Academic literature on the topic 'Brain death Moral and ethical aspects'

Scientific advances have enabled thousands of individuals to extend their lives through organ donation. Yet, shortfalls of available organs persist, and individuals in the United States die daily before they receive what might have been lifesaving organs. For years, the legal foundation of organ donation in the United States has been known as the Dead Donor Rule, requiring death to be defined for organ donation purposes by either a cardiac standard (termination of the heartbeat) or a neurological one (cessation of all brain function). In this context, one solution used by an increasing number of health care facilities since 2006 is donation after circulatory death, generally defined as when care is withdrawn from individuals who have known residual brain function. Despite its increased use, donation after circulatory death remains ethically controversial. In addition, some ethicists have advocated forgoing the Dead Donor Rule altogether and allowing donation before or near death in certain circumstances. However, nurses and other health professionals must carefully consider the practical and ethical implications of broadening the Dead Donor Rule—as may be already occurring—or removing it entirely. Such changes could harm both the integrity of the health care system as well as efforts to secure organ donation commitments from the public and are outweighed by the moral and pragmatic cost. Nurses should be prepared to confront the challenge posed by the ongoing scarcity of organs and advocate for ethical alternatives including research on effective care pathways and education regarding organ donation.

Most contributors to the debate about brain death, including Dr. James Bernat, share certain assumptions. They believe that the concept of death is univocal, that death is a biological phenomenon, that it is necessarily irreversible, that it is paradigmatically something that happens to organisms, that we are human organisms, and therefore that our deaths will be deaths of organisms. These claims are supposed to have moral significance. It is, for example, only when a person dies that it is permissible to extract her organs for transplantation.It is also commonly held that our univocal notion of death is the permanent cessation of integrated functioning in an organism and that the criterion for determining when this has occurred in animals with brains is the death of the brain as a whole – that is, brain death. The reason most commonly given for this is that the brain is the irreplaceable master control of the organism's integration.

AbstractTheme I: Health and Human Rights. Health and human rights in relation to children and other vulnerable groups - for example, ethnic minorities and migrants; the role of health professionals in promoting respect for human rights; discrimination on the basis of health status. Theme II: The Death Debates. Cross-cultural and comparative religion perspectives on dying; euthanasia; nurse-assisted and physician-assisted suicide; the futility debate; advance directives; transplantation ; procuring organs from heart-beating donors or anencephalic infants. Theme III: Genetics and Reproductive Technology. The nature of human identity; genome mapping; genetic manipulation and counselling ; embryo research; preimplantation and prenatal diagnosis; the legal status of embryos, fetuses, infants, and families created by assisted reproduction; fetal tissue transplants; eugenics; population ethics. Theme IV: Health, Ecology, Persons and Planet. The connections between human health and ecological health, including how concepts developed in medicine, ethics, and law might be applicable in the promotion of ecological health, and vice versa. These include resource allocation; justice (including intergenerational justice) in health care; open and closed legal systems; and concepts of trust, covenant, and quality of life.

Abstract Ethical issues surrounding brain death and end-of-life have not been afforded in Brazil the same attention as in many developed countries. There appears to be reluctance on the part of Brazilian doctors to limit or suspend procedures or treatment which prolongs life of patients in terminal phases of severe incurable illness, or to suspend the artificial means of supporting vegetative functions in cases of brain death outside the context of organ and tissue donation for transplant. Fears grounded in possible administrative (Regional Medical Councils) or legal repercussions, as well as ambiguous interpretations of religious precepts, partially explain this reluctance which often results in unnecessary prolonging of patient suffering. A recent resolution by the Federal Medical Council on end-of-life may offer doctors some guidance and confidence in dealing with highly complex ethical situations.

Brain organoid research raises ethical challenges not seen in other forms of stem cell research. Given that brain organoids partially recapitulate the development of the human brain, it is plausible that brain organoids could one day attain consciousness and perhaps even higher cognitive abilities. Brain organoid research therefore raises difficult questions about these organoids' moral status – questions that currently fall outside the scope of existing regulations and guidelines. This paper shows how these gaps can be addressed. We outline a moral framework for brain organoid research that can address the relevant ethical concerns without unduly impeding this important area of research.

