It is not possible in this chapter to provide a philosophical education. In order to
learn philosophy there is no substitute for a carefully formulated programme of
study undertaken over several years. However, it is possible to show how a
philosophically informed nurse might at least begin to react to resource allocation
problems, and in so doing to offer insight into one method of coping with
seemingly impossible situations.
8.14 A number ± or a free person?
Nursing is a hierarchical and often authoritarian profession. All groups of nurses
have pecking-orders', and those nurses who do not toe the line can, in some cir- cumstances, suffer severe reprimand. This is a deep-seated aspect of nursing culture. It is an equally long-established tradition that most nurses are of a lower rank to doctors. These circumstances are changing somewhat nowadays, with the advent of nurse managers and as nursing is increasingly thought of as a profession. However, for very many nurses it remains the case that they are able to exert only a very limited influence on health service policy. So, when it comes todoing therightthing', most nurses apparently have very
little choice; the right thing' is defined bythe system' in which they are a cog' or a number' and their only option is to implement it. Theright thing',inother words, is handed down to them !this might be calleddoing the right thing 1'). Of course,
there is an alternative form of doing the right thing', which can be defined as a nurse taking that course of action which she has, after careful deliberation, deemed to be the best ± whether or not this is the action recommended by the system. Theright thing', in this form, is a matter of conscience and intelligent
reflection !and might be called doing the right thing 2'). How might the nursedo the right thing' in the two case studies offered by
Robert Lee in part A of this chapter?
8.14.1Caseone
Consider again the first case study of the nurse !N) on night duty in charge of a
small hospital where R brings V, the victim of a hit-and-run accident, despite the
sign at the gate advising that there is no accident and emergency unit there !section
8.7).
As far as doing the right thing 1' is concerned, Robert Lee has already given part of a possible answer thatin purely legal terms, N would be free to refuse treatment
to V and urge R and V to present themselves at the nearest accident and emergency
department'. Officially the hospital does not provide accident and emergency
services, so there is no legal obligation on the nurse to do anything. Furthermore, if
this hospital is cost-conscious, and if the management have made it clear that
emergency cases are not to be treated, then to do the right thing 1' the nurse must turn the potential patient away ± and must do so whatever her feelings about it, and whatever help she might have been able to give. Since she would havedone
the right thing' there would be no sanction `the authorities' could take against the
nurse.
152 NursingLawandEthics