Nursing vaccine mandates: Ethically justified, an infringement on autonomy, or both?

After almost a year and a half of the COVID-19 pandemic, many healthcare institutions in the United States announced that they would mandate COVID-19 vaccination, with medical and religious exceptions, as a term of employment. The mandates resulted in widely publicized protests from hospital staff, including some nurses, who argued that these medical institutions violated the ethical principle of autonomy. As the world enters the "post-pandemic period," decisions such as these, made during times of crisis, must be reviewed to provide clarity for when the next pandemic occurs. In this paper, we support the argument that such mandates are ethically justifiable. We explore the framework of objections that were brought forward by dissenters of this vaccine mandate. Next, we provide an analysis of conflicting ethical principles present when such mandates were deployed. Utilizing the American Nurses Association's Code of Ethics for Nurses, notably provisions 2, 3, and 6 we argue that it is an ethical duty of the nurse to be vaccinated. Specifically, we turn to provision two, which most explicitly underscores the necessity of vaccination as a function of the nurse's primary commitment to the patient. Next, we highlight the International Council of Nurses Code of Ethics which provides similar guidance internationally. Finally, we examine the applicability of the principles of public health, care ethics, and the nursing role as frameworks to underpin such mandates both for the current and for potential future pandemics, arguing that the nurse's ethical duty to be vaccinated spans these contexts.

End-of-life care at home: Dignity of family caregivers.

BACKGROUND: Healthcare services are increasingly being shifted to home settings for patients nearing end-of-life. Consequently, the burden on family caregivers is significant. Their vulnerable situation remains poorly understood and there is little information available regarding their experiences of dignity. AIM: This study seeks to understand the experiences of family caregivers related to dignity and loss of dignity, aiming to provide a deeper insight into their situation when caring for a home-dwelling family member nearing end-of-life. RESEARCH DESIGN AND PARTICIPANTS: This exploratory study consists of a second analysis combining data from two primary studies, including 24 family caregivers of a family member nearing end-of-life, and is founded upon Gadamer's philosophical hermeneutics. ETHICAL CONSIDERATIONS: Approval was obtained from the Norwegian Agency for Shared Services in Education and Research and was based on voluntary participation, informed consent, and confidentiality. RESULTS: The following three main themes were identified: Having a meaningful existence within the living environment, being seen and valued as a family caregiver in relation with others and suffering in a space of loneliness. These contextual, relational, and existential perspectives were found to be closely interrelated. CONCLUSION AND FINAL CONSIDERATIONS: The dignity of family caregivers was closely tied to being seen as unique individuals, not merely caregivers, thereby requiring healthcare professionals (HCPs) to understand their personal needs. This study highlights the emotional distress and loneliness family caregivers feel in their dual role within the healthcare system, thereby calling for HCPs to adopt an attitude of gentleness and recognition to impart dignity-preserving care in homecare practices.

Gerontechnologies, ethics, and care phases: Secondary analysis of qualitative interviews.

BACKGROUND: Gerontechnologies are increasingly used in the care for older people. Many studies on their acceptability and ethical implications are conducted, but mainly from the perspective of principlism. This narrows our ethical gaze on the implications the use of these technologies have. RESEARCH QUESTION: How do participants speak about the impact that gerontechnologies have on the different phases of care, and care as a process? What are the moral implications from an ethic of care perspective? RESEARCH DESIGN: Secondary analysis of semi-structure interviews, whose segments on specific technologies were analysed through reflexive thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT: Sixty-seven Swiss stakeholders involved in the use of gerontechnologies, including professional caregivers, informal caregivers, and older persons themselves. ETHICAL CONSIDERATIONS: The research study was evaluated by the Ethics Commission of Northwest and Central Switzerland (EKNZ). All participants received an information document before the interview date detailing the purpose, procedure, and anonymization measures. After explaining the study during the agreed upon interview time and upon receiving their written informed consent, the interview process began. FINDINGS/RESULTS: Four themes are identified: Identifying care needs, Taking responsibility, Hands-on work, Responding to care. As part of these themes, many codes highlighting the ambivalent impact of gerontechnologies are created, ranging from 'Expanded capacity for…identifying care needs' to 'Create new & (un)necessary…hands-on work'. The moral implications of these results from the care ethics perspective are discussed, through the ethical elements of: attentiveness, responsibility, competence, and responsiveness. CONCLUSIONS: The moral implications of gerontechnologies on care phases from the care ethics perspective open up several questions on whether they actually help give care a central role in social life and provide more competent care.

