Nursing and the Ethical Dimension of Practice

Nursing and the Ethical Domain of

Practice
• The ethical domain of human life relates to how we behave towards each other and the
reasons we do so. As the American scholar Martha Levine, writing for practicing nurses in
the 1970s, succinctly and powerfully states:
Ethical behaviour is not the display of one’s moral rectitude in times of crisis. It is
the day-to-day expression of one’s commitment to other persons and the ways in
which human beings relate to one another in their daily interactions (Levine
1977, p. 845)
In nursing we interact with human beings made more than ordinarily vulnerable
(Sellman 2011, p. 67) by illness, disease, or other life circumstances. These human
beings need our professional help and care. Good nursing practice therefore requires
us to engage at a human as well as a professional level. Patients assume
professional competence, until we prove them wrong (de Raeve 2002, p. 158).
A Duty-Based Approach for Nursing Ethics &
Practice
Kant’s Deontology
There are different forms of duty-based ethics, yet Kant’s deontology is
the most prominent form. Indeed, Kant has been described as the “…
archetypical deontologist” (McDonald 1978 p. 7).
Good Will, Duty & Autonomy
• The starting point for Kant’s ethics is the concept of a good will.
According to him, there is nothing unconditionally good in the world
except the good will of the person (Kant 2002 p. 9). He goes on to
explain that “the good will is good not through what it effects or
accomplishes, not through its efficacy for attaining any intended end,
but only through its willing …” (Kant 2002 p. 10). The good will is
the capacity of the person to recognise and to act from a duty to follow
the moral law.
Good Will, Duty & Autonomy
• In parallel to the supremacy of the good will is the experience of duty,
which is a central experience in the moral life for deontology. What is
important for Kant is that actions should be done not only in accordance
with the moral law (i.e. actions should be right) but actions should be done
from a duty to the moral law (i.e. actions should be done out of a good will)
and therefore have moral worth. Kant (2002 p. 13) gives the example of a
merchant not overcharging his customers. His action may be right and in
conformity with his duty as a merchant as he does what is expected of him.
But his action is not necessarily done from a duty to the moral law, i.e. done
from the intention of wanting to act honestly. It is only in the latter case that
his action can be said to have moral worth.
The Categorical Imperative
• 1. “Act only in accordance with that maxim through which you can at
the same time will that it become a universal law” (Kant 2002 p. 37).
• 2. “Act so that you use humanity, as much in your own person as in
the person of every other, always at the same time as end and never
merely as means” (Kant 2002 pp. 46–47).
• 3. “… act in accordance with maxims of a universally legislative
member for a merely possible realm of ends…” (Kant 2002 p. 56).
The Practical Imperative
• we are self-governing agents. This is part of what makes us worthy of
respect, and respecting rational nature is partly a matter of respecting
the rational choices, the plans and intentions we and others form.
• Persons can create moral laws through their reason using the
categorical imperative. Persons have the ability not to be governed by
feelings but to act autonomously and to dutifully follow the moral law.