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Chapter 11 Values, ethics and advocacy
whose professional practice is consistent with high ethical and
professional standards of practice. These behaviours generally
include elements of ethical/moral agency and are further
reinforced through professional codes of conduct and ethics.
Agency
Ethics or morals are concepts that require translation into
action. This is known as
agency
. Bandura (2001) described
agency as an intentional human activity that makes things
happen by one’s actions. It involves intentionality and fore-
thought; an agent is a motivator and self-regulator. Agency
involves making choices and having ability to shape one’s
own decisions as well as influencing the decisions of others.
Lastly, agency involves self-reflection and evaluation of
one’s motivation and life pursuits. Taking action that trans-
lates ethics and
morals
into practice is ethical or moral
agency. These terms are used interchangeably and may be
found in the literature under either term.
Ethical or moral agency
It is unrealistic to assume that the simple desire to be a nurse
is accompanied by the natural ability to behave in an ethical
way and to do the ethically right thing because it is the right
thing to do. This ability,
ethical/moral agency
, must be cul-
tivated in the same way that nurses and midwives cultivate
the ability to do the scientifically right thing in response to a
physiological alteration. Nurses and midwives who appreci-
ate the ethical challenges in professional practice value their
ethical development sufficiently to work hard to develop
these skills. Essential elements of ethical agency include:
•
Ethical sensibility
: Ability to recognise the ‘ethical
moment’ when an ethical challenge presents itself
•
Ethical responsiveness
: Ability and willingness to
respond to the ethical challenge
•
Ethical reasoning and discernment
: Knowledge of and
ability to use sound theoretical and practical approaches
to ‘thinking through’ ethical challenges, to ultimately
decide how to respond to a particular situation after
identifying and critiquing alternative courses of action;
these approaches are used to inform as well as to justify
moral behaviour
•
Ethical accountability
: Ability and willingness to accept
responsibility for one’s ethical behaviour and to learn
from the experience of exercising ethical agency
•
Ethical character
: Cultivated dispositions that allow one
to act as one believes one ought to act
•
Ethical valuing
: Valuing in a conscious and critical way,
which squares with good ethical character and ethical
integrity
•
Transformative ethical leadership
: Commitment and
proven ability to create a culture that facilitates the
exercise of ethical agency, a culture in which people do
the right thing because it is the right thing to do.
Box 11-2 illustrates these elements of ethical/moral agency
in action.
The clinician–patient relationship is central to the
care-
based approach
, which directs attention to the specific
situations of individual patients viewed within the context of
their life narrative, including their culture and values relating
to care and caring. The care perspective suggests that how
you choose to ‘be’ and act each time you encounter a patient
or colleague is a matter of ethical significance. In distin-
guishing professional therapeutic caring from the care given
by family members, care-based ethics emphasise the impor-
tance of respect for individuals and encourages a sense of
connectedness in the clinician–patient relationship. Charac-
teristics of the care perspective include the following:
•
Centrality of the caring relationship
•
Promotion of the dignity and respect of patients as people
•
Attention to the particulars of individual patients
•
Cultivation of responsiveness to others and professional
responsibility
•
A redefinition of fundamental moral skills to include
virtues like kindness, attentiveness, empathy,
compassion and reliability (Taylor, 1993).
Feminist-based approach
Modern feminist approaches to ethical analysis developed in
the 1970s and represent a particular type of ethical approach
popular among nurses and midwives. The
feminist-based
approach
aims to critique existing patterns of oppression
and domination in society, especially as these affect women
and the poor. There are many forms of feminist ethics, and
their subjects range from gender-related inequities to
concern for the least well-off. Nurses and midwives working
within a feminist framework promote social policy that
reflects a fundamental trust in the moral agency of women
and those on the margins. This supports the belief that all
persons deserve the opportunity to make legitimate choices
about conditions that affect their lives, and are deserving of
respect whenever they exercise such agency.
Anderson & Pelvin (cited in Pairman et al., 2010, p. 289)
discuss a contemporary example of how a feminist approach
may differ practically from a principles approach to ethics:
Awoman undergoing cosmetic surgery decides to enlarge
her breasts. While a principle approach might consider
factors such as her competence to consent and her
autonomous right to choose, a feminist approach might
raise concerns about the subordination of women to
oppressive ideas of beauty and youth and how women
might be forced to conform to these in order to get work
or please a partner.
ETHICAL CONDUCT
Nurses and midwives committed to high-quality care base
their practice on professional standards of ethical conduct. The
study of professional ethical behaviour is introduced through
foundational studies, continues in formal and informal discus-
sions with colleagues and peers, and culminates when nurses
and midwives ‘try on’ and adopt the behaviours of role models