AbstractAlthough the concept of death by neurologic criteria is accepted throughout much of the world and death can legally be determined by neurologic criteria throughout the United States, the process is fraught with contentious ethical and legal controversies. I explore historic and contemporary ethical and legal disputes about determination of death by neurologic criteria including the need for consent from patients' surrogates prior to determination of death, the role of religion in determination of death, management of objections to determination of death by neurologic criteria, the approach to patients who are dead by neurologic criteria but are pregnant, and gamete retrieval after determination of death.

Infant death has extreme emotional and symbolic effects on parents and health care professionals who face the moral and ethical aspects of life and death decisions, complicated by government ideology. Social workers can help with understanding the resulting dilemmas and suggest possible interventions.

In recent years, increasing pressures have been brought to bear upon nurses and others more closely to inform, involve and support the rights of parents or guardians when crucial ‘life and death’ ethical decisions are made on behalf of their seriously ill child. Such decisions can be very painful for all involved, and may easily become deadlocked when there is an apparent clash of moral ideals or values between the medical team and the parents or guardians. This article examines a growing number of such cases in New Zealand and analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. The article concludes with a recommendation that nurses should be recognized as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations.

This article combines a philosophical critique of the idea that public health nurses are primary technicians who neutrally hand over scientifically established facts on risks to the public and an empirical analysis of the actual work of public health nurses. It is argued that the relationship between facts and values in public health is complex and that, despite the introduction of several scientifically-based standards and guidelines, public health nurses are not technicians. They do moral work and experience ethical dilemmas. To get a grip on the specific character of this moral work, we distance ourselves from the idea that there are ethical dilemmas in public health nursing for which we can provide general ethical rules and principles. Instead we suggest a contextual ethical approach, in which several different kinds of consideration may be important. To illustrate this, we analysed 15 in-depth interviews with nurses involved in the prevention of cot deaths in the Netherlands. It is shown that these nurses do not neutrally pass on the epidemiological facts on the risks of prone sleeping, warm bedclothes and passive smoking, but they are the moral architects of this preventive practice. It is also shown that this moral work and the ethical dilemmas they experience cannot be characterized in terms of general ethical rules and principles. It becomes clear that the moral work of nurses differs according to the three main risks at stake: the balance between virtue, risk taking and responsibility depends on the specific context.

Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded.

