theory 6or a unified set of theories) to account for all our ethical judgements. Given
such an overarching theory we could identify any particular decision ,action ,
policy or person to be right or wrong ,or good or bad ,in specified respects. Phi-
losophers disagree about the extent to which it is possible or desirable to aim for
such general accounts ,or whether they should be satisfied with the untidyness' of competing or complementary accounts. They also disagree about the extent to which ethics lends itself to rational analysis ,and the extent to which it is rooted in conventional codes and customs 6note that these two things are not necessarily incompatible). However ,anyone with an interest in applied ethics is interested in seeing how far systematic thinking can be of help in making or evaluating ethical decisions. Hence one of the benefits of philosophical ethics is that it allows us to reflect in more depth about such things as utilitarianism ,the idea of respect for persons ,or the idea of principles of health care ethics: What are the different versions of utilitarianism? How far are utilitarian ways of thinking inevitable ,how far are they useful? etc. We can ask this sort of question in the hope that we might arrive at a definitive overview of the basis and nature of ethics ,or merely in the hope that we will illuminate some of the complexity of the subject. Although there is a danger that health professionals may see these philosophical questions as irrelevant traps 6and something like the four principles approach may be preferred as aworking
model') ,it is important for everyone to recognise that these basic questions are
hotly disputed ± i.e. that there is no definitive knowledge base' in nursing ethics. For example ,in the health care ethics literature there is frequent mention of the value ofautonomy' ,and there are many references to informed consent'. It would not be unreasonable for someone coming to the subject for the first time to assume that ,in relation to such basic building blocks ,there was a clear consensus as to their meaning and role. Thus it might easily be supposed that each time an author uses such an expression he or she is making use of a shared technical vocabulary; that ,for example ,autonomy' always means precisely the same thing ,that it is
always valued for the same reason ,and that its relative importance to other values
is agreed. In reality there are commonalities and differences in the way these terms
are used ,and this is not a product of poor `co-ordination' but a function of the
inherent contestability of ethics. 6Incidentally some of these commonalities and
differences are illustrated by the ethical perspectives in the second part of this
book ,and some disagreements about the meaning and value of autonomy are
discussed explicitly in the ethical discussions of consent.)
There are a number of other things which the philosophical tradition can offer to
nursing ethics. First ,there is a considerable literature in which the terms and
issues of ethics are clarified and debated. So much has been written over centuries,
and over recent years ,about well-being and justice and so on. Second ,there are
conventions for debate ,based upon ideals such as disinterested and reasoned
discussion ,which can serve as useful models for people entering the subject.
Third ,there are many issues of health care ethics which have philosophical pro-
blems built into them. For example ,questions about abortion and euthanasia do
not only turn upon factual matters but also upon intrinsically philosophical mat-
ters to do with the nature and value of life. In these cases it is impossible to treat
these issues seriously without some consideration of philosophical questions.
TheEthicalDimension 27