RENOWNED NURSING ETHCIST BOWS OUT

Megan-Jane Johnstone was delving into the study of philosophy at New Zealand's Waikato University in the early 80s when her lightbulb moment hit.

Invisibility, Moral Knowledge and Nursing Work in the Writings of Joan Liaschenko and Patricia Rodney

The ethical ‘eye’ of nursing, that is, the particular moral vision and values inherent in nursing work, is constrained by the preoccupations and practices of the superordinate biomedical structure in which nursing as a practice discipline is embedded. The intimate, situated knowledge of particular persons who construct and attach meaning to their health experience in the presence of and with the active participation of the nurse, is the knowledge that provides the evidence for nurses’ ethical decision making. It is largely invisible to all but other nurses. Two nurse researchers, Joan Liaschenko of the University of Minnesota and Patricia Rodney of the University of Victoria, have investigated the ethical concerns of practising nurses and noted in their separate enquiries the invisible nature of critical aspects of nursing work. Noting the similarities in their respective observations, and with the feminist ethics of Margaret Urban Walker as a theoretical framework, this article examines the concept of ‘invisibility’ as it relates to nursing work and nursing ethics.

Nurses and National Socialism a Moral Dilemma: one historical example of a route - to euthanasia

If euthanasia were to be made legal in other countries apart from the Netherlands and Belgium, nurses would be faced with ethical dilemmas that could impact on their professional accountability and their personal moral beliefs. As a part of history has demonstrated, the introduction of the practice of euthanasia could also significantly change the relationship between nurses and patients. In Germany between 1940 and 1945, in response to a government directive, nurses participated in the practice of euthanasia and as a result many innocent German people were killed by what were considered to be ‘mercy deaths’. It is important to try and understand the moral thinking and examine the complex issues at this historical junction that led German nurses to participate in the killing of thousands of innocent people. Such reflection may help to stimulate an awareness of the moral issues that nurses in the twenty-first century could confront if euthanasia were to be made legal in their own country. This has implications for future nursing practice.

‘The Demolition of a Man’: Lessons From holocaust literature for the teaching of nursing ethics

The events of the Holocaust of European Jews (and others) by the Nazi state between 1939 and 1945 deserve to be remembered and studied by the nursing profession. By approaching literary texts written by Holocaust ‘survivors’ from an interpersonal dimension, a reading of such works can develop an ‘ethic of responsibility’. By focusing on such themes as rationality, duty, witness and the virtues, potential lessons for nurses working with people in a variety of settings can be drawn. Implications for the teaching of nursing ethics are made in the areas of the virtues, relationships, professional ethics and the moral community of nursing.

Duty and 'Euthanasia': the Nurses of Meseritz-Obrawalde

This article examines the actions and testimonies of 14 nurses who killed psychiatric patients at the state hospital of Meseritz-Obrawalde in the Nazi 'euthanasia' program. The nurses provided various reasons for their decisions to participate in the killings. An ethical analysis of the testimonies demonstrates that a belief in the relief of suffering, the notion that the patients would 'benefit' from death, their selection by physicians for the 'treatment' of 'euthanasia', and a perceived duty to obey unquestioningly the orders of physicians were the primary ethical reasons that were stated for their behavior. However, 20 years had elapsed between the killings and the trial, thus giving ample opportunity for the defendants to develop comfortable rationales for their actions and for their attorneys to have observed successful defenses of others accused of euthanasia.

Nurses Writing about Psychiatric Nurses' Involvement in Killings during the Nazi Era: A Preliminary Discourse Analysis

Nurses actively killed people in Nazi Europe between 1939 and 1945. The so-called ‘science of eugenics’ underpinned Nazi ideology, used to further the Nazi racist agenda. Edicts sanctioned selection and medically supervised killing of people, and nurses, principally in mental hospitals, participated in the killing of between 100–300 thousand patients. Erroneously termed ‘euthanasia', there were three phases: the initial programme involving children, the T4 adult programme, and ‘wild euthanasia'. Unofficial killings also took place before 1939. This paper uses discourse analysis to map and analyse published texts which explore the role of nurses in Nazi Germany. The aim is to identify its characteristics as a body of literature, to note strengths and weaknesses, emphases and silences, and to note aspects that need further exploration. It acknowledges that how these events are to be understood and represented in contemporary discourse constitutes a significant problem for historians of nursing.