Thesis (PhD)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: Moral theories on abortion are often regarded as mutually exclusive. On the one hand, pro-life advocates maintain that abortion is always morally wrong, for life is sacred from its very beginning. On the other hand, the extreme liberal view advocated by the absolute pro-ehoieers claims that the unborn is not a person and has no moral standing. On this view there is no conflict of rights; women have the right to dispose of their body as they wish. Therefore, killing a non-person is always permissible. In between the two extreme views, some moral philosophers argue that a 'pre-sentient' embryo or fetus cannot be harmed because it lacks the ability to feel pain or pleasure, for it is 'sentience' that endows a living entity (human and non-human) with moral considerability. Therefore, abortion of a pre-sentient embryo or fetus is permissible. Neurophilosophy rests a philosophical conclusion on neurological premises. In other words, to be tenable sentientism - the claim that sentience endows an entity with moral standing - needs robust neurobiological evidence. The question is, then: What is the basic neuroanatomical and neurophysiological apparatus required to be sentient? The answer to that question requires a fair understanding of the evolution, anatomy and function of the brain. The exploration thereof shows quite convincingly that the advocates of sentientism do not provide convincing arguments to root their theory in neurobiological facts. Their claims rest rather on emotions and on behaviours that look like a reaction to pain. The other shortcoming of sentientism is that it fails to distinguish pain from suffering, and that as a utilitarian moral theory it considers only the alleged pain of the aborted sentient fetus and disregards the pregnant woman's pain and suffering. And, finally, sentientism leaves out of our moral consideration living and non-living entities that deserve moral respect. The main thrust of the dissertation is that the argument of sentience as its advocates present it has no neurophilosophical grounds. Therefore, the argument from sentience is not a convincing argument in favour or against abortion.
AFRIKAANSE OPSOMMING: Morele teorieë wat handeloor aborsie word dikwels as wedersyds uitsluitend beskou. "Pro-life" kampvegters hou oor die algemeen vol dat aborsie onder alle omstandighede moreel veroordeelbaar is, omdat die lewe van meet af heilig is. Daarteenoor hou die ekstreem-liberale oogpunt, wat deur "Pro-choice" voorstaanders ingeneem word, vol dat die ongeborene nie 'n persson is nie, en as sulks geen morele status het nie. Volgens hierdie standpunt is daar geen konflik van regte hier ter sprake nie; vroue het uitsluitelike beskikkingsreg oor hulle eie liggame. Dus is dit toelaatbaar om onder hierdie omstandighede 'n "nie-persoon" om die lewe te bring. Tussen hierdie twee ekstreme standpunte argumenteer party morele filosowe dat die voorbewuste embrio of fetus nie skade berokken kan word nie, omdat dit nie oor die vermoë beskik om pyn of plesier te voel nie. Dit is juis bewussyn en die vermoë om waar te neem wat morele status aan 'n entiteit (hetsy menslik of nie-menslik) verleen. Dus is dit toelaatbaar om 'n voorbewustw embrio of fetus te aborteer. Neurofilosofie basseer filosofiese gevolgtrekkinge op neurolgiese beginsels. Met andere woorde, so 'n standpunt sal eis dat 'n argument oor bewustheid op betroubare neurologiese feite gebasseer word, om sodoende met sekerheid morele status, al dan nie, aan de fetus of embrio toe te ken. Die vraag is dan: Wat is die basiese neuroanatomiese en neurofiologiese apparatuur waaroor 'n entiteit moet beskik om as bewus beskou te word? Die antwoord op hierdie vraag vereis dan ook 'n redelik grondige kennis van die evolusie, anatomie en funksie van die brein. Wanneer die vraagstuk van naderby beskou word, word dit duidelik dat voorstaanders van die bewustheids-argument oor die algemeen nie hulle standpunte op oortuigende, neurologiese feite berus nie. Hulle beweringe rus dan eerder op emosie en op waargenome optredes wat voorkom asof dit 'n reaksie op pyn is. Nog 'n tekortkoming van die bewustheids-argument is dat dit nie 'n onderskeid tref tussen die konsep van pyn en die van leiding nie, en dat dit as 'n utilitaristiese morele teorie slegs die beweerde pyn van die ge-aborteerde fetus in ag neem en nie die leiding van die swanger vrouw nie. Ten slotte neem die bewustheids-argument ook nie morele status van lewende en nie-lewende entiete, wat geregtig is op morele respek, in ag nie. Die hoof uitgangspunt van hierdie dissertasie is dan dat die bewustheids-argument, soos wat dit tans deur voorstanders daarvan voorgehou word, nie neurofilosfies begrond kan word nie. Dus is die argument vanuit 'n bewustheids-standpunt nie 'n oortuigende argument hetsy vir of teen aborsie nie.

This dissertation is primarily about the ethical evaluation ofbrain death, brain-dead persons and organ transplantation in contemporary Muslim ethics.
Cette tQese est premierement au sujet de l'évaluation éthique de la mort cérébrale et les personnes dans un coma dépassé aux éthiques Musulmanes contemporaines.