Conceptualisations of "good care" within informal caregiving networks for older people in rural South Africa.

Good care in social policy statements is commonly implied as familial and person-centred, provided by family members and focused on upholding the autonomy, dignity and respect of the care recipient. Policy consideration of the relational nature of caregiving, the sociomaterial determinants of good care, the practical knowledge of caregivers and responsibilities of the state, is limited. Drawing on the ethics of care theory and a care ecology framework, which conceptualises the dynamic interactions between formal and informal care "systems," we analysed ethnographic data of the interactions of 21 caregivers and their older care recipients in South Africa to understand how they conceptualised good care. Conceptualisations of good care included: having the right, altruistic and reciprocal, motivations; providing care frequently and consistently; and demonstrating hope for a better future through practical action. Caregivers also considered restricting autonomy a feature of good care, when doing so was perceived to be in the care recipient's best interest. Conceptualisations of good care were influenced by but also countered policy and cultural ideals. When they subverted policy values and practices, by overriding autonomy, for instance, caregivers' conceptualisations reflected their practical experiences of caregiving amidst gross material inadequacies, underpinned by deficiencies in the formal care system. We highlight the need for policies, interventions and theories of care that focus broadly on the care ecology and particularly on the "carescape" (formal care system). We advocate relational approaches that consider and balance the needs, desires and rights of caregivers and care recipients, and recognise caregivers' experiential knowledge, rather than person-centred approaches that focus exclusively on the care recipient.

In Darkness We Meet: Annie Ernaux's Account of Care and Dementia.

BACKGROUND AND OBJECTIVES: The complexities surrounding aging, dementia, and care are timely issues that transcend beyond institutional boundaries, evincing a critical debate on later life across disciplines. The aim of this study is to offer fresh insights into the intricate paradigms of living and growing older with dementia. The study focuses on the Nobel Prize-winning author Annie Ernaux's memoir I Remain in Darkness (1999), which provides a candid account of her mother's journey through dementia from its onset to the gradual decline. RESEARCH DESIGN AND METHODS: This article employs the theoretical frameworks of literary gerontology, illness narratives and life writing to address the challenges of aging, dementia and care that are represented in Ernaux's memoir. It also addresses societal attitudes and stigma associated with aging and dementia by exploring the embarrassment that individuals and families experience when confronted with the deteriorating mental health of their loved ones. RESULTS: Ernaux's memoir explores the nuances of dementia and caregiving within both the familial and institutional context, and sheds light on the complex relationship between a mother and a daughter. Through the act of witnessing, Ernaux embarks on a path of healing, which allows her to confront her past wounds and better navigate the challenges that lie ahead. However, Ernaux's confessional memoir also troubles the ethics of life writing and identity issues, and seems to perpetuate the pathologizing medical gaze through the exposure of her mother's vulnerability and intimacy in the face of dementia and care. DISCUSSION AND IMPLICATIONS: Ernaux's account of her mother's dementia and aging is both a confessional piece of writing and a narrative therapy, which reveals the challenges of aging, illness, and unresolved family tensions. Her work illuminates the interconnectedness between the past, present, and future, and shows that illness narratives can act as a catalyst for transformative change, identity formation, and self-reflection. The article addresses the intricacies of old age, showcasing how life writing and humanities-based inquiry can bring to the fore key aspects of the latest stages in life, which are often unvoiced because they represent the most unpleasant and feared aspects of aging in contemporary society.

