Nursing Ethics Questions Paper

Provision 1 • Guide to the Code of Ethics for Nurses with Interpretive Statements, 2nd Ed. • 1

Provision 1. Affirming Health through Relationships of Dignity and Respect

Introduction

There is, perhaps, no better place to begin a discussion of ethics in nursing than with attention to the momentous concepts of compassion and human dignity. Because of their magnitude and central importance to nursing, it warrants dwelling a moment on these concepts of compassion, suffering, and human dignity. That compassion responds to suffering is to be expected, as the word itself joins together the Latin com- (meaning together with) and pati (meaning to suffer), thus “to suffer with” another.1 Sharing the same root, the patient, also from the Latin pati—meaning to suffer or to endure affliction is the subject of compassion.2 This relationship between compassion and suffering has been a topic of intense reflection for millennia in both religious and philosophical literature. Nursing Ethics Questions Paper

Hinduism, in its urreligious (oldest, primeval, or proto) form, is thought to have its origins around 2,600 BCE and is sometimes referred to as “the oldest religion.”3 It has no single founder and is an amalgamation of numerous indigenous religions of the Indian subcontinent. It coalesces into a “Hindu synthesis,” that is, a more unified form, around the beginning of the Common Era.4,5 Hinduism would seem an odd place to start a discussion of compassion in modern nursing, yet 4,600 years of human observation and reflection can provide some astute insights of relevance to nursing.

Hinduism has not one but several words that translate into English as the single word compassion. Each has a subtle shade of meaning. The three most common words are daya (Hindi: दया), karuna (करुणा), and anukampa (अनुकम्पा ). 6 Daya is the first among the eight essential qualities of the soul that must be developed. It means “the desire of one’s bosom to mitigate the sorrow and

Provision 1 The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Nursing Ethics Questions Paper

Co py ri gh t © 2 01 5. A me ri ca n Nu rs es A ss oc ia ti on . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed

un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 4/4/2017 7:56 PM via STATE COLLEGE OF FLORIDA, MANATEE-SARASOTA AN: 1021763 ; Fowler, Marsha Diane Mary, American Nurses Association.; Guide to the Code of Ethics for Nurses with Interpretive Statements : Development, Interpretation, and Application Account: macc

2 • Guide to the Code of Ethics for Nurses with Interpretive Statements, 2nd Ed. • Provision 1

difficulties of others by putting forth any amount of efforts.” It is also defined as “…to treat a stranger, a relative, a friend or foe as one’s own self,” as someone who is as susceptible to suffering as I am. Karuna is “…born of grief on account of loss or difficulties of [persons] near and dear.” Anukampa means “to experience mild and gentle movement in the heart following the observance of pain and suffering in the other person.”7

It is evident from these definitions that they are based on critical reflection and address a number of pivotal underlying questions that are deeply relevant to nursing ethics. These questions include: Nursing Ethics Questions Paper

Is compassion a virtue? If so, what kind of virtue? Is it innate or learned? Can compassion be taught? Is compassion the same as sympathy or pity? Does compassion involve empathy or mercy? Is compassion a response? What is the function of compassion? Is compassion nothing more than a feeling? Is compassion a cognitive decision? Does compassion require tangible action? Who or what is the object of compassion? Who or what is worthy of my compassion? Is compassion toward one’s self or a loved on the same as compassion toward a foe? Need a person merit compassion? How does compassion relate to my own potential or real suffering? Is the one who expresses compassion in a superior position? Are there degrees of compassion? If there are degrees of compassion, on what are those degrees based? Are there constitutive elements in a compassionate response? Why be compassionate? Must I show compassion toward myself?

Within the sacred Hindu texts one finds discourses that grapple with these questions and provide profound answers.

