Essay: Nursing Ethical Theories

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[. . .] Due to this deficiency mostly thinkers have supported deontological ethics theory.

Justice Ethics vs. Care Ethics

Justice Ethics

The word 'justice' means 'to be fair with all people' and it is intimately attached to the legal system. In the nursing profession, decisions have to be taken on each and every spot, therefore, there is a code of justice ethics to be followed for elderly, poor or disable patients.

All the human beings are liable to look for the well-being of humanity and to reduce pains from the world and this relates to the basic duties of a nurse. The basic principle of this theory has been placed on the right and wrong of an act and on principles that coerce the performance. According to Emmanuel Kant (1724-1804), every act has a moral compulsion rooted in the admiration for rights and reception of liability that is why the principles must be clearly defined. Every human being is worthy of respect, the respect for independence (Kantian, nd) this is the principle based on which nurse respects independence of the patient and support patient through work.

Justice can be deliberated in terms of equality, impartiality or need. In nursing, justice is applied to equal access for every patient to the health care and on evenhanded limited resource allocation. With regard to the limited resources, for example, if two areas needed critical care nurses in abundant but there is less number of critical care nurses to be provided. It means supply is less then the demand. Here the question for justice arises whether these nurses have to work hard or longer? Whether they are paid according to their working? And so on. In other cases if there is sufficient nursing staff in a hospital to care the patients then questions of justice arises; Are they all working full time?; Are they providing the same care to all the patients?; What is their expertise?; Are they being paid according to their expertise?, etc. Under these conditions, who is the most effected by unequal nursing care as well as non-provision of equal financial resources will be served by justice? This is the most important moral issue that needs to be resolved employing highest standards of justice.

Another aspect of justice is the social justice, a well-known slogan preserving dignity and promoting justice directly relates to the social justice. In nursing, the social justice does not only benefit the nurses and the patients but also uplift safe and secure social environment. For example a public health nurse working in a rural community health care system has just learned that the town's hospital is slated for closure. Losing the hospital in an area where already a lot of health-related problems increasing day by day and having other social issues too would be a blow to the community.

Therefore, keeping in mind justice ethics, it is the responsibility of that nurse to develop awareness related to the need of hospital among the community officials. Moreover, she can collaborate with other nurses of that area and all together they can help the community to develop awareness with regard to the benefits of having hospital in their own area and realizing that its closure would raise a lot of problems especially for the vulnerable members of the society, thus leading to social injustice. These all nurses could accompany the community officials to take their issues to the government officials and help them to raise their voice for social justice.

Another scenario related to social justice is that of a nurse working in an emergency department in a hospital observes that the student nurses are working very hard but still are treated worse which is leading to an unhealthy environment. In this case, the nurse should study the whole situation and find out the cause and then if this treatment is from the side of any physician or head nurse then she should take in confidence the staff members. She can also discuss this issue with the unit head to resolve the problem. Thus social equity can not be achieved individually but it is the responsibility of the whole staff to develop a socially secure and justified environment.

Care Ethics

A care-based ethics as the moral foundation for nursing appears to provide an alternative, or at leas counter-balance, to the rationalist ethic adopted from medicine. Although this perspective often is discussed as a feminist ethic grounded in Gilligan's (1982) psychological study of the moral development and orientation of men and women, the conceptualization of caring as a consideration in determining what one ought to do is not a recent philosophical notion. Heidegger (1927/1962) posited caring as a fundamental mode of being in the world. In Buber's (1947/1965) work, caring is a form of dialogue that may be spoken or silent, but it is a state "where each of the participants really has in mind the other or others in their present and particular being and turns to them with the intention of establishing a living mutual relation…" (p. 19). And Mayeroff (1971) described the elements of a caring relationship that are foundational for ethical behavior.

Gilligan's (1982) psychological studies of moral development gave rise to further interest in and articulation of care as a normative ethical theory. She found traditional ethical theory inadequate to explain the "different voice" she uncovered in studying female and male moral decision making. Her research identified a difference between the moral consideration of men and those of women: moral deliberation in men generally centers on a concern with competing rights and the principled resolution of such conflicts -- a concern for justice, whereas moral judgment for women centers on responsibility and relationships -- a care orientation. According to Gilligan, the ideal of care "is thus an activity of relationship, of seeing and responding to need, taking care of the world by sustaining the web of connection so that no one is left alone" (p.62). Consequently, the moral concern is with competing needs and corresponding responsibilities within relationships, where moral choice is bound by context.

Noddings' (1984) Caring: A Feminine Approach to Ethics and Moral Education offered insights about relationships that are compatible with Gilligan's (1982) findings. This educator's model of a moral theory of caring identifies caring as rooted in receptivity (acceptance of confirmation of the person by the caregiver), relatedness (relation of the caregiver to the person as a fact of human existence), and responsiveness (commitment from the caregiver to the one cared for). Noddings conceives of caring responses as existing on two levels. The first, natural caring, originates in the mother-child relationship and extends to family and friends. The second level is that of ethical caring, which involves care for strangers and is a moral obligation within her theory.

Both Gilligan and Noddings contend that moral deliberations are contextual and relational: a care-based ethic invites immersion into the dilemma with consequent appreciation of the complexity of the moral situation as it is experienced by the other although both authors consider an ethic of care to be intrinsic to female moral deliberation, neither claims the moral superiority of women nor that caring is beyond the realm of male moral deliberation. Moreover, neither Gilligan nor Noddings views rights-based ethics and care-based ethics as necessarily dichotomous. Rather, each approach to moral deliberation and choice are conceived by them as informing the other. Although no single definitive formulation of a care ethic exists apart from Noddings' (1984) work, all formulations share features with the works of these scholars.

For nursing, the conceptualization of care and caring as an ethical framework for practice was articulated first in 1979 by Carper, who posited, "Caring, as a professional and personal value, is of central importance in providing a normative standard which governs our actions and our attitudes toward those for whom we care" (pp. 11-12). Hers was not a criticism of principle-based ethics, but of the dehumanization of the patient by the health care system and its developing advanced technology. Since this early work, a proliferation of nursing literature has explored caring and its place in nursing. This literature can be categorized into three distinct areas: the epistemological (caring as a way of knowing), the ontological (caring as a way of being), and the ethical (caring as prescriptive) (Crigger, 1997). The following discussion focuses on the latter category.

Some nurse theories view caring as a moral imperative and ideal for nursing (Carutin, 1980; Gadow, 1985; Watson, 1985, 1999). Others have proposed different formulations of care-based nursing ethic. These include a synthesis of care with other moral perspectives (Cooper, 1990b; Gallagher, 1995), caring as a point-of-view or disposition for recognizing the morally salient features of a situation (Fry, 1990; Kuhse, 1995), and care as a virtue essential for nursing practice (Brody, 1988). Schultz and Schultz (1990) identified that an adequate ethical theory for nursing should… [END OF PREVIEW]

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