Summary of Code of Ethics

The Guide to the Code of Ethics for Nurses is an excellent guideline for all nurses regardless of their area of practice. I greatly enjoyed reading the revisions in place within the 2015 edition and refreshing my nursing conscience. I plan to always keep my Guide to the Code of Ethics for Nurses near in order to keep my moral compass from veering off the path of quality care.

The Nursing Code of Ethics: Its Value, Its History

To practice competently and with integrity, today's nurses must have in place several key elements that guide the profession, such as an accreditation process for education, a rigorous system for licensure and certification, and a relevant code of ethics. The American Nurses Association has guided and supported nursing practice through creation and implementation of a nationally accepted Code of Ethics for Nurses with Interpretive Statements. This article will discuss ethics in society, professions, and nursing and illustrate how a professional code of ethics can guide nursing practice in a variety of settings. We also offer a brief history of the Code of Ethics, discuss the modern Code of Ethics, and describe the importance of periodic revision, including the inclusive and thorough process used to develop the 2015 Code and a summary of recent changes. Finally, the article provides implications for practicing nurses to assure that this document is a dynamic, useful resource in a variety of healthcare settings.

"Mrs. Tilley had a very hasty wedding!": the class-based response to marriages in the Grenfell Mission of Newfoundland and Labrador

The International Grenfell Association (IGA) attracted hundreds of single young women for nursing in northern Newfoundland and Labrador between 1939 and 1981. Under contract with the Mission, the Grenfell nurse was expected to behave in a non-sexual manner and uphold a strict moral code of behaviour. However, the Grenfell experience provided nurses with a unique opportunity for socializing with young men who ranged the social spectrum, from fishermen and labourers to medical professionals. This paper highlights the relationships and marriages of the nurses that developed during or immediately after their tenure with the IGA and evaluates the Grenfell Mission's class-based responses to those relationships. The administration responded either positively or negatively to nurses' marriages, depending on the socioeconomic background of the husband in question. Marriages to physicians or dentists were almost always celebrated while marriages to local men were usually questioned or treated with ambivalence. From the perspective of the IGA, the social status of the nurse could be raised or lowered depending on the socioeconomic background of her marriage partner.

'Faced' with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing

This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform 'hands on' nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the philosopher Emanuel Levinas (1906-1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses' stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses' responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable.

Practices of responsibility and nurses during the euthanasia programs of Nazi Germany: A discussion paper

In this paper, we focus on the contexts of moral decision-making by nurses in the euthanasia programs of Nazi Germany between 1939 and 1945 using Urban Walker's philosophical model. We use the second hypothesis of this model, that morality consists of practices of responsibility, to give an analysis of the understandings nurses had of their responsibilities in the euthanasia programs. The article starts with a brief introduction to the euthanasia programs of Nazi Germany from 1939 to 1945 and nurse participation, to illustrate how the responsibilities of nurses were manipulated. Secondly, nursing as moral practices are analysed in the context of the euthanasia programs that implement commonly shared understandings and practices of responsibility. Thirdly, the reasons that nurses gave for avoiding any responsibilities are examined. Fourthly, it is examined if nurses took any responsibility in the euthanasia programs. In conclusion, this paper discusses three points of relevance such a reflection on moral responsibility in the context of Nazi Germany has for nurses today who may be confronted with euthanasia.

