This paper analyses the question what other healthcare professions should learn from nursing ethics, e.g. what should medical ethics learn from nursing ethics. I first analyse and reject all strong versions of the claim that nursing ethics is unique, because nursing is a unique practice. I then move to the question of whether the link between nursing ethics and nursing theory can be a model for other areas of healthcare ethics. I provide an analysis of the possibility of creating a (...) theory of medicine and find that there cannot be a theory of medicine, and I argue briefly that this finding is also applicable to nursing. If there cannot be a theory of nursing, this entails that nursing ethics cannot be justifiably based on such a theory. In the final section, I then analyse the success of nursing ethics in resisting certain of the vices of Anglo‐American analytic ethics, in particular the reductionism and individualism that characterizes much of healthcare ethics. I conclude that other healthcare ethics could usefully learn from this aspect of nursing ethics. (shrink)

Many of the activities of clinical practice happen to, with or upon vulnerable human beings. For this reason numerous nursing authors draw attention to or claim a significant moral domain in clinical practice. A number of nursing authors also discuss the emotional involvement and/or emotional labour which is often experienced in clinical practice. In this article I explore the importance of emotion for moral perception and moral agency. I suggest that an aspect of being a good nurse is having an (...) emotional sensitivity to other human beings (patients), because this emotional sensitivity allows the nurse to perceive more accurately the context and perspective of the patient. It is thus important to the moral agency of the nurse and to morally sensitive clinical practice. As such education of the emotions should be a feature of the moral education of the nurse. A useful conception of the role of educated emotion in the moral life can be discovered in Aristotelian ethics. (shrink)

For more than 15 years Professor Per Nortvedt has been arguing the case for moral realism in nursing and the health‐care context more generally. His arguments focus on the clinical contexts of nursing and medicine and are supplemented by a series of persuasive examples. Following a description of moral realism, and the kinds of considerations that support it, criticisms of it are developed that seem persuasive. It is argued that our moral responses are explained by our beliefs as opposed to (...) moral realities. In particular, two key arguments presented by Nortvedt are challenged: the so‐called argument from convergence and the argument from clinical sensitivity. Both of these key planks in the case for moral realism are rejected, and an alternative ‘social conditioning’ account briefly sketched, which, it is claimed, has the same explanatory power as Nortvedt's thesis but does not rest on an appeal to independently existing moral properties. (shrink)

DINÇ L and GASTMANS C. Nursing Inquiry 2012; 19: 223–237 Trust and trustworthiness in nursing: an argument‐based literature reviewCaring requires nurses to establish trusting relationships with patients and to be trustworthy professionals. This article provides insight into the conceptual understanding of trust and trustworthiness in nursing through an argument‐based literature review of 17 articles published between 1980 and 2010. Trust is characterized as an attitude relying with confidence on someone. The importance of trust relationships is considered by addressing the imbalances (...) of power in nurse–patient relationships as they increase the vulnerability and dependency of the truster. Trust is considered as a process, and time, reliance on others, risk and fragility are identified as basic attributes of trust. However, trustworthiness is inadequately explored in the nursing ethics literature. Nurse educators have a responsibility to ensure that nurses are equipped with the attitudes and knowledge that are needed to establish trusting nurse–patient relationships. (shrink)

The patient–physician relationship is of primary importance for medical ethics, but it also teaches broader lessons about ethics generally. This is particularly true for the philosopher Emmanuel Levinas whose ethics is grounded in the other who “faces” the subject and whose suffering provokes responsibility. Given the pragmatic, situational character of Levinasian ethics, the “face of the other” may be elucidated by an analogy with the “face of the patient.” To do so, I draw on examples from Martin Winckler’s fictional physician (...) narratives. In addition, I explore how the standpoint of the physician conceals a related but often unacknowledged dimension of care: the obligation to nurse. For both nurse and physician, one question encapsulates Levinas’ medical ethics: “What does the patient say?” Using this as my guiding question, I examine the context within which physician, nurse, and patient meet in order to highlight their shared vulnerability and the care relationship that binds them together. (shrink)

