Feminist Ethics, Care Ethics AND Nursing Ethics23 September 2015

Rels 300 / Nurs 330

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Case Study Group Analysis

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A 46-yr-old man ……comes to a clinic for a routine physical check-

up needed for insurance purposes. His doctor suspects the man has a form of cancer likely to cause him to die within 6 months.

Chemotherapy may prolong life by a few extra months, but will have side effects the physician does not think warranted in this case. In addition, she believes that such therapy should be reserved for patients with a chance for recovery or remission.

The patient expresses no concerns about his health. He expects to take a short vacation in a week.

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The physician has several decisions to makeShould she tell the patient what she suspects?

Should she withhold this information?

If the doctor decides to reveal her concern:• Should she wait until the patient returns from

his vacation?• Should she mention the possibility of

chemotherapy and her reasons for not recommending it?

• Should she recommend chemo even though she believes it would not be warranted?

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Further Discussion:

1. What would the virtue ethicist advise the doctor to do? … for what reasons?

2. What advice would the deontologist have? … and why?

3. What would the utilitarian have to say about the dilemma?

4. What would you do, and why?

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Feminist Ethics Feminist ethics values women and resists oppression or

domination When men dominate women because of their gender,

that is “patriarchy” = rule of the fathers Feminist ethics affirms that women are as valuable and

capable as men Both men and women should be treated as equals Neither should oppress or dominate the other Both are deserving of justice rather than

discrimination or privilege

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Social JusticeThe subordination of women is morally wrong and

harms both women and men.Feminist ethics began with this gender focus for understanding oppression

Who else is oppressed in our society?Minority status? Give examples.Economic status? Who, in particular?Which children are most at risk in their development and health?

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Must nurses be feminists?Selections from Nursing World

• (online at www.nursingworld.org)• Fundamental commitment to addressing oppression• Social determinants of health & social activism of nurses

Silva, M. and Ludwick, R. (May 14, 2002). Ethics Column:

"Domestic Violence, Nurses, and Ethics: What Are the Links?"

Online Journal of Issues in Nursing. Vol. 7 No. 2. Available:

www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/DomesticViolenceandEthics.aspx

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Social justice and equity

“Social justice focuses on the relative position of one social group in relation to others in society, as well as on the root causes of disparities

and what can be done to eliminate them.”

Guiding assumptions of social justice:• Every individual (and therefore every profession) has an obligation to

take responsible action to eliminate forms of systematic inequity and oppression, such as racism, sexism, heterosexism and classism, inherent to diverse social groups.

Social justice is grounded in four key ideas: 1) fairness; 2) the relative position or social advantage of individuals and groups in society; 3) an understanding of the root causes of inequities in society; and 4) taking action to eliminate inequities.

(excerpts from Social Justice . . . A means to an end, an end itself, http://www2.cna-aiic.ca/CNA/documents/pdf/publications/Social_Justice_2010_e.pdf

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CARE ETHICS

o a form of virtue ethics with some aspects of feminist ethics

o emerged from Carol Gilligan’s study of moral development of womeno http://www.webster.edu/~woolflm/gilligan.html

o emphasis on personal relationships and responsibilities to care for others

o adopted as a primary moral theory in nursing practice

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Care Ethics (cont’d)

moral obligations arise out of our relationships with others and our mutual duties of caring

What does it mean to be “caring”

caring = being attentive to the needs of others respectful caring = sustained attention and response to needs of patients & their families

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Critics critics say that care ethics colludes in the identification of

nurturing and self-sacrifice with care by women women are socially conditioned to nurture & self-

sacrifice in caring for children, partners, elderly parents, etc. in our society

also can be co-opted into sustaining patterns of male domination and female subordination

Can a care ethic based on female gender stereotypes perpetuate injustice, even if the nurse is male? – HOW?

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Characteristics of an ethics of care (text p.32)

1. Focusses on relationships with particular others (e.g., parent/child, adult child/elderly parent, caregiver/patient);

2. Includes both reason and emotion;

3. Points out that impartiality is neither possible nor warranted;

4. Morality is attentive to disadvantage and injustice within both the public and private spheres;

5. Human persons are interdependent and formed through personal relationships.

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Most Important Contribution to Health Care EthicsMedical decisions and ethical choices are made within a

context of relationships: With differentials in power With particular vulnerabilities With a need to advocate for the most vulnerable

If a care ethics is not amplified by the feminist perspective (which is alert for evidence of subordination, oppression & injustice), then it may not be an adequate antidote to the weaknesses of an ethical focus on rationality and impartiality.

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Nursing ethics

foundational commitment to an ethic of care and sustained attention to the needs of patients

amplified by commitment to justice and principled moral judgements

evident in nurturing, empathic care; active participation in health care team decision-making; and patient advocacy

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Fundamental Moral Commitments…

…of care ethics:

Avoid harm

Respond to need

Recognize and respond to vulnerability

Maintain caring relations

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Shouldering the Burden of Care

TW, a fifty-two-year-old Ohio woman, cares daily for her elderly mother … TWs mother requires constant supervision, so she came to live with TW and her family.

Since TW could not afford a home health aid during the day, she reduced her hours and now works part time…

In recent months, TWs mother has declined rapidly… TW's mother told TW on many occasions that she never wanted to

be placed in a nursing home… TW faces a dilemma. She can place her mother in a nursing home

to ease her own burdens… Alternatively, she can respect her mother's stated wishes by continuing to care for her at home…

Sanders, S. J., & Eva, F. K. (2005). Shouldering the burden of Care/commentary/commentary. The Hastings Center Report, 35(5), 14-5.

Retrieved from http://search.proquest.com/docview/222398618?accountid=13803

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Case Study AnalysisWhat should TW do?

First, apply each moral theory to the case to help you see different moral perspectives and options: Utilitarianism / Consequentialism Deontology Virtue theory

Natural law theory

Feminist theory Ethic of Care Nursing Ethics

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Next, consider your alternatives; see if you can reach a consensus about what TW should do; give reasons for your recommendation for a course of action

TW should . . .and . . .because . . .

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What can a feminist ethic of care offer in response to this dilemma?The subordination of women is morally wrong and harms both

women and men.

Both men and women should be treated as equals

Both are deserving of justice rather than discrimination or privilege

Moral obligations arise out of our relationships with others and our

mutual duties of caring

Human persons are interdependent and formed through personal

relationships.

Maintain caring relations

Avoid harm; Respond to need

Recognize and respond to vulnerability

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One Feminist Analysis: Eva Feder Kittay

“[C]aregiving is a human capacity, not a gendered one”

For caregivers to be able to express love, they “need to be able to maintain [their] own selves from which our gift can flow”

“Imagine a world where familial caregiving was remunerated through paid family leave policies and funds to provide care”

“If nursing homes were personalized and varied places… then they would not be a dreaded specter hovering over old age”

“distribute the burden of caregiving more equitably…if her brother cannot contribute time, he must assist in other ways, such as contributing funds for home assistance”

“To continue the current situation can only further embitter TW, alienating her from her mother and her family, and this fracturing

of relations would be the most injurious of all outcomes.”