Chapter 2
TheEthicalDimension:Nursing
Practice,NursingPhilosophyand
NursingEthics
Alan Cribb
What are the values that shape nursing practice? This is a much debated question.
In fact most of the debate that takes place in nursing and academic nursing lit-
erature is about values. The only exception is debate about purely factual or
technical matters. Value debates take place about the nature of professional±
patient relationships ,and ideas like empowerment ,partnership and advocacy.
More specifically there are a host of particular debates about such things as how
midwives can best protect the interests of pregnant women ,or how far the work of
health visitors should be dictated by public health targets. Set alongside these are
discussions about the professional standards of nursing ,the framework of which
is reviewed in the next chapter. All these debates should be seen as continuous
with nursing ethics ,because they all involve making value judgements about the
means or ends of nursing care; in short they all ask What is good nursing?'. Anyone who has an interest in ,and some grasp of ,these issues is already 'inside' nursing ethics although they may not have thought about their concerns in these terms. This is not meant to imply that nursing ethics is easy ± far from it: all of these issues are complex. In any case even if someone was very good at debating the nature of 'good nursing' this would not make thema good nurse'. If nursing ethics
is to be of more than academic interest it should have something to say about how
people might become good nurses. I will return to this question later but notice
that there is some apparent ambiguity in it. If we talk about a nurse being `a good
nurse' are we talking about her professional or technical skills or are we making an
ethical judgement about her character ,or perhaps both? It would certainly seem
odd to call someone a good nurse if she could demonstrate many 'competences'
but she lacked any concern or commitment for her clients or colleagues. In this
respect it seems very different from calling someone a good mathematician ± a set
of skills which is ,on the face of it ,compatible with being lazy ,insensitive ,and self-
centred!
All nursing practice is necessarily informed ,partly implicitly ,by some nursing
philosophy. Such a philosophy embodies answers to a range of questions which
are faced by any nurse. These include questions about the aims of care,