Preface

It is 27 years since the first edition of this book was published, and it is no small measure of the continuing importance of ethical issues in nursing and health care that a demand for this sixth, revised edition exists. In 1989, when the first edition of this work was published, very little had been written on bioethics from a nursing perspective and nursing ethics itself was largely invisible and poorly understood. This situation made it difficult for nurses to have their concerns about ethical issues heard, let alone addressed, and to fulfil their professional responsibilities associated with promoting the moral interests of the individuals, groups and communities for whose health care they shared responsibility.

At the time of its 1989 publication, Bioethics: a nursing perspective stood as the first text of its kind to be written from an Australasian perspective, and it sought to give ‘visibility’ to nursing concerns about ethical issues in health care domains and to remedy the palpable lack of understanding about nursing ethics that existed at the time. It also attempted to give nursing a much-needed ‘voice’ in both the health professional and the bioethics literature, and to ‘defend’ the legitimacy of a nursing point of view. To this end, a key aim (and focus) of the first and second editions was to demonstrate that bioethics was a legitimate professional concern for nurses and one that warranted serious attention by all concerned. In this aim, the first two editions succeeded beyond all expectations.

At the time that the third, revised edition was prepared, much had changed. Nursing ethics had gained legitimacy and respect as a distinctive discipline in its own right and the ‘defensive’ position taken in the first two editions was no longer warranted. Although retaining Chapter 2 (‘Be good women but don’t have a code of ethics’) in which a number of important historical examples of the marginalisation of nursing ethics were discussed, the third edition thus largely abandoned the emphasis placed on defending the legitimacy of nursing ethics evident in the previous two editions. In response to new and emerging developments in the field, the third, revised edition included new and / or expanded discussions on a range of issues including, but not limited to: the changing moral world and its implications for nurses (including the problems of moral pluralism, post-modern ethics, and the demise of traditional moral certainty in health care domains), the history and nature of mainstream bioethics and its relationship to nursing ethics, and the nature and implications of nursing ethics (including a new and more substantive definition of what constitutes nursing ethics and distinguishes it from other branches of ethics). The third, revised edition also included new material on human rights and the mentally ill, ethical issues associated with the reporting of child abuse, and the promotion of ethical practice in nursing. In regard to the last of these, particular attention was given to a range of issues, including: the formulation and enactment of meaningful standards of ethical nursing conduct, providing preventive and remedial nursing ethics education programs, ethical management and improving the moral culture of the organisations in which nurses work, supporting nursing research and scholarship, and taking political action aimed at achieving public policy and law reforms to facilitate the ethical practice of nursing.

The fourth, revised edition marked a significant turning point in nursing ethics in that it served not only to inform but also to revitalise and progress debate on the issues presented. To this end, several chapters were entirely new, or contained entirely new material, and others were greatly rewritten; still others had been removed altogether as, over the past decade, their relevance had declined or they had been addressed appropriately and comprehensively in other forums. Notable among the revisions made in the fourth edition (and which distinguished it from its previous editions) were those contained in the entirely new chapters: Chapter 1, which addressed the topic ‘Professional standards and the requirement to be ethical’; Chapter 14, which raised the issues of nursing ethics futures and the need for nurses to engage in moral activism; and Chapter 15, in which the challenges posed by considering the concerns of Indigenous peoples were presented as a ‘final word’ to the edition. Meanwhile, the discussions on the popular issues of: transcultural ethics, patients' rights (especially in regard to informed consent and competency to decide, and quality of life), mental health ethics (including new material on the use of psychiatric advanced directives or ‘Ulysses contracts’), abortion (and the ‘new abortion ethics’), euthanasia and assisted suicide (including the issue of withholding / withdrawing food and fluids from sedated patients), end-of-life decision-making (including new material on medical futility, advanced directives, and quality of life) and clinical ethics committees were all substantially updated and, where relevant, expanded. The theoretical underpinnings of these issues were, in turn, modified to ensure that they were articulated succinctly and in a manner that could be readily understood and applied. In this regard, the more complex discussions on ethical theory contained in the earlier editions were removed. Despite these major changes, the essence and methodological starting point of the work had not changed – that is, the lived realities of nurses and nursing practice. Accordingly, the fourth edition increased significantly its collection and discussion of case exemplars pertinent to everyday nursing practice and the ethical practice of nursing.

The fifth, revised edition built on the new focus achieved in the fourth edition, but with some notable refinements that were reflective of the 21st century and some of the ‘new’ ethical issues arising in this period. Issues of particular note were: ectogenesis and artificial uteruses, abortion terrorism, cybersuicide (pact suicides or suicide attempts influenced by the internet), psychiatric euthanasia, and ‘climate change euthanasia’ (after the euthanasia of four elderly patients stranded in a hospital in the aftermath of Hurricane Katrina in the US city of New Orleans in 2005). In an attempt to improve the capacity of nurses to respond effectively to the many modern ethical challenges they face, a much stronger emphasis was placed on the principles and standards of human rights and social justice in health care. To this end, new material was added on the topic of ‘justice as reconciliation and reparation’ and its emphasis on ‘healing rather than hurting, moral learning, community participation and community caring, respectful dialogue, forgiveness, responsibility, apology and making amends’. The problem of ‘unrestricted isolated individualism’ (also called ‘rampant individualism’) and the need for people to exercise their moral rights responsibly was also considered. Other issues given renewed attention in the fifth revised work were: quantum ethics (based analogously on the principles of quantum physics) as a means of fostering a cooperative and creative approach to ethical relationships, ethical decision-making and resolving moral disagreement in health care contexts; racism and the right that peoples of diverse cultural and language backgrounds have to cultural liberty (that is, the right to maintain their ethnic, linguistic, and religious identities); the problem of stigmatisation, prejudice and discrimination against people with mental illnesses; ‘psychiatric wills’ and advance psychiatric directives; ‘Not For Treatment’, advance care planning and ‘respecting patient choices’; and patient safety ethics and the moral responsibility of nurses to identify and report nursing errors.

This sixth revised edition of Bioethics: a nursing perspective builds on the discussions and thought advanced in the fifth edition and reflects the increasing maturity and sophistication of nursing ethics discourse, locally and globally. Following a substantial review and revision of the book's chapters a clearer understanding is advanced on such topics as: ethical conduct, unprofessional conduct, and professional misconduct; ‘morality politics’ and the nature and influence of public opinion on ethical issues in health care (e.g. abortion and euthanasia); the importance of distinguishing between ‘wants’ and ‘needs’ in ethical decision-making; the characteristics of ‘good’ ethical decision-making and moral judgments in practice; and processes for preventing unnecessary ethical conflicts in health care domains. Of particular note, however, is the inclusion of entirely new material pertinent to contemporary nursing practice in an increasingly complex world – for example, in Chapter 6 ‘Ethics, dehumanisation and vulnerable populations’ (in which critical and unprecedented attention is given to the notions of vulnerability and dehumanisation and their critical relationship to the stigmatisation and prejudicial and discriminatory treatment of certain groups of people such as: older people, people with mental health problems, people with disabilities, ethnic minorities, refugees, asylum seekers and stateless persons, Indigenous peoples, prisoners and detainees, homeless people, and LGBTI people); Chapter 12 ‘Professional obligations to report harmful behaviours’ (which has, as its...