Abstract
A desired outcome for members of healthcare disciplines is to have straight thinking regarding human health and quality of life issues. Difficult situations, embedded with a demand for quick, value-laden healthcare decisions, abound in an ever-changing, complex healthcare arena. The author begins a discussion about potential implications for future disciplinary nurse practice as nurse leaders contemplate what it means to have a straight thinking ethos as providers of vital human health services. Reflections and recommendations for future dialogue with interdisciplinary professionals on the topic of nursing ethics is offered.
Ethics is important to the discipline of nursing as well as for other healthcare disciplines. Professional nurses engage with persons as they face myriad health decisions and desire to have straight thinking about issues involving choices of human health and quality of life. Underlying an increasingly complex global healthcare climate are ever-changing complex value choices that are undertaken by individuals and groups living in the global community. Having straight thinking in healthcare ethics has been commonly viewed and articulated from the perspective of medical problems or dilemmas to be resolved. The term bioethics has been used to refer to the enterprise of disciplined reflection incorporated during the analysis of choices in medicine that involves all of the health professions.
Ethics is a branch of philosophical thought that contains systematized approaches and theories embedded with principles and concepts that deal with basic questions of meaning and value in human life. Philosophers as well as theologians spend lifetimes dealing with issues from abstract theories to applied ethics. Philosophers take normative rules and principles and relate them to one another in individual situations for determining straight thinking regarding what we mean when we say an action is right or wrong. From a biomedical perspective, ethics is the enterprise of disciplined reflection on the moral intuitions and moral choices made by people. According to Veatch (1997), those concerned with medical ethics attempt to compare healthcare choices for consistency, formulate rules of conduct accounting for considered judgments, and articulate general principles that underlie these judgments and rules. Ethical conduct or straight thinking from this perspective is often rule-based and making a good or right decision is viewed through the lens of conduct consistent with codes, positional statements, and the expert opinions of the medical community.
With the advent of healthcare reform and a global emphasis on restructuring healthcare for systematized cost containment and healthcare improvement initiatives, the discipline of nursing stands on a precipice in choosing whether to align itself with the biomedical interdisciplinary healthcare movement or to fortify its unique identity as a discipline. In the interdisciplinary movement in healthcare and policy formation, the straight thinking of ethics in nursing is reduced to membership in diverse healthcare teams where there is an expectation that analysis of large sets of health data derived from health information technology will be applied to healthcare decision-making and health policy formation. Trends and inferential statistical analysis will be used to create and modify national health policy and potentially contribute to global healthcare reforms and improve population health. In the emerging waves of the movement, many nurse leaders of doctoral nurse education and advanced practice nurse education envision future generations of nurses as members of interdisciplinary team science groups. These groups would analyze large healthcare data sets and create new health policies that could be applicable to all in a one-size-fits-all approach for healthcare reform and changing global health policy. From this perspective, the straight thinking of what is right action in healthcare decision-making potentially will be based upon what is considered to be most cost effective, efficient, and good for the whole of national and global health communities.
Contemporary philosophies of bioethics are normative in nature where health has been equated to the presence of disease or no disease, thus health choices may be viewed as right or wrong on the basis of what is deemed to be statistically significant relationships from objective data. As nurse leaders consider marching onward with the bandwagon of interdisciplinary empirical team science, here an illumination of philosophical assumptions and possible consequences and ethical implications of bioethical objectivism is offered.
Empiricism and Bioethical Straight Thinking Assumptions
First, can positivistic empirical objectivism and its predominant views in healthcare ethics be truly objective and lead to straight thinking for those who provide disciplinary healthcare services and those who receive health services? Objectivists believe that health and disease are concepts that are inherently known through the pathophysiological diagnosis of disease and that the definition of health may be known or addressed as social determinants. Accordingly, consistent with understanding the concepts of health and disease, one must realize that decisions have to be made about treating separate states of the body and mind. From this perspective, the values embedded in healthcare decisions must involve determinations of what is desirable or undesirable, useful or useless, good or bad, and applicable or not for a specified population. In the process of classifying and determining what is good health and what is disease, possibilities loom that human difference and living human value priorities are not acknowledged and potentially will not be honored. From the author’s perspective, viewing human life and worth through a lens of socioeconomic determinants of health potentially de-values individual human choice and any acknowledgment of human difference.