Ethical questioning in arts and health-based research: propositions and reflections.

Ethical questioning is a framework for considering the ethical implications and practices in research and is used as a tool for thinking about the connections between art and health. It enables researchers and practitioners to gain a deeper understanding of the emotional dimensions in the field of art and health. In this paper, we propose that ethical questioning, grounded in the principles of ethics of care, can foster a more reflexive and holistic approach to understanding the concept of well-being. We also propose that adopting ethical questioning as a methodology, which requires intentional self-reflection and recognition of positionality, can expose and challenge conventional knowledge hierarchies, resulting in more ethical research outcomes and relationships between researchers and participants. Ultimately, our hypothesis proposes that ethical questioning holds the potential to offer an actionable practice that demonstrates ethics of care.

Truth-telling to the seriously ill child - Nurses' experiences, attitudes, and beliefs.

BACKGROUND: Nurses play an integral role in the care of children hospitalised with a serious illness. Although information about diagnostics, treatments, and prognosis are generally conveyed to parents and caregivers of seriously ill children by physicians, nurses spend a significant amount of time at the child's bedside and have an acknowledged role in helping patients and families understand the information that they have been given by a doctor. Hence, the ethical role of the nurse in truth disclosure to children is worth exploring. METHODS: A systematic academic database and grey literature search strategy was conducted using CINAHL, Medline Psych Info, and Google Scholar. Keywords used included truth, children, nurse, disclosure, serious illness, and communication. A total of 17 publications of varying types were included in the final data set. ETHICAL CONSIDERATIONS: As this was a review of the literature, there were no direct human participants. Empirical studies included in the review had received ethics approval. RESULTS: Of the 17 articles included in the review, only one directly reported on the experiences of nurses asked to withhold the truth from patients. Empirical studies were limited to HIV-positive children and children diagnosed with cancer and the dying child. CONCLUSION: A paucity of literature exploring the experiences, attitudes, and beliefs of nurses with regard to truth-telling to seriously ill children is evident. Little consideration has been given to the role nurses play in communicating medical information to children in a hospital setting. The 17 articles included in the review focused on cancer, and HIV, diagnosis, and end-of-life care. Further research should be undertaken to explore the experiences and attitudes of nurses to clinical information sharing to children hospitalised with a wide range of serious illnesses and in diverse clinical scenarios.

Eutanasia: ¿una solución equivocada a un problema no reconocido? / Euthanasia: a wrong solution to an unrecognized problem?

La Ley Orgánica 3/2021, de 24 de marzo, de regulación de la eutanasia, ha intensificado un duro de bate. A priori se trata de un conflicto de valores bioéticos y de una visión antropológica diferente entre las diferentes partes, sin embargo, no debemos olvidar que quizá antes de plantearse ningún debate se deba interpretar correctamente lo que el paciente realmente quiere cuando manifiesta que quiere morir. En nuestro sistema sanitario y en nuestra sociedad, hay ciertos rasgos y necesidades de la persona que son ignorados, y que requieren urgentemente, para el paciente, de atención. Descubrir el sentido de la propia vida, considerar la trascendencia humana, encontrar un orden personal y poder experimentar el amor, son elementos vitales de la vida, que en un momento tan crítico como es un sufrimiento de alto grado o una muerte inminente, requieren de toda la atención del personal sanitario. Todo ello puede contrastar fuer temente con los valores de nuestra sociedad, no dedicándosele la atención adecuada, entre otros motivos, por el esfuerzo que supone llevar a cabo una atención integral de este tipo, así, resulta mucho más sencillo realizar los trámites requeridos por la ley de regulación de la eutanasia que abordar carencias tan íntimas del ser, a pesar de que éstas puedan ser el verdadero problema del paciente, que en su dramática vivencia pide auxilio (AU)

