Gallagher A
Nurs Ethics. 1995 Jun;2(2):95-101. doi: 10.1177/096973309500200202.
Since the publication of Carol Gilligan's In a different voice in 1982, there has been much discussion about masculine and feminine approaches to ethics. It has been suggested that an ethics of care, or a feminine ethics, is more appropriate for nursing practice, which contrasts with the 'traditional, masculine' ethics of medicine. It has been suggested that Nel Noddings' version of an 'ethics of care' (or feminine ethics) is an appropriate model for nursing ethics. The 'four principles' approach has become a popular model for medical or health care ethics. It will be suggested in this article that, whilst Noddings presents an interesting analysis of caring and the caring relationship, this has limitations. Rather than acting as an alternative to the 'four principles' approach, the latter is necessary to provide a framework to structure thinking and decision-making in health care. Further, it will be suggested that ethical separatism (that is, one ethics for nurses and one for doctors) in health care is not a progressive step for nurses or doctors. Three recommendations are made: that we promote a health care ethics that incorporates what is valuable in a 'traditional, masculine ethics', the why (four principles approach) and an 'ethics of care', the 'how' (aspects of Noddings' work and that of Urban Walker); that we encourage nurses and doctors to participate in the 'shared learning' and discussion of ethics; and that our ethical language and concerns are common to all, not split into unhelpful dichotomies.
自卡罗尔·吉利根1982年出版《不同的声音》以来，关于男性和女性的伦理道德取向一直存在诸多讨论。有人认为，关怀伦理或女性伦理更适用于护理实践，这与医学的“传统男性”伦理形成对比。有人提出，内尔·诺丁斯的“关怀伦理”（或女性伦理）版本是护理伦理的合适模式。“四原则”方法已成为医学或医疗保健伦理的流行模式。本文将指出，虽然诺丁斯对关怀及关怀关系进行了有趣的分析，但存在局限性。“四原则”方法并非是“关怀伦理”的替代，而是为构建医疗保健中的思维和决策框架所必需。此外，本文还将指出，医疗保健中的伦理分离主义（即护士一种伦理，医生一种伦理）对护士或医生而言并非进步之举。本文提出三点建议：一是推广一种融合“传统男性伦理”中有价值内容（“四原则”方法）以及“关怀伦理”（诺丁斯及厄本·沃克著作中的相关内容）的医疗保健伦理；二是鼓励护士和医生参与伦理道德的“共同学习”与讨论；三是我们的伦理语言和关注点应是共同的，而非分裂为无益的二分法。
