The ethics of care still appeals to many in spite of penetrating criticisms of it which have been presented over the past 15 years or so. This paper tries to offer an explanation for this, and then to critically engage with three versions of an ethics of care. The explanation consists firstly in the close affinities between nursing and care. The three versions identified below are by Gilligan (1982 ), a second by Tronto (1993 ), and a third by Gastmans (...) (2006 ), see also Little (1998 ). Each version is described and then subjected to criticism. It is concluded that where the ethics of care is presented in a distinctive way, it is at its least plausible; where it is stated in more plausible forms, it is not sufficiently distinct from nor superior to at least one other common approach to nursing ethics, namely the much-maligned 'four principles' approach. What is added by this paper to what is already known: as the article tries to explain, in spite of its being subjected to sustained criticism the ethics of care retains its appeal to many scholars. The paper tries to explain why, partly by distinguishing three different versions of an ethics of care. It is also shown that all three versions are beset with problems the least serious of which is distinctiveness from other approaches to moral problems in health care. (shrink)

Professional codes of ethics are regarded as elements of nurses' ethical knowledge base and consequently part of their ethics education. However, research focusing on these codes from an educational viewpoint is scarce. This study explored the need and applicability of nursing codes of ethics in modern health care, their importance in the nursing ethics curriculum, and the need for development of their teaching. A total of 183 Finnish nurse educators and 212 nursing students answered three structured questions, with an opportunity (...) to justify their responses, and one open-ended question. Descriptive statistics and content analysis were used to analyse the data. The results suggest that the existence of the codes was seen as important and their applicability mainly as appropriate, despite new challenges posed by modern health care. The codes were regarded as an important part of nurses' ethics education, but current integrated teaching methods require development. (shrink)

This article contends that an ethics of care has a particular moral ontology that makes it suitable to argue for the normative significance of relational responsibilities within professional health care. This ontology is relational. It means that moral choices always have to account for the web of relationships, the relational networks and responsibilities that are an essential part of particular moral circumstances. Given this ontology, the article investigates the conditions for health care professionals to be partial and to act on (...) the basis of particular responsibilities to their patients. We will argue that priorities could be partial in three ways: first, because there may be exceptional circumstances that allow for giving priority to one patient over another; second, because the integrity of the patient and a health care worker may be connected in special ways; and, finally, even if impartiality is essential, the institutional basis of health care must always give ample space for an ethically qualified individual and personal care for patients. Even if difficult priorities may be necessary, the conditions of institutional health care should always seek to create the prerequisites for nurses and doctors to administer proper care. (shrink)

George Herbert Mead (1863-1931) had a powerful influence on the development of American pragmatism in the twentieth century. He also had a strong impact on the social sciences. This classic book represents Mead's philosophy of experience, so central to his outlook. The present as unique experience is the focus of this deep analysis of the basic structure of temporality and consciousness. Mead emphasizes the novel character of both the present and the past. Though science is predicated on the assumption that (...) the present is predictable based on a thorough knowledge of the past, the experience of the present, says Mead, is an utterly unique moment comparable to no other, and when it is past the novel character of that unique experience is irrevocable. The emergence of novelty within the perceived rational order of reality is the crux of the problem that Mead explores. The present, in his words, is "the emergent event . . . something which is more than the processes that have led up to it and which by its change, continuance, or disappearance, adds to later passages a content they would not otherwise have possessed." The present as "the seat of reality" heavily conditions our retrospective view of the past as much as it helps to shape the future. The novelty of every present experience causes us to reconstruct our preceding experiences to make sense of the past, which is naturally assumed to be the main cause of what we presently experience. Our perspective on reality is thus relative to the conditioning of each new event and it changes continuously as the effects of the present shift our view of the past and future. This emphasis on the integrative, holistic nature of reality, in which everything past, present, and future is a condition of everything else, makes Mead's philosophy highly relevant to today's scientific picture of a quantum universe, where chance and probability play a role in the emergence of reality. Also of great interest is the way in which he extends his basic analysis of temporal-spatial reality to the emergence of mind and consciousness as a natural development of the evolutionary process. This stimulating and provocative work attests to John Dewey's praise of Mead as "the most original mind in philosophy in America" of his generation. (shrink)

