contemplative analysis of the merits !or justice) of the management of the acutely
ill patient must consider and explain what justice means in this case !whether the
patients have the samerightto treatment as other patients in the hospital, and so
no special priority; whether they haveneedsof such gravity that they are entitled to
treatment before those with lesser needs; whether this set of patients merits
privileged attention and sodeservespriority treatment for some reason).
Philosophers are used to such discussions, and often spend much time trying to
disentangle the various issues, only to see them knot together again the moment
they move their attention elsewhere. Such detailed reflection requires a fair
amount of expertise ± and countless hours ± neither of which are usually available
to the nurse. And this can place the nurse who sees that these are complex matters,
and who recognises that they can be properly dealt with only by careful analysis, at
aconsiderable disadvantage. If she tries to protest in an intelligent way it is very
easy to defeat her. Her opponent can say :We don't have the time for this sort of reflection'; or,What you are suggesting requires an analysis ofeverythingwe do,
and this is not a practical proposition' !which of course means that everything can
continue unchanged ± inertia is not only a natural tendency but also a powerful
weapon in the hands of those who are happy with the status quo). Her opponent
might also ask :What do you mean by justice?', knowing full well that any credible answer must take more time and effort than almost any nurse can give !and knowing that even if the nurse does attempt an answer it will be very easy to say later :please spell out your interpretation of need/rights/equity' or whatever other
terms she has not fully explained).
In such circumstances the nurse has three strategies open to her. She might
spend many hours developing her case !she might even enlist the help of a trained
philosopher); she might take a simpler course and analyse her work problems
using the context, outcomes and obligations' framework !in the knowledge that this is by no means all there is to ethical analysis); or she might take her opponent on, on his own terms. Whenever he says,Could you expand on that?' or What do you mean?', then the nurse might ask in turnWhat do you mean by efficiency?',
How do you justify removing resources from this ward and increasing them on that?' orWhat are your principles for resource allocation within this hospital, and
on what grounds do you justify these?'.
8.16 Conclusion
This part of the chapter has raised questions, but only sketched out answers to
them. The rest is for the individual nurse to decide, and there are many books and
papers available to which she might turn for more detailed guidance. What is most
important is that each nurse realises the complexity of any resource problem she is
facing, and, if she so decides, is able to tackle it in a systematic manner. If she
genuinely tries to do this, and if she feels she has arrived at a defensible decision,
then there is probably little more she can do. She cannot change the world, and
whatever she does she is hardly likely to unsettle governments focused so intently
on financial balance sheets.
Nevertheless, there will always ± if only occasionally ± be times when the nurse
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