BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

A recent article in this journal described practical and conceptual difficulties faced by public health researchers studying scabies outbreaks in British residential care facilities. Their study population was elderly, decisionally incapacitated residents, many of whom lacked a legally appropriate decision-maker for healthcare decisions. The researchers reported difficulties securing Research Ethics Committee approval. As practicing healthcare ethicists working in a large Canadian research hospital, we are familiar with this challenge and welcomed the authors’ invitation to join the discussion of the ‘outstanding (...) ambiguities and further questions’ that their experience uncovered. We propose a Power of Attorney for Research as one substantive solution to help address the problems they identified. Although we acknowledge the familiar shortcomings associated with Advance Directives in the clinical context, we believe that Powers of Attorney for Research Participation, accompanied by Advance Research Directives, may increase the likelihood of gaining deeper understandings of potential participant’s values and priorities and how they might apply to foreseeable research opportunities. (shrink)

The demand for science trainees to have appropriate responsible conduct of research instruction continues to increase the attention shown by federal agencies and graduate school programs to the development of effective ethics curriculums. However, it is important to consider that the main learning environment for science graduate students and post-doctoral research fellows is within a laboratory setting. Here we discuss an internal laboratory program of weekly 15-minute ethics discussions implemented and used over the last 3 years in addition to the (...) graduate school’s program of scientific integrity training. During this time, the environment and culture within our laboratory has changed to place greater emphasis on the ethical implications of our own research and the research we evaluate. We still struggle with how to accurately assess this behavioral change; although, we present preliminary survey results on the evaluation and impact of this style of curriculum for ethics instruction in our laboratory. (shrink)

Detecting contract cheating in written submissions can be difficult beyond direct plagiarism detectable via technology. Successfully identifying potential cases of contract cheating in written work such as essays and reports is largely dependent on the experience of assessors and knowledge of student. It is further dependent on their familiarity with the patterns and clues evident in sections of body text and reference materials to identify irregularities. Consequently, some knowledge of what the patterns and clues look like is required. This paper (...) documents how to identify some of the patterns and clues observed in essay and report submissions. Effective assessment design with specific contextual requirements make irregularities easier to detect and interpret. The irregularities identified were confirmed as instances of contract cheating through conversations held with postgraduate students. An essential element of the conversations was the evidence presented for discussion. Irregularities were noted on a pro-forma specifically developed for this purpose. Patterns identified include misrepresented bibliographic data, inappropriate references, irrelevant material and generalised text that did not address the assessment question or grading criteria. The validated patterns formed the basis of identifying potential instances of contract cheating in later submissions. Timely conversations with students before the end of semester are essential to determining whether the patterns and clues link to poor knowledge of academic writing conventions or classified as contract cheating necessitating the application of appropriate penalties under institutional policies and procedures. (shrink)

This paper outlines a strategy for teaching an Introduction to Philosophy anthology. The author argues that students in introductory philosophy courses are unable to comprehend primary sources in philosophy anthologies because of the distance and foreignness of the text. A course relying on lectures as the primary mode of engagement with texts results in mere exposition and does not facilitate a critical engagement with primary texts for students. The author suggests that teachers in introductory courses should integrate weekly and monthly (...) writing assignments into the curriculum to help facilitate a critical engagement with primary texts. The writing assignments provide students with constant feedback on their own thoughts and allow educators to assess how well students read and comprehend primary sources before the course lectures. The writing assignments also encourage more classroom discussion because students are able to think through their objections and critiques and to feel more comfortable talking in class. (shrink)

The United States National Preparedness System has evolved significantly in the recent past. These changes have affected the system structures and goals for disaster response. At the same time, actors such as private businesses have become increasingly involved in disaster efforts. In this paper, we begin to fill the gap in the cross-sector literature regarding interactions that have systemic impacts by investigating how the simultaneous processes of systemic change and intensifying cross-sector interaction worked and interacted in the context of the (...) preparedness system. We examine these inter-linkages through a qualitative study in the setting of Hurricane Sandy. Drawing from systems theory, we develop a grounded model that provides an explanation for the system change and highlights how cross-sector interaction relates to the changes observed in the system. (shrink)

Traditional theistic proofs are often understood as evidence intended to compel belief in a divinity. John Clayton explores the surprisingly varied applications of such proofs in the work of philosophers and theologians from several periods and traditions, thinkers as varied as Ramanuja, al-Ghazali, Anselm, and Jefferson. He shows how the gradual disembedding of theistic proofs from their diverse and local religious contexts is concurrent with the development of natural theologies and atheism as social and intellectual options in early modern Europe (...) and America. Clayton offers a fresh reading of the early modern history of philosophy and theology, arguing that awareness of such history, and the local uses of theistic argument, offer important ways of managing religious and cultural difference in the public sphere. He argues for the importance of historically grounded philosophy of religion to the field of religious studies and public debate on religious pluralism and cultural diversity. (shrink)

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although (...) the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients. (shrink)

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although (...) the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients. (shrink)

Research on emotion and psychopathology has blossomed due in part to the translation of affective science theory and methods to the study of diverse disorders. This translational approach has helped the field to hone in more precisely on the nature of emotion deficits to identify antecedent causes and maintaining processes, and to develop promising new interventions. The future of emotion research in psychopathology will benefit from three inter-related areas, including an emphasis on emotion difficulties that cut across traditional diagnostic boundaries (...) (i.e., a transdiagnostic approach), the explicit linking of emotion and cognition in behavioral and neuroimaging studies in psychopathology, and continued translation of the latest conceptualizations of emotion to the study of psychopathology. (shrink)

How should nursing knowledge advance? This exploration contextualizes its evolution past and present. In addressing how it evolved in the past, a probable historical evolution of its development draws on the perspectives of Frank & Gills's World System Theory, Kuhn's treatise on Scientific Revolutions, and Foucault's notions of Discontinuities in scientific knowledge development. By describing plausible scenarios of how nursing knowledge evolved, I create a case for why nursing knowledge developers should adopt a post‐structural stance in prioritizing their research agenda(s). (...) Further, by adopting a post‐structural stance, I create a case on how nurses can advance their disciplinary knowledge using an engaging post‐colonial strategy. Given an interrupted history caused by influence(s) constraining nursing's knowledge development by power structures external, and internal, to nursing, knowledge development can evolve in the future by drawing on post‐structural interpretation, and post‐colonial strategy. The post‐structural writings of Deleuze & Guattari's understanding of ‘Nomadology’ as a subtle means to resist being constrained by existing knowledge development structures, might be a useful stance to understanding the urgency of why nursing knowledge should advance addressing the structural influences on its development. Furthermore, Bhabha's post‐colonial elucidation of ‘Hybridity’ as an equally discreet means to change the culture of those constraining structures is an appropriate strategy to enact how nursing knowledge developers can engage with existing power structures, and simultaneously influence that engagement. Taken together, ‘post‐structural stance’ and ‘post‐colonial strategy’ can refocus nursing scholarship to learn from its past, in order to develop relevant disciplinary knowledge in its future. (shrink)

The demand for science trainees to have appropriate responsible conduct of research instruction continues to increase the attention shown by federal agencies and graduate school programs to the development of effective ethics curriculums. However, it is important to consider that the main learning environment for science graduate students and post-doctoral research fellows is within a laboratory setting. Here we discuss an internal laboratory program of weekly 15-minute ethics discussions implemented and used over the last 3 years in addition to the (...) graduate school’s program of scientific integrity training. During this time, the environment and culture within our laboratory has changed to place greater emphasis on the ethical implications of our own research and the research we evaluate. We still struggle with how to accurately assess this behavioral change; although, we present preliminary survey results on the evaluation and impact of this style of curriculum for ethics instruction in our laboratory. (shrink)

The purpose of this study was to extend the previous research on ethics in retailing. Prior research of Dornoff and Tankersley, Gifford and Norris, Norris and Gifford, and Burns and Rayman examined the ethics orientation of retail sales persons, sales managers, and business school students. These studies found the college students less ethically-oriented than retail sales people and retail managers. The present study attempts to extend the research on ethics formation to a geographically and academically diverse sample, and to determine (...) if retail management experience in the form of a professional practicum or internship, or entry level management training programs, such as experienced by recent graduates, are critical factors in the formation of business ethics. The sample consisted of thirty-three students majoring in Human Ecology with a concentration in Retail Merchandising and 51 recent graduates of the retail Merchandising program. The series of fourteen vignettes developed by Dornoff and Tankersley was used. An acknowledged limitation of this study is the validity of the questionnaire developed by Dornoff and Tankersley due to the method of development and new laws concerning warranties and credit etc. which have occurred since 1976. The instrument was used, however, to maintain consistency with earlier studies for the purpose of comparison of groups. No significant differences were found in the students' perceptions of the fourteen actions presented in the vignettes, but the range of the responses in the post-internship tests increased in many cases. The alumni appeared to be slightly more ethical than the students but not as ethical as the managers surveyed in 1986 by Norris and Gifford. Indications are that the critical point of ethics formation may be at the mid-management level and that internships and management training programs have little effect on the ethical perceptions of participants. These findings are consistent with studies such as Gable and Topol, and Jordan and Davis which showed high Machiavellian scores among young retailing executives, often buyers, as opposed to upper level retailing management. Scales with measure Machiavellianism, or manipulativeness, have been used as an alternative method of examining business ethics. (shrink)

This paper explores the notion of practical wisdom asan alternative to current formulations of criticalthinking. The practical realm is that ofill-structured problems that emerge from life aslived; it is a realm of legitimate uncertainty andambiguity that requires an ethical responsiveness orpractical wisdom. The death of a child is a case inpoint. The author identifies and examines threeaspects of practical wisdom – the ethical claims ofpartiality, a yielding responsiveness and the play ofthought – and juxtaposes them with aspects of criticalthinking. The (...) work of Martha Nussbaum and RichardPaul are interwoven throughout the discussion. Theauthor concludes that the discourse of criticalthinking is in danger of lapsing into a form of moralescapism wherein all we are rationally responsible foris thinking correctly. Practical wisdom, on theother hand, recognizes that thinking is not simply anintellectual cognitive act of an individual but adance between the life of a child and the love of anelder, a conversation between what is and what couldbe, an openness to passionate sorrow and surprise, aplay between understanding and perception. As such,practical wisdom provides a more likely account ofliving in good faith with oneself and others. (shrink)

This paper engages with debates around transformations in the production and circulation of images and the changes in modes of perception that these offer. Paul Virilio has argued that technological developments have produced a shift in the site of meaning‐production from the material reference space of the image to the time of visual contact by the viewer. I consider what significance these temporalities have in relation to social difference, and I develop debates around the performative to consider how the viewer (...) is constituted in visual performativity. This focus on time and performativity opens up questions of how vision may constitute the agency, intention and responsibility of the viewer. Drawing on an example of visual irony in advertising, I explore how the temporal suspension of meanings allows for a suspension of the terms of intent and responsibility. This visual performative accesses and reworks the terms of social difference and privilege in what I have called ‘retroactive intentionality’. (shrink)

Developments in neuroscience over the last few decades have shown an increasing interest in examining art and culture as a means of acquiring a greater understanding of the human brain. By the same token, our knowledge of the brain can be tremendously helpful in the study of cultural output, not only in terms of how culture works in a biological sense but why it remains so indispensable and integral to the well-being of individuals and societies. In Self Comes to Mind, (...) neuroscientist Antonio Damasio describes the development of culture as a form of homeostasis that regulates our social environments and engages the very same neurological mechanisms that manage our internal bodily environments. These mechanisms are... (shrink)

Domain analysis is useful for examination of individual spheres of intellectual activity, both academic and otherwise, and has been used in the knowledge organization (KO) literature to explore specific communities and uses, including web pornography (Beaudoin and Ménard 2015), virtual online worlds (Sköld, Olle 2015), gourmet cooking (Hartel 2010), healthy eating (McTavish 2015), art studies (Ørom 2003), the Knowledge Organization journal (Guimarães et al. 2013), and domain analysis itself (Smiraglia 2015). The results of domain analyses are useful for the development (...) of controlled vocabularies, taxonomies, ontologies, metadata schemas, and other systems for the documentation, description, and discovery of resources, as well as for knowledge discovery in general (Smiraglia 2015; Hjørland 2017). This research describes a methodology for the elucidation of knowledge organization systems (KOS) currently in use on image websites that document graffiti, graffiti art, and street art around the world. (shrink)

Recently, we reported that melanoma risk in redheads is linked not only to pale skin, but also to the synthesis of the pigment – called pheomelanin – that gives red hair its color. We demonstrated that pheomelanin synthesis is associated with increased oxidative stress in the skin, yet we have not uncovered the chemical pathway between the molecule pheomelanin and the DNA damage that drives melanoma formation. Here, we hypothesize two possible pathways. On one hand, pheomelanin might generate reactive oxygen (...) species (ROS) that directly or indirectly cause oxidative DNA damage. On the other hand, pheomelanin synthesis might consume cellular antioxidant stores and make the cell nucleus more vulnerable to other endogenous ROS. Uncovering the mechanistic pathway between pheomelanin and oxidative DNA damage will be an important step in developing strategies to lower melanoma risk in redheads. (shrink)

Anyone who has ever been moved by picture, poem or symphony will understand the power of art to bring meaning to the often dissonant counterpoint of light and darkness which is reflected in life and death. Human creativity, as the expression of hope, need and desire, is a statement of belief that life is meaningful. From classical philosophies of beauty to Celtic scholarship, through the mysticism of Patrick Kavanagh and the witness of women's writing, and from the sacred sounds of (...) Faure through the spiritual impact of the visual arts to the prophetic soundings of contemporary Irish writing, these essays suggest, that the imagination can indeed uncover neglected wells of spirituality for our contemporary society. (shrink)

Over one-third of older adults in many countries have a companion animal, and pets may harbor health-promoting potential. Few studies have considered pet-ownership in relation to economic vulnerability, and pet-ownership has not been often considered within policy efforts to promote ageing-in-place. We conducted a mixed methods case study to understand perspectives of both community agencies that support ageing-in-place and older adults themselves. A shortage of affordable, appropriate pet-friendly housing emerged as a challenge, even when framed as a legitimate choice and (...) preference for many older adults. In this manuscript, we share the trajectories of three economically vulnerable older adults whose affordable housing needs became entangled with commitments to pets. Guided by dialogical narrative methodology, we offer each narrative as a short vignette to illustrate the extent to which older adults will practice ‘more-than-human solidarity’ for a pet, even when their own well-being is compromised as a result; and highlight incongruence between the underlying moral values that shape solidaristic practices of individuals versus solidaristic arrangements that shape affordable housing opportunities. We suggest that housing rules and legislation that disrupt, rather than confirm, more-than-human solidarity may render older adults susceptible to, rather than protected from, deteriorating physical, mental and social well-being. We propose that collective solidaristic practices must reflect and subsume the moral complexity of solidarity practiced by individuals, to enable fair and equitable ageing-in-place. (shrink)

Research on emotion perception in schizophrenia has focused primarily on the perception of static faces displaying different emotion signals or expressions. However, perception of emotion in daily life relies on much more than just the face. In this article, we review the role of context in emotion perception among people with and without schizophrenia. We argue that not only is context central to the perception of emotion, it in fact helps to construct the perception. Implications for future research on emotion (...) perception are discussed. (shrink)

Agricultural intensification and extensification are standard responses to ecological and economic vulnerability among smallholder communities. Climate change has exacerbated this vulnerability and thrown the complexity of and critical need for managing a healthy natural resource base while increasing on-farm productivity into sharp light. Sustainable intensification is one of many mechanisms for accomplishing this balancing act. This study examines the adoption of sustainable intensification practices, namely input packages focused on tef row planting—designed to boost yield and promote more efficient use of (...) inputs. This study utilized a mix methods approach to survey 115 smallholder farmers in the South Wollo zone of the Amhara region in Ethiopia. This study found that cash and capital, more so than contact with the AIS, influenced farmers’ decisions to adopt row planting input packages. Khat production was an important source of cash for inputs and was more likely to be available to farmers with irrigation schemes. Long-term, farmers who cultivate khat may not successfully engage in SI, as khat replaces traditional food crop production in the region. Yet, for farmers who do not grow khat, long-term investment in SI practices is unlikely unless access to affordable credit options is improved. (shrink)

Ethicists differ considerably in their reasons for using empirical data. This paper presents a brief overview of four traditional approaches to the use of empirical data: “the prescriptive applied ethicists,” “the theorists,” “the critical applied ethicists,” and “the particularists.” The main aim of this paper is to introduce a fifth approach of more recent date (i.e. “integrated empirical ethics”) and to offer some methodological directives for research in integrated empirical ethics. All five approaches are presented in a table for heuristic (...) purposes. The table consists of eight columns: “view on distinction descriptive-prescriptive sciences,” “location of moral authority,” “central goal(s),” “types of normativity,” “use of empirical data,” “method,” “interaction empirical data and moral theory,” and “cooperation with descriptive sciences.” Ethicists can use the table in order to identify their own approach. Reflection on these issues prior to starting research in empirical ethics should lead to harmonization of the different scientific disciplines and effective planning of the final research design. Integrated empirical ethics (IEE) refers to studies in which ethicists and descriptive scientists cooperate together continuously and intensively. Both disciplines try to integrate moral theory and empirical data in order to reach a normative conclusion with respect to a specific social practice. IEE is not wholly prescriptive or wholly descriptive since IEE assumes an interdepence between facts and values and between the empirical and the normative. The paper ends with three suggestions for consideration on some of the future challenges of integrated empirical ethics. (shrink)

Déjà vu is the striking sense that the present situation feels familiar, alongside the realization that it has to be new. According to the Gestalt familiarity hypothesis, déjà vu results when the configuration of elements within a scene maps onto a configuration previously seen, but the previous scene fails to come to mind. We examined this using virtual reality technology. When a new immersive VR scene resembled a previously-viewed scene in its configuration but people failed to recall the previously-viewed scene, (...) familiarity ratings and reports of déjà vu were indeed higher than for completely novel scenes. People also exhibited the contrasting sense of newness and of familiarity that is characteristic of déjà vu. Familiarity ratings and déjà vu reports among scenes recognized as new increased with increasing feature-match of a scene to one stored in memory, suggesting that feature-matching can produce familiarity and déjà vu when recall fails. (shrink)

A translator and her science consultant, who have worked together on many books, consider the problems of translating primary and secondary texts in science. Various problems encountered in translating an ongoing documentary edition in the history of science are discussed using the collected works of Albert Einstein as a test case. For instance, each language has its own preferred sentence structure; moreover, not every historical term finds a perfect equivalent in modern usage, and historical accuracy is contextually bounded.

The distinction between stakeholders and shareholders frequently employed in business ethics can illuminate challenges faced by a bioethics advisory panel. I use the distinction to reflect back on the work of an advisory panel on which I served, a panel on US transplant policy. The panel hearings were akin to a shareholders’ meeting, with many stakeholders absent. In addition to ‘hearing out’ the shareholders who were present, the panel had duties to absent stakeholders to insure their interests were included in (...) public discussion. While panel efforts to include stakeholder perspectives rightfully framed its report, such duties should have framed its operating procedures more robustly. The stakeholder/shareholder distinction also offers a critical prism on the actual evolution of organ allocation policy, which the panel failed to influence. Current policy embodies a compromise among shareholders that obscures major stakeholder interests. This results in under‐attention to likely medical benefit of transplant, compared to other allocation criteria. Recognition of duties to stakeholders amidst pressures of shareholders complicates the notion of ‘consensus’ for an advisory panel. Consensus framed on terms defined only by shareholders, not stakeholders, may be an inadequate measure of public interest. (shrink)

The goal of this book is to help the reader gain knowledge on ethical and legal issues in the field of student affairs and develop competency to follow the profession’s principles and standards of conduct. The significance of the book is due to its focus on the practical value of ethics and legal issues and its aim to address the knowledge, skills, and dispositions required of student affairs educators to develop and maintain integrity in their life and work as described (...) by the ACPA/NASPA. The text offers readers a number of major unique features: It offers multiple ethical decision-making models to guide student affairs educators in their ethical decision-making process. It proposes that ethics is not an individual but an organizational responsibility. It offers that ethical decision making is a professional skill that can be practiced and applied in student affairs educators’ day-to-day practice. It presents the reader with the most current legal issues in student affairs and higher education. Finally, it reflects three themes: integration of ACPA/NASPA competency areas; development of professional identity; and application of knowledge and theory to practice. The book is critical and timely. A book that focuses on ethical and legal issues in student affairs is needed for faculty in preparation programs, new professionals navigating their identity as student affairs educators, and a resource for mid- and senior-level professionals facilitating ongoing professional development. The book begins to address what it means to have a professional identity, which is ground in the shared ethical and legal values espoused within the profession and academia. Each chapter uniquely contributes to the complexity embedded in the study of ethics and how that is applied to practice. Additionally, the volume is a balance of procedural knowledge, case illustrations, and guided practice exercises to facilitate the reader’s ability to translate the theory and research discussed into professional decision making and application. (shrink)

Background: ICU patients’ family members are in a new, uncertain, and vulnerable situation due to the patient’s critical illness and complete dependence on the ICU nurses and physicians. Family members’ feeling of being cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care. Research design: A qualitative study using participant observation, focus groups, and thematic narrative (...) analysis. Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses’ and physicians’ attitudes, behavior, and personality traits. Three main themes were identified: being attentive, an active approach, and degree of tolerance. Discussion: The findings are discussed in light of the ethics of care and empirical research from the intensive care environment. Conclusions: This study shows that attentive, active, and tolerant clinicians represent a culture of ethical care that gives families greater freedom of action and active participation in patient care. Clinicians must not bear sole responsibility for this culture; it must have a firm basis in the hospital and ICU and be established through training, interprofessional reflection, and support of clinicians. (shrink)