Professional codes of ethics are regarded as elements of nurses' ethical knowledge base and consequently part of their ethics education. However, research focusing on these codes from an educational viewpoint is scarce. This study explored the need and applicability of nursing codes of ethics in modern health care, their importance in the nursing ethics curriculum, and the need for development of their teaching. A total of 183 Finnish nurse educators and 212 nursing students answered three structured questions, with an opportunity (...) to justify their responses, and one open-ended question. Descriptive statistics and content analysis were used to analyse the data. The results suggest that the existence of the codes was seen as important and their applicability mainly as appropriate, despite new challenges posed by modern health care. The codes were regarded as an important part of nurses' ethics education, but current integrated teaching methods require development. (shrink)

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses’ opinions of the content and function of codes and their use in nursing practice. A total of 49 focus (...) groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be ‘paper tigers’ with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice. (shrink)

The aim of this study was to explore how Belgian nurses view issues related to the development, dissemination and implementation of a code of ethics for nurses. Fifty nurses took part in eight focus groups. The participants stated that, on the whole, a code of ethics for nurses would be useful. They stressed that a code should be a practical and useful instrument developed by nurses for nurses, and that it should be formulated and presented in a practical way, just (...) as educational courses dealing specifically with codes of ethics require a practical approach to be effective. They emphasized that the development of a code should be an ongoing process, enabling nurses to provide input as they reflect on the ethical issues dealt with in the code and apply the code in their practice. Finally, they stressed the need for support at institutional level for the effective implementation of a code. (shrink)

This article briefly outlines some of the key problems with the way in which the moral realm has traditionally been understood and analysed. I propose two alternative views of what is morally interesting and applicable to nursing practice and I indicate that instability has its upsides. I begin with a moral tale – a 'Good Samaritan' story – which raises fairly usual questions about the nature of morality but also the more philosophically fundamental question about the relationship between subjectivity and (...) moral agency. I then consider this relationship from the perspectives of two twentieth century philosophers: Emmanuel Levinas and Michel Foucault. Levinas' basic point is that the experience of ethical subjectivity is made possible through others: the demand to respond to the existence of others is the basic social structure that precedes individual freedom. If Levinas posits intersubjectivity as a fundamental or primitive feature of the moral realm, Foucault poses an even more basic question: how have moral subjects and relations of obligation been constituted? The aim of ethical inquiry, for Foucault, is to describe the network of discourses, institutions, relations, and practices through which certain kinds of subjects are constituted and constitute themselves, e.g. as a kind of person who can act morally. Finally, I consider some recent research in philosophy of nursing which illustrates how Levinasian and/or Foucauldian perspectives can deepen understanding of nurses' moral practices, specifically, the work of Norwegian public health nurses, Canadian pediatric nurses, and Irish midwives. I suggest that in spite of the instability of morality in general and the particular ethical challenges that face nurses, there are grounds for hope and possible strategies for living in unstable times. (shrink)

The aim of this study was to synthesize the concepts from empirical studies and analyze, compare and interrelate them with normative ethics. The International Council of Nurses (ICN) and the Health and Medical Service Act are normative ethics. Five concepts were used in the analysis; three from the grounded theory studies and two from the theoretical framework on normative ethics. A simultaneous concept analysis resulted in five outcomes: interconnectedness, interdependence, corroboratedness, completeness and good care are all related to the empirical (...) perspective of the nurse’s interaction with the older patient, and the normative perspective, i.e. that found in ICN code and SFS law. Empirical ethics and normative ethics are intertwined according to the findings of this study. Normative ethics influence the nurse’s practical performance and could be supporting documents for nurses as professionals. (shrink)

Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on care has been at (...) the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes. (shrink)