Tag: Nursing Ethics

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Medical versus care ethics

medical ethics

As a former medical student – but not a doctor – studying the field of care ethics, I was always interested in bringing these two worlds together. Whereas the dominant (bio)medical ethics in healthcare revolves around four principles – beneficence, non-maleficence, respect for autonomy, and justice – care ethics questions whether morality can be derived from abstract principles and suggests it rather emerges from relational practices. As a medical student I wasn’t even aware of an, or any, alternative brand of ethics. Was it just me or was my lack of knowledge a consequence of medical education and the profession I was briefly acquainted with?

My years as a medical student had left me with a negative stance towards medical education and health care practice in general, without actually being able to explain why. My negative feelings were corroborated by several (non-)scientific sources describing harm in the medical encounter. In 2011, Elin Martinsen ((Martinsen, E. (2011). Harm in the absence of care: Towards a medical ethics that cares. Nursing Ethics, 18(2), pp.174-183.)) attributed this harm to the dominant ethics in healthcare.

She pleads to include “care as a core concept in medical ethical terminology” because of “the harm to which patients may be exposed owing to a lack of care in the clinical encounter,” specifically between doctors and patients. She leaves the didactical challenges arising from such a venture open for further enquiry. This left me with a chance to tackle both my personal questions and fill a scientific gap.

The informal and hidden curriculum of medical education

In this paper, medical education in the Netherlands is investigated through a “care-ethical lens”. This means exploring the possibility of enriching medical education with care-ethical insights, while at the same time discovering possible challenges emerging from such an undertaking. We present an overview of what is written on medical education, we describe care-ethical theories and what implementing these theories into medical education would imply, and we consider the accounts of several authors on the subject of care ethics and medical education.[pullquote]Master Care Ethics and Policy, University of Humanistic Studies.[/pullquote]

Personally, I have learnt most from further investigating medical education. Several authors offer alarming insights into its unintended, educational effects. Besides a formal curriculum or the explicated learning objectives, an informal and a hidden curriculum are also described. The informal curriculum is about the interpersonal level of teaching and learning between teacher and student. The hidden curriculum is also about learning objectives, but, as its name suggests, hidden, unintentional, and implicit.

What is so alarming about this, is that these curricula can lead to the erosion of expectations, ideals, and personal traits in students. Several examples of erosion have been described, such as the loss of idealism, adopting a ritualized professional identity, emotional neutralization, change of ethical integrity, tolerance of abuse, and acceptance of hierarchy. Students become hidebound, focused on facts, emotionally detached, cynical, arrogant, and irritable. Important to note here is that erosion doesn’t occur in every medical student nor does it always happen to the same extent.

Enriching medical education

What do these hidden, unintentional, and implicit effects of medical education imply for the possibility of enriching medical education with care-ethical insights? By connecting the collected bodies of knowledge on both medical education and care ethics, possible challenges are identified which can be narrowed down to two: didactical and non-didactical. These challenges might be overcome through focusing more deeply on the clinical phases of training and creating awareness of the medical morality and all that is implicit among healthcare practitioners.

With care ethics, we are dealing with a different way of thinking, one that deviates from what is currently dominant within the medical field, as I quickly realized leaving that field. We should not underestimate the possible resistance to a paradigm shift.

Eva van Reenen, MA Care Ethics

Van Reenen, E. & Van Nistelrooij, A.A.M. (2017). A spoonful of care ethics: the challenges of enriching medical education. Nursing Ethics. doi: 10.1177/0969733017747956

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Late modern uncertainty and beyond demarcation

demarcation

This week, two new papers of Dutch care ethicists have been accepted and published in peer-reviewed journals.

Rethinking

Frans Vosman and Alistair Niemeijer published their paper on ‘Rethinking critical reflection on care: late modern uncertainty and the implications for care ethics’ in Medicine, Health Care and Philosophy ((Vosman, F. & Niemeijer, A. Med Health Care and Philos (2017). doi: 10.1007/s11019-017-9766-1)). In their paper, Vosman and Niemeijer rethink care ethics through complexity and precariousness.

Late modern organizations, like the general hospital, codetermined by various (control, information, safety, account ability) systems are characterized by complexity and the need for complexity reduction, both permeating care practices.

By means of a heuristic use of the concept of precariousness, taken as the installment of uncertainty, it is shown that relations and power in late modern care organizations have changed, precluding the use of a straightforward domination idea of power.

A proposition is made how to rethink the care ethical inquiry in order to take late modern circumstances into account: inquiry should always be related to the concerns of people and practitioners from within care practices.

Abstract

Care ethics as initiated by Gilligan, Held, Tronto and others (in the nineteen eighties and nineties) has from its onset been critical towards ethical concepts established in modernity, like ‘autonomy’, alternatively proposing to think from within relationships and to pay attention to power. In this article the question is raised whether renewal in this same critical vein is necessary and possible as late modern circumstances require rethinking the care ethical inquiry. Two late modern realities that invite to rethink care ethics are complexity and precariousness. Read more >>

Beyond demarcation

The newest paper on ‘Care ethics as an interdisciplinary field of inquiry’ of Carlo Leget, Inge van Nistelrooij and Merel Visse has been accepted for publication by Nursing Ethics and will appear soon. This paper is a contribution to the ongoing discussion about the status and nature of care ethics. 

Responding to ‘Demarcation of the ethics of care as a discipline’ by Klaver et al. (2014)((Klaver, K., Elst, E. van, Baart, A. Nursing Ethics, Vol. 21-7, 755-765 (2014). doi: 10.1177/0969733013500162)) and ‘Three versions of an ethics of care’ by Edwards (2009)((Edwards, S. Nursing Philosophy, Vol.10-4, 231-240 (2009). doi: 10.1111/j.1466-769X.2009.00415.x)), Leget et al. propose to conceive care ethics as an interdisciplinary field of inquiry, incorporating a dialectical relation between empirical research and theoretical reflection.

Departing from the notion of caring as a practice of contributing to a life sustaining web, they argue that care ethics can only profit from a loosely organised academic profile that allows for flexibility and critical attitude that brings us close to the good emerging in specific practices.

This asks for ways of searching for a common focus and interest that is inherently democratic and dialogical, and thus beyond demarcation​.

Please check the website of Nursing Ethics or email the authors via info@care-ethics.org.

Abstract

For many years the body of literature known as ‘care ethics’ or ‘ethics of care’ has been discussed as regards its status and nature. There is much confusion and little structured discussion. The paper of Klaver et al. (2014) was written as a discussion article to which we respond.

We propose to conceive care ethics as an interdisciplinary field of inquiry, incorporating a dialectical relation between empirical research and theoretical reflection. Departing from the notion of caring as a practice of contributing to a life-sustaining web, we argue that care ethics can only profit from a loosely organized academic profile that allows for flexibility and critical attitude that brings us close to the good emerging in specific practices. This asks for ways of searching for a common focus and interest that is inherently democratic and dialogical and thus beyond demarcation. Read more >>

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