High technology and nursing: ethical dilemmas nurses and physicians face on high‐technology units in Norway Results from two studies of ethical dilemmas nurses and doctors experience on two high‐technology units are compared and discussed. The qualitative comparative methodology of grounded theory was used to generate theoretical frameworks grounded in the empirical realities of the units. The ethical dilemmas they faced were related to: treating the one vs. the common good; end of life questions; and resource allocations with inadequate staffing. Similarities (...) were related to intensity and urgency of nursing care and patient treatment, clear nursing ideologies based on treating humans within a framework of hope, embracing technology and scarce resources. Differences between the two study units were patient diagnosis, hierarchical structure on one unit while one had a vertical structure and decision‐making processes, and finally how nursing knowledge and autonomy were used. The two studies demonstrated that clinical, ethical and administrative interactions and decisions are highly compounded, stressful and intertwined. (shrink)

This article highlights the distinction between the ‘art of nursing’ and ‘fine art’. While something in the nature of nursing can be described as ‘the art of nursing’, it is not to be misunderstood as ‘fine art’ or craft. Therefore, the term ‘aesthetic’ in relation to nursing should not be linked to the aesthetic of modern art, but instead to a broader and more general meaning of the word. The paper's main focus is the aesthetic experience, which is treated in (...) a hermeneutic way and elucidated from classical sources and the philosophy of nursing and from Art. The paper argues that the pioneers used the term ‘art of nursing’ in a metaphorical way to say something more specific on the nature of nursing. The term illustrates the nurse's ability to practise at the highest possible level of excellence. (shrink)

This article highlights the distinction between the ‘art of nursing’ and ‘fine art’. While something in the nature of nursing can be described as ‘the art of nursing’, it is not to be misunderstood as ‘fine art’ or craft. Therefore, the term ‘aesthetic’ in relation to nursing should not be linked to the aesthetic of modern art, but instead to a broader and more general meaning of the word. The paper's main focus is the aesthetic experience, which is treated in (...) a hermeneutic way and elucidated from classical sources and the philosophy of nursing and from Art. The paper argues that the pioneers used the term ‘art of nursing’ in a metaphorical way to say something more specific on the nature of nursing. The term illustrates the nurse's ability to practise at the highest possible level of excellence. (shrink)

Illness creates a range of negative emotions in patients including anxiety, fear, powerlessness, and vulnerability. There is much debate on the ‘therapeutic’ or ‘helping’ nurse–patient relationship. However, despite the current agenda regarding patient-centred care, the literature concerning the development of good interpersonal responses and the view that a satisfactory nursing ethics should focus on persons and character traits rather than actions, nursing ethics is dominated by the traditional obligation, act-centred theories such as consequentialism and deontology. I critically examine these theories (...) and the role of duty-based notions in both general ethics and nursing practice. Because of well-established flaws, I conclude that obligation-based moral theories are incomplete and inadequate for nursing practice. I examine the work of Hursthouse on virtue ethics’ action guidance and the v-rules. I argue that the moral virtues and a strong (action-guiding) version of virtue ethics provide a plausible and viable alternative for nursing practice. I develop an account of a virtue-based helping relationship and a virtue-based approach to nursing. The latter is characterized by three features: (1) exercising the moral virtues such as compassion; (2) using judgement; and (3) using moral wisdom, understood to include at least moral perception, moral sensitivity, and moral imagination. Merits and problems of the virtue-based approach are examined. I relate the work of MacIntyre to nursing and I conceive nursing as a practice: nurses who exercise the virtues and seek the internal goods help to sustain the practice of nursing and thus prevent the marginalization of the virtues. The strong practice-based version of virtue ethics proposed is context-dependent, particularist, and relational. Several areas for future philosophical inquiry and empirical nursing research are suggested to develop this account yet further. (shrink)