Dr Ann Gallagher
Reader (Nursing Ethics) and Director of the International Centre for Nursing Ethics
Qualifications: PhD, MA, BA (Hons), PGCEA, RMN, SRN
Phone: Work: 01483 68 9462
Room no: 16 DK 04
Monday - Friday 9.00 - 5.30 by appointment
Ann has extensive experience as a healthcare ethicist, nurse, educator, researcher & editor (of the international journal 'Nursing Ethics').
She is Chair of the University of Surrey Ethics Committee, a member of the RCN Ethics Committee, the SE NHS Research Ethics Committee and of Princess Alice Hospice Clinical Ethics Committee working with practitioners to resolve ethical challenges in everyday practice. She is also a Stakeholder Governor of a NHS Trust and a member of the Nuffield Council on Bioethics.
• SCOPE project: a scoping project exploring ethical issues, challenges and opportunities in the social care of older people (in collaboration with the ETHOX foundation)
• CUSPP project: Consensus towards Understanding and Sustaining Professionalism in Paramedic practice (in collaboration with SECAMB)
• SHIFTS project: [Shift patterns in Hospital: Impact on nurses’ Fatigue, acTivity levels & Sleep] - nurses shift patterns and sleep study (in collaboration with Surrey Sleep Centre & Ashford & St Peters NHS Foundation Trust)
• CHOICE project: End of life care: confidence and competence for carers (in collaboration with Ashford & St Peters NHS Foundation Trust)
• End of Life Decision making project: in collaboration with University of Sao Paulo, University College Cork, Ireland & University Vallendar, Germany)
• Validation of international Dignity Tool project (in collaboration with Nagoya University, Japan)
The current focus of research relates to understanding and responding to deficits in care, dignity in care, professionalism, end of life ethics and research ethics. Ann has published on a wide range of topics in healthcare ethics, for example, on restraint, whistleblowing and conflicts of interest. She is co-author of 'Nursing and Human Rights' (with Jean McHale) and 'Ethics in Professional Life: Virtues for Health and Social Care' (with Sarah Banks). She is co-editor of 'Ethical, Legal and Professional Aspects of Healthcare: A practice-based approach' (with Sue Hodge 2012).
Recent publications include:
Gallagher A. (2013) Patients, Not Politics, Are Nurses’ Concern New York Times (see: http://www.nytimes.com/roomfordebate/2013/05/01/the-ethics-of-force-feeding-inmates/patients-not-politics-are-nurses-concern)
Gallagher A. (2013) Slow ethics will tackle moral winter Times Higher Education 10th January
Gallagher A. (2012) The key to improving nursing lies with nurses themselves The Times 04/05/12 p.61 (Public Sector section)
Gallagher A. (2012) How nursing should tackle its image problem The Guardian 10/05/2012 (See http://www.guardian.co.uk/healthcare-network/2012/may/10/nursing-should-tackle-image-problem#start-of-comments)
Gallagher A. (2011) If the culture is unethical, acts of heroic staff may be futile Nursing Times 107 (36) p.7 (‘In my view’ section)
Gallagher A., Wainwright P., Tompsett H. & Atkins C.(2012) Findings from a Delphi Study regarding Conflicts of Interest, General Practice and Safeguarding Children: Listen Carefully, Judge Slowly Journal of Medical Ethics Vol. 38 pp. 87-92
Gallagher A. (2011) Moral Distress and Moral Courage in everyday Nursing Practice Online Journal of Issues in Nursing Vol.16, No.2
Gallagher A. & Gannon C. (2011) Difficult Decisions in Cancer Care – Conducting an Ethics Case Analysis European Oncology & Haematology 7 (2) pp.101-105
Gallagher A. (2011) Ethical issues in patient restraint Nursing Times Vol. 107, No. 9. pp, 18-20
Gallagher A. (2010) Whistleblowing: what influences nurses on whether to report poor practice? Nursing Times 106 (4), pp.22-25
Gallagher A. (2010) Have you thought about assisted suicide? NMC News Issue 31, pp. 12-13
Evaluation of the RCN Dignity Campaign – ‘The Little Things Make a Difference’ (2009) – co-authored with Lesley Baillie
‘Receiving bad news about your mental health’ pilot research project (2008) – A collaborative project with Anne Arber, University of Surrey and Rob Chaplin and Alan Quirke, Royal College of Psychiatrists.