Thesis (MPhil)--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: This thesis discusses the value of medical futility as an action guide for neonatal endof- life decisions. The concept is contextualized within the narrative of medical progress, the uncertainty of medical prognostication and the difficulty of just resource allocation, within the unique African situation where children are worse off today than they were at the beginning of the last century. parties actively engage in an interactive deliberation for a plan of action. Both parties ought to accept moral responsibility. Such a model of deliberation has the added advantage of transcending the limitations of the participants to arrive at a higher-level solution, which is considered more than just a consensus. It has been argued that medical progress has obscured the basic need for human compassion for the dying and for their loved ones. The literature furthermore reports that the quality of end-of-life care is unsatisfactory for both patients and their families. It is within this context that the concept of medical futility is positioned as a useful action guide. As we do not have the luxury of withdrawing from the responsibility to engage in the deliberation of end-of-life decisions, such responsibility demands an increasing awareness of ethical dilemmas and a model of medical training where communication, conflict-resolution, inclusive history taking, with assessment of patient values and preferences, is focussed on. The capacity for empathetic care has to be emphasized as an integral part of such approach. Finally, in this thesis, the concept of medical futility is tested and applied to clinical case scenarios. It is argued that the traditional medical paradigm, with its justification of an 'all out war' against disease and death, in order to achieve utopia for all, is outdated. Death in the neonatal intensive care unit is increasingly attributed to end-of-life decisions. Futile treatment could be considered a waste of scarce resources, contradicting the principle of nonmaleficence and justice, particularly in an African context. The ongoing confidence in, and uncritical submission to the technological progress in medicine is understood as a defence and coping mechanism against the backdrop of the experience of life's fragility, suffering and the inevitability of death. Such uncritical acceptance of the technological imperative could lead to a harmful fallacy that cure is effected by prolonging life at all cost. What actually occurs, instead, is the prolongation of the dying process, increasing suffering for all parties involved. The historical development of the concept of medical futility is discussed, highlighting its applicability to the paradigmatic scenario of cardio-pulmonary resuscitation. Particular attention is given to ways in which the concept could endanger patient-autonomy by allowing physicians to make unilateral, paternalistic decisions. It is argued that the informative model of the patient-physician relationship, where the physician's role is to disclose information in order for the patient to indicate her preferences, ought to be replaced by a more adequate deliberative model, where both
AFRIKAANSE OPSOMMING: Hierdie tesis bespreek die waarde van mediese futiliteit as 'n maatstaf vir aksie in gevalle van neonatale 'einde-van-lewe' besluite. Die konsep word gekontekstualiseer binne die wêreldbeskouing van mediese vooruitgang, die onsekerheid van mediese prognostikering en die probleme wat geassosieer IS met regverdige hulpbrontoekenning; spesifiek binne die unieke Afrika-situasie. Dit word aangevoer dat die tradisionele mediese paradigma, met regverdiging vir voorkoming van siekte en dood ten alle koste, verouderd is. Sterftes in neonatale intensiewe sorgeenhede word toenemend toegeskryf aan 'einde-van-lewe' besluite Futiele behandeling sou dus beskou kon word as 'n vermorsing van skaars hulpbronne, wat teenstrydig sou wees met die beginsels nie-skadelikheid ('nonmaleficence') en regverdigheid. Die volgehoue vertroue in en onkritiese aanvaarding van aansprake op tegnologiese vooruitgang lil geneeskunde, kan beskou word as verdediging- en hanteringsmeganisme in die belewenis van lewenskwesbaarheid, lyding en die onafwendbaarheid van die dood. Sodanige onkritiese aanvaarding van die tegnologiese imperatief kan tot 'n onverantwoordbare denkfout, naamlik dat genesing plaasvind deur verlenging van lewe ten alle koste, lei. Wat hierteenoor eerder mag plaasvind, is 'n verlenging die sterwensproses en, gepaard daarmee, toenemende lyding van all betrokke partye. Die historiese ontwikkeling van die konsep van mediese futiliteit word bespreek met klem op die toepaslikheid daarvan op die paradigmatiese situasie van kardiopulmonêre resussitasie. Spesifieke aandag word gegee aan maniere waarop die konsep pasiënte se outonomie in gevaar stel, deur die betrokke medici die reg te gee tot eensydige, paternalistiese besluitneming. Die argument is dan dat die informatiewe model, waar die verhouding tussen die dokter en pasiënt gebasseer is op die beginsel dat die dokter inligting moet verskaf aan die pasiënt sodat die pasiënt 'n ingeligte besluit kan neem, vervang moet word met 'n meer toepaslike beraadslagende model, waar sowel die dokter as die pasiënt aktief deelneem aan interaktiewe beraadslaging oor 'n aksieplan. Albei partye word dan moreel verantwoordbaar. So 'n model van beraadslaging het die bykomende voordeel dat dit die beperkings van die deelnemers kan transendeer. Sodoende word 'n hoër-vlak oplossing - iets meer as 'n blote consensus - te weeg gebring. Die argument word ontwikkel dat mediese vooruitgang meelewing met die sterwendes en hul geliefdes mag verberg. Verder dui die literatuur daarop dat die kwaliteit van einde-van-lewe-sorg vir sowel die pasiënte as hul familie onaanvaarbaar is. Dit is binne hierdie konteks dat die konsep van mediese futiliteit kan dien as 'n maatstaf vir aksie. Medici kan nie verantwoordelikheid vir deelname aan beraadslaging rondom eindevan- lewe beluitneming vermy nie, en as sodanig vereis die situasie toenemende bewustheid van sowel die etiese dilemmas as 'n mediese opleidingsmodel waann kommunikasie, konflikhantering, omvattende geskiedenis-neming, met insluiting van die pasient se waardes en voorkeure, beklemtoon word. Die kapasiteit vir empatiese sorg moet weer eens beklemtoon word as 'n integrale deel van hierdie benadering. Ten slotte, hierdie tesis poog om die konsep van mediese futiliteit te toets en toe te pas op kliniese situasies.

