Metaphysical justifications  of  normative  ethics for nurses   

Andrzej Brodziak    

Abstract   

The careful  inspections of the content of the educational programs and  manuals, as manuals of  normative  medical ethics reveal, that however  the appropriate behavior of nurses and doctors is  described  and indicated,  but there are lack of arguments about  reasons which should incline  them  to this kind of behavior.   

The question arise  if the  normative standards of medical  profession could be  deduced  or derived from some " metaphysical assumptions ".  It seems that, this kind of  inference, deriving " rules of ethics " from metaphysics  could  persuade  the medical adepts  more effective to obey the normative  ascertainments.   

The authors  try  to  link some metaphysical theories with recommendations for  medical, normative, ethical principles. They  propose to  interrelate the old Aristotle concept of 1. virtue ethics  with the 2. necessary  endeavors of  the assumed Creator of the Universe and  3. His  probable need  to call up a  special group of people, undertaking the mission  to care about the condition ( health) of  living human beings.   

The authors try also to search for metaphysic rationale for  the value of human dignity, what could be also useful to support claims of authors of  normative medical  ethics. They  ground human dignity on modern substantiations  of the meaning of life  based on the cosmological role of conscious beings.   

Introduction  

The reasons  why people  expect the ethical, even friendly attitude  from the side of  nurses  staff are obvious. Only thoughtful, careful, mindful and friendly attitude of  medical professionals  secure the right course of diagnostic and therapeutic activities, our security,  when being a patient   and  our  comfort and a good frame of mind in contacts with  medical institutions.  

The citizens, the patients expect this kind of ethical and friendly attitude. So,  during  the study of   nursing  students are  informed and   educated  in the realm of so called normative ethics for professional nurses.    

It is interesting and important  to inspect  the arguments,  presented  on nurse school  courses of normative ethics, which aim   to convince  adepts of  nursing   to  comply  to these social expectations,   related to this  thoughtful, friendly attitude. We could also   review the manuals and publications of these subject of study and examine the why of argumentations for ethical attitude [1,2,3,4].

In our  opinion, and according to our  experiences -  the careful  inspections of the present, real content of the education of the mentioned subject of study - proves that the appropriate behavior of nurses  is  described  and indicated,  but there are lack of arguments about  reasons which should incline  them  to this kind of behavior.   

It is known  that   among so called classic theories of ethics there are some,  even actually widespread ethical systems,   based on the principle that  the  rules, which should be obeyed where determined by God, and another justifications are not necessary. The Christian, Jewish and Islamic ethical system  have these features.    

It seems that the  statements of normative  medical  ethics have the same status. It means,  its  authors  talk  about  moral standards, without explanations why it should be obeyed.  For example, in  the English Wikipedia entry.:  " Medical ethics " it can be found that .:   

[" Medical ethics shares many principles with other branches of healthcare ethics, such as nursing ethics. Ethical thinkers have suggested many methods to help evaluate the ethics of a situation. These methods provide principles that doctors should consider while decision making. Six of the principles commonly included are:   

1. Beneficence - a practitioner should act in the best interest of the patient. ( Salus aegroti suprema lex ) …   

2. Non- maleficence - " first, do no harm" (primum non nocere). ….

3. Autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.) 

4. Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment.  

5. Dignity - the patient (and the person treating the patient) have the right to dignity.   

6. Truthfulness and honesty - the patient should not be lied to, and deserves to know the

     whole truth about his/her illness and treatment…."]

Some  important points  should be  however emphasized and discussed.:

(1)  Irena Wronska  remarked that  attitudes of nurses,  at least in Poland  are based on

      religious background [5]. The problem emerges if  indications for an  appropriate

      behavior of  nurses result from  Christian or Jewish ethical  set of   commandments. It is

      not so easy however to dwell all  normative ethical rules  from these orders. The inquiry

      is needed  if  they  are  justify yet in another way?

(2) Even in the case, when particular normative principles  results from mentioned

     commandments  the question arises  if   such argumentation  really effectively influences

     adepts of nursing study.        

(3) The justification  of  some known, classical ethical theories, like Plato ethics, Epicure 'ian

      hedonism, Aristotle ethics, Stoicism, Kant's ethics, Spinoza's ethics, Utilitarism -  are

      based on another principle then  normative statements. Many  classical theories are based

      on  assumption  that they should  determine principles of behavior, which  will cause

      that  the life  according to  these principles will be " good and happy ". Majority of these

      classical  ethical theories are derived from " metaphysical assumptions ". 

(4) So, the question arise then - if the  normative standards of nurse  profession could be

     deduced  or derived from some " metaphysical assumptions ".  It seems that, this kind of

     inference, deriving " rules of ethics " from metaphysics  could  augment the effectiveness

     of the normative statements. In another words,  probably this kind if inference could

     persuade  the adepts of nursing study   more effective to obey the normative

     ascertainments.        

Original propositions of the inference linking metaphysics   and normative medical ethics   

We  try to propose, in  this article just this kind of  reasoning , which  could link some metaphysical theories with recommendations for  normative, ethical principles.  

We  try to interrelate the old Aristotle concept of 1. virtue ethics  with the 2. necessary  endeavors of  the assumed Creator of the Universe and 3. His  probable need  to call up a  special group of people, undertaking the mission  to care about the condition ( health) of  living human beings. Additionally,  we  try to search the  metaphysic rationale for  the value of human dignity (  an absolute inner worth ), what could be useful to support claims of authors of   normative medical  ethics, who incite to abide  human dignity, however without discussing its  source.     

Practical relevance  of  moral virtues    

Our  reasoning was inspired first  by readings about relevance of old concept of values  of virtues in  medical ethics.   

T. Biesaga  remarked   recently that  since the years 60 -ties of  former century, we found  in the literature dedicated to ethics,   again much attention  devoted to virtue  ethics, it means to personality  features like " good character, " good motives  and intentions of  actions "  of   a human subject [6]. This relatively recent  discussion was stimulated  by the very known  article of  G.E.M. Anscombe.:  " Modern moral philosophy ". Her ideas developed later E. Pellegrino [7]. These  authors   points out  that bad condition  of  contemporary ethics, results from theories  dominated by  Kant's  formalism and  ideas of   Utilitarism. Anscombe  undertaking  once more consideration of  Plato's and Aristotle's,  as well as St. Thomas concepts of  virtues maintains that  it become aware to us  how much  negative was  