Approaches to Nursing Ethics

Abstract

To many minds, the publication of Joseph Fltichtfs Morals and Medicine^ in 1954 signaled a new beginning in medical ethics. I believe that the publication of the first edition of Ethical Dilemmas and Nursing Practice^ by Anne J. Davis and Mila A . Aroskar in 1978 has a similar status within the field of nursing ethics. Comparatively, contemporary nursing ethics literature is still in its infancy, but it has grown to the point that useful observations about its emerging shape can be made.^ It will be the aim of this paper to argue that the nursing ethics literature (i.e. books and articles on ethical issues in nursing) can be characterized as exhibiting three basic approaches to nursing ethics. What distinguishes these various approaches from one another is the primary focus of appeal in resolving ethical issues. Of course, the broadest and most obvious sort is to appeal to moral theories. A second approach looks to traditional moral principles and ideals found within the medical profession. A third approach deals with ethical issues from the perspective of a philosophical conception of the nature of nursing. For the sake of convenience, let's refer to these three approaches as the ethical theory approach, the moral principles approach and the philosophical foundation approach, respectively. It will be the burden of my paper to suggest that it is the third—the philosophical foundations approach—which is the best approach for conceptually framing and discussing ethical issues in nursing. I believe that it captures more of the considerations which actually determine how a nurse chooses to act. In addition to having greater empirical adequacy with respect to the professional decision-making process, it also possesses a kind of theoretical fruitfulness not found in the others. That is, it has generated bold professional stances on issues such as informed consent and orders not to resuscitate which might not have been anticipated on the other approaches. In the following sections I will briefly illustrate the other two approaches, making my case for the third, and finally make some observations about what this approach implies about doing applied ethics.