Nursing ethics Flashcards
What are the four fundamental responsibilities as articulated by NMBA ACM and ACN, ANMF?
Four fundamental responsibilities to:
- Promote health
- Prevent illness
- Restore health
- Alleviate suffering
What is particularly distinctive about nursing ethics is the underlying commitment to ‘care.’ This is not simply the practice of nursing, but a moral attitude and ethical concept/theory.
Describe the Kohlberig Gilligan moral framework anddiscussits limitations
Level 1 (Pre-Conventional)
1. Obedience and punishment orientation
2. Self-interest orientation
Level 2 (Conventional)
3. Interpersonal accord and conformity
4. Authority and social-order maintaining
Level 3 (Post-Conventional)
5. Social contract orientation
6. Universal ethical principles
Whilst working with Kohlberg in the late 1970s, Carol Gilligan noted that his research was almost exclusively conducted with boys (also WEIRD). Furthermore, on evaluation, women tended to be scored at stage 3/4, whilst men tended to be 5/6.
Gilligan pursued her own program of research with both men and women. She argued that men (or masculine individuals) tend to see ethics in terms of rights, laws, and universal principles:
- An ethics of justice: Rational judgment, based on the morally objective features of the case.
In contrast, women (or feminine individuals) tend to see morality in terms of relationships, compassion, and responsibility to others:
- An ethics of care: Concern for interrelated others, based on subjective reality or ‘lived experience.’
One’s orientation is not simply a matter of sex, but of character or disposition and, therefore, a question of gender (masculinity/femininity) and how it informs personality and worldview. It is also context-sensitive. We are not exclusively concerned with justice or care, even if one generally predominates.
Gilligan suggests this treats the dilemma as a kind of math problem, isolated in time and space, whilst framing the issue in terms of justice alone. It neglects the kind of responses prompted by what is now called an ‘ethics of care.’ Such responses tend to focus on relationships over time and narratives of fracture and reconciliation. Insisting on dialogue with the pharmacist ‘breaks the rules of the game,’ but such responses arguably better approximate our actual moral experiences and responses to a greater degree.
Describe feminist ethics
Since Gilligan, it has become clear that an ethics of care cannot be contrasted with an ethics of justice or, at least, that there must be a place for justice (and various other ethical concepts, including autonomy vis-à-vis relational autonomy).
In the philosophy of science, feminist epistemology has advocated for ‘strong objectivity,’ particularly in the human sciences. This involves researchers being reflexive about their own subject position, rather than attempting to embody an unattainable ‘view from nowhere.’
Contemporary feminist ethics makes an analogous move. It rejects a certain kind of moral objectivity (individualist, universal, emotion incompatible with rationality) in favor of an alternative stance. It remains objective but is relational, situated, and is cognizant of our moral emotions (affect) and the ineliminable role they play in moral reasoning.
‘Feminist ethics has been closely intertwined with disability ethics, and the notion of vulnerability now sits alongside care as a distinctive moral concept.
On the one hand, the vulnerable might be thought of as those who are at some physical disadvantage. However, we might also think of those who are socially disadvantaged in some way, perhaps due to discrimination (of various kinds) or simply due to their socio-economic status.
On the other hand (and without wishing to deny the existence of privilege), all human beings might be considered vulnerable in some fundamental sense. Certainly, none of us are invulnerable. Equally, we are all interdependent. What varies is the degree of vulnerability and interdependence.
Nursing—and perhaps health and social care in general—involves caring for the more-than-ordinarily-vulnerable or the more-than-ordinarily-dependent.
What could be a possible way to bridge the gap between the different ethical ‘languages’ of medicine and nursing?
both doctors and nurses should or, at least, can draw on the four principles. Whilst they might have different perspectives, whether as a matter of philosophical outlook or professional background, this can be productive and facilitate a more comprehensive understanding of the issue(s) at hand.
She also argues that the established dynamic of patient advocate (nurse) and final decision-maker (doctor) should be abandoned in favor of working together.
Discuss relational autonomy
Whilst respect for autonomy means tolerating poorly made choices, it presumes we are able to make our own decisions and that we do so as individuals acting in our own best interests.
However, we exist inevitably in various networks of interpersonal and institutional relationships that constrain or configure the choices we can realistically make. We cannot simply act in our own (medical) best interests; we must also consider the broader consequences for ourselves and others.
In this context, relationships of care and the existence of vulnerability take on particular significance. Our decisions can be expressions of care, our interdependence, and therefore related to our (or others’) vulnerabilities.