Organic Law 3/2021, of March 24, regulating euthanasia, has intensified a harsh debate. A priori, it is a conflict of bioethical values and a different anthropological vision between the different parties, however, we must not forget that perhaps before considering any debate, it is necessary to correctly interpret what the patient really wants when he states that he wants to die. In our health system and in our society, there are certain traits and needs of the person that are ignored, and that urgently require attention for the patient. Discovering the meaning of one’s life, considering human transcendence, finding personal order and being able to experience love are vital elements of life, which at such a critical moment as high-grade suffering or imminent death, require all the attention of the health personnel. All this can contrast sharply with the values of our society, not dedicating adequate attention to it, among other reasons, due to the effort involved in carrying out comprehensive care of this type, thus making it much easier to carry out the procedures required by law regulation of euthanasia than addressing such intimate deficiencies of the being, despite the fact that these may be the real problem of the patient, who in his dramatic experience asks for help (AU)

Making invisible care visible. Ethics and aesthetics of care in participatory arts practices in times of COVID-19.

The COVID-19 pandemic emphasises the importance of care for our societies, yet underscores the inferiority of relational caring practices. During this time, we studied the participatory work of artists working with older adults using participant observations, in-depth interviews and visual ethnography. In this article, we present a case study of one arts initiative, a theatre company engaging seniors in the Netherlands, using ethics and aesthetics of care as sensitising concepts. The findings reveal that this work can promote relational forms of care. This study makes visible how different forms of care can be identified in a participatory art project.

Participation through the lens of care: Situated accountabilities in the codesign of a digital health platform for HIV care.

Participation of citizens and service users is increasingly commonplace in research, policy and technology development. Alongside this development, social scientists have become increasingly incorporated into large-scale research and innovation projects to facilitate participatory spaces. This requires reflection on the mechanisms, outcomes and, ultimately, the accountabilities of participation. In this paper, we propose the lens of care framework for approaching such reflections. We illustrate its value by using it to account for our role in establishing participatory spaces as part of a European Horizon 2020-funded research and innovation project, entitled EmERGE. We describe the codesign processes we developed and implemented with the aim of enabling heterogeneous voices, distinct experiences and multiple ideas to be articulated to inform the development and implementation of a digital platform for HIV care. We show how the lens of care framework enables us to trouble participation along prior theoretical distinctions between patients/citizens roles, invited/uninvited spaces and inclusive/scientistic voices and provides novel lines of inquiry to capture the relational and emergent processes of participation in digital health innovation. In the EmERGE project, spaces of participation were co-created within and by the community, whose members skilfully arranged the material, social and temporal set-up. Within these spaces we were able to articulate voices, deliberate knowledge and study the potentialities of technology so that initial technological inscriptions of empowerment through information-push were challenged and were, eventually, replaced by more interactive forms of clinician-patient engagement in digital HIV care. Through the lens of care, this paper aims to provide a reflective tool for researchers and practitioners who are involved in the design, implementation, and evaluation of participatory projects.

Ethical conflicts experienced by community nurses: A qualitative study.

BACKGROUND: Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals. RESEARCH AIM: To identify ethical conflicts experienced by community nurses. RESEARCH DESIGN: Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage ethical conflict. RESEARCH CONTEXT AND PARTICIPANTS: Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed. ETHICAL CONSIDERATIONS: Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities. FINDINGS: Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences. CONCLUSIONS: Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion.

Euthanasia in Colombia: Experience in a palliative care program and bioethical reflections.

The increased prevalence of advanced-stage chronic diseases has augmented the need for palliative care teams. In Colombia, although the legislation promotes palliative care development, people still die without receiving management from a palliative care team. In addition, judiciary regulations regarding euthanasia have generated public confusion and ethical conflicts among members of the palliative care teams. Therefore, this study aimed to perform a bioethical reflection on the relationship between palliative care and euthanasia supported by data on euthanasia requests in a palliative care program. This reflection is based on retrospective and descriptive observational data, collected in two highly complex hospitals in Bogotá, Colombia. A total of 50 euthanasia requests were identified, of which 62% met the defined criteria, 16% did not, and 22% were not considered by the interdisciplinary committee for the right to die with dignity due to early death. All patients were treated and followed up by a palliative care team until their death. This study considered that palliative care could be a complement management for patients requesting euthanasia based on their experience by supporting the decision-making, alleviating suffering, and providing emotional support in the last days of life.

