Transcript class notes

Feminist Ethics,
Care Ethics AND Nursing Ethics
23 September 2015
Rels 300 / Nurs 330
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Case Study Group Analysis
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A 46-yr-old man …
…comes to a clinic for a routine physical checkup needed for insurance purposes. His doctor
suspects the man has a form of cancer likely
to cause him to die within 6 months.
Chemotherapy may prolong life by a few extra
months, but will have side effects the
physician does not think warranted in this
case. In addition, she believes that such
therapy should be reserved for patients with a
chance for recovery or remission.
The patient expresses no concerns about his
health. He expects to take a short vacation in
a week.
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The physician has several decisions to make
Should she tell the patient what she suspects?
Should she withhold this information?
If the doctor decides to reveal her concern:
• Should she wait until the patient returns from
his vacation?
• Should she mention the possibility of
chemotherapy and her reasons for not
recommending it?
• Should she recommend chemo even though
she believes it would not be warranted?
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Further Discussion:
1.
2.
3.
4.
What would the virtue ethicist advise the
doctor to do? … for what reasons?
What advice would the deontologist have? …
and why?
What would the utilitarian have to say about
the dilemma?
What would you do, and why?
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Feminist Ethics
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Feminist ethics values women and resists oppression or
domination
When men dominate women because of their gender,
that is “patriarchy” = rule of the fathers
Feminist ethics affirms that women are as valuable and
capable as men
 Both men and women should be treated as equals
 Neither should oppress or dominate the other
 Both are deserving of justice rather than
discrimination or privilege
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Social Justice
The subordination of women is morally wrong and
harms both women and men.
 Feminist ethics began with this gender focus for
understanding oppression
Who else is oppressed in our society?
 Minority status? Give examples.
 Economic status? Who, in particular?
 Which children are most at risk in their
development and health?
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Must nurses be feminists?
Selections from Nursing World
• (online at www.nursingworld.org)
• Fundamental commitment to addressing oppression
• Social determinants of health & social activism of nurses
Silva, M. and Ludwick, R. (May 14, 2002). Ethics Column:
"Domestic Violence, Nurses, and Ethics: What Are the Links?"
Online Journal of Issues in Nursing. Vol. 7 No. 2.
Available:
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Co
lumns/Ethics/DomesticViolenceandEthics.aspx
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Social justice and equity
“Social justice focuses on the relative position of one social group in
relation to others in society, as well as on the root causes of disparities
and what can be done to eliminate them.”
Guiding assumptions of social justice:
• Every individual (and therefore every profession) has an obligation to
take responsible action to eliminate forms of systematic inequity and
oppression, such as racism, sexism, heterosexism and classism,
inherent to diverse social groups.
Social justice is grounded in four key ideas: 1) fairness; 2) the relative
position or social advantage of individuals and groups in society; 3) an
understanding of the root causes of inequities in society; and 4) taking
action to eliminate inequities.
(excerpts from Social Justice . . . A means to an end, an end itself, http://www2.cnaaiic.ca/CNA/documents/pdf/publications/Social_Justice_2010_e.pdf
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CARE ETHICS
a form of virtue ethics with some aspects of feminist
ethics
o emerged from Carol Gilligan’s study of moral
development of women
o
o http://www.webster.edu/~woolflm/gilligan.html
emphasis on personal relationships and
responsibilities to care for others
o adopted as a primary moral theory in nursing
practice
o
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Care Ethics (cont’d)
 moral obligations arise out of our relationships
with others and our mutual duties of caring
What does it mean to be “caring”
 caring = being attentive to the needs of others
 respectful caring = sustained attention and
response to needs of patients & their families
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Critics
 critics say that care ethics colludes in the identification of
nurturing and self-sacrifice with care by women

women are socially conditioned to nurture & selfsacrifice in caring for children, partners, elderly
parents, etc. in our society
 also can be co-opted into sustaining patterns of male
domination and female subordination
 Can a care ethic based on female gender stereotypes
perpetuate injustice, even if the nurse is male? – HOW?
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Characteristics of an
ethics of care (text p.32)
1.
2.
3.
4.
5.
Focusses on relationships with particular others (e.g.,
parent/child, adult child/elderly parent,
caregiver/patient);
Includes both reason and emotion;
Points out that impartiality is neither possible nor
warranted;
Morality is attentive to disadvantage and injustice within
both the public and private spheres;
Human persons are interdependent and formed
through personal relationships.
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Most Important Contribution to
Health Care Ethics
Medical decisions and ethical choices are made within a
context of relationships:
 With differentials in power
 With particular vulnerabilities
 With a need to advocate for the most vulnerable
If a care ethics is not amplified by the feminist perspective
(which is alert for evidence of subordination, oppression &
injustice), then it may not be an adequate antidote to the
weaknesses of an ethical focus on rationality and
impartiality.
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Nursing ethics
 foundational commitment to an ethic of care and
sustained attention to the needs of patients
 amplified by commitment to justice and principled
moral judgements
 evident in nurturing, empathic care; active participation
in health care team decision-making; and patient
advocacy
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Fundamental Moral Commitments…
…of care ethics:
Avoid harm
Respond to need
Recognize and respond to vulnerability
Maintain caring relations
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Shouldering the Burden of Care
 TW, a fifty-two-year-old Ohio woman, cares daily for her elderly
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mother … TWs mother requires constant supervision, so she came
to live with TW and her family.
Since TW could not afford a home health aid during the day, she
reduced her hours and now works part time…
In recent months, TWs mother has declined rapidly…
TW's mother told TW on many occasions that she never wanted to
be placed in a nursing home…
TW faces a dilemma. She can place her mother in a nursing home
to ease her own burdens… Alternatively, she can respect her
mother's stated wishes by continuing to care for her at home…
Sanders, S. J., & Eva, F. K. (2005). Shouldering the burden of Care/commentary/commentary. The
Hastings Center Report, 35(5), 14-5.
Retrieved from http://search.proquest.com/docview/222398618?accountid=13803
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Case Study Analysis
What should TW do?
First, apply each moral theory to the case to help you see
different moral perspectives and options:
 Utilitarianism / Consequentialism
 Deontology
 Virtue theory
 Natural law theory
 Feminist theory
 Ethic of Care
 Nursing Ethics
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Next, consider your alternatives; see if you can
reach a consensus about what TW should do;
give reasons for your recommendation for a
course of action
TW should . . .
and . . .
because . . .
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What can a feminist ethic of care offer in response to
this dilemma?
The
subordination of women is morally wrong and harms both
women and men.
Both men and women should be treated as equals
Both are deserving of justice rather than discrimination or
privilege
Moral obligations arise out of our relationships with others and
our mutual duties of caring
Human persons are interdependent and formed through
personal relationships.
Maintain caring relations
Avoid harm; Respond to need
Recognize and respond to vulnerability
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One Feminist Analysis: Eva Feder Kittay
“[C]aregiving is a human capacity, not a gendered one”
For caregivers to be able to express love, they “need to be able
to maintain [their] own selves from which our gift can flow”
“Imagine a world where familial caregiving was remunerated
through paid family leave policies and funds to provide care”
“If nursing homes were personalized and varied places… then
they would not be a dreaded specter hovering over old age”
“distribute the burden of caregiving more equitably…if her brother
cannot contribute time, he must assist in other ways, such as
contributing funds for home assistance”
“To continue the current situation can only further embitter TW,
alienating her from her mother and her family, and this fracturing
of relations would be the most injurious of all outcomes.”