Getting it right: the teaching of philosophical health care ethics

This article seeks to show one way in which moral philosophy, considered by the authors to be essential to the nursing and midwifery curricula, can be presented to achieve an optimal learning experience for nurses and midwives. It demonstrates that what might be considered a standard approach, that is, one that begins with ethical principles concerned with rights and duties and then often follows a linear pattern of teaching, may be in danger of promoting a focus on standardized outcomes. Such use of philosophy could therefore actually detract from the process of care. Moral philosophy underpinning health care ethics is commonly misperceived as a method of problem solving when there is an obvious dilemma regarding appropriate care and/or treatment. However, it is readily recognized that key principles within philosophy, for example, deontology and utilitarianism, despite their approach to a standard or criterion of right action, are both deficient in terms of providing ready-made right decisions. This is because their main virtue is to expose the difficulty rather than to solve the problem. Given these difficulties, any subsequent principles such as respect, beneficence, nonmaleficence and justice, incur the same deficiencies a fortiori. It can be argued that the complexity of the environment in which nurses and midwives now practice requires them to develop a capability that begins with the philosophical construction of an issue. This can subsequently enable a recognition of the essential nature of their own involvement as a nurse or midwife. By so doing, nurses and midwives can then bring issues into a nursing or midwifery paradigm and ensure that this perspective informs debate. Ultimately the focus is on the process by which care decisions are made. The intent therefore, is not simply for nurses or midwives to learn moral philosophy or to copy what is considered by others to be right action, but to recognize that a number of right actions are possible and, in so doing, develop their ability either to choose or influence a final action through a valid process. This article proposes and demonstrates by case example that what is often considered as a chance effect for nurses and midwives learning moral philosophy should be seen as the main effect and intended outcome.