Buddhism also addresses compassion. The Buddha lived sometime between the 6th and 4th centuries BCE. The words of the Buddha were originally passed via oral tradition, then recorded in the Path of Purification (Visuddhimagga) and other works. The Buddha’s understanding of compassion was as follows:

When there is suffering in others it causes (karoti) good people’s hearts to be moved (kampana), thus it is compassion (karuóá). Or alternatively, it combats (kióáti) others’ suffering, attacks and demolishes it, thus it is compassion. Or alternatively, it is scattered (kiriyati) upon those who suffer, it is extended to them by pervasion, thus it is compassion (karuóá).8

Restated in more modern language: “Compassion is that which makes the heart of the good move at the pain of others. It crushes and destroys the pain of others; thus, it is called compassion. It is called compassion because it shelters and embraces the distressed.”9

Co py ri gh t © 2 01 5. A me ri ca n Nu rs es A ss oc ia ti on . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed

un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 4/4/2017 7:56 PM via STATE COLLEGE OF FLORIDA, MANATEE-SARASOTA AN: 1021763 ; Fowler, Marsha Diane Mary, American Nurses Association.; Guide to the Code of Ethics for Nurses with Interpretive Statements : Development, Interpretation, and Application Account: macc

Provision 1 • Guide to the Code of Ethics for Nurses with Interpretive Statements, 2nd Ed. • 3

In Buddhist thought, compassion is a virtue. Compassion rises above respect, sympathy, and pity. In compassion we identify with the other and try to understand from her or his point of view. Buddhist scholar William Irwin writes:

Compassion and kindness are virtues that direct us away from ourselves and our craving…. We owe it to ourselves to treat other people with something greater than respect, namely compassion… Compassion involves both the recognition that others are suffering and the fellow-feeling that the recognition brings…. I do not feel sorry for them or have pity for them; I have compassion for them, recognizing their state of being as my own.… Compassion thus involves an ethics of intention. While the carelessness and foolishness of certain actions makes them blameworthy even with good intentions, it is charitable, kind, and appropriate for us to consider others’ intentions. Looking to others with their intentions in mind helps me to cultivate compassion… And on a daily basis, empathic listening requires compassionate intentionalist interpretation. The goal is not to understand the other person as suits me; or from my point of view; or to find some piece of common ground. The goal is to understand the other from his point of view, as he intends and hopes to be understood.10

Note that the questions that underlie Hindu perspectives on compassion are shared in the Buddhist considerations—and those of other religions as well.

Religious discourse on compassion goes beyond the definitional and theoretical to encompass actual “interventions.” Take, for example, the man named Job in the Jewish Tanakh (Bible). The Book of Job dates between the 7th and 4th centuries BCE, with the 6th century as the probable date.11 Job, a righteous man experienced calamity. His children were killed when a wind caused their house to fall in, his sheep and servants were killed in a fire storm, his camels stolen, and Job himself became covered with “loathsome sores… from the sole of his foot to the crown of his head.”12 In addition, he had a nagging wife and friends with a knack for saying exactly the wrong thing. But his friends did get one thing right: they showed compassion.

Now when Job’s three friends heard of all these troubles that had come upon him, each of them set out from his home… They met together to go and console and comfort him. When they saw him from a distance, they did not recognize him, and they raised their voices and wept aloud; they tore their robes and threw dust in the air upon their heads. They sat with him on the ground for seven days and seven nights, and no one spoke a word to him, for they saw that his suffering was very great.13

Co py ri gh t © 2 01 5. A me ri ca n Nu rs es A ss oc ia ti on . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed

un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 4/4/2017 7:56 PM via STATE COLLEGE OF FLORIDA, MANATEE-SARASOTA AN: 1021763 ; Fowler, Marsha Diane Mary, American Nurses Association.; Guide to the Code of Ethics for Nurses with Interpretive Statements : Development, Interpretation, and Application Account: macc

4 • Guide to the Code of Ethics for Nurses with Interpretive Statements, 2nd Ed. • Provision 1

In their compassion, Job’s friends engage in presence, a key means of expressing compassion. Presence receives considerable discussion in theological literature, and is a concept and intervention fundamental to nursing and one that nurse scholars have recently begun to explore. However, the Jewish literature also offers insight into hearing another’s lament. It is in expressing, fully expressing, one’s lament—and having that lament heard by another rather than stifled that compassion meets and mitigates suffering. There are, in this ancient literature, specific literary forms or templates for the expression of individual and collective lament. These forms guarantee the full expression of lament and prompt the person to end on a note of hope that they can draw from within.14

These are but three examples. Extensive discussions of compassion are found in all major and most smaller religious traditions. There are also discussions of compassion in the philosophical literature.

