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Religious and Cultural Moral Values Informing the Process of Ethical Decision Making of Jordanian Nurses


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Title: Religious and Cultural Moral Values Informing the Process of Ethical Decision Making of Jordanian Nurses

Religious and Cultural Moral Values Informing the
Process of Ethical Decision Making of Jordanian
  • Marianne Hattar-Pollara D.N.Sc. FAAN

  • Many thanks to
  • The Jordanian Nurses Council for their continued
    efforts in promoting nursing education and
    scholarly pursuit in Jordan and in the region
  • Special thanks to
  • All nursing faculty and students who in one way
    or another helped inform the research in this

Why this is important
  • Throughout history and across cultures and
    nations religion has been a potent and pervasive
    influence on peoples worldviews, especially
    during times of illness.
  • Ethical challenges arise when the
    religious-cultural moral values take precedence
    over principled bioethical values.
  • The actual impact of such challenges is not known
    but very likely has negative psychological
    consequences on nurses role performance and

The Purpose of This Report
  • To examine the received ethics of Jordanian
    nurses so as to promote ethical debate and
    reflection among nurses in Jordan and to inform
    the Jordanian nursing code of ethics.
  • It is important to note that the ethical
    challenges that will be exemplified in the text
    of this paper are similar to those found
    throughout the Arab Middle East and will have
    important ethical implications for all of the
    Arab Middle Eastern.

Sources of Moral Values in Jordan
  • Ethics in Jordan does not occupy a separate
    academic discipline in the sense of a discipline
    drawing exclusively on human reason or human
  • The religious and cultural tradition of
    Jordanians occupies central importance and
    constitutes core moral and social values to which
    Jordanians uphold as supreme.
  • These core religious and cultural moral values
    shape Jordanian nurses ethical reasoning the
    process of which is influenced by the
    intersection of the religious, the cultural and
    health systems.

Religion Source of Moral Values
  • Islamic religion has an extensive moral component
    that is utilized in resolving religious, ethical
    and legal issues of in all spheres of life
    including health and illness.
  • The moral component in Islam is drawn from
    Shari'ah, which is the scared law of Islam and
    consists of commandments and prohibitions.
  • Shariah demands a moral existentialism of doing
    right and is concerned with both the purpose and
    the principles of the law.
  • The principles of the law have particular
    relevance to clinical applied ethics and may have
    a degree of conceptual semblance to Western
    ethical principles of duty, justice, benevolence,
    honesty, and integrity, yet the purpose and the
    theological rationale of these principles may be
    entirely different from the Western philosophical

Principles of Shariah
  • Shari'ah offers two fundamental principles of
    common good
  • Istihsan Literally means the act that which is
    desired for the benefit of most. Stemming from
    the root word Hassan (good) and it derivative
    hassanah (giving, donating), it can also mean
    offering from oneself or ones material goods to
    improve or meet others needs.
  • Maslaha, on the other hand, has meaning at both
  • Personal (Maslaha Khassa) and
  • Public interest (Maslaha Ammah).
  • While one is free to exercise personal interest
    as long as such interest does not pose harm to
    others, the importance of pursuing personal
    interest diminishes when it conflicts with the
    common or public interest.

Western Bioethics
  • Bioethics in the United States has largely
    adopted the language and arguments of philosophy
    as the language of moral discourse in health
  • Historically, normative ethics has always been
    the domain of religions if for no other reason
    than that religious persons needed ways to think
    about actions and relationships and to know
    whether or not they had erred morally.
  • With the rise of bioethics in the 1960s, many of
    the early bioethicists were trained in
    theological seminaries, were religiously
    identified, and wrote from a religious
  • It remains the case that a large number of
    medical ethicists writing in bioethics today
    continue to do so from an explicitly religious

Western Bioethics Phases of development in the
US (Fox. 1990)
  • Three Phases
  • The first phase centered on the voluntary consent
    to participation of human research subjects.
  • The second focused on end-of-life issues
    including definitions of life, death, personhood,
    the use of technology at the end of life, and
    advance directives.
  • The third phase focused on access to care, cost
    containment, rationing, and the allocation of
    medical resources.