[Ethical dilemma in the Women's Hospital of Basle. Diaconesses took a stand on abortions]

In the 1940s there occurred an ethical conflict in the Women's Hospital of Basle. It arose in the context of a shortage of nurses, the introduction of the Swiss national criminal law, the change of the hospital director, the increase of abortion and the nursing ideal of obedience and serving. The conflict showed the social change towards measures of birth control such as abortion and sterilisation. Different political opinions and strong convictions clashed. The paper is focusing on denominationally affiliated nurses, the deaconesses of Riehen, who were standing between the religious conviction to protect unborn life and the professional principle of unconditional nursing. Finally they decided to leave the hospital.

Nurses and the sterilization experiments of Auschwitz: a postmodernist perspective

The medical experiments conducted on non-consenting prisoners of Nazi concentration camps during World War II necessitated the codification of principles to protect human subjects of research. Auschwitz was the largest and one of the most infamous of the camps and the site of numerous 'medical' experiments. This historical study uses primary source documents obtained from archives in England and Germany to describe one type of experiment carried out at Auschwitz - the sterilization experiments. The purpose of these experiments was to perfect a technique in which non-Aryans could be prevented from reproducing while still being able to work as slave laborers. These narratives regarding the sterilization experiments at Auschwitz are remarkable in that they contain previously undocumented information regarding the voluntary and involuntary involvement of nurses. Following these narratives, a discussion of ethics in relation to the Holocaust is presented with a specific focus on the work of Agamben. Implications of the Auschwitz narratives for the application of codes of ethical principles and contemporary nursing are discussed from a postmodernist perspective.

Marcelian charm in nursing practice: the unity of agape and eros as the foundation of an ethic of care

In the nursing literature, a number of qualities are associated with loving care. Reference is made to, among other things, humility, attentiveness, responsibility and duty, compassion, and tenderness. The author attempts to show that charm, in the Marcelian sense, also plays a central role. It is argued that the moral foundation of charm is a unity of agape and eros. An impartial giving of the self for others is clearly of fundamental importance in an ethic of care. Including charm in the discussion points to the fact that eros also plays a crucial role. Eros produces a passion for people and for life. It is a physical and spiritual energy that animates a person in all facets of her life, including her caring work.

Autonomy and autonomy competencies: a practical and relational approach

This essay will address a general philosophical concern about autonomy, namely, that a conception of autonomy focused on freedom of the will alone is inadequate, once we consider the effects of oppressive forms of socialization on individuals' formation of choices. In response to this problem, I will present a brief overview of Diana Meyers's account of autonomy as relational and practical. On this view, autonomy consists in a set of socially acquired practical competencies in self-discovery, self-definition, self-knowledge, and self-direction. This account provides a distinction between choices that express unreflectively internalized social norms and those that are the result of a critical 'self-reading'. I conclude that this practical conception of autonomy makes much higher demands upon nurses (and patients) than has previously been thought. In fact, if nurses are to be expected to genuinely promote autonomy, they are going to need specific training in counselling-type communication skills.

The phenomenology of life phenomena ? in a nursing context

The purpose of this article is to describe and develop knowledge about life phenomena in a life-philosophical and nursing context. Knowledge about life phenomena is part of a care-ethical understanding with a focus on relations. Life phenomena are to be understood as a generalized label for the various phenomena which are given with human existence. The Danish life philosophical tradition with the perspective of life as experienced has something to say in relation to a further refinement of the phenomenology of life phenomena. The refinement will be described as an ethical and existential understanding of the phenomena of nursing. The first part of the article takes a philosophical approach to the phenomenology of life phenomena. It attempts to locate life phenomena in relation to, respectively, needs, senses, and feelings. In order to maintain an overview, the attempt is made to separate needs, senses, and feelings, although in real life these are closely interwoven. The article also describes philosophy and life phenomena in relation to nursing as an empirical field. In nursing there is a risk that life phenomena become invisible to those whose task is to help the ill person adjust to a new life situation. For the nurse, it will be a continuing task, never completed, to develop a sensory-based, situation-determined attention to the patient. And the nurse must be continually aware of whether mere 'need-oriented' nursing is controlling her professional actions as a nurse. Taking a point of departure in the nurse's sensory, situationally determined attention, the last part of the article focuses on needs, senses, and feelings in connection with the nurse being able to direct her attention to the patient's life phenomena.