Aristotle (384–322 BCE) held that there are five essential social virtues (sing. arête’; pl. aretai): courage, compassion, self-love, friendship, and forgiveness. He sees virtues as larger than moral virtues alone. For Aristotle, moral virtues are aimed at fine and right action. He taught that virtues, as moral aspects of character, can be learned, cultivated, and strengthened. The goal of moral education is to control unruly desires and habits so that desires might be rightly ordered and that virtues might be cultivated. (See Chapter 5 for additional discussion of virtues.) Aristotle distinguished compassion from pity. Pity is condescending and not welcome by its recipient. Compassion, on the other hand, sees the suffering of the other as if it were one’s own suffering. It is possible to have an excess of compassion—softheartedness—as well as a deficiency of compassion as cold-heartedness or callousness. Aristotle ascribes distinctive content to each virtue, including actions, motives, and capacities.15, Nursing Ethics Questions Paper

Aristotle argues that compassion is a painful emotion in response to another person’s suffering or misfortune.16 There are three constitutive elements for compassion: (a) the person’s misfortune or suffering must be of significance, that is, not trivial, (b) the person has no role in causing her or his suffering, i.e., it is undeserved, and (c) an awareness that I, and those whom I love, share in the vulnerabilities and weaknesses of this person and are likewise susceptible to suffering. Martha Nussbaum takes issue with Aristotle’s third condition and maintains that:

in order for compassion to be present, the person must consider the suffering of another as a significant part of his or her own scheme of goals and ends. She must take that person’s ill as affecting her own flourishing. In effect, she must make herself vulnerable in the person of another. It is that eudaimonistic judgment, not the judgment of similar possibilities, that seems to be a necessary constituent of compassion.17

Co py ri gh t © 2 01 5. A me ri ca n Nu rs es A ss oc ia ti on . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed

un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 4/4/2017 7:56 PM via STATE COLLEGE OF FLORIDA, MANATEE-SARASOTA AN: 1021763 ; Fowler, Marsha Diane Mary, American Nurses Association.; Guide to the Code of Ethics for Nurses with Interpretive Statements : Development, Interpretation, and Application Account: macc

Provision 1 • Guide to the Code of Ethics for Nurses with Interpretive Statements, 2nd Ed. • 5

Eudaimon, often translated as happiness, welfare or even well-being, is more accurately understood as a concept of human flourishing. What Nussbaum is saying is that we all have a concept of what human flourishing looks like and we make a eudaimonistic judgment about persons who are suffering—that they are or are not flourishing—consistent with our understanding of the goals and ends we would seek for our own flourishing. She agrees with Aristotle that we all share in the human condition of susceptibility to suffering, and thus share in a sense of common human community. Where she disagrees with him is that she believes that is it not a judgment of similar possibility of suffering that drives compassion, but rather a judgment about what it takes for me or that person to flourish.

Aristotle is hardly alone in his concern for compassion. Other philosophers have argued about compassion, including the Stoics, Seneca, Schopenhauer, Hume, Hutcheson, Nietzsche, and Kant.

Nurses tend to skim the religious or philosophical literature in their investigations of compassion. Van der Cingel is an exception; she explores selected philosophical works, including those of Aristotle, Schopenhauer, and Nietzsche (largely through Nussbaum’s work). She writes that:

