Feminist Ethics, Care Ethics and Nursing Ethics

1. Feminist Ethics, Care Ethics and Nursing Ethics September 25, 2013 Rels 300 / Nurs 330

2. 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 300/330 appleby

3. Social Justice The 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? 300/330 appleby

4. 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 300/330 appleby

5. 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 300/330 appleby

6. CARE ETHICS • a form of virtue ethics with some aspects of feminist ethics • emerged from Carol Gilligan’s study of moral development of women • http://www.webster.edu/~woolflm/gilligan.html • emphasis on personal relationships and responsibilities to care for others • adopted as primary moral theory in nursing practice 300/330 appleby

7. 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 • respect =sustained attention and response to needs of patients & their families 300/330 appleby

8. 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? 300/330 appleby

9. Characteristics of an ethics of care (text p.26) • Focusses on relationships with particular others (e.g., parent/child, adult child/elderly parent, caregiver/patient); • Includes both reason and emotion; • Points out that impartiality is neither possible nor warranted; • Morality is attentive to disadvantage and injustice within both the public and private spheres; • Human persons are interdependent and formed through personal relationships. 300/330 appleby

10. Most Important Contribution to Health Care Ethics Medical 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. 300/330 appleby

11. 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 300/330 appleby

12. Fundamental Moral Commitments… …of care ethics: • Avoid harm • Respond to need • Recognize and respond to vulnerability • Maintain caring relations 300/330 appleby

13. 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 300/330 appleby

14. 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 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 300/330 appleby