Consequences for Straight Thinking in Nursing Ethics

The Overused Metaphor of Social Contract

The social contract metaphor has been used from Plato to Rawls to express the concept that the complex relationship between medicine and society is best described as a social contract and that professionalism is the medical profession’s contribution to the contract (Harris, 2017). Contracts involve obligations from both sides, so it is easy for medicine to expect certain deliverables from society, including financial rewards. Cruess and Cruess (2004) remind physicians of the terms of their social contract with beliefs that society granted physicians status, respect, autonomy in practice, the privilege of self-regulation, and financial rewards on the expectation that the physicians would be competent, altruistic, moral, and address the health needs of society within this arrangement. In this context, the abstract concept of medical professionalism has acquired the metaphor’s attributes of a bargaining chip and that the services rendered are reduced to a contracted deliverable. It is unfortunate that the discipline of nursing has also chosen to view the profession of nursing as a social contract as found in various scholarly writings. The views and priorities of medical business contracting is not consistent with the mission or the ethos of practice for members of the discipline of nursing.

The discipline of nursing has simultaneously both opportunities and consequences for describing the professionalism of nurses with unique language and descriptions. Instead of staying with the status quo and borrowing terminology from other healthcare disciplines’ language, scholars of the discipline must conduct the philosophical and theoretical work to conceptualize nurse ethics strictly from the underpinnings of its theoretical frameworks. Nurse ethics is not an add-on from the science of bioethics or something to be analyzed from early philosophers of science and medicine. Rather, the concepts raised must reflect the mission and philosophies of the discipline of nursing. The discipline of nursing should not follow medicine’s social contract but rather create duties and obligations of its own discipline for the good of humankind and the future generations of nurses. Consequences unfold for the discipline’s lack of straight thinking. The author wishes for readers to consider the following when discussing what it means to have or not have straight thinking ethics in the discipline of nursing.

Consequences and Straight Thinking in Ethics

One of the potential consequences of borrowing ethical words or phrases from other disciplines is that those who receive nurse services in a complex healthcare arena do not know what nurses’ responsibilities are and what they stand for philosophically. There is a naming confusion as other members of healthcare teams refer to themselves as nurses. Further ambiguity surfaces as people desire and state they trust nursing services but fail to recognize the roles and responsibilities of the discipline of nursing. When someone enters the door of places where healthcare is delivered, people often mistakenly assume it is a nurse, while others fail to properly identify themselves. It is vital that members of the discipline of nursing identify themselves and offer terminology unique to its call. Taking responsibility in practice requires that nurses have the ethical straight thinking courage to articulate and document the desires and hopes of others’ living quality while engaging in a chaotic healthcare system.

In facilitating others’ voices and conversations for desires regarding their healthcare, nurses must have a seat at the policy-making table and participate in the arduous work of health policy development from a nurse perspective. This work should seek to honor human dignity and respect those who have the courage to articulate what their hopes and desires are as both providers and recipients of care. Families desire to engage in meaningful conversations as they struggle to honor their loved ones in health decision-making.

Nurses have an obligation with listening and being with others in the silences-being still. This is especially true in critical illness settings. It is within these moments of arduous beauty that persons demonstrate courage in making their wishes known. The unknown remains as persons choose to disclose-not disclose that which is most important to them. It is not the nurse’s role to push others for the signing of an advance care document. Nursing ethics demands respect for the freedom to choose and the honoring of others’ wishes even at the spontaneous moments of changing their minds. If nurses choose to say they “don’t go there” and ignore the needs of those who are the recipients of services, there is the potential of shame and betrayal of the nurse-person and nurse-family relationship.

Finally, there are consequences for the future of the discipline of nursing. Nurse theorists and their scholars must begin to utilize unique language that is coherent and consistent with the ontology, epistemology, and methodologies of their frameworks. Budding scholars and experienced scholars of the discipline must begin to define and utilize the theory-specific terminology. Ethics cannot be an add-on dimension or a separate division of sociocultural norms. Instead, it must be embedded in the theory construction. The humanbecoming theory (Parse, 2014) is an example of theory-embedded ethical truths such as reverence, awe, betrayal, and shame. It is the author’s hope that scholarly work will continue in discovering ethical truth in the context of situations known as nursing ethics. Analysis of ethical dilemmas and situations must include the theory-embedded truths for disciplinary clarity of thinking and potential resolution of dispute. This ought to be a priority for scholarly inquiry and the future of straight thinking nursing ethics.