Western Bioethics Representing Western Medicine
  • The major representative issues that arose in
    these three phases have included informed
    consent, protection of human subjects, protection
    of vulnerable subject groups, definitions of
    personhood, allowing infants with Downs Syndrome
    to die, privacy and confidentiality, withholding
    or withdrawing life-sustaining treatment,
    treatment futility, access to care, cost of care,
    restriction of resources received by elderly
    persons, allocation of donor organs, and the use
    of genetic materials, genetic patents, and
    genetic prejudice.
  • These issues are specifically representative of
    the practice of Western allopathic medicine.
    That is to say that the moral discourse that has
    predominated has focused on Western systems and
    medical practice other systems of medicine and
    the issues encountered by non-physician health
    professionals have received substantially less
    treatment in the dominant bioethical literature
    in the US.

Bioethics The Jordanian Case
  • Concerted efforts were made to introduce Western
    Bioethics in curriculum of nursing and medical
  • Other Motivating factors Include
  • developing Jordanian health care system for
    medical tourism and the need to respond
    coherently to Western clients bioethical health
    care needs.
  • the desire to establish the same level of
    bioethical knowledge between Jordanian health
    care providers and their Western counterparts.

The Study
  • The purpose of this study is
  • To critically examine the native received ethics
    of Jordanian nurses through examination of
    religious moral prescription and proscriptions
    and through analysis and examinations of the
    dominant cultural moral values and norms.
  • To critically examine Jordanian nurses received
    ethics so as to explicate the areas of agreement
    and the areas of discord between the native
    religious-cultural moral principles with that of
    Western bioethical ethics.

  • Design Survey
  • Sample Non-probability sampling of students in
    the undergraduate an program in a local
  • Measurements Demographics and open ended
    interview schedule. The questions were clustered
    around the following areas
  • Training in biomedical ethics
  • Encountered ethical dilemmas
  • Sources of ethical authority utilized

Findings Demographic Data
  • Sample size 27
  • Religion All are Muslim women ranging in age
    from 22 to 44 with an average age of
  • Income 33 has an income of less than 500 JD,
    44 has an income of less than 1000 JD, the
    remaining ranged from less than1500 to 2000 JD
    with only 7 earning a family income of over 3000
  • Years in clinical experience ranged from 2 to 24
    with an average of 7.2 years
  • Years in educational settings ranged from 1.5 to
    20 years with an average of 3.85
  • Level of education About 66 are currently
    completing the MSN program and the remaining are
    in the Ph.D. program
  • Formal training in nursing ethics 85 had formal
    training in bioethics

On ethical dilemmas and decision making
  • Cluster of responses
  • Nurses input is not taken into account
  • Nurses are not part of the decision making
  • Are required to carry out orders despite
    opposition to ethical decision made
  • There is no system in place to manage ensuing
    distress or role conflict of health care providers

On Bioethical Theories
  • Ethical theories provide the rational ground for
    moral reasoning, however these are in direct
    conflict with own belief and values
  • When ethical decision making clashes with
    religious belief, the process is distressing and

On Principled Ethics
  • Jordanian nurses listed doing good, doing no
    harm, justice and fairness
  • Jordanian nurses failed to list respect for
  • Yet, when asked which principle they appeal to,
    when conducting moral or ethical reasoning, they
    spoke about their own religious belief and values

Where Do We Go From Here?
  • For the purposes of nursing ethics, the nursing
    profession must come to a better and more
    knowledgeable understanding of the ways in which
    local culture and religious beliefs intersect
    with ethics.
  • For the purpose of patient decisions, nursing and
    other health disciplines must engage in exploring
    the ways in which religions informs, critiques
    and enlarges moral discourse within health care.
  • For the purpose of health care providers, a
    system must be put in place to achieve the above
    objectives and to safe guard for potential
    distress and demoralization.