Fundamentals of Nursing and Midwifery 2e

Chapter 11 Values, ethics and advocacy

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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 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 virtues like kindness, attentiveness, empathy, compassion and reliability (Taylor, 1993).

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.