Webb J, Warwick C
Middlesex University, School of Health, Biological and Environmental Sciences, London, UK.
Nurs Ethics. 1999 Mar;6(2):150-6. doi: 10.1177/096973309900600208.
This article seeks to show one way in which moral philosophy, considered by the authors to be essential to the nursing and midwifery curricula, can be presented to achieve an optimal learning experience for nurses and midwives. It demonstrates that what might be considered a standard approach, that is, one that begins with ethical principles concerned with rights and duties and then often follows a linear pattern of teaching, may be in danger of promoting a focus on standardized outcomes. Such use of philosophy could therefore actually detract from the process of care. Moral philosophy underpinning health care ethics is commonly misperceived as a method of problem solving when there is an obvious dilemma regarding appropriate care and/or treatment. However, it is readily recognized that key principles within philosophy, for example, deontology and utilitarianism, despite their approach to a standard or criterion of right action, are both deficient in terms of providing ready-made right decisions. This is because their main virtue is to expose the difficulty rather than to solve the problem. Given these difficulties, any subsequent principles such as respect, beneficence, nonmaleficence and justice, incur the same deficiencies a fortiori. It can be argued that the complexity of the environment in which nurses and midwives now practice requires them to develop a capability that begins with the philosophical construction of an issue. This can subsequently enable a recognition of the essential nature of their own involvement as a nurse or midwife. By so doing, nurses and midwives can then bring issues into a nursing or midwifery paradigm and ensure that this perspective informs debate. Ultimately the focus is on the process by which care decisions are made. The intent therefore, is not simply for nurses or midwives to learn moral philosophy or to copy what is considered by others to be right action, but to recognize that a number of right actions are possible and, in so doing, develop their ability either to choose or influence a final action through a valid process. This article proposes and demonstrates by case example that what is often considered as a chance effect for nurses and midwives learning moral philosophy should be seen as the main effect and intended outcome.
本文旨在展示一种方式，即作者认为对护理和助产课程至关重要的道德哲学，如何呈现才能为护士和助产士带来最佳学习体验。文章表明，一种可能被视为标准的方法，也就是从与权利和义务相关的伦理原则入手，然后常常遵循线性教学模式，可能存在促进对标准化结果的关注的风险。因此，这种对哲学的运用实际上可能会损害护理过程。当在适当护理和/或治疗方面存在明显困境时，支撑医疗保健伦理的道德哲学通常被误解为一种解决问题的方法。然而，人们很容易认识到，哲学中的关键原则，例如义务论和功利主义，尽管它们对正确行为的标准或准则有自己的方法，但在提供现成的正确决策方面都存在不足。这是因为它们的主要优点是揭示困难而非解决问题。鉴于这些困难，任何后续原则，如尊重、行善、不伤害和公正，更不用说也存在同样的不足。可以说，护士和助产士现在工作的环境的复杂性要求他们培养一种能力，这种能力始于对一个问题的哲学构建。这随后能够使他们认识到自己作为护士或助产士参与其中的本质。通过这样做，护士和助产士然后可以将问题带入护理或助产范式，并确保这种视角为辩论提供信息。最终重点在于护理决策的过程。因此，目的不仅仅是让护士或助产士学习道德哲学或模仿他人认为的正确行为，而是要认识到可能有多种正确行为，并通过一个有效的过程培养他们选择或影响最终行为的能力。本文通过案例示例提出并证明，对于护士和助产士学习道德哲学，通常被视为偶然效果的东西应被视为主要效果和预期结果。
