Stephen Wilmot

Professional values and interprofessional dialogue

Although professional values present problems of definition and evidence, differences and similarities can nonetheless be identified in relation to nursing and social work. There are good arguments for accepting the differences as being unavoidable, and perhaps desirable; and for concentrating on optimising the quality of interprofessional dialogue around values, rather than for seeking to remove those differences. A conceptual framework for evaluating that dialogue is considered.

Corporate Moral Responsibility: What Can We Infer from Our Understanding of Organisations?

The question of corporate moral responsibility – whether corporate bodies can be held morally responsible for their actions – has been debated by a number of writers since the 1970s. This discussion is intended to add to that debate, and focuses for that purpose on our understanding of the organisation. Though the integrity of the organisation has been called into question by the postmodern view of organisations, that view does not necessarily rule out the attribution of corporate agency, any more than the postmodern view of the person rules out the attribution of individual agency. The postmodern view is opposed to a reifying, metaphysical view of corporate agency, but a semantic view of corporate agency would seem to sit more comfortably with it. A bigger problem for the idea of corporate moral responsibility arises from the fact that in Kantian terms organisations are not ends in themselves. In that sense they are not like persons, and this must limit their autonomy, and their responsibility. This aspect of organisations also limits their punishability. For these reasons corporate moral responsibility must be seen as more limited than the responsibility of persons.

Principles of distributive justice used by members of the general public in the allocation of donor liver grafts for transplantation: a qualitative study.

Objective  To investigate the nature of public preferences in the allocation of donor liver grafts for transplantation.

Foundation Trusts and the Problem of Legitimacy

The UK government is setting up a new kind of organisation as part of the National Health Service, the foundation trust. Foundation trusts will be more distanced from government than existing NHS bodies, and will have closer community links. In this paper I identify the importance of legitimacy in health care and explore the potential situation of foundation trusts in terms of the bases of their legitimacy as organisations. Relationships with community, stakeholders and government are all considered as sources of legitimacy for foundation hospitals, and comparisons are made with other organisations, state, voluntary and private. I conclude that the blueprint of the foundation hospital creates a set of relationships which are incoherent and mutually conflicting, and conceals a crucial relationship with the state. I argue that these problems are likely to weaken the legitimacy of the foundation trust.The UK government is setting up a new kind of organisation as part of the National Health Service, the foundation trust. Foundation trusts will be more distanced from government than existing NHS bodies, and will have closer community links. In this paper I identify the importance of legitimacy in health care and explore the potential situation of foundation trusts in terms of the bases of their legitimacy as organisations. Relationships with community, stakeholders and government are all considered as sources of legitimacy for foundation hospitals, and comparisons are made with other organisations, state, voluntary and private. I conclude that the blueprint of the foundation hospital creates a set of relationships which are incoherent and mutually conflicting, and conceals a crucial relationship with the state. I argue that these problems are likely to weaken the legitimacy of the foundation trust.

A Fair Range of Choice: Justifying Maximum Patient Choice in the British National Health Service

In this paper I put forward an ethical argument for the provision of extensive patient choice by the British National Health Service. I base this argument on traditional liberal rights to freedom of choice, on a welfare right to health care, and on a view of health as values-based. I argue that choice, to be ethically sustainable on this basis, must be values-based and rational. I also consider whether the British taxpayer may be persuadable with regard to the moral acceptability of patient choice, making use of Rawls’ theory of political liberalism in this context. I identify issues that present problems in terms of public acceptance of choice, and also identify a boundary issue with regard to public health choices as against individual choices.

Corporate moral responsibility in health care

The question of corporate moral responsibility – of whether it makes sense to hold an organisation corporately morally responsible for its actions,rather than holding responsible the individuals who contributed to that action – has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom(UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially a moral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish

Ethics, agency and empowerment in nurse education.

The ethical demands of professional nursing practice are considered, and the concept of Agency is offered as a potentially useful part of the nurses conceptual equipment for such practice. The pressures of working in large organisations are suggested to be inimical to a sense of Agency, and it is also suggested that some of the academic disciplines involved in nurse education are offering an ambiguous view of the issue of Agency. The discipline of Ethics, while also ambiguous on this issue, is presented as offering useful ways of exploring that ambiguity. Several theories of Ethics are considered in relation to human freedom and responsibility, and the issue between determinism and free will is likewise considered. It is suggested that these offer ways of helping the individual to explore and develop their own stance on freedom and responsibility, and thereby on the issue of Agency. This discussion is related to the United Kingdom Central Council (UKCC) Code of Professional Conduct, and the paradox of choice is acknowledged.

Social justice and the Canadian Nurses Association: justifying equity.

This paper considers the social justice initiative of the Canadian Nurses Association (CNA). It focuses mainly on the two editions of the CNAs discussion document on social justice, and particularly on its emphasis on the principle of equity. The paper considers whether a coherent justification can be made for the CNAs espousal of equity, and the discussion focuses in turn on the principle of equity itself and on the CNAs position in relation to equity. A body of arguments supporting an active moral role for professions, generally known as civic professionalism, provides a framework for exploring the CNAs role in this respect. Justifications for equity are explored in relation to the liberal-contextualist spectrum, and civic professional arguments are subjected to the same structure of analysis. This is in turn related to evidence from the literature concerning nursing perceptions of equity. The paper concludes that contextualist justifications of equity and civic professionalism support one another more robustly than liberal justifications in relation to the CNAs initiative; and that they also sit more comfortably with the realities of the CNAs role in relation to nursing, and to the Canadian health care system.

The Use of an Ethical Advisory Group in a Learning Disability Service

The paper examines the concept of an interprofessional ethical advisory group and the contribution which it might make towards improving care provision for people with learning disabilities. It describes briefly the policy and professional practice background and outlines the aims and functions of such a group, focusing upon that established within the Southern Derbyshire Community NHS Trust.

Evidence, ethics and inclusion: a broader base for NICE

The National Institute for Health and Clinical Excellence (hereafter NICE) was created in 1998 to give guidance on which treatments should be provided by the British National Health Service, and to whom. So it has a crucial role as an agent of distributive justice. In this paper I argue that it is failing to adequately explain and justify its decisions in the public arena, particularly in terms of distributive justice; and that this weakens its legitimacy, to the detriment of the National Health Service as a whole. I argue that this failure arises from the fact that NICE works within the frameworks of positivist science and liberal ethics, largely to the exclusion of other perspectives. This narrowness of view prevents NICE from properly connecting with the range of moral concerns represented in the population. I argue for NICE’s deliberations to become more inclusive, both in terms of epistemology, and also in terms of ethical perspectives. And I suggest a range of perspectives that could usefully be included. Finally I offer a framework of structures, philosophies and discussion process that will enable competing perspectives to be debated fairly and productively in this process.