The paradoxical position of nurses regarding euthanasia and its legalisation: A descriptive quantitative study.

AIMS AND OBJECTIVES: To learn about the attitudes of nurses working in the Andalusian Public Health System regarding euthanasia and its legalisation. BACKGROUND: Euthanasia often finds itself in the crosshairs of ethical and political debate on an international scale. Currently, the Spanish Organic Law 3/2021 of 24 March, 2021, recognises euthanasia as a fundamental right in Spain. It is of particular interest to know about the views, attitudes and stances that Andalusian nurses have of euthanasia as they are key players within the framework of euthanasia and administration of life-ending drugs. They play a central role in guiding patients through the euthanasia application process. DESIGN: Observational descriptive study. METHODS: A study of Andalusian Public Health System nurses was carried out using non-probability convenience sampling. 518 nurses with an average age of 44.75 years answered in a questionnaire that was distributed on an online platform. Socio-demographic and occupational variables were assessed, together with the Death Anxiety Scale and the Euthanasia Attitude Scale. A bivariate analysis and a multivariate linear regression model were performed. The STROBE checklist was used. RESULTS: The mean score obtained on the Euthanasia Attitude Scale was 75.95 (SD = 16.53). The mean score obtained on the Death Anxiety Scale was 7.56 (SD = 3.05). The variables age and work experience were negatively correlated with the total scores of the Euthanasia Attitude Scale and the categories 'Ethical considerations', 'Practical considerations' and 'Treasuring life'. On the other hand, there was a significant positive correlation between age and work experience and 'Spiritual beliefs' category. CONCLUSIONS: The current situation shows a worrying paradox. There is a stark difference between positive professional attitudes towards euthanasia and the desire to participate in its application. RELEVANCE TO CLINICAL PRACTICE: It is vital that educational and healthcare institutions make the necessary efforts to ensure that nurses develop sound moral judgement, displaying the moral conscience and ethical commitment required of this established profession. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A care ethics approach to a reduced ability to eat.

Patients with advanced cancer often experience a reduced ability to eat, which may result in tensions between patients and family members. Often with advanced cancer diagnoses, patients' appetites decline markedly, while family members focus on nutritional intake with the hope that this will postpone death. This hope might cause tensions between the patient and family; the family may expect healthcare professionals to encourage the patient to eat more, whereas the patient needs to be supported in their reduced ability to eat. When these tensions arise, healthcare professionals can experience challenges in providing good palliative care. To address these challenges in the provision of palliative care, healthcare professionals may adopt a care ethics approach. Similar to palliative care's focus on patient and family members' relationships, a care ethics approach emphasizes interdependency and social relationships. Using Joan Tronto's care ethics approach, we conducted a normative analysis of what caring for patients with reduced ability to eat and their family members should look like. Tronto's approach includes five phases of care: caring about, taking care of, care giving, care-receiving, and caring with. Based on our analysis and empirical studies on patients with advanced cancer and family members, concerns with their lack of appetite, we assert that healthcare professionals must be mindful of the potential of tensions related to appetite and be adept in dealing with these tensions. We urge that education is needed for healthcare professionals regarding the psychosocial impact of reduced ability to eat on both patients and family members and interprofessional collaboration is of the essence.

