Smith, Russell E.

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The Linacre QuarterlyVolume 58 | Number 1 Article 16February 1991[Book Review of ] Ethics in Nursing Practice: BasicPrinciples and Their Application, by F. J. FitzpatrickRussell E. SmithFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationSmith, Russell E. (1991) "[Book Review of] Ethics in Nursing Practice: Basic Principles and Their Application, by F. J. Fitzpatrick,"The Linacre Quarterly: Vol. 58: No. 1, Article 16.Available at: http://epublications.marquette.edu/lnq/vol58/iss1/16This is a book which deals with homosexuality, its origins and treatment. For those who are involved in this field , it is "must" reading. The book reaffirms in the most practical fashion , the wisdom and integration of the Church's traditional teaching and its applicability to a most difficulty medical syndrome. -John P. Mullooly, M,D. Medical College of Wisconsin Ethics in Nursing Practice: Basic Principles and Their Application F. J. Fitzpatrick The Linaere Center, London, 1988. 290+xii. £9.95 "Divide only to unite" is a philosophical maxim which describes any kind of analysis. One takes something apart in order to understand how the parts work together as a whole. This maxim describes the movement of Fitzpatrick's fine volume on ethics for nurses . First, the author locates a critically important yet widely neglected field of study: the crossroads of nurses' training and ethics. Standard texts on medical ethics have heretofore been addressed to the mixed audience of pre-medical students and nurses . Fitzpatrick's introductory thesis, however, is that nursing ethics is somewhat distinct from ethics for physicians, especially today with high-tech nursing on the one hand and with home care nursing on the other. Once the target audience is specified, he begins in Chapter I with the analysis of the nursing profession, the role and responsibility of nurses. The question of the nurse's identity is immediately raised by analysis of a moral problem: telling patients the truth. "Many moral problems arising in nursing, can be intelligently handled only if one has first determined what the proper role of the nurse consists in." (p. 3). Is the nurse one who primarily carries out doctor's orders or one who is primarily concerned to protect and enhance the well-being and dignity of each person in her care? Is the nurse's primary responsibility to the physician or to the patient? Once the identity question is on the table, Chapter 2 is an analysis of various professional codes of conduct formulated in the UK and Canada. The point here is to demonstrate a code's inability to answer specific moral questions that arise in nursing. Beyond legal constraint and exhortation, there are questions which are properly philosophical. The competence and distinctive contribution of philosophy regarding meaning in life and in one's actions are analyzed in Chapter 3. Chapters 4-6 deal with the nuts and bolts of philosophical ethics. Fitzpatrick maintains that the essence of real basic moral disagreement is over the acceptance or rejection of basic moral principles as (rue. "Is there an objective moral order or is morality a matter of personal taste, like art and literature?" is a basic question. Fitzpatrick argues very competently and thoroughly for an objective moral order. He clearly shows how moral "pluralism" inexorably leads to the absurd conviction that one can have no convictions. (p. 59). He offers a lucid , yet not simplistic presentation and critique of emotivism and utilitarianism. The most telling argument against the latter is that it makes morally obligatory what is generally held to be immoral. (p. 89). Fitzpatrick's negative assessment of the contemporary, largely Anglo-Saxon methodolo-gies of emotivism and utilitarianism lead to his proposition of a moral theory which posits an objective moral order. The author adopts the broader strokes of what he calls the "absolute respect" theory of J. Finnis, G. Grisez. W. E. May and J. Boyle. He presents a very lucid outline of this theory on pp. IOOff. Again, his presentation is simple without being simplistic. 90 Linacre Quarterly Chapter 7 completes the process of analysis a nd begins the process of synthesis. The rarts that were divided and examined now begin to be reassembled . " Moral Character" is the watershed of concern. While Fitzpatrick does not make very clear the relationship between choices - acts - character, this is. nevertheless. obviously his intention . The development of one's character through the moral fabric of one's life is examined here . Also presented are the principles of the double effect and cooperation. and difficulties he has with apparent inconsistencies in the "absolute respect" theories of the authors cited above (r. 127 footnote I) . The principles are presented with concrete examples from the wards of hosritals. Chapters 8 and 9 deal with very practical issues that face nurses all the time: questions of respect due to patients and questions concerning professional honesty and confidentiality. Certainly these are less dramatic but equally urgent issues in nursing care. Fitzpatrick's analysis of human dignity involves an explicit theological reference. That is. he does not think that moral questions regarding the meaning of life (and therefore its inherent worth) can be answered apart from reference to God. This departure from a self-sufficient natural law theory becomes particularly evident in his arguments against euthanasia in Chapter 10. Fitzpatrick presents a very interesting discussion of lying regarding the patient's knowledge of his condition. confidentiality and the use of placebos. Chapters 10-12 deal with life and death issues: euthanasia. the terminally ill. the fatally injured. abortion and the treatment of handicapped newborns. His arguments against euthanasia rest on the theological appreciation of humankind 's limited dominion over creation. Only God calls one from non-existence at conception and from earthly existence at death. Effective argumentation against euthanasia. says Fitzpatrick. rests n a theological component. (p. 197). A real surprise for readers . especially in the USA. comes in his consideration of the terminally and fatally ill. While he leaves open the question of whether to provide