The ethics of Foucault and Ricoeur: an underrepresented discussion in nursing

Paul Ricoeur and Michel Foucault enjoy a privileged status in nursing academia as two thinkers who influence both nursing research and philosophical explorations of nursing practice. Most nurse authors, however, focus only on the earlier works of these two philosophers and, for example, base qualitative research methodologies on Foucault's genealogy and Ricoeur's hermeneutics. In their later years, both these writers talk more explicitly about being an ethical self. Ideas from their earlier writing is evident in their writing on ethics and both writers could not discuss ethics without also exploring their ideas of the self and the other. I suggest that some of their thoughts on ethics connect with or complement each other quite well. I will first give an overview of Foucault's ethics, self and the other, and then do the same with Ricoeur's thought. In the third part of the paper I will describe how Foucault and Ricoeur complement each other, and conclude the paper by briefly suggesting how these writers influence my own practice as a nurse educator.

Perceiving the moral dimension of practice: insights from Murdoch, Vetlesen, and Aristotle

This paper situates the moral domain of practice within the context of a particular description of nursing practice - one that sees human interaction at the heart of that practice. Such a description fits not only with professional rhetoric but also with literature from patients and recent empirical work exploring the nature of nursing practice. Martha Levine in her 1977 description of ethics, within the context of nursing practice, indicated that what was important from an ethical perspective was how we interact with each other, with patients and colleagues, on a daily basis. What enables such interaction to display moral sensitivity, insight into patient need, and a focus on the good for the patient? Of relevance when answering this question is the empirical evidence indicating that professional socialization, as a nurse or a doctor, may dull the individual's moral sense. If this is the case, cognizance needs to be taken of such evidence when identifying theoretical approaches from mainstream ethics that may provide insight and value for nurse education. It is suggested that such insight and value can be gained from a consideration of the work of Aristotle, Murdoch, and Vetlesen.

Embracing bioethics in neonatal intensive care, part I: evolving toward neonatal evidence-based ethics

Ethical treatment dilemmas are not new to the NICU. With technologic advances over the past 20 years, NICU care has developed rapidly, and survival rates have improved for some of the tiniest and most critically ill infants. In guiding clinical practice, however, standards in evidenced-based medicine have often superseded standards in evidence-based ethics. Part I of this article presents a historical review of neonatal care and an overview of cases that have set precedents in neonatal ethical debate. It also includes recommendations for enhancing the skills of neonatal nurses as patient advocates in NICU ethical issues, an area that is, at times, controversial and baffling to clinicians.

Nursing, obedience, and complicity with eugenics: a contextual interpretation of nursing morality at the turn of the twentieth century

This paper uses Margaret Urban Walker's "expressive collaborative" method of moral inquiry to examine and illustrate the morality of nurses in Great Britain from around 1860 to 1915, as well as nursing complicity in one of the first eugenic policies. The authors aim to focus on how context shapes and limits morality and agency in nurses and contributes to a better understanding of debates in nursing ethics both in the past and present.

‘Til Death Do Us Part?’ The Nurse’s Role in the Care of the Dead

In the immediate hours after a person takes his or her last breath, the nurse has always been present. In the hospital or at home, under hospice care or without warning, the nurse is frequently the last to hold the hand of those transitioning from life to death. The nurse, in assuring the patient and family a peaceful transition, finds her role to include caring for the body with reverence to the religious and cultural concerns that the patient holds sacred.