Compassion is an answer to suffering despite the fact that suffering will not disappear by it. Serious suffering can happen to everyone because to suffer is part of human existence. Still, suffering is not always easy to recognize because the meaning of what is lost differs from person to person. In order to recognize the meaning of a loss it is necessary to set aside one’s own perspective. This is troublesome when the relevant perspective is remote from one’s own experience and ideas.… Imagination and reflection…help to develop susceptibility for the other person’s perspective.… Compassion is also defined by the specific thought that suffering is terrible.… Further, compassion is unconditionally valid for everyone suffering.… There is a choice to be made in showing or not showing compassion. To acknowledge suffering by showing compassion means to acknowledge the loss of something valuable, to deny this means adding suffering to suffering that already exists. Therefore, compassion is the morally right thing to express.18, Nursing Ethics Questions Paper

In the empirical portion of her study (with older persons with chronic diseases), she identifies seven dimensions of compassion: attentiveness, active listening, naming of suffering, involvement, helping, being present, and understanding.19 While not identical to the discussions of compassion in the philosophical literature, her findings corroborate a number of the elements that they raise. Nursing Ethics Questions Paper

Co py ri gh t © 2 01 5. A me ri ca n Nu rs es A ss oc ia ti on . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed

un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 4/4/2017 7:56 PM via STATE COLLEGE OF FLORIDA, MANATEE-SARASOTA AN: 1021763 ; Fowler, Marsha Diane Mary, American Nurses Association.; Guide to the Code of Ethics for Nurses with Interpretive Statements : Development, Interpretation, and Application Account: macc

6 • Guide to the Code of Ethics for Nurses with Interpretive Statements, 2nd Ed. • Provision 1

Only a few, including van der Cingel, have drawn rigorously upon the rich religious sources on compassion that are available.20 Those resources continue to develop through theological discourse, and also through such vehicles as the Parliament of the World’s Religions and the Charter for Compassion. In these venues, compassion becomes a social and political force, much like the context of an ethic of care (see Chapter 2) that extends beyond the dyadic nurse– patient relationship. Compassion becomes a social force to address suffering globally by addressing the social determinants of suffering. The text of the Charter for Compassion says, in part:

The principle of compassion lies at the heart of all religious, ethical and spiritual traditions, calling us always to treat all others as we wish to be treated ourselves. Compassion impels us to work tirelessly to alleviate the suffering of our fellow creatures, to dethrone ourselves from the centre of our world and put another there, and to honour the inviolable sanctity of every single human being, treating everybody, without exception, with absolute justice, equity and respect. It is also necessary in both public and private life to refrain consistently and empathically from inflicting pain. To act or speak violently out of spite, chauvinism, or self-interest, to impoverish, exploit or deny basic rights to anybody, and to incite hatred by denigrating others—even our enemies—is a denial of our common humanity. We acknowledge that we have failed to live compassionately and that some have even increased the sum of human misery in the name of religion.21

Note that the Charter for Compassion encompasses many of the facets of compassion addressed by the religious and philosophical traditions noted above, speaking to many of the concerns that nursing shares. The extension of compassion into the larger social and political realm can also be found in these same traditions. Nursing Ethics Questions Paper

Considering how important compassion is to nursing, it does not appear in the codes to the degree that it should. The successive revisions of the Code err on the side of scientifically skilled nursing, and to some degree have neglected the art of nursing for the science of nursing. This is, in part, a reflection of nursing’s aspirations to be regarded as scientific and as a profession. To some degree, compassion, comfort, and care were assumed and subsumed under rights and patient protection language. In addition, the codes were rightly influenced by shock and outrage at the Nazi experiments exposed after WWII, the disclosures by both Beecher and Pappworth of morally reprobate medical experiments in the United States and UK, the multiple international documents incorporating human rights and self-determination, as well as the rise of bioethics in the mid-1960s emphasizing respect for autonomy. (See Chapter 7 for additional discussion.) These influences lead to a resolute affirmation of rights, self-

Co py ri gh t © 2 01 5. A me ri ca n Nu rs es A ss oc ia ti on . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed

un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 4/4/2017 7:56 PM via STATE COLLEGE OF FLORIDA, MANATEE-SARASOTA AN: 1021763 ; Fowler, Marsha Diane Mary, American Nurses Association.; Guide to the Code of Ethics for Nurses with Interpretive Statements : Development, Interpretation, and Application Account: macc

