jeopardizes the efforts to involve the military-industrial complex and military operations in the global climate and biodiversity agendas. Besides that, many military-related challenges, such as specificity of operational requirements and lifecycles, dependence on fossil fuels, complex supply change, inadequate civilian technologies and innovations, and requirements of structural changes, can hinder emission reduction. Meanwhile, wars and conflicts not only threaten to drain all human and material resources available to tackle environmental problems but also inflict long-lasting destructions, pains, and trauma that can lead to hatred and distrust among nations and parties. With the rising hatred and distrust, global agreement and commitment to address climate change and biodiversity will hardly be achieved. Thus, promoting peace is the humanistic and planetary conscience.

Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.