A Philosophy of Nursing Forum
Wednesday, February 14, 2007
Nursing Ethics and Pedagogy

Many community colleges in North Carolina require nursing students to take introductory ethics as one of their humanities courses. My institution, Guilford Technical Community College, does not. It, and several others like it, choose to satisfy the Board of Nursing's requirements for ethical instruction by incorporating "ethics modules" in specific nursing courses. Nevertheless, after much tireless missonary work, I feel like I am making SOME headway, and each semester that I teach the subject, I have 3 or 4 nursing students in both sections. Not enough, to be sure, as I consider it to be self-evident that every human being who claims to be truly educated should have (at least) one general survey course on the history of philosophy, and one introductory ethics couse. Still, progress is being made. Enough progress that a pedagogical question arises.

As I survey (via the internet) various approaches to providing people (and especially nurses) with an introduction to the subject of ethics, there is a growing trend in the US to "specialize" the subject, even at the introductory level. Courses entitled "healthcare ethics," "business ethics (an oxymoron?)," and the like, abound. None of them have prerequisites, so it is NOT the case that these courses constitute a more focused, "in depth," look at some narrow issues of special interest to one particular profession or another. Instead, these courses are the FIRST, and often the ONLY, courses of the field that these students will take. I see this as an unfortunate trend.

First, if the published syllabus for the typical course is any guide, these courses rarely "survey" the field. Some philosophers of vital importance are often left out entirely (Hume and Adam Smith come to mind), and others are often marginalized and their views traduced (Kant especially). In other words, after completing the class the student remains uninformed or, worse, misinformed.

Second, as a dogmatic moral realist (or, at least, quasi-realist), the idea that 'the right and the good" might somehow be different in the case of, say, nurses, as opposed to doctors, lawyers or indian chiefs, is something I find highly suspect.

Third, these specialized approaches seem to involve a good deal of "rules of the profession" instruction, the discussion of which takes the students no where near "the right and the good." For example, in a "legal ethics" course in the USA (another oxymoron?) one will learn that, in a criminal case, if the defendant wishes to testify in his own behalf, his counsel ought to call him to the stand even when counsel knows the defendant intends to testify falsely (our UK cousins have a different rule, I hope and believe). Little, if any, discussion time will be devoted to the question of whether or not this OUGHT to be the rule, whether counsel as a moral agent has a duty to disobey the rule and accept the consequences (and there will be some - see my Vita if you think there won't be), etc.

In sum, the very notion a profession specific "ethics" at least SUGGESTS a form of ethical relativism I find repugnant. This is NOT to say that a member of a profession does not have special obligations that others do not. I would argue, on broadly kantian grounds, that they often do, inasmuch as the acceptance of a professional role can amount to a promise to perform certain acts, or undertake to do certain things, that other people are not, in general, obliged to do. A blunt illustration: most people are not obliged to wipe someone else's bottom after an episode of bowel incontinence, but nurses on duty are. Still, I think this sort of example is not contrary to my general point. Nurses, lawyers, plumbers and politicians all inhabit a single moral universe; one in which, per Kant, it is always wrong to, say, tell a lie or subourn one. If members of a special profession have special duties, they are surely grounded upon, or arise from, the same considerations of "right and good" that should guide the conduct of everyone.

I have another source of unease, as regards the notion of "nursing ethics" as a distinct area of inquiry. Nursing, it seems to me, still suffers a bit from "ghettoizaton" in the American academy. Even at the community college level, the students and their faculty spend most of their time over in their own building doing "nursing stuff." They venture "outside" only when they must. As a nursing student, I have taken nursing, and nursing related, courses at two different community colleges and two (very good) 4 year universities. In each case, interdepartmental activities were notably absent. Four schools is not enough in the way of data points to reach any firm conclusion, but I can't help but wonder if things are much different anywhere else. A study of ethics, at least, could be a shared experience.

Here's a thought - good "transcultural" nursing is going to necessitate, on the part of nurses, the development of something like the "kosmos polis" of the stoics - a sense of world citizenship, and a sense of identity with all that is "human." It is difficult for me to see how we can care for humanity if we decide there is no such THING as "humanity," or that "humanity" is a social construction we somehow "make up" which fails to somehow pick out any real features of an objective world. One way to START developing that "sense" is to participate in a learning experience which at least explores the possibility that all human beings inhabit the same universe - the MORAL one.

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