African Americans’ tendency to choose life-prolonging treatments (LPT) over comfort focused care (CFC) at end-of-life is well documented but poorly understood. There is minimal knowledge about African American (AA) perceptions of decisions to continue or discontinue LPT. The purpose of this study was to examine AA family members’ perceptions of factors that influenced end-of-life care decision-making for a relative who recently died from serious illness. A conceptual framework informed by the literature and the Ottawa Decision Support Framework was developed to guide this study. A retrospective, mixed methods design combined quantitative and qualitative descriptive approaches. Forty-nine bereaved AA family members of AA decedents with serious illness who died between 2 to 6 months prior to enrollment participated in a one-time telephone interview. Outcomes examined include end-of-life treatment decision, decision regret, and decisional conflict. Quantitative data were analyzed using descriptive statistics, independent-sample t-tests, Mann-Whitney U tests, chi-square tests, Spearman and Pearson correlations, and linear and logistic regressions. Qualitative data were analyzed using content analysis and qualitative descriptive methods. Family members’ decisional conflict scores were negatively correlated with their quality of general communication (rs = -.503, p = .000) and end-of-life communication scores (rs = -.414, p = .003). There was a significant difference in decisional regret scores between family members of decedents who received CFC versus those who received LPT (p = .030). Family members’ quality of general communication (p = .030) and end-of-life communication (p = .014) were significant predictors of family members’ decisional conflict scores. Qualitative themes related to AA family members’ experiences in end-of-life decision-making included understanding (e.g., feeling prepared or unprepared for death), relationships with healthcare providers (e.g., being shown care, distrust) and the quality of communication (e.g., being informed, openness, and inadequate information). Additional qualitative themes were related to perceptions of the decision to continue LPT (e.g., a lack of understanding, believe will benefit) or discontinue LPT (e.g., patient preferences, desire to prevent suffering). In conclusion, this study generated new knowledge of the factors that influenced AA bereaved family members’ end-of-life decision-making for decedents with serious illnesses. Directions for future research were identified.

Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple complex chronic conditions. While these advances in medicine are beneficial to many, it can also unnecessarily prolong inevitable deaths. Concerns over the ability to have a death that is in alignment with personal values has increased the interest in the use of formal end-of-life planning including writing an advance instructional directive and assigning a durable power of attorney for health care. Although research has indicated that the use of these formal planning strategies is beneficial, not everyone completes them. Using a current nationally representative sample, the three specific aims of this study were to examine whether there are racial and ethnic differences in formal end-of-life planning done by older African American, Hispanic, and White adults; to examine socioeconomic factors including education and income in formal end-of-life planning as well as assess the contribution of these factors in explaining racial and ethnic differences in formal end-of-life planning; and to examine the role of religiosity in formal end-of-life planning and to assess its influence on racial and ethnic differences in explaining formal end-of-life planning. Logistic regression was run on data from the Health and Retirement Study (HRS) in order to analyze the completion of formal end-of-life plans by African American, Hispanic, and White decedents. Exit interviews conducted with knowledgeable proxies in 2008 or 2010 were combined with data from earlier waves of the HRS survey in order to analyze the completion of formal end-of-life plans, race and ethnicity, socioeconomic status, and religion. Both Blacks and Hispanics were less likely to complete a written advance directive, assign a proxy, or complete both forms of formal planning than were Whites. Group differences remained after controlling for region of death and cause of death. Both Blacks and Hispanics were less likely to complete any form of formal planning than Whites. Group differences remained after additionally controlling for gender, age, marital status, whether the decedent had children, income, education, religious preference, importance of religion, and frequency of attending religious services. Higher levels of income and education both increased the odds that formal advance planning would take place. Religious preference was not significant, but decedents who had stated that religion was very important were less likely to plan while those that attended services frequently were more likely to plan. I speculate that the role of cultural capital may partially explain the persistent racial and ethnic disparities and the importance of income and education. Additionally the dominant religious doctrines of Christianity may have a greater influence than the different religious teachings of Protestant and Catholics around end-of-life medical care. Contrary to expected findings, reference groups of those who attend religious services frequently may assist in formal planning. These finding may help guide interventions that can diminish disparities in the end-of-life experience. Understanding who are completing formal plans can help ensure end-of-life care that is in alignment with personal beliefs and values.

This dissertation examines Peter Singer's proposed ethical value of the "person" in Rethinking Life and Death . Chapter 1 introduces and outlines Singer's proposal, which argues for abortion, infanticide, euthanasia, and assisted suicide. His proposal consists of four key points. First, there is the foundation for his proposal--rejecting creation for evolution. Second, there is the substance of his proposal--replacing the value of the "human" with the value of the "person." Third, there is the criteria for his proposal--using "indicators" and "relevant characteristics" to identify the kinds of beings who qualify as "persons." Fourth, there are the consequences of his proposal--promising an ethical "Copernican Revolution." Chapters 2-5 critically evaluate the four key ideas from Singer above. The evaluation of the respective key idea in each chapter covers five steps: (1) the context of Singer's proposal; (2) the content of Singer's proposal; (3) positive evaluation; (4) negative critique; and (5) conclusion. The research methodology for the dissertation is to treat Singer's ethical proposal on the "person" as a hypothesis to be tested by his own truth standards of logical consistency, empirical evidence, and practicality. Following these four key chapters, Chapter 6 provides "Summary and Conclusions." The conclusion of this dissertation is that Peter Singer's proposal on life and death is not to be commended because its key elements are not supported by his own standards for testing truth. In fact, when examined by his own truth tests, Singer's program should be rejected because its foundation is faulty, its substance is illusory, its criteria are circular, and its consequences would be grave.
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The rapid pace of technology's evolution and uptake since the end of the Cold War, coupled with its role as a driver of many recent political changes, suggests that some uses of technology might contribute to genocide. Technological change and new developments in its use can redistribute power and impact the global environment, as well as reshaping the dynamics of local natural, political and social environments. Use of new media, including the internet, social media and mobile phones, promotes "citizen journalism", in which news and video footage is gathered and disseminated by amateurs. Citizen journalism is increasing during times of conflict and there exists a hotly contested "arms race" for control of these fora between genocidal governments, resistance groups and foreign governments and their citizens. By democratising control of communication, use of new media might shift the balance of power toward those who would resist, or prevent, genocide. An increasing and unsustainable use of technology has contributed to climate change. Climate change will likely enhance genocide risk through a number of causal pathways including resource scarcity, inequality and reduced economic growth. Implications for prevention are assessed with a focus on the doctrine of the Responsibility to Protect (R2P). This thesis works toward filling a major policy gap in R2P, in which international responsibility to prevent and intervene in genocide remains diffuse, allowing for inaction. Rather than weakening the doctrine, linking genocide prevention with action to mitigate climate change would strengthen its standing as an international norm. The insight that technology use can influence genocide is applied to genocide prevention. Evidence suggests that aspects of technology use can be harnessed for prevention, and these are often most effectively used "upstream", well before genocide is imminent.

