Arries E
School of Nursing, University of Johannesburg, Auckland Park.
Curationis. 2005 Aug;28(3):64-72. doi: 10.4102/curationis.v28i3.990.
Nurses are increasingly confronted with situations of moral difficulty, such as not to feed terminally ill patients, whistle blowing, or participation in termination of pregnancy. Most of these moral dilemmas are often analyzed using the principle-based approach which applies the four moral principles of justice, autonomy, beneficence, and non-malificence. In some instances, consequentialism is considered, but these frameworks have their limitations. Their limitations has to do with a consideration for the interpersonal nature of clinical nursing practice on the one hand, and is not always clear on how to judge which consequences are best on the other hand. When principles are in conflict it is not always easy to decide which principle should dominate. Furthermore, these frameworks do not take into account the importance of the interpersonal and emotional element of human experience. On the contrary, decision-making about moral issues in healthcare demands that nurses exercise rational control over emotions. This clearly focuses the attention on the nurse as moral agent and in particular their character. In this article I argue that virtue ethics as an approach, which focus of the character of a person, might provide a more holistic analysis of moral dilemmas in nursing and might facilitate more flexible and creative solutions when combined with other theories of moral decision-making. Advancing this argument, firstly, I provide the central features of virtue ethics. Secondly I describe a story in which a moral dilemma is evident. Lastly I apply virtue ethics as an approach to this moral dilemma and in particular focusing on the virtues inherent in the nurse as moral agent in the story.
护士越来越多地面临道德困境,比如不给绝症患者喂食、揭发不良行为或参与堕胎。大多数这类道德困境通常采用基于原则的方法进行分析,该方法应用正义、自主、行善和不伤害这四条道德原则。在某些情况下,会考虑结果主义,但这些框架都有其局限性。一方面,它们的局限性在于没有考虑临床护理实践的人际性质;另一方面,对于如何判断哪种结果是最好的并不总是明确的。当原则相互冲突时,并不总是容易决定哪个原则应该占主导地位。此外,这些框架没有考虑到人类体验中人际和情感因素的重要性。相反,医疗保健中道德问题的决策要求护士对情绪进行理性控制。这显然将注意力集中在作为道德主体的护士身上,尤其是他们的品格。在本文中,我认为作为一种关注人的品格的方法,美德伦理学可能会对护理中的道德困境提供更全面的分析,并且与其他道德决策理论相结合时可能会促成更灵活、更有创造性的解决方案。为了推进这一论点,首先,我阐述美德伦理学的核心特征。其次,我描述一个明显存在道德困境的故事。最后,我将美德伦理学作为一种方法应用于这个道德困境,尤其关注故事中作为道德主体的护士所固有的美德。