Para além dos limites da saúde: cuidado em perspectiva interdisciplinar / Beyond the limits of health: care from an interdisciplinary perspectivea / Más allá de los límites de la salud: cuidado desde una perspectiva interdisciplinaria

Este relato apresenta reflexões sobre uma experiência interdisciplinar que envolveu idealização, planejamento, organização, realização e divulgação de um evento científico virtual como requisito da disciplina Seminários Avançados de Pesquisa 1, oferecida pelo Programa de Pós-graduação em Informação e Comunicação em Saúde desenvolvido pelo Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, uma das unidades técnico-científicas da Fundação Oswaldo Cruz. Os doutorandos da turma de 2020 promoveram o webinário "Para além dos limites da saúde: cuidado em perspectiva interdisciplinar", como parte da formação acadêmica, e este relato é produto científico daquele evento. Além do desenvolvimento de habilidades e atitudes, essa experiência representou um aprendizado pessoal, intangível e emocional do cuidado para além dos limites da saúde, e também ético sobre as "coisas negligenciadas" e acerca da força dos consensos diante de um cenário complexo marcado por uma pandemia causada pelo vírus SARS-CoV-2, a pandemia de covid-19

This report presents reflections about an interdisciplinary experience that involved the idealization, planning, organization, implementation and dissemination of a virtual scientific event as requisite for the Seminários Avançados de Pesquisa 1 (Advanced Research Seminars 1), one of the disciplines offered by the Programa de Pós-graduação em Informação e Comunicação em Saúde (Postgraduate Program in Health Information and Communication) developed by the Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (Institute of Communication and Scientific and Technological Information in Health), one of the technical-scientific units of the Fundação Oswaldo Cruz (Oswaldo Cruz Foundation). The students who began in 2020 their classes to obtain the PhD Degree promoted the webinar "Beyond the limits of health: care from an interdisciplinary perspective" as part of the academic education, and this report is a scientific product of that event. In addition to the development of skills and attitudes, that experience represented a personal, intangible and emotional learning of the care beyond the limits of health as well as an important ethical learning about the "neglected things" and the strength of consensus in the face of a complex scenario marked by a pandemic caused by the SARS-CoV-2, the Covid-19 pandemic

Este relato presenta reflexiones sobre una experiencia interdisciplinar que implicó la idealización, planificación, organización, realización y difusión de un evento científico virtual como requisito de la disciplina Seminários Avançados de Pesquisa 1 (Seminarios Avanzados de Investigación 1), ofrecida por el Programa de Pós-graduação em Informação e Comunicação em Saúde (Programa de Posgrado en Información y Comunicación en Salud) desarrollado por el Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (Instituto de Comunicación y Información Científica y Tecnológica en Salud), una de las unidades técnicas y científicas de la Fundação Oswaldo Cruz (Fundación Oswaldo Cruz). Los doctorandos del curso de 2020 promovieron el webinario "Más allá de los límites de la salud: cuidado desde una perspectiva interdisciplinaria" como parte de la formación académica, y este relatoes producto científico de aquel evento. Además del desarrollo de habilidades y actitudes, esa experiencia representó un aprendizaje personal, intangible y emocional del cuidado más allá de los límites de la salud, y también un importante aprendizaje ético sobre las "cosas tratadas con negligencia" y aún acerca de la fuerza de los consensos ante un escenario complejo marcado por una pandemia provocada por el virus SARS-CoV-2, la pandemia de Covid-19

Two cases of nursing older nursing home residents during COVID-19.

INTRODUCTION: Two ethical challenges of nursing home nurses during the COVID-19 pandemic in Sweden are discussed in this paper. BACKGROUND: Historically, the nurse's primary concern is for the person who is ill, which is the core of nurses' moral responsibility and identity. In Sweden, person-centered care is generally deemed important in nursing older nursing home residents. OBJECTIVE: To chart moral responsibilities of nursing home nurses in two cases involving older residents during the COVID-19 pandemic in Sweden. METHODS: We used Margaret Urban Walker's framework for moral responsibilities and the International Council of Nurses (ICN) code of ethics for nurses (2021) for our normative analysis. ETHICAL CONSIDERATIONS: Written and verbal consent was obtained before the interviews, and information was given that participation was entirely voluntary and possible to cancel at any time before the work was published. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to this research project (Dnr. 2020-05649). FINDINGS: Case #1: a palliative older nursing home resident who was coercively tested for COVID-19, and case #2: a COVID-19-infected resident with dementia who was isolated using sedation. The decision that was finally made in the respective case was analyzed in the light of either consequentialist/utilitarian or non-consequentialist/deontological reasons. DISCUSSION: Empowerment of nurses as moral agents is required for the application of practical wisdom in the balancing of different care relationships (responsibilities), moral identities (professional virtues), and competing moral values. This requires resources and opens possibilities for profound ethical reflection in nursing education and at work. CONCLUSION: During the COVID-19 pandemic, the moral and professional responsibility of nursing home nurses to deliver person-centered care was sometimes problematically abandoned in favor of a more utilitarian manner of ethical decision-making.

