Milliken Aimee
Boston College, Chestnut Hill, MA, USA.
Nurs Philos. 2018 Jan;19(1). doi: 10.1111/nup.12185. Epub 2017 Aug 11.
Research in moral psychology has recently raised questions about the impact of context and the environment on the way the human mind works. In a 2012 call to action, Paley wrote: "If some of the conclusions arrived at by moral psychologists are true, they are directly relevant to the way nurses think about moral problems, and present serious challenges to favoured concepts in nursing ethics, such as the ethics of care, virtue, and the unity of the person" (p. 80). He urges nurse ethicists and scholars to evaluate the impact these findings may have for moral theory. In this paper, I review some of Paley's (Nursing Philosophy, 13, 2012, 80) critique, focusing on the argument that theories of nursing ethics have failed to account for the role of context; both in terms of its impact on the way nurses make moral judgements and in terms of the environment's influence on the way the mind works. I then examine nursing literature on moral agency, and focus on the role of the environment and context play within existing theory. I argue that theories of moral agency have often accounted for the role of context on the way nurses make decisions; however, less attention has been paid to its impact on the mind. With this background, I use insights from the fields of moral philosophy and moral psychology to refine the conceptualization of nurse moral agency in a way that is reflective of current cognitive, philosophical and nursing practice-based science.
道德心理学的研究最近提出了关于情境和环境对人类思维方式影响的问题。在2012年的一份行动呼吁中，佩利写道：“如果道德心理学家得出的一些结论是正确的，那么它们与护士思考道德问题的方式直接相关，并对护理伦理学中备受青睐的概念，如关怀伦理、美德和人的统一性，提出了严峻挑战”（第80页）。他敦促护士伦理学家和学者评估这些发现可能对道德理论产生的影响。在本文中，我回顾了佩利（《护理哲学》，第13卷，2012年，第80页）的一些批评意见，重点关注护理伦理学理论未能考虑情境作用的观点；这既体现在情境对护士做出道德判断方式的影响方面，也体现在环境对思维方式的影响方面。然后，我审视了护理文献中关于道德能动性的内容，并聚焦于环境和情境在现有理论中所起的作用。我认为，道德能动性理论常常考虑到了情境在护士决策过程中的作用；然而，对其对思维的影响关注较少。在此背景下，我运用道德哲学和道德心理学领域的见解，以一种反映当前基于认知、哲学和护理实践的科学的方式，完善护士道德能动性的概念。