Second, healthcare decisions should not be defined as a one-size-fits-all. Embedded ethical straight thinking in complex, often arduous issues of human living are not resolved in neat and tidy resolutions. From an empirical bioethics perspective, straight thinking is often equated with decision trees and what if scenarios rather than contemplating and making straight thinking choices that are situated contextually. Truth is personal and can be known in person-person human connections and relationships. Labeling health as objective truth implies an acceptance that the healthcare professional is expert in defining what health and disease are for another person or group; and potentially, may exert control in decision-making over the wishes of those who are living the situation.
Third, there is danger in making things of us all as objects that are out there to be manipulated or controlled. As such, by not acknowledging human difference with persons, in groups, or with defined populations, there is potential for divisiveness as well as trust-mistrust in nurse-person, nurse-group, and nurse-community relationships. Feelings of oppression may surface as healthcare professionals determine what the definition of health is, dictate interventions, and promote specific practices that are empirically evaluated as ideas and endeavors that are best for others. From this view, objectivists strive for straight thinking that defines health for others potentially through governmental controls while striving for a more equitable and just distribution of resources that can positively promote a community’s health.
Lastly, in following a biomedical empirical model or ethos, questions may arise over nurses’ unique disciplinary commitment to serve humankind. In following a team empirical science approach, what will be nursing’s unique contribution in serving others? How will nurse knowledge be advanced and fortified as the ethical straight thinking responsibilities and obligations of the nurse are blurred when the dominant agendas of other healthcare disciplines with the never-ending drive for cost efficient healthcare systems is promoted? What must nurse leaders consider to preserve the uniqueness of the discipline in light of the predominant views described above?
Nursing Theories and Straight Thinking
It is the author’s view that ethical straight thinking is embedded and may be known through nursing’s paradigms, theoretical ontologies, epistemologies, and methodologies specific to the discipline. Nurse theorists and their scholars should be explicating an ethos for what is straight thinking by elaborating on ethical concepts from a specific disciplinary theoretical perspective. For example, the author has written extensively on concepts specific to the discipline and illuminated possible meanings for what it means to have straight thinking as persons live with changing health patterns and living quality. Columns have been written to elaborate on possible straight thinking implications for practice, research, and education from a humanbecoming ethos (Parse, 2010). From this theoretical perspective, all straight thinking emanates from truths that all human life is to be revered and all human experiences are incarnated with intrinsic value. The straight thinking ethos is embedded in the notion of human dignity, a noble bearing of inherent uniqueness, where all persons are honored by healthcare professionals with the highest regard and esteem. Through the personal incarnation of these truths, nurses are guided in practice and are with people in meaningful ways that reflect these truths. All health policy position statements, curriculum guidelines, and formal paths of inquiry may be informed and articulated from these emanating truths. The straight thinking found in the humanbecoming ethos may be known to others in the articulation of concepts as well as in nurse-person, nurse-group, and nurse-community relationships.
It is the author’s view that the time has arrived for nurse scholars of discipline-specific theoretical perspectives to step forward to the platform and articulate theoretical views that will guide future nurse practice and global health policy. Though it may be a small voice in a majority crowd of bioethical-thought leaders in healthcare arenas, nurse scholars have an obligation to articulate health policy and demonstrate ethical straight thinking discussions that honor human values and not just those of normative, empirical thinking that informs the determinant health policy agenda. It is encouraged that we continue the discussions for the good of humankind.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this editorial.
Funding
The author received no financial support for the research, authorship, and/or publication of this editorial.