artificial nutrition and hyd ration to the "irreversibly comatose" (p. 2 I 3). he also maintains that brain death is not really death (p. 223) and therefore organ retrieval cannot proceed on this assumption. "If the surgeon intends to rely on the brain-death criterion to establish that the donor is dead he will act wrongly in proceeding with the operation. The nurse who cooperates formally with him will also. then. act wrongly." (ibid.) This is a st rong opinion which finds no equally strong current of agreement in the United States. but rather encounters the contrary. In Chapter 13. Fitzpatrick deals with the constellation of sexual issues. Again. he maintains that the inseparability of the unitive and procreative aspects of the marital act cannot be conclusively demonstrated by natural law theory. He employs an explicitly theological argument. For many. it will seem that Fitzpatrick abandons purely philosophical deliberation too quickly. Also. it is in this chapter that the principle of totality is introduced for the first time. In other textbooks , it is taught in relation to the moral justification of surgery. Also. when speaking about artificial insemination and in vitro fertilization . he does not mention the moral distinction between artificial .and assisted insemination. That is a crucial moral distinction brought out in Donum vitae. [ILb.7] One gets the impression that this chapter was written in some haste. Chapter 14 concludes the work. Here, Fitzpatrick offers practical advice for nursing professionalism regarding " blowing the whistle" on the unethical conduct of one's colleagues and on the touchy issue of nurses' strikes. This is a fine volume for the classroom. The subject matter - nursing ethics - is very timely. and very necessary. Ethics teachers in nursing schools will find this to be the answer to their prayers . It is a presentation of ethics specifically for their students' specialty. It is a faithful presentation of the Church's moral teaching applied to the full spectrum of nursing care issues . from professional identity to the necessity of ethical reflection on specific issues in medicine (abortion. surgery. etc.) and back again to professional character and conduct. It is clearly written and divided into manageable chapters and topics. It employs practical examples at every turn taken from nurses themselves. Certain adaptations would have to be made for use in the United States. The Ethical and Religious Diretives for Catholic Health Facilities receive no mention. for example. This February, 1991 91 would be an essential addition to the text if used for classes in the USA. As mentioned above, there are a few surprises along the way. The "Harvard Criteria" for the determination of death, and the report of the President's Commission - not to mention the practice of physicians and the conviction of many philosophers and theologians - stand in sharp contrast to the opinion of the author regarding death. Also , it may be objected that the author too quickly scuttles reliance on natural law when facing questions of the dignity of human existence and the meaning of human choices. These are by no means insuperable difficulties, and the volume is a very welcome and valuable contribution to the field of applied ethics. -Rev. Russell E. Smith, S.T.D. Director of Education Pope John XXIII Center Braintree, MA Abortion and Catholicism: The A merican Debate edited by Patricia Beattie Jung and Thomas V. Shannon New York: Crossroads. 1988.331 pp. $14.95. Paper. The editors of this collection obviously think that the Church's teaching on abortion is erroneous, and that Catholics should be free to hold any position on the subject. They likewise think that their decision to publish a book of this kind is an act of courage, for they have chosen to go ahead with the work despite the fact that by doing so they believe that they are opening themselves to "the possibility of all sorts of vilification" (p. 5). The essays, all of which save that by Anne E. Patrick are published elsewhere, are grouped around the "moral", "political", and "ecclesial" apsects of the abortion debate. The view that abortion is morally permissible, either in a wide or more narrow range of instances, and that it ought to be legally available is championed by the majority of the essays included. The authoritative teaching of the Church on abortion is set forth in a somewhat comprehensive manner in the essay by Archbishop John R. Roach and Cardinal Terence Cooke (originally, this paper was presented to the U.S. Senate as testimony is support of the Hatch amendment). This teaching is also reflected , although quite briefly, in a piece by Thomas J. O'Donnell. A public policy rooted in a respect for the rights of unborn children is developed in an essay by Cardinal John O'Connor. Sydney Callahan, in one of the essays written from a feminist perspective, ably criticizes the fallacies of those who try to justify abortion by appealing to the right of women to control their own bodies, the need for autonomy in exercising responsibility, etc. Nonetheless, because she endorses the use of contracpetives, one can hardly view Callahan's article as a strong defense of Catholic teaching. Essays by Cardinal Bernardin on the "consistent ethic" of life, by John Connery on some problems with this approach and on the significance of innocent human life as being absolutely inviolable, and by Cardinal Ratzinger on the proper relationship between theologians and bishops are also supportive of Church teaching, although they are somewhat peripheral to the precise issue of abortion. But the majority of the 21 easays included are clearly opposed to the teaching of the Church on abortion. What about these? [ shall now try to give something of the "flavor" of the volume. Of the essays supporting abortion as a morally good choice, only one is by a male, namely Joseph F. Donceel , S.J. , whose well-known advocacy of delayed hominization is set forth in 92 Linacre Quarterly 

[Book Review of] Ethics in Nursing Practice: Basic Principles and Their Application, by F. J. Fitzpatrick

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[Book Review of] Ethics in Nursing Practice: Basic Principles and Their Application, by F. J. Fitzpatrick

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