‘The Good Nurse: UK Pilot Study’ (2008) – A replication of the Far East Good Nurse Project with Khim Horton, Verena Tschudin and Sara Lister
‘Defending Dignity – Challenges and Opportunities’ (2008) – commissioned to develop e-survey, analyse data, write report and contribute to the development of educational materials with Professor Paul Wainwright and Dr Lesley Baillie.
Conflicts of Interests, General Practitioners and Safeguarding Children research project report (Tompsett et al 2008) - funded by the Department for Education and Skills & Department Health ‘Safeguarding Children Research Initiative’ – Co-researcher with social work and health colleagues at Kingston University and St George’s University of London – member of project management team and lead on designing, implementing and analysing Delphi Expert panel component
‘Arts for Life’ report (2007) - patients’ and carers’ perceptions of the value of the arts in palliative care – Commissioned by St Christopher’s Hospice. Awaiting publication in Nursing Standard.
‘Complementing the Community Project’ report (2007) relating to the perceived benefits of complementary therapies by those with non -malignant conditions – Commissioned by St Christopher’s Hospice.
Dignity in Practice Pilot Project Report (2001) with Professor David Seedhouse at Middlesex University.
- 'Slow ethics: a sustainable approach to ethical care practices?'. Sage Clinical Ethics, UK: 8 (4), pp. 99-104. . (2013)
- 'The ethics of reviewing.'. Nurs Ethics, England: 20 (7), pp. 735-736. . (2013)
- 'Justice for Older People'. CAMBRIDGE UNIV PRESS AGEING & SOCIETY, 33, pp. 1287-1288.Full text is available at: http://epubs.surrey.ac.uk/804544/
- 'Values for contemporary nursing practice: waving or drowning?'. Nurs Ethics, England: 20 (6), pp. 615-616. . (2013)
- 'Solidarity and moral perception.'. Nurs Ethics, England: 20 (5), pp. 499-500. . (2013)
- 'Learning from family and nurse narratives'. Nursing Times, 109 (19) . (2013)
- 'The good death.'. Sage Nurs Ethics, England: 20 (3), pp. 243-244.Full text is available at: http://epubs.surrey.ac.uk/804547/
- 'Twentieth anniversary of nursing ethics.'. Nurs Ethics, England: 20 (2), pp. 121-122. . (2013)
- 'Challenging care deficits: showing, telling and teaching.'. Nurs Ethics, England: 20 (1), pp. 3-4. . (2013)
- 'Transcultural Research Ethics: Impossibility or Panacea'. FrancoAngeli Salute E Società,
[ Status: Accepted ]
- 'Assisted Dying: The View from Solidarity'. Michigan State University College of Law Journal of Medicine and Law,
[ Status: Accepted ]
- 'Perspectives on medicine adherence in service users and carers with experience of legally sanctioned detention and medication: A qualitative study'. Patient Preference and Adherence, 7, pp. 787-799.doi: 10.2147/PPA.S44894
- 'Elements of an engaged clinical ethics: A qualitative analysis of hospice clinical ethics committee discussions'. Clinical Ethics, 7 (4), pp. 175-182.Full text is available at: http://epubs.surrey.ac.uk/804554/
Social, legal and health-care changes have created an increasing need for ethical review within end-of-life care. Multiprofessional clinical ethics committees (CECs) are increasingly supporting decision-making in hospitals and hospices. This paper reports findings from an analysis of formal summaries from CEC meetings, of one UK hospice, spanning four years. Using qualitative content analysis, five themes were identified: timeliness of decision-making, holistic care, contextual openness, values diversity and consensual understanding. The elements of an engaged clinical ethics in a hospice context is not generally acknowledged nor its elements articulated. Findings from this study have the potential to explain some of the most challenging ethical problems and to contribute to their resolution. It may also guide future deliberation and raise CEC members' awareness of the recurrent issues and values of their CEC practice.
- 'Slow ethics for nursing practice.'. Nurs Ethics, England: 19 (6), pp. 711-713. . (2012)
- 'Dignity in care: where next for nursing ethics scholarship and research?'. Rev Esc Enferm USP, Brazil: 46 Spec No, pp. 51-57. . (2012)
- 'Ethics and compromised consciousness.'. Nurs Ethics, England: 19 (4), pp. 449-450. . (2012)
- 'Educational responses to unethical healthcare practice.'. Nurs Stand, England: 26 (41), pp. 35-41. . (2012)
- 'Acknowledging small acts of kindness.'. Nurs Ethics, England: 19 (3), pp. 311-312. . (2012)
- 'Four countries, four views of nursing ... the best of times, the worst of times?'. Nurs Ethics, England: 19 (2), pp. 181-182. . (2012)
- 'Findings from a Delphi exercise regarding conflicts of interests, general practitioners and safeguarding children: 'Listen carefully, judge slowly'.'. J Med Ethics, England: 38 (2), pp. 87-92. . (2012)
- 'The demise of nursing?'. Nurs Ethics, England: 19 (1), pp. 3-4. . (2012)
- 'Keeping research ethics under review.'. Nurs Ethics, England: 18 (6), pp. 751-752. . (2011)
- 'We need to talk about dying.'. Nurs Ethics, England: 18 (5), pp. 623-625. . (2011)
- 'Respecting dignity in care in diverse care settings: strategies of UK nurses.'. Int J Nurs Pract, Australia: 17 (4), pp. 336-341. . (2011)
- 'Editorial: What do we know about dignity in care?'. Nurs Ethics, England: 18 (4), pp. 471-473. . (2011)
- 'Editorial: all you need is love?'. Nurs Ethics, England: 18 (3), pp. 283-284. . (2011)
- 'Ethical issues in patient restraint.'. Nurs Times, England: 107 (9), pp. 18-20. . (2011)
- 'Moral distress and moral courage in everyday nursing practice'. Online Journal of Issues in Nursing, 16 (2) . (2011)
- 'The ethics of impact factors.'. Nurs Ethics, England: 18 (1), pp. 3-5. . (2011)
- 'The ethics of research ethics committees.'. Nurs Ethics, England: 17 (6), pp. 683-684. . (2010)
- 'The use of vignettes within a Delphi exercise: a useful approach in empirical ethics?'. B M J PUBLISHING GROUP JOURNAL OF MEDICAL ETHICS, 36 (11), pp. 656-660. . (2010)
- 'Understanding general practitioners' conflicts of interests and the paramountcy principle in safeguarding children'. B M J PUBLISHING GROUP JOURNAL OF MEDICAL ETHICS, 36 (5), pp. 302-305. . (2010)
- 'Educating for ethical leadership'. CHURCHILL LIVINGSTONE NURSE EDUCATION TODAY, 30 (3), pp. 224-227. . (2010)
- 'Service users' experience of receiving bad news about their mental health'. INFORMA HEALTHCARE JOURNAL OF MENTAL HEALTH, 19 (1), pp. 34-42.Full text is available at: http://epubs.surrey.ac.uk/804603/
- 'Understanding student nurse attrition: Learning from the literature'. CHURCHILL LIVINGSTONE NURSE EDUCATION TODAY, 30 (2), pp. 202-207. . (2010)
- 'The ethics of mutuality'. SAGE PUBLICATIONS LTD NURSING ETHICS, 17 (5), pp. 539-540. . (2010)
- 'Untitled'. SAGE PUBLICATIONS LTD NURSING ETHICS, 17 (2), pp. 155-156. . (2010)
- 'The good reviewer?'. SAGE PUBLICATIONS LTD NURSING ETHICS, 17 (3), pp. 283-284. . (2010)
- 'The scope and purpose of nursing ethics'. SAGE PUBLICATIONS LTD NURSING ETHICS, 17 (1), pp. 3-4. . (2010)
- 'Evaluation of the Royal College of Nursing's 'Dignity: At the heart of everything we do' campaign: Exploring challenges and enablers'. Journal of Research in Nursing, 15 (1), pp. 15-28. . (2010)
- 'Untitled'. SAGE PUBLICATIONS LTD NURSING ETHICS, 17 (4), pp. 419-420. . (2010)
- 'GENEROSITY AND THE MORAL IMAGINATION IN THE PRACTICE OF TEAMWORK'. SAGE PUBLICATIONS LTD NURSING ETHICS, 16 (6), pp. 775-785.Full text is available at: http://epubs.surrey.ac.uk/732158/
- 'The RCN dignity survey: implications for leaders.'. Nurs Manag (Harrow), England: 16 (4), pp. 12-16. . (2009)
- 'Exploring the views of patients with cancer on what makes a good nurse--a pilot study.'. Nurs Times, England: 105 (23), pp. 24-27. . (2009)
- 'A pilot evaluation of the Arts for Life project in end-of-life care.'. Nurs Stand, England: 22 (50), pp. 42-46. . (2008)
- 'On different types of dignity in nursing care: a critique of Nordenfelt'. BLACKWELL PUBLISHING NURS PHILOS, 9 (1), pp. 46-54. . (2008)
- 'Terminal sedation: promoting ethical nursing practice.'. Nurs Stand, England: 21 (34), pp. 42-46. . (2007)
- 'The respectful nurse.'. Nurs Ethics, England: 14 (3), pp. 360-371. . (2007)
- 'Ethical aspects of withdrawing and withholding treatment.'. Nurs Stand, England: 21 (33), pp. 46-50. . (2007)
- 'Breaking bad news revisited: the push for negotiated disclosure and changing practice implications.'. Int J Palliat Nurs, England: 9 (4), pp. 166-172. . (2003)
King L.A., Jackson M.T., Gallagher A., Wainwright P. & Lindsay (2009) Towards a model of the expert practice educator – interpreting multi-professional perspectives in the literature Learning in Health and Social Care Vol. 8, Issue 2, pp.135-144
Gallagher A., Li S., Wainwright P., Rees Jones I. and Lee D. (2008) Dignity in the Care of Older People - A Review of the Theoretical and Empirical Literature BMC Nursing 2008, 7:11 (11 July 2008)
Wainwright P. and Gallagher A. (2008) ‘On different types of dignity in nursing care: a critique of Nordenfelt’ Nursing Philosophy 9. pp.46-54
Gallagher A. (2007) ‘The Respectful Nurse’ Nursing Ethics Vol.14, No.3, pp. 360-371
Gallagher A. (2004) ‘Dignity and Respect for Dignity – Two Key Health Professional Values: Implications for Everyday Nursing Practice’ in Nursing Ethics 11 (6) pp.587-599.
Arber A. & Gallagher A. (2003) ‘Breaking bad news revisited: the push for negotiated disclosure and changing practice implications’ International Journal of Palliative Nursing Volume 9. No.4, pp.166-172
Seedhouse D. & Gallagher A. (2002) ‘Undignifying Institutions’ Journal of Medical Ethics 28: 368-372
McHale J., Gallagher A. & Mason I. (2001) ‘The Human Rights Act 1998: Implications for Nurses’ Nursing Ethics, 8 (3), pp. 223-233
Gallagher A. and McKie A. ‘The potential of literature and poetry’ in Warne T. and McAndrew S. Creative Approaches in Health and Social Care Education and Practice: Knowing Me, Knowing You – In press.
Gallagher A ‘Ethics and Culturally Competent Care’ in Papadopolous R. (Ed.) (2006) Transcultural Health and Social care: The Development of Culturally Competent Practitioners Elsevier
Gallagher A. ‘Promoting Ethical Competence’ in Davis A.J., Tschudin V. and De Raeve (eds) (2006) The Teaching of Nursing Ethics: content and methods Elsevier
Gallagher A. Chapter ‘Do virtues have a role in the practice of counselling?’ in Robb M., Barrett S, Komaromy C. and Rogers A. (2004) Communication, Relationships and Care: A Reader Routledge, London
Baxter C. & Gallagher A. ‘Blowing the Whistle on Racism in Services: Ethical Professional and Legal Aspects’ in Baxter C. (ed.) (2001) Diversity & Equality in Health Care, Bailliere Tindall/ Harcourt
PUBLICATIONS IN PROFESSIONAL JOURNALS
Baillie L., Ford P., Gallagher A. and Wainwright P. (2009) Dignified care for children and young people: nurses’ perspectives Paediatric Nursing Vol. 21, No.2, pp.24-28
Gallagher A., Wainwright P., Baillie L. and Ford P. (2009) The RCN Dignity Survey: Implications for Leaders Nursing Management Vol. 16, No. 4 pp.12-16
Gallagher A., Horton K., Tschudin V. and Lister S. (2009) Exploring the views of patients with cancer on what makes a good nurse – a pilot study Nursing Times Vol. 105., No. 23, pp. 24-27
Gallagher A. and Sykes N. (2008) ‘A Little Bit of Heaven for a Few: Clinical Ethics Case Analysis’ Ethics and Social Welfare practice section Vol.2, No.3, pp.299-307
Gallagher A. (2008) ‘A pilot evaluation of the Arts for Life project in end-of-life care’ Nursing Standard Vol 22, No. 50, pp.42-46
Gallagher A. and Wainwright P. (2007) ‘Terminal Sedation: Promoting Ethical Nursing Practice’ Nursing Standard Vol. 21, No.34, pp. 42-46
Wainwright P. and Gallagher A. (2007) ‘Ethical Aspects of Withdrawing and Withholding Treatment’ Nursing Standard Vol. 21, No. 33, pp.46-50
Stanley R., Gallagher A., Eberhardie C. and Wainwright P. (2007) ‘An Introduction to Neuroethics: The values of ethics and the neurosciences British Journal of Neuroscience Nursing Vol.3, No. 3, pp. 112-116
Gallagher A. (2005) Too clever to care? Nursing Standard Vol.19, No.18, pp.14-15
Gallagher A. and Holland L. (2004) ‘Work-based learning: Challenges and Opportunities’ Nursing Standard Vol. 19, No.14016, pp.39-42
Alland C., Gallagher A. and Henderson J. (2003) ‘Staying Close: Remaining Distant -The Ethics of Continuous Observation’ Mental Health Practice Vol.7, No.3, pp.15016
Gallagher A. and Belshaw C. (2003) ‘Neither saint nor sinner’ (re good character in nursing) Nursing Standard Volume 17 No.45, pp. 22-23
Gallagher A and Seedhouse D. (2002) ‘Dignity in care: the views of patients and relatives’ Nursing Times Volume 98, No. 43, pp. 38-40
Gallagher A. and McHale J. (2001) ‘Consent to Treatment – Implications of the Bristol Recommendations for Nurses’ Nursing Times Vol. 97, No 49, pp.32-34
Ann is module leader for post-graduate module ‘Professional Ethics in a Global Context’ – this provides opportunities for UK and international professionals and students to enhance their understanding of professional ethics and to share experiences of working in complex and ever-changing cultural, political and policy contexts
She teaches ethics to undergraduate health processionals (nurses, midwives, paramedics, and operating department attendants.
