Identify Blooms Taxonomy Cognitive Levels in the reading and & provide an example, especially of application and analysis. on Hospital Ethics Committees and the Dismissal o

123

Helen Kohlen Joan McCarthy Editors

Nursing Ethics: Feminist Perspectives

Nursing Ethics: Feminist Perspectives

Helen Kohlen • Joan McCarthy Editors

Nursing Ethics: Feminist Perspectives

Editors Helen Kohlen Department of Nursing Science Philosophical-Theological University of Vallendar Vallendar Rheinland-Pfalz Germany

Joan McCarthy School of Nursing and Midwifery University College Cork Cork Ireland

ISBN 978-3-030-49103-1 ISBN 978-3-030-49104-8 (eBook) https://doi.org/10.1007/978-3-030-49104-8

© Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Living a feminist life does not mean adopting a set of ideals or norms of conduct although it might mean asking ethical questions about how to live better in an unjust and unequal world … how to create relationships with others that are more equal; how to find ways to support those who are not supported or are less supported by social systems; how to keep coming up against histories that have become concrete, histories that have become as solid as walls (Sarah Ahmed, Living a Feminist Life, 2017, p. 1).

vii

Foreword

I have had the pleasure of knowing Joan McCarthy and Helen Kohlen for many years. Both Joan and Helen serve as Editorial Board members of the journal Nursing Ethics. At our Board meetings, we take stock of journal trends and note the progress of the journal year on year. A regular topic of discussion is the dominance of empiri- cal research submissions to the journal and the paucity of groundbreaking philo- sophical scholarship in nursing ethics.

I was then excited to learn of plans for a book on the theme of feminist perspec- tives, edited by Joan and Helen.

It is a privilege to write the foreword to this book and to have had the pleasure of reading the manuscript before it moved to production. It became clear that this is a book which is timely, important, and innovative. It is a book that fills a gap for inno- vative and radical scholarship in nursing ethics.

The book is timely as it is published during the COVID-19 pandemic when usu- ally invisible care practices have been made visible and, temporarily at least, recog- nised as being of value. It is timely also in that it is published during the 200th anniversary year of the birth of Florence Nightingale, an anniversary which is stim- ulating a renewed interest in nursing history and values. The World Health Organization (WHO) nominated 2020 as ‘International Year of the Nurse and Midwife’ and responded to some of the international challenges for nursing in a seminal report by WHO, in partnership with the International Council of Nurses and the global Nursing Now campaign. The State of the World’s Nursing Report 2020 points out that the global nursing workforce is 27.9 million with 19.3 million identi- fied as ‘professional nurses’.

The WHO report confirms that ‘nursing remains a highly gendered profession with associated biases in the workplace’. Whilst some 90% of nurses are female, few are in leadership positions and there is evidence of gender-based discrimination in pay and in the work environment. The report also points out that there is a global shortage of some 6 million nurses and that one in every eight nurses works in a country other than their home country. The ten key actions identified in the State of the World’s Nursing Report 2020 include deliberate planning ‘for gender-sensitive nursing workforce policies’ which ensures ‘equitable and gender-neutral’ remu- neration, ‘enabling work environments for women’ and ‘gender transformative leadership development for women in the nursing workforce’. Another key action, pertinent to this book, relates to the effective monitoring and responsible and ethical

viii

management of nurse mobility and migration. For too long, more affluent countries have recruited nurses from areas which need their expertise and experience (see file://homes.surrey.ac.uk/home/downloads/9789240003279-eng%20(3).pdf).

This book is important in speaking to these critical issues and, it is hoped impact- ful, in bringing to readers’ attention insights from 14 expert feminist and ethics scholars from 6 countries (Ireland, Germany, USA, Canada, New Zealand, and England). Their contributions inform of the breadth and depth of feminist theory and illuminate its potential to challenge conventional approaches to ethical practice, thus promoting improvements in the way we think, value, and practice. The book is also important in highlighting the complexity of care practices and necessary engagement with history, culture, politics, economics, gender relations, and ethics. The book is, overall, a treasure trove of scholarship from some of our finest feminist and ethics theorists and researchers.

The book is innovative in that it brings together—and makes accessible—an engaging range of feminist perspectives. Many of the perspectives being brought to bear are new and are persuasive in urging a critical rethinking of conventional approaches to nursing ethics. A rethinking that goes beyond gender to consider also race, class, religion, and culture. A rethinking that embraces intersectional, intercul- tural, interrelational, and interconnected lenses on nursing and midwifery care prac- tices. The book chapters stimulate reflection on the relationships amongst past, present, and future scholarship; between philosophical and practical approaches to nursing ethics; between ‘real ethical problems’ and those considered ‘petit ethical problems’; and amongst personal, professional, policy, and political dimensions of care practices.

What is also innovative is the inclusion of many diverse ethical concepts, drawn from feminist perspectives, which illuminate the complexity and contextual and cultural richness of care practices. These concepts include, for example, moral hab- itability, care respect, bearing witness, presence, we-identity, moral space, and con- scientious commitment. The book also urges action, for example, in relation to the tragic Canadian example of Brian Sinclair who was ‘ignored to death’ (Chap. 4); the author asks if there might have been a different outcome ‘if even one nurse had advocated on his behalf’.

The book delivers on its promises to, first, explore historical and philosophical perspectives, drawing on feminist thought. Introductory chapters on the history, evolution, and interaction between feminist perspectives and nursing ethics set the scene. These chapters challenge readers to critically consider different ways of engaging with the role and nature of nursing ethics and to expand their horizons from the local to the global and from the personal and professional to the philo- sophical and political. The inclusion of feminist and ethical perspectives applied to experiences of indigenous and marginalised peoples enables readers to go beyond usual parochial concerns. Secondly, the book delivers on its promise to apply a feminist lens to some of the most pressing ethical issues encountered by nurses and midwives: issues such as technology in home care, organisational culture and lead- ership, clinical ethics support, research, and providing care during a pandemic.

Foreword

ix

This book is a call to action, a book to stimulate much-needed reflection and to challenge complacency. It is a book which enables us to consider anew our global care obligations and to enact what Shelagh Rogers refers to as ‘a collective respon- sibility to make things better. To act. Because if we do nothing, nothing will change.’

Ann Gallagher International Care Ethics Observatory

University of Surrey Guildford, UK

Foreword

xi

First of all, we thank the authors who have generously contributed to this book with enthusiasm, integrity, and patience—it has been our honour and delight to work with you.

Joan thanks her colleagues in the School of Nursing and Midwifery, University College Cork (UCC), who have always been ready to humorously and patiently put up with the fact that, even though she is not a nurse herself, she is never short of some pronouncement or other on what nurses should or should not, could or could not, do! Truth to tell, what motivates and inspires Joan is the work ethos, valour, and patient-centred commitment of her university colleagues, clinical colleagues, and students. She is also indebted to other UCC colleagues and friends who have stretched her feminist bow beyond the healthcare realm: Dolores Dooley, Department of Philosophy (now retired but always philosophising); Órla O’Donovan, Department of Applied Social Studies; Róisín O’Gorman, Department of Theatre; Mary Donnelly, Faculty of Law; and Claire Murray, Faculty of Law. Her medical ethics colleague, Louise Campbell, in the School of Medicine, National University of Ireland Galway, is also deserving of sincere thanks for her ever-vigilant and astute philosophical and feminist oversight, as is her colleague, Katherine O’Donnell, Department of Philosophy, University College Dublin, who keeps Joan’s feminist ruminations current and modest. In the summer of 2015, Helen was invited to the University for Humanistic Studies in Utrecht (UvH) as a visiting professor to teach feminist ethics and its application in the clinical setting. The discussions with stu- dents and colleagues were very motivating to broaden and deepen her knowledge in feminist care ethics. Helen particularly thanks her colleagues from the UvH, Inge van Nistelrooy, Merel Visse, Carlo Leget, Alistair Niemeijer, Frans Vosman, and Vivianne Baur, who continuously support her in developing her expertise. Helen also thanks her doctoral students at the University of Vallendar for their interest in raising feminist questions and reading feminist work beyond the curriculum.

In April 2019, thanks to Brocher Foundation in Switzerland, we were able to spend a full month writing and editing on the shores of Lake Geneva. We thank our international ‘April Hermits’ group (Zoe Dubus [France], Michal Lavidor [Israel], Sara Mattheisen [USA], Bernike Pasveer [Netherlands], Diane B.  Paul [USA], Oddgeir Synnes [Norway], Gerrit Jan van der Wilt [Netherlands]), who shared the time with us in Brocher and with whom we had inspirational talks about the book. In November 2019 we went to New York to interview Joan Tronto and there we

Acknowledgements

xii

benefitted from her wise and witty insights about nursing ethics, care ethics, and our plans for the book.

Finally, we would like to extend our thanks to Springer Nature for taking a chance on our idea. When we both got an invitation from Springer Nature to work on a book on nursing, the publisher had some initial doubts about the necessity of a book on feminist ethics. An extended book proposal and evaluations by respected international scholars were convincing and we were eventually given the go-ahead to undertake this feminist project.

We would especially like to thank Barbara Zöhrer who was convinced about our idea from the beginning and supported us in every way possible. We would also like to thank Nathalie Lhorset-Poulain who took over the editorship when Barbara went on maternity leave and has guided us to this point. Finally, we thank Smitha Diveshan and Vinodhini Subramaniam who patiently accompanied us on every step of the development of the book.

Of course, no woman is an island. Alice and June, Helen’s daughters, supported the work of the book as they are convinced about any endeavour necessary to move on with the goals of feminism. We also deeply appreciate all the Sundays, holidays, and other days, when our partners (Helen’s Tom and Joan’s Elixxchel) talked through our editorial conundrums with us, kept the home fires burning and the din- ner in the oven while we Skyped or typed or crafted this book into being.

Cork, Ireland Joan McCarthy Bremen, Germany Helen Kohlen

Acknowledgements

xiii

Introduction

Over the course of our personal and professional lives, we have been deeply engaged with feminist thinking and its emancipatory implications for human life, health, and well-being. We first met in 2007 at the 10th Nursing and Philosophy Conference in Dublin when Joan presented her co-authored book, Nursing Ethics: Irish Cases and Concerns (with Dolores Dooley, Gill and Macmillan, Dublin, 2005/2012). Over the years, shared participation in nursing ethics conferences and collaboration on an international research project confirmed that our interests and politics were closely aligned and that our work together was as much fun as it was productive.

Helen began thinking about feminism and feminist ethics during her studies in literature when she read Toni Morrison, Charlotte Perkins Gilman, and Susan Sontag. She had enthusiastically read La Deuxième Sexe by Simone de Beauvoir when she was 14, but did not know anything about feminism at that time. Similarly, Joan was astonished and relieved to read Simone de Beauvoir, Iris Marion Young, and Sarah Hoagland in her undergraduate and graduate studies. Tools that were not the master’s tools (thanks Audre Lorde) became available to them to make sense of their lives and their place in the world.

Helen’s time training as a nurse was marked by everyday ethical concerns and questions of gender inequality. She kept a diary with narrative accounts of ethical issues that stimulated her later to investigate the political-ethical dimensions in clin- ical ethics. During her time as a visiting researcher at the Center for Bioethics, University of Minneapolis, in the USA, Helen was introduced to feminist philoso- phy and its relevance for nursing by Joan Liaschenko. Meanwhile, Joan’s PhD supervisor, Dr. Dolores Dooley, University College Cork (UCC), introduced her to nursing ethics and to the nursing ethics curriculum that she was developing for pub- lic health nurses who were undertaking the first programme of nursing studies to be rolled out by the university. She also introduced Joan to the seminal feminist text on medical ethics, Feminist Perspectives in Medical Ethics, edited by Helen B. Holmes and Laura Martha Purdy (Bloomington and Indianapolis; Indiana Press. 1992). In the intervening years, Joan Liaschenko and, later, her co-author and friend, Elisabeth Peter, from the University of Toronto, have consistently brought a feminist voice to nursing ethics scholarship—their contribution to advancing the political breadth and depth of the field continues to inspire us both. We are very thankful that they supported our book from the very first step and immediately agreed to contribute their work.

xiv

Nursing Ethics and Feminist Perspectives

Nursing ethics is a field of scholarship that pays attention to the ethical dimensions of the professional work and practices of nurses and midwives (Midwifery is a pro- fession that has its own distinct history, practices, and goals. Nevertheless, there are some significant overlaps between the practices of nurses and midwives – especially as they pertain to the gendered nature of these practices. As such, we suggest that much of the content of this book is also relevant to midwifery professionals and chapters 2 and 10 explicitly address midwifery concerns). To do this, nursing ethics draws on traditional ethical theories such as deontology and utilitarianism, and, in the last four decades, principlism, which have provided diverse conceptual and methodological resources for policy makers, healthcare organisations, regulatory bodies, and health professionals, including nurses, who are faced with ethical chal- lenges in the provision of healthcare. Historically, these theories have dominated the ethical landscape navigated by health professionals in general. However, while nursing ethics scholarship applies many of the tools of these traditional ethical approaches, it is also deeply engaged with the unique history, goals, and practices of nursing which have evolved around a distinctive way of engaging with patients and with health. Many scholars working in nursing ethics pay attention to the specific quality of the everyday relationship the nurse has with patients. Human relation- ships, and the ethical bonds and responsibilities to which they give rise, have been seen to be at the heart of the moral realm of nursing practice. In the 1990s, US-based Anne Bishop and John R. Scudder stated, ‘if the moral sense is inherent in nursing, then moral problems appear in everyday practice and are resolvable from within practice’ (Bishop and Scudder 1990, p. 113). Patricia Benner’s seminal work also pays close attention to the quality and range of caring practices required of the nurse in order to expertly engage in a more holistic way with patients (Benner 1984). From Canada, Janet Storch describes nursing ethics as being centrally about ‘being in relationship to persons in care’ (Storch 2004, p. 7). She highlights the everyday ethical dimension of nursing practices: ‘Almost every nursing action and situation involves ethics. To raise questions about ethics is to ask about the good in our prac- tice’ (Storch 2004, p. 7).

In addition, the scholarship of nursing ethics has also viewed the practice of nursing as an act of service to the wider community and has involved deliberation on the responsibilities of nurses in relation to the welfare of society as a whole. Attention was given to this theme in the very first documented textbook on nursing ethics by Isabel Robb, Nursing Ethics: For Hospital and Private Use, published in 1900, and the first journal of nursing, The Trained Nurse, that included articles on nursing ethics starting in 1888 (Fowler 1984). Ongoing international scholarship on issues of equality, equity, and justice, as well as the inclusion of a commitment to social justice in many contemporary nursing codes, also suggests that the idea of service, human rights, and social inclusion continues to be a key concern of nursing ethics (The ICN 2012; Canadian Nursing Code of Ethics 2017). For example, the Faculty of Nursing at the University of Alberta has established a Health Equity Research Group that aims to build and support research capacity and scholarship

Introduction

xv

related to global health, social justice, and social policies, which specifically con- siders the ways in which these broad topics intersect with issues of equity, diversity, and inclusion.

The history of the nursing profession and of nursing ethics as a discipline is also, inescapably, a history of women. That nursing has been, and continues to be, a predominantly female profession—over 90% of the global nursing workforce is female (World Health Organisation 2020)—is not a matter of chance or ‘nature’; it is because the work of caring has long been designated the work of women. It would seem necessary then that any enquiry about the ethical nature and scope of nursing practices should address the ways in which gender might impact our understanding of these—hence the need for a feminist perspective on nurs- ing ethics.

The diversity of theoretical starting points when tackling the subject of ethics makes it difficult to identify a single ‘feminist perspective’ in ethics. Some of these starting points include traditional ethical theories as well as more contemporary approaches. What feminist perspectives on ethics share is that they critique these ethical frameworks from a feminist perspective. Feminist approaches to ethics, in general, consider the impact of gender roles and gendered understandings on the moral lives of individual human beings. In addition, they draw attention to the power and power differentials inherent in moral relationships at individual, societal, and organisational levels. These emphases are applicable to women and men wher- ever power differentials and gender bias are evident. As Margaret Little points out, feminist perspectives concern the way in which gender impacts the ways women and men live in the world, but also the ways in which they think about the world, what they value, and what they attend to:

At its most general, feminist theory can be thought of as an attempt to uncover the ways in which conceptions of gender distort people’s view of the world and to articulate the ways in which these distortions, which are hurtful to all, are particularly constraining to women. These efforts involve theory—and not merely benign protestations of women’s value or equality—According to feminist theory, that is, distorted and harmful conceptions of gen- der have come to affect the very ways in which we frame our vision of the world, affecting what we notice, what we value, and how we conceptualize what does come to attention (Little 1996, pp. 1–2).

Feminist perspectives are also not just concerned with the marginalisation and disempowerment of women in sexist societies; they are often sensitive to the way in which oppressive structures and power imbalances are experienced among different social groupings based on age, race, class, sexual orientation, and identity. Applied to healthcare, these feminist approaches to ethics have widened the scope of health- care ethics to include consideration of the social, economic, cultural, and political dimensions of moral decision-making in healthcare settings. Susan Sherwin makes this point in the following way:

[M]edical and other health care practices should be reviewed not just with regard to their effects on the patients who are directly involved but also with respect to the patterns of discrimination, exploitation, and dominance that surround them (Sherwin 1992, p. 4–5).

Introduction

xvi

While, historically, feminism and nursing, more generally, have had a somewhat tense and troubled relationship (Chinn and Wheeler 1985; Susan 1987a, b; Baer 1991; Gelfand Malka 2007), some pioneering work by a number of nurse ethicists forged a common ground between nursing ethics and feminist ethics scholarship (Fry 1989; Liaschenko 1993; Bowden 2000; Rodney et al. 2004; Storch 2004; Peter and Liaschenko 2003). We hope that bringing a range of feminist perspectives to nursing ethics in this volume will add to this important trajectory. We believe that the issues raised by feminists in the humanities more than three decades ago are more relevant than ever in the twenty-first century. This makes exploring the hori- zon and meaning of feminist lines of thinking for the nursing profession worthwhile.

Moreover, it is important to recognise that nursing ethics, as with all areas of inquiry, has not occurred in a vacuum. History, culture, gender relations, political and economic forces, healthcare policies, and organisational hierarchies all contrib- ute to the often vastly different roles and responsibilities that nurses assume locally and globally. This means that we need to be sensitive to the possibility that nursing practices themselves may reflect disempowering structural relations that could ren- der aspects of the good inherent in these practices ethically problematic.

The Organisation of This Book

This book is divided into two parts. Part I examines historical and philosophical perspectives on the impact of feminist thought on the field of nursing ethics scholar- ship. A short interlude—an interview with political theorist, Joan Tronto—provides a theoretical/practical hinge between Parts I and II. Part II applies a feminist lens to some of the ethical issues that arise in nursing and midwifery managerial and administrative roles, clinical practice, and research.

In Part I, Marsha Fowler focuses on the history of nursing ethics scholarship and the impact of feminist ethical and political perspectives on its evolution in ‘The Influence of the Social Location of Nurses-as-Women on the Early Development of Nursing Ethics’. She traces the birth of nursing ethics to the work of early nursing leaders largely based in the USA at the end of the nineteenth century. Her analysis and appraisal of their work suggest that they were acutely aware of women’s social location and disenfranchisement and that their cognisance of this shaped their per- spective on the professional roles, responsibilities, and ethical norms of nurses as women working under medical hegemony. Highlighting the creation, in 2019, of the Nursing Ethics Collection at the University of Surrey, which makes the early works of nursing leaders accessible to contemporary scholars of nursing ethics, Fowler draws attention to the feminist concerns of the early pioneers of nursing ethics scholarship. These included issues of authority over their personal lives as well as practice and education; suffrage and civic participation; and rigid gender roles and expectations.

‘An Evolution of Feminist Thought in Nursing Ethics,’ by Elizabeth Peter and Joan Liaschenko, reminds us that the feminist concerns articulated by nurse ethicists in the nineteenth century continue on into the twenty-first century. They begin their

Introduction

xvii

chapter by outlining the engagement of nurse ethicists in the 1980s and 1990s, firstly, with the ethic of care and its focus on human caring and relationship and, secondly, with feminist scholars who paid attention to the operations of power and structures of oppression. They draw attention to the transformative potential of feminist per- spectives to situate nursing care practices in relation to race, class, gender, and so on and to understand the oppressive and the emancipatory potential of power. Central too, for Peter and Liaschenko, is the feminist location of the experience of illness within a network of relationships and in particular socio-political contexts. They pay particular attention to the influence of feminist thought on midwifery and nursing ethics which has made central the importance of women’s autonomy and relation- ships during birth. They go on to explain and discuss the significance for nursing ethics of a range of feminist concepts such as care, respect, moral responsibility, cultural safety, and moral habitability.

‘Piecing Together a Puzzle: Feminist Materialist Philosophy and Nursing Ethics,’ by Janice L. Thompson, challenges nursing ethics scholars to think critically about the political-economic structures—specifically transnational corporate capital- ism—that impact our understanding of gender, care, nursing practice, and nursing ethics. First, Thompson takes time to outline and explain some of the key themes of Nancy Fraser’s pragmatic materialist feminist philosophy highlighting, in particu- lar, her nuanced account of social justice and she demonstrates its relevance to understanding the challenges experienced among personal care workers during the COVID-19 pandemic. In the second section, Thompson provocatively proposes that ignoring, obscuring, or not addressing the context of capitalism is unhelpful for nursing and nursing ethics and that a pragmatic materialist feminist approach pro- vides a means of transforming the root causes of oppression in capitalism, including its exploitation of care activities. The chapter concludes with an in-depth critical analysis of the development of an ethics of care, a feminist ethics of care, and an ethics of social justice in nursing and outlines the emancipatory potential of Fraser’s feminist materialist philosophy as a theoretical tool that will strengthen the reach and relevance of nursing ethics.

In ‘Bearing Witness and Testimony in Nursing: An Ethical-Political Practice,’ Christine Ceci, Mikelle Djkowich, and Olga Petrovskaya explore the concept of bearing witness and testimony in nursin

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.