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Nursing Ethics: Communities in Dialogue
  1. J Conder
  1. jennyc{at}

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    R M Volbrecht. Prentice Hall, 2002, US$36.80, pp 303. ISBN 0–13–030521–9

    This book is well set out; an initial look at the contents suggests that key issues for nursing ethics will be covered and that the range of theories is relevant to nursing today. Each chapter begins with an outline and ends with key points and reflection and discussion questions. This structure is helpful and providing reflection and discussion questions is in line with the philosophies of the current nursing curricula of my experience, giving students using this as a text opportunities to develop their critical thinking skills. The whole text positioned as “communities in dialogue” is consistent with nursing education and theories of nursing practice, making it a book that would complement many nursing programmes.

    It is clear from the start that this is a book written for nurses, placing nursing ethics as distinct from medical ethics. This is definitely not a book for the purist, as the author demonstrates how different approaches to ethics can be applied to nursing practice. Three distinct approaches to ethics are addressed: rule ethics, virtue ethics, and feminist ethics. The author is careful in explaining the theories that she has chosen for each of these, using examples relevant to nursing practice to illustrate her points. In explaining each position, her writing is supported by mainstream ethical texts. Undergraduate nursing students should find this information accessible, while there is also enough depth for postgraduate students to begin their exploration of the issues.

    The first chapter introduces the reader to nursing ethics and sets this out as a communal dialogue. It also outlines a framework for decision making processes, which is then used consistently throughout the book, the reader being reminded each time of the steps involved. The subsequent chapters introduce an approach in one chapter and then follow this by a further chapter in which an example is used to illustrate how reasoning may occur according to this approach. The chapter on rule ethics is a comparatively brief outline of the theories that have dominated in the past, that is, Kantian, and utilitarian ethics. Readers looking for depth in either of these would need to use other sources; however the attention given to them in this text is a sound start. It is refreshing to see a book that brings a new balance to the way that we view nursing ethics by including similar amounts on virtue and feminist ethics. I thought that the author chose well in selecting virtues, particularly in developing further the virtues of compassion and practical reasoning from the initial list. In discussing feminist ethics, the ethic of care is outlined and critiqued in line with the writing of feminist ethicists before the author turns her attention to a broader contextual feminist perspective on ethics and health care.

    Throughout the book a number of examples are used, which tend to be particularly relevant to nursing; for other health professionals they may provide some insight into the issues for nurses. The strengths are focused on in the chapters that illustrate a preceding approach, and while this makes it less confusing for the reader, it would be helpful to have the limitations of the approach also addressed, in order to develop students’ skills of ethical analysis. The first example offered was related to liver transplantation for recovering alcoholics (rule ethics), the second to pain management for neonates (virtue ethics), and the third to eating disorders (feminist ethics). Initially I was concerned that the example of liver transplantation might not seem to have much relevance at the personal level of nursing care, however the author carefully developed her position to tease out the points that bring the arguments back to individual care. Pain management for neonates was a good choice for virtue ethics; the author provided some discussion around moral distress in this chapter. As this is a concern for nurses, who can feel caught in the middle of decisions made by others, I believe this section is worth a read by other health professionals, to give them an insight into the position of nurses as moral beings. The example of eating disorders does suit a feminist perspective, however, I think some students would struggle to see how this section fits within an ethics text. It does illustrate that feminist issues are inevitably ethical issues and that context is inseparable from the issue. There are also some very simple suggestions as to how nurses can address these issues in their practice, which is helpful for making the link back to feminist ethics. As a whole, the three main examples are well thought out and carefully related to nursing practice at a variety of levels.

    The final chapter of the book draws together all three approaches in consideration of care for the frail elderly. This provided a useful summary, although arguments were not developed as fully as they were in previous chapters. This chapter also reminded me of the focus of the book on the United States. It would be important for teachers from other countries using the book, to be aware of the reliance on data particularly relevant to the United States in the arguments being presented. With different health structures in other countries some of the issues may be less significant. Overall, this isn’t a weakness in the arguments presented but may provide a confusing picture for students from other health contexts. The inclusion of codes from the American and Canadian Nurses Associations and contact details for North American bioethics centres in the appendices, also make it obvious that the target is a North American audience.

    On the whole, I enjoyed reading this book and see it as a welcome addition to the currently available nursing ethics texts. It provides a variety that isn’t found in many other books. I would recommend it as suitable for nursing students and for nurses who were interested in exploring the ethical dimension of their practice.