Murder is not a phenomenon that sits comfortably with the typical image of nurses and yet the number of cases of nurses accused and convicted of murdering patients is mounting. The nursing literature is quiet on the subject and therefore what is generally known on the topic predominantly comes from the media. An analysis of this seemingly unfathomable phenomenon is required to re-consider the problem and understand from new perspectives how and why this is happening. The aim of the study is to provide information for health professionals and organisations that will help them work together to recognise situations in which murder by nurses can occur. The research question is: How do the various discourses surrounding murder committed by nurses on patients in the course of their work shape the definition and treatment of these crimes? A discursive analysis of texts guided by a number of discourse theorists is undertaken to reveal the social construction of murder of patients by nurses. Texts related to the media and professional reporting of over 50 cases of registered nurses, enrolled and licensed nurses and assistants were retrieved from searches of Factiva, CINAHL and MEDLINE between 1980 to 2006. The software program JBI-NOTARI® (Joanna Briggs Institute, 2003b) houses the texts and facilitated analysis. Discursive constructions are reported in four findings chapters and include: the profile of murderous nurses; types of murders; contexts in which murder takes place; factors that aid detection and apprehension; legal processes that guide charges, convictions and punishment; and finally the reactions of the public, the profession, the regulators and the families. The murder of patients by nurses is construed as a combination of extraordinary nurses, extraordinary deeds in ordinary contexts. While members of the nursing profession may not be held accountable for the actions of aberrant nurses who murder there is a responsibility to understand how hospitals and units form crucibles in which murder can take place. The recommendations from this study relate to both practice and research. Practitioners are recommended to critically reflect on structures and processes.
Thesis(Ph.D.)-- School of Population Health and Clinical Practice, 2008

M.Cur. (Psychiatric nursing)
Withdrawal of life-support treatment is a well-known concept which has been studied often, especially from a medical point of view. The life-world of families involved in decision making concerning withdrawal of life-support of a family member is, however, an unknown field. This leads to the reaction and behavior of families to this traumatic process often begin mistakenly described by professionals as "difficult" , "passive" or "incapable of decision making". The patient and his/her family have, to a large extent, the right of self-determination and the right to take part in decision making. In the intensive care unit it often happens, according to Burger (1996:1-175), that the patient is not able to participate actively in the decision making process because of his/her illness and/or medication. The family then steps forward as decision maker and as the patient's "mouthpiece". The situation arises where the family, who must make the decision about withdrawal of life support treatment, are exposed to utterly moral conflict. Burger (1996:163) found that a family that experiences such trauma is not capable of focusing and assimilating knowledge. Members of the family have a great need for support and the intensive care nurse cannot provide that support for different reasons. One of the reasons being limited time and the other not being able to build therapeutic relationships. Because of the above mentioned, the overall objective of this study is to analyse the phenomenon of families who are involved in decision making concerning withdrawal of life-support treatment of a family member. Guidelines have been formulated according to the analysis of this phenomenon for the psychiatric nurse specialist to mobilise resources for the family to promote, maintain and restore their mental health as integral part of health. The research model of Botes (1989:1-283) is used in this study. The study is undertaken from the Judeo-Christian perspective of Nursing for the Whole Person Theory (Oral Roberts University, Anna Vaughn School of Nursing, 1990:136-142). A phenomenon analysis was undertaken in two phases. During the first phase, secondary analysis of primary data was done on the family used in Burger (1996:1-175) and was followed up by phenomenological interviews with families in the same circumstances and according to the same criteria that Burger (1996:1-175) used in her study. Data were analysed in collaboration with an independent coder. The family used for member checking in this study was also used in data control. A literature control was conducted as part of data control. On the ground of the repetitive themes from the secondary analysis and phenomenological interviews with the family involved in member checking, guidelines were formulated in phase two, based on all the data obtained from phase one, for psychiatric nursing specialists to mobilise resources for families in this situation. The proposed guidelines leave the door open for follow-up research where a model for assistance can be formulated for psychiatric nursing specialists to assist these families, since intensive care personnel are either too involved in the process, or do not always know how to build therapeutic relationships and usually also do not have enough time to attend to the patient's family.

