and it is worth noting in passing that a good deal of apparent ethical disagreement
stems from disagreements about the facts. Also ,because so much ethical thinking
involves weighing together the conflicting demands of different principles ,it is
possible for a small difference between two similar cases to result in apparently
contradictory conclusions. We have already seen ,for instance ,how a decision to
act paternalistically can rest upon very fine judgements about a client's degree of
autonomy. Hence not only abstract reasoning but also sensitivity and attention to
detail are an essential part of ethical thinking.
2. 5Philosophical ethics ± its value and limitations
Philosophy students study Ethics' as an academic subject ,albeit one which is normally seen to have an applied element. The questions typically considered in this context vary in their level of abstraction. The most abstract or general ones include ,for example: What is the basis of ethics? Is it possible to have ethical knowledge? What is the meaning and the uses of the conceptgood'? Then there
are middle order questions which raise matters of practical substance but at a
considerable level of generality ,for example: What are the various conceptions of a
fair society? Under what circumstances is it permissible to break promises? Finally
there are the most applied questions in which philosophers analyse the rights and wrongs' of specific policies or actions. In relation to health care this might include consideration of specific cases in which it is asked if nurse X was right to Y 6e.g. breach of confidentiality) in circumstances Z 6where these could be spelled out in some detail). Nurses who are also philosophers ,or nurses who are interested in philosophy ± and there are increasing numbers of both ± will be interested in all of these questions ,but what is their relevance to nurses with other interests? Philosophers who wanted tosell' their subject could offer the following argu-
ment: every nurse has to answer the applied or practical questions ,and it is
impossible to avoid answering them even if only by default 6i.e. faced with
circumstances Z you either do or do not breach confidentiality; you cannot fail to
answer' the question merely by not thinking about it). But ,it could be argued , answers to the applied questions lower down the list depend upon having or assuming answers to the sort of questions higher up the list. Therefore ,if you want to answer the practical questions responsibly you must address the more philo- sophical questions. This is a very plausible argument. It takes the same form as all sales talk ±You cannot do what you want to ,or have to ,without my product'. For
this reason we should be suspicious of it; however I would suggest that in essence
it conveys a truth. The only way in which we can appraise specific circumstances is
by standing back and comparing them with others. In so doing we will also find
ourselves asking what kind of yardsticks ,if any ,we have. Are there some general
standards we can apply ,or does it vary from case to case ,or from person to
person?
Philosophical ethics is a discipline which is commited to this process of
`standing back' and systematic reflection and argument. There are a number of
competing theoretical traditions which attempt to organise ethical reflection into
systems of thought. At their most ambitious they attempt to produce a single
26 NursingLawandEthics