Caring in an Algorithmic World: Ethical Perspectives for Designers and Developers in Building AI Algorithms to Fight Fake News.

This article suggests several design principles intended to assist in the development of ethical algorithms exemplified by the task of fighting fake news. Although numerous algorithmic solutions have been proposed, fake news still remains a wicked socio-technical problem that begs not only engineering but also ethical considerations. We suggest employing insights from ethics of care while maintaining its speculative stance to ask how algorithms and design processes would be different if they generated care and fight fake news. After reviewing the major characteristics of ethics of care and the phases of care, we offer four algorithmic design principles. The first principle highlights the need to develop a strategy to deal with fake news on the part of the software designers. The second principle calls for the involvement of various stakeholders in the design processes in order to increase the chances of successfully fighting fake news. The third principle suggests allowing end-users to report on fake news. Finally, the last principle proposes keeping the end-user updated on the treatment in the suspected news items. Implementing these principles as care practices can render the developmental process more ethically oriented as well as improve the ability to fight fake news.

Ethics of care in technology-mediated healthcare practices: A scoping review.

BACKGROUND: Introducing new technologies into healthcare practices may challenge professionals' traditional care cultures. The aim of this review was to map how the 'ethics of care' theoretical framework informs empirical studies of technology-mediated healthcare. METHOD: A scoping review was performed using eight electronic databases: CINAHL with full text, Academic Search Premier, MEDLINE, the Philosopher's Index, SocINDEX with Full Text, SCOPUS, APA PsycInfo and Web of Science. This was followed by citation tracking, and articles were assessed against the inclusion criteria. RESULTS: Of the 443 initial articles, 18 met the criteria and were included. We found that nine of the articles used the concept of 'ethics of care' (herein used interchangeably with the terms 'feminist ethics' or 'relational ethics') insubstantially. The remaining nine articles deployed care ethics (or its equivalent) substantially as an integrated theoretical framework and analytical tool. We found that several articles suggested an expansion of ethics of care to encompass technologies as part of contemporary care. Furthermore, ethics of care contributed to the empirical research by recognising both new relationships between patients and healthcare professionals as well as new ethical challenges. CONCLUSION: Ethics of care is sparsely used as a theoretical framework in empirical studies of technology-mediated healthcare practices. The use of ethics of care in technology-mediated care brings new dilemmas, relational tensions and vulnerabilities to the foreground. For ethics of care to be used more explicit in empirical studies, it is important that it is recognised by research community as an adequate, universal ethical theory.

Moral distance, AI, and the ethics of care.

This paper investigates how the introduction of AI to decision making increases moral distance and recommends the ethics of care to augment the ethical examination of AI decision making. With AI decision making, face-to-face interactions are minimized, and decisions are part of a more opaque process that humans do not always understand. Within decision-making research, the concept of moral distance is used to explain why individuals behave unethically towards those who are not seen. Moral distance abstracts those who are impacted by the decision and leads to less ethical decisions. The goal of this paper is to identify and analyze the moral distance created by AI through both proximity distance (in space, time, and culture) and bureaucratic distance (derived from hierarchy, complex processes, and principlism). We then propose the ethics of care as a moral framework to analyze the moral implications of AI. The ethics of care brings to the forefront circumstances and context, interdependence, and vulnerability in analyzing algorithmic decision making.