I recently joined a group of Trinity Western University graduate nursing students and their professor in an online discussion about nursing ethics. The professor, who read my book, The Moral Work of Nursing, in which I use narratives to facilitate ethical reflection, invited me to talk about narrative ethics as an alternative to the principled approach of bioethics.
I shared stories from nursing practice that led me to study health care ethics in the 1980’s. At the time, the application of bioethical principles, such as autonomy, beneficence, non-maleficence, was prominent in health care ethics circles. I was surprised to learn that some bioethicists did not recognize nurses as moral agents and considered nursing ethics as a sub-category of medical ethics. In spite of its popularity at the time, I was uncomfortable with the bioethics approach that did not take into account the contextual and interpersonal aspects of moral situations. Viewing ethics from a relational perspective, my thesis work focused on power relationships in health care.
My recent discussion with the students led me to reflect further on the connection between relational and narrative ethics. It is in the context of respectful relationships that we trust each other enough to tell our stories. As we listen to our patient/clients’ stories and as nurses and other health professionals reflect on and share stores from their practice, we gain a fuller understanding of patients’ situations and the context in which care is received. We are then better able to empathize, respect patients’ choices, and advocate for quality health care.
Calling for a return to “nursing ethical tradition and identify” which was disrupted by bioethics and “a medical colonization of nursing’s ethics,” nurse ethicist Marsha Fowler reviews nursing ethics literature and history In the United States from the late 1800s to the mid1960s. Her article (to be published in the first 2016 issue of Nursing Ethics) provides an account of nursing ethics that “points toward nursing ethics as always both patient-centered and socially concerned.” Fowler describes the “donative (gift) element of nursing practice:
It is the donative element of the nurse-patient relationship that more generously situates that relationship as covenantal, beyond the contractual… nurses who have gone before this generation, who have given of themselves and their lives both to improve patient care and to advance the profession so that nurses, patients, and societies may benefit have also participated in the gift element of nursing. (Fowler, Marsha (2016). “Heritage ethics: Toward a thicker account of nursing ethics,” Nursing Ethics, p. 2.)