AbstractThe algorithms implemented through artificial intelligence (AI) and big data projects are used in life-and-death situations. Despite research that addresses varying aspects of moral decision-making based upon algorithms, the definition of project success is less clear. Nevertheless, researchers place the burden of responsibility for ethical decisions on the developers of AI systems. This study used a systematic literature review to identify five categories of AI project success factors in 17 groups related to moral decision-making with algorithms. It translates AI ethical principles into practical project deliverables and actions that underpin the success of AI projects. It considers success over time by investigating the development, usage, and consequences of moral decision-making by algorithmic systems. Moreover, the review reveals and defines AI success factors within the project management literature. Project managers and sponsors can use the results during project planning and execution.

Neurologic diseases may lead to brain dysfunction and consequently to impairment of consciousness, cognitive decline, and emotional disturbances. These conditions may give rise to a wide array of ethical issues. Cerebral dysfunction can be temporary but many conditions are chronic and/or progressive, and the impact of such long-lasting brain dysfunction on decision-making processes is substantial. In this chapter, disturbances of consciousness and the decision-making process, with focus on communication during the various stages of coma, persistent vegetative state, and permanent vegetative state, are discussed. Special attention is paid to the role of proxies, who often have to act as surrogate decision-makers. Further, some aspects of brain death and organ donation are reviewed and the role of the neurologist as a specialist with respect to brain functioning, but also as an advocate acting in the interest of the patient and the patients’ relatives is depicted. Subsequently, consequences of impaired decision-making capacity in dementia and other diseases leading to diminished cognitive functioning are discussed and a short reflection is dedicated to driving ability. Ultimately, ethical issues in connection with decisions on withdrawing and withholding life-sustaining treatment including end-of-life decisions are discussed, both in neurologic diseases with diminished cognitive functioning but also in neurologic disorders, like motor neuron disease, where cognitive functions are preserved.

The ethical schools of thought are essential to decision-making for peacebuilding and positive social change. The directives emerging from ethical schools often contradict each other, but Compassionate Reasoning can help resolve these contradictions and guide people in a more coherent direction of thinking and acting. The cultivation of compassion is shown to be a glue that bonds schools of ethics into one enterprise of moral reasoning as seen through several lenses. People who reason together are more adept at problem solving than when reasoning alone, but only if they have cultivated caring and compassionate relationships as a group. Moral reasoning in fierce competition with others, by contrast, retards the discovery of solutions to thorny problems. Compassionate Reasoning encourages collective reasoning rather than isolated and selfish reasoning. Excessive obedience to authority is also one of the most dangerous aspects of the human lower brain. A critical antidote is extensive training in taking the perspectives of others through Compassionate Reasoning.

Life and death are fundamental antinomian concepts of human existence. Life as a process of becoming gives us the chance to realize ourselves personally and professionally. Man's attitude towards the value of life, in different historical periods, was different: for the ancient man, life is a complex process, which sums up contemplative and moral aspects, which would help him delimit truth from falsehood, value from non-value, etc.; for the medieval man, the moral life is in close correlation with the observance of church canons, intelligence being defined as the main instrument of morality; for the modern man, life holds supreme value; the postmodern man is confused and uncertain, discussing contradictory issues related to the meaning and value of life in the context of multiple overlapping crises (spiritual, moral, political, etc.). The issue of the value of human life becomes an object of study of bioethics starting from the second half of the XX century. Bioethics has always been focused on ethical-moral norms and values, human life representing the supreme moral value.