Provision 1 • Guide to the Code of Ethics for Nurses with Interpretive Statements, 2nd Ed. • 7

determination, respect for autonomy, and the like in the successive iterations of the Code. This content displaces the interpersonal art of nursing concerns that remain at the heart of nursing care and are encompassed in part in the developing ethic of care. (See Chapter 3). Though compassion is not mentioned specifically, the Tentative Code (1940) does state that the nurse is a “bearer of comfort,” “a source of strength and comfort,” and that “honesty, understanding, gentleness, and patience should characterize all of the acts of the nurse. A sense of the fitness of things is particularly important.”22 Compassion appears in the 2001 revision of the Code: “Provision 1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.”23, Nursing Ethics Questions Paper

The 2015 revision of the Code retains the concern for compassion and continues to assert it in the actual provision itself: “Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.”24

Compassion is inextricably linked to valuing the other, whether the other is another human being, other sentient life, or the environment. This valuing calls for a response of respect in the case of human life, and more specifically those lives that come into contact with nurses, respect for human dignity.

1.1 Respect for Human Dignity

Human dignity first appears in the 1960 Code for Professional Nurses, and in every successive revision thereafter. This is, again, reflective of the international concern for the protection of human dignity. There are some subtle shifts in language as the “dignity of man” (1968 Code) subsequently becomes “human dignity.” The concern for human dignity shifts from the second to the first provision after 1960. Through 1985, the emphasis is on affirming and preserving human dignity in patient care. From the 2001 revision forward, the Code emphasizes affirming and preserving the human dignity of all those with whom nurses have contact, in all nursing roles and settings. This would include the preservation of the human dignity of patients, clients, participants in research, nursing students, co-workers, other health professionals, and colleagues—in short, everyone, including ourselves! Nursing Ethics Questions Paper

The requirement to respect, affirm, protect, and preserve human dignity still does not explain or define the concept of human dignity. When the concept of human dignity was introduced through the 1948 UN Universal Declaration of Human Rights no attempt was made to define human dignity.25 Düwell notes

Co py ri gh t © 2 01 5. A me ri ca n Nu rs es A ss oc ia ti on . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed

un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 4/4/2017 7:56 PM via STATE COLLEGE OF FLORIDA, MANATEE-SARASOTA AN: 1021763 ; Fowler, Marsha Diane Mary, American Nurses Association.; Guide to the Code of Ethics for Nurses with Interpretive Statements : Development, Interpretation, and Application Account: macc

8 • Guide to the Code of Ethics for Nurses with Interpretive Statements, 2nd Ed. • Provision 1

that when human dignity was introduced, it was intended to serve as a moral reference point and that:

Most people believed that they knew what human dignity was about: a consensus within the humanistic tradition, a secularized version of the Judeo-Christian concept of Imago Dei [humankind made in the image of God], an overlap between the ethical doctrines of important thinkers like Kant and Confucius, the normative core of the natural law tradition, a moral-political statement against the atrocities of the Nazi régime, etc.…it thus appeared superfluous to strive for a theoretical explanation and justification of the concept.26

Sulmasy identifies three different uses of dignity in moral discourse: attributed, intrinsic, and inflorescent.27 Attributed dignity refers to worthiness conferred upon a person based on one’s social standing, reputation, or civic office; it is based on merit in a social or public sense. Intrinsic dignity, based in Immanuel Kant’s formulation, is: Nursing Ethics Questions Paper

that worth or value that people have simply because they are human, not by virtue of any social standing, ability to evoke admiration, or any particular set of talents, skills, or powers. Intrinsic dignity is the value that human beings have simply by virtue of the fact that they are human beings. Thus we say that racism is an offense against human dignity. Used this way, dignity designates a value not conferred or created by human choices, individual or collective, but is prior to human attribution. Kant’s notion of dignity is intrinsic.28

