Pedro Perez, Universitat de Valencia

Nursing profession and the ethics of care.

An article appeared last Wednesday on the “Daily Mail” referred to a report of the Healt Service Ombudsman concerning to the treatment given to the elderly in British Hospitals. The report recounted several cases of abuse and neglect received by elderly. Among the examples, the report cites the cases of elderly who do not receive food or water for days or who are neglected in his room without receiving the minimum hygienic care over weeks.
The article’s author asserts that these behaviors show that the elderly have lost all the respect they have always had in society. He focuses in the work of nurses in Hospitals and says that their negligence is due to the lack of vocational sense of the nursing profession. Without doubt, it’s a fundamental reason, but in my opinion we should take account other important element not less important: the lack of an ethics of care in the practice of nursing profession.
Certainly, along history the elderly have been object of veneration and respect as they were holder of great wisdom and experience that they transmitted to the following generations. Our parents gave us our live and raised us to be who we are today. For that reason, the sons’ moral duty was to care of their parents in the best way possible. However, this mentality has deeply changed. The knowledge that elderly could transmit to us is useless for us because of the development of new technologies, the cultural change and the migrations from country to the city. Our world is not the world of our grandparents. On the one hand, traditional works are being lost, agricultural techniques changed and the ancient traditions were forgotten. The wisdom of the elderly is despised and is replaced by the technological knowledge of young researchers, who develop the most revolutionary inventions. On the other hand, the model of country “broad family” in which woman was at home caring of the elderly and ills became in small families living in small flats in the city and in which husband and wife work. So, there is anybody to care of the grandparents at home. However, the internment of the grandparents in a Hospital doesn’t seem a good option at all, as the article shows.
But why does this lack of respect toward the elderly in the Hospitals if the duty of nurses is to provide a good care to all patients? In my opinion one of the keys to understand this elder abuse is a lack of an ethics of care in the nursing profession. The concept of “ethics of care” was employed by several authors; among them we should stress to Carol Gilligan. She opposed the “ethics of justice” (which she related to Kohlberg) to the “ethics of care” that she supported. These are two different ways to understand the relations among persons. The ethics of justice is grounded in abstract moral principles, the defence of formal rights and social atomism on minimal rules of coexistence. In contrast, the ethics of care focuses the attention in the particularities, the mutual relation with the other, the sympathy and the responsibility. It values not only the formal rules, but other sentimental elements which give sense to interpersonal relations. In this sense, while the ethics of justice has a cognitive sense, the ethics of care gives a main role to the emotions and virtues. Only the promotion of emotions and virtues can provide a humane treatment to ill and elderly. In contrast, the rational calculation of the optimization of resources will lead to commit the abuses mentioned in the article. Therefore it is necessary to promote an ethics of care in the exercise of the profession of nursing.
And which are the elements that articulate the ethics of care? This ethics requires not only a vocational attitude, which is essential, but also the development of other attitudes and virtues necessary to convert a minimum (the due treatment to elderly) into a maximum: the correct practice and professional excellence. Some virtues that should guide the profession of nursing to achieve professional excellence would be the following ones:
– Compassion for the person who depends on the nurse. Compassion is the ability to locate where the person suffering.
– Competition: it’s the reasoning ability, skills, experience and motivation to respond to the issues raised in the exercise of the profession. The good nurse tries to be excellent in the course of their work. Competition should therefore complement the compassion because compassion without competition would only be a good intention while competence without compassion can be inhumane.
– Trust: This is a relationship that should be essential between the elderly and the nurse, as it presupposes both truthfulness and mutual respect. The elderly receive adequate treatment only if he or she can feel safe and supported by medical staff and nurses. So honesty is a core value too. Hence we can understand the relevance of this virtue in an ethics of care.
– Responsibility: The nurse must feel responsible for the welfare of the person who has been entrusted to their care.
– Attention: The core of the practice of care should always be the patient. Hence the main interest of nurses should be the search for internal goods of their profession and not external goods, as could be the profit. Otherwise, the health profession would be flawed.

These virtues embody the ethics of care that is necessary to promote the education of healthcare not only to prevent the abuses that might occur in nursing profession, but to promote a professional excellence. Professionals should always aspire to excellence. Only in this way elderly can regain the care and respect they deserve in our society.

Gilligan, Carol. In a different voice: psychological theory and women’s development. Harvard University press, Cambridge, Ma., 1982.

New work on neuroethics in Spain.

The growing relevance of neurosciences within Bioethics leads to the appearance of new Centres dedicated to the study of neuroethics around the world. This is the case of a new group just appeared at my home University, the University of Valencia. I would like to dedicate my first contribution to this blog to introduce this group, and specifically the first contributions that they are beginning to produce. I do this because these first contributions are being published in Hispanic journals and for that reason they would not be accessible to the English audience. Continue reading

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