School of Health & Social Services, Massey University, Palmerston North, New Zealand.
Nurs Philos. 2012 Jan;13(1):56-65. doi: 10.1111/j.1466-769X.2011.00525.x.
In the last few decades, a growing number of commentators have questioned the appropriateness of the 'justice view' of ethics as a suitable approach in health care ethics, and most certainly in nursing. Essentially, in their ethical deliberations, it is argued that nurses do not readily adopt the high degree of impartiality and objectivity that is associated with a justice view; instead their moral practices are more accurately reflected through the use of alternative approaches such as relational or care-based ethics. Yet, it has also been argued that this viewpoint does not necessarily 'do justice' to the broader moral responsibilities of nurses towards humanity in general, i.e. to the wider socio-cultural and socio-political issues in society, and to the concept of social justice in particular. This criticism has triggered a much closer examination of relational and care-based ethics in nursing at levels beyond individual responsiveness within relationships and brought into the spotlight the need for a more ethically refined nursing response to an increasingly complex set of socio-cultural inequalities. This article explores a relational ethic within nursing practices with contemporary ideas regarding social justice. In particular, it is argued that the synergy between the two actually produces an ethic that is capable of not only challenging the continuing predominance of justice-based ethics within health care, but of replacing it. Subsequently, in the discussion that follows, it is suggested that a combined social justice and relational care-based approach, as a social ethic, should guide the moral deliberations and actions of nurses. It is maintained that such an approach is not only possible, but crucial if nurses are to realize their full potential as ethical agents for individual and social good.
在过去的几十年中,越来越多的评论家质疑伦理学中的“公正观”是否适合作为医疗保健伦理学,尤其是护理伦理学的合适方法。从本质上讲,有人认为,在进行伦理思考时,护士并不容易接受与公正观相关的高度公正和客观性;相反,他们的道德实践更准确地反映在使用替代方法,如关系或关怀伦理。然而,也有人认为,这种观点不一定“公正对待”护士对整个人类的更广泛道德责任,即对社会更广泛的社会文化和社会政治问题,以及对社会正义的概念。这种批评促使人们更密切地审视护理中的关系和关怀伦理,超越了关系中个人的反应,并凸显了需要一种更具伦理意义的护理反应来应对日益复杂的一系列社会文化不平等现象。本文探讨了护理实践中的一种关系伦理,以及当代关于社会正义的观点。特别是,有人认为,两者之间的协同作用实际上产生了一种伦理,不仅能够挑战医疗保健中基于正义的伦理的持续主导地位,而且能够取代它。随后,在接下来的讨论中,有人提出,一种结合了社会正义和以关系为基础的关怀的方法,作为一种社会伦理,应该指导护士的道德思考和行动。有人认为,这种方法不仅是可能的,而且如果护士要充分发挥其作为个人和社会利益的道德行为者的潜力,是至关重要的。