This is the sense in which this Code and all prior codes use the term dignity. Inflorescent is an odd term, as it refers to a flower coming into bloom. Inflorescent dignity, for Sulmasy, refers to the person who is coming into the “full bloom” of virtuous humanity:

to individuals who are flourishing as human beings—living lives that are consistent with and expressive of the intrinsic dignity of the human. Thus, dignity is sometimes used to refer to a state of virtue—a state of affairs in which a human being habitually acts in ways that expresses the intrinsic value of the human. We say, for instance, that so-and-so faced a particularly trying situation with dignity.29

Inflorescent dignity is seen in the caring, compassionate, skilled nurse who brings genuine comfort to the anxious patient; in the researcher who diligently and rigorously pursues a line of inquiry with integrity, skill, perseverance, and a best effort; and in the nursing educator who seeks to advance the knowledge of both the strongest and weakest students with rigor, compassion, wisdom, and devotion to their learning. We can also see inflorescent dignity in the legend of Florence Nightingale, the attributed founder of modern nursing. Nursing Ethics Questions Paper

Co py ri gh t © 2 01 5. A me ri ca n Nu rs es A ss oc ia ti on . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed

un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 4/4/2017 7:56 PM via STATE COLLEGE OF FLORIDA, MANATEE-SARASOTA AN: 1021763 ; Fowler, Marsha Diane Mary, American Nurses Association.; Guide to the Code of Ethics for Nurses with Interpretive Statements : Development, Interpretation, and Application Account: macc

Provision 1 • Guide to the Code of Ethics for Nurses with Interpretive Statements, 2nd Ed. • 9

Düwell identifies five models of the term dignity that correlate with Sulmasy’s three forms. Düwell’s particular concern is to identify that form of dignity that will undergird human rights. Of the five models—rank, virtue and duty, dignity and religious status, the cosmological status of the human being, and respect for the dignity of the individual human being—he identifies respect for the dignity of the individual human being as best suited to the task of undergirding human rights, with direct links to the moral and political dimensions of life:30

the specific idea can be distinguished that each single human individual would have dignity. In this line, human dignity should be seen as an expression that signifies a status which other human beings and political institutions have to respect. This respect can be interpreted primarily in a sense of moral obligations or – as happened in the twentieth century – in the sense of individual rights that can be legally enforced. And since this respect is of immanent importance from a moral point of view, it can be seen as a reason to understand the entire legal and political state and international order as based on the respect for the dignity and rights of each individual human being. This concept of ‘human dignity’…is universal; it signifies a status that cannot be lost, and thus may provide a foundation of rights.31

This perspective on human dignity is that which is found in the nursing ethical literature: that human dignity has three distinct features: it is inherent (i.e., it is essential and permanent as it inheres, or “sticks” and is “fixed”), intrinsic (i.e., it is “situated within”; “inner,” and naturally belonging), and inviolable (i.e., it may not be violated).32. Nursing Ethics Questions Paper

However, Macklin has maintained that bioethics has no need for the concept of human dignity, that “dignity is a useless concept in medical ethics and can be eliminated without any loss of content.”33,34 While she uses the principles of respect for persons and respect for autonomy interchangeably, she argues that the principle of respect for persons or respect for autonomy will suffice without the concept of human dignity. Nursing, and particularly an ethic of care (see Chapter 2), would challenge Macklin on this point and would agree with Schulman, who notes that:

in locating human dignity entirely in rational autonomy, Kant was forced to deny any moral significance to other aspects of our humanity, including our family life, our loves, loyalties, and other emotions, as well as our way of coming into the world and all other merely biological facts about the human organism. His exclusive focus on rational autonomy leaves Kant with a rather narrow and constricted account of our moral life.35

Co py ri gh t © 2 01 5. A me ri ca n Nu rs es A ss oc ia ti on . Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed

un de r U. S. o r ap pl ic ab le c op yr ig ht l aw .

EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 4/4/2017 7:56 PM via STATE COLLEGE OF FLORIDA, MANATEE-SARASOTA AN: 1021763 ; Fowler, Marsha Diane Mary, American Nurses Association.; Guide to the Code of Ethics for Nurses with Interpretive Statements : Development, Interpretation, and Application Account: macc