Killing while caring: the nurses of Hadamar

This research was conducted to examine the participation of nurses in the euthanasia program as it existed in the time of National Socialism in Germany and to describe the participation of nurses at one of the six killing centers, Hadamar, located near Frankfurt, Germany. Over 10,000 mentally and physically handicapped patients were killed by nurses as a part of the euthanasia programs, with over 100,000 being killed in all. Factors influencing the nurses' willingness to kill are described and include the socialization of the German people toward euthanasia as well as ideological commitment, economic factors, and putative duress.

Caring as a slave morality: Nietzschean themes in nursing ethics

BACKGROUND

Sceptical arguments about 'caring' can be divided into three categories. First, it is suggested that, while caring is no doubt an admirable thing in itself, it is just one ideal among others. Secondly, it is claimed that caring is not really a virtue at all, and that it should be regarded as more of a vice, because it promotes favouritism, injustice, and self-deception. Thirdly, there is a worry that caring is not politically realistic, and that its advocates underestimate the powerful organizational and social structures which conspire to subvert nursing.

AIM

This paper outlines a fourth, and more radical, type of scepticism, which explains why caring is subject to these drawbacks. In doing so, it considers the relation between caring, phenomenology and holism in nursing discourse, and the way in which all three fit together to form the 'caring paradigm'.

METHODS

The paper adopts a genealogical approach, borrowed directly from Nietzsche's Genealogy of Morality. That book argues that the values associated with caring are the expression of a profound resentment, harboured by the slaves (weak, powerless, timorous) against the nobles (strong, powerful, self-confident). Caring represents an inversion, a sort of 'fantasy revenge', in which the nobles can be portrayed as 'evil', while the slaves portray their own weakness as 'good'. Taking its cue from Nietzsche, the paper shows that the Genealogy narrative can be transposed into a modern health care context, with nurses as the 'slaves' and the medical profession as the 'nobles'.

CONCLUSIONS

The ideology of caring is, in the Genealogy's terms, a slave morality. It represents an attack on the 'medical-scientific model', motivated by resentment, and designed to establish nursing's superiority. Its effects have been debilitating, and it has prevented nursing from becoming a 'noble' (that is, a properly scientific) discipline.

From salvation to civics: service to the sick in nursing discourse

This paper explores the emergence of civics discourse in early 20th-century nursing. It foregrounds this discussion with an analysis of the attempt to secularise nursing that occurred in 1789 during the French Revolution. It then examines the discursive displacement of religious vocational fervour by civic and patriotic imperatives during the first two decades of the 20th century. Contemporary scholars have portrayed nursing's professional development as characterised by tension between the professional elitist agenda of the nursing leadership, and the rank and file positioning of nursing as a female occupation. By contrast, this paper focuses on the porosity of nursing to broader trends such as civic discourse, the labour movement, feminism and socialism, and works to shift our understanding of nursing's professional history from a dialectical model (professional versus industrial), to one of multiplicity in political and ethical values. It argues that civic and patriotic discourse provided the framing for the secular nurse's subjectivity and the mechanism by which nurses negotiated the moral dangers of care of the sick and male bodies without the protection of vow or veil.

Science and compassion: vacillation in nursing ideas 1940s-1960

The author's thesis is that during the mid-20th century, an intellectual shift toward scientific notions of care challenged the nursing profession's oldest practice values grounded in religious ideas of suffering and compassion. The author uncovers the vacillation between the expression of dominant scientific and rival compassionate ideas in the published and unpublished nursing literature of the 1950s. The evidence is first placed in a historical context of 20th century nursing history, explaining why the profession emphasized scientific approaches to care following World War II. The evidence is then placed into two larger contexts: (a) that of the greater body of scientific and humanistic writing during the period showing concern about the applications of science and technology and its moral implications, and (b) the context of early to mid-20th century notions of "positivism," highlighting the relationship between empirical knowledge and moral ideas that orient human actions. The article concludes with an analysis of implications for nursing practice.