• 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.
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 Care Ethics (ICE) Observatory
- 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
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.
Dignity is recognised as both a central and also a contested value in bioethics discourse. The aim of this manuscript is to examine some of the key strands of the extensive body of dignity scholarship and research literature as it relates to nursing ethics and practice. The method is a critical appraisal of selected articles published in Nursing Ethics and other key manuscripts and texts identified by researchers in the UK and Brazil as influential. The results suggest a wide and rather confusing range of perspectives and findings albeit with some overall themes relating to objective and subjective features of dignity. In conclusion, the authors point to the need for more sustained philosophical engagement contextualising human dignity within a plurality of professional values. Future empirical work should explore what matters to patients, families, professionals and citizens in different cultural contexts rather than foregrounding qualitative research with such a contested concept.
In this article the author examines the concepts of moral distress and moral courage within the context of nursing practice. Examples of challenging healthcare situations from the United Kingdom and Ireland are discussed in the light of the examination of these two concepts. The examples illuminate features of healthcare situations that need to be considered in relation to different organisational and cultural contexts. This requires an understanding of the complexity of clinical contexts and an appreciation of the fallibility and vulnerability of nurses and other practitioners. The goal of this article is to encourage healthcare organisations to create supportive structures and sensitive leadership that will enhance moral courage in the work setting.
This article revisits the ethical, legal, professional and emotional issues involved with disclosing bad news. The authors examine the push for disclosure that has come from a number of quarters in the UK, including ethical and legal challenges, in particular the Bristol Royal Inquiry Report, professional codes of conduct, health policy and the expectations of the public. The contribution of nurses to breaking bad news is not widely discussed in the literature. With the development of new nursing roles and evidence-based practice it is timely to consider the role of nurses in this process. The article highlights some limitations with current guidelines for breaking bad news, in particular, that these guidelines tend to be constructed from a professional standpoint and lack patient-centred evidence. The issue of emotional labour and how it relates to giving bad news is discussed with respect to professional staff and patients. The article concludes by raising some practice implications, including: the importance of context and continuity; the significance of information and support; the desirable qualities of the professional; and issues to consider in determining patient preferences.
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
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