- Chair of University Ethics Committee
-Developing research proposals, applying for funding and conducting empirical research relating to healthcare ethics
- Writing and publishing in peer-reviewed and professional journals
- Leading staff development in relation to teaching healthcare ethics
- Lead on nursing research collaboration with University of Sao Paulo, Brazil
- Developing international research and scholarship collaborations through the International Centre of Nursing Ethics (ICNE)
- Editor of international journal Nursing Ethics
- Teaching ethics to undergraduate and post-graduate students
- Supervising MSc, DCP and PhD students undertaking ethics-related research
Death on Prescription?
The Commission on Assisted Dying provides an impetus for reflection and critical debate
If you or a family member were terminally ill, would you like your GP to have the option of prescribing a lethal dose of medication? What if your diagnosis or prognosis was incorrect? Might you be concerned that a disabled or elderly person might feel pressurised to opt for assisted dying should it become available? Perhaps you think it abysmal that some UK citizens have to travel to Dignitas in Switzerland to avail of assisted death? Or, perhaps, you think that we should not allocate scarce healthcare resources to those who are terminally ill….? The recent report from the Commission on Assisted Dying requires that we engage with, and consider our responses to, these and other challenging questions relating to end of life choices. (See http://www.demos.co.uk/publications/thecommissiononassisteddying ).
The Commission considered ‘that the current legal status of assisted suicide is inadequate and incoherent’. It concludes that there is ‘a strong case for providing the choice of assisted dying for terminally ill people.’ Following an extensive consultation process and visits to regions that permit assisted dying (Oregon, the Netherlands, Belgium and Switzerland) the Commission proposed a framework that would, should assisted dying be legalised, provide ‘safeguarded access to assisted dying for eligible people’.
People considered eligible must be: over 18 years old; have a diagnosis of a terminal illness; make a voluntary choice; and have the mental capacity required to make such a choice. Safeguards include a decision-making model involving the independent judgements of two doctors (with support from other health and social care professionals) and processes to ensure the person is fully informed of treatment and care options, that he/she has capacity, that the lethal medication is transported and stored safely and that the assisted death is properly supported and recorded.
The ethical arguments for and against assisted suicide are discussed in some detail in Chapter 2 of the report and supported by data from evidence submitted to the Commission. These arguments relate to individual autonomy, the value and sanctity of life, compassion, the protection of vulnerable people, the balance of harms, non-discrimination in law and policy and, what is referred to as, medical ethics. Under the latter heading, the report discusses ‘the prohibition on doctors ending life’ and ‘the doctor’s role in relieving suffering’ (p.85).
The report has, understandably, generated a lot of controversy and debate. It urges us to consider questions we would probably rather ignore. Death and dying continue to be taboo topics and few people are willing or able to discuss them openly. The Commission’s report offers the opportunity to engage with these topics critically and constructively. Adopting an ostrich-like approach is not an option in educational programmes for health professionals and we need to consider additional and crucial questions. These would relate to, for example, the role of nurses and allied professionals should assisted dying be legalised, how conscientious objection would be operationalised; and what would constitute adequate educational preparation for nurses and other professionals should assisted dying be legalised? Professional education is directed not only towards the prevention of ill-health and the promotion of health but also towards helping people live well until they die. The School of Health and Social Care at the University of Surrey, in collaboration with our local hospices and hospitals, already offers an exemplary range of palliative care educational provision.
The debate about assisted dying is not, in my view, going to subside and we need to consider the very real possibility that in the years to come it will be legalised in the UK. Health professionals currently have to give a good deal of thought to how they balance respect for patient autonomy with the values of not doing harm, of doing good and treating people fairly. Should assisted dying be legalised in the future, the most pressing imperative for health professionals must be to protect, and advocate for, the most vulnerable individuals and groups. Professionals must also have the resources required to continue to deliver dignifying end of life care and the opportunity to opt out of assisted dying should this conflict with their personal and professional values.
Dr Ann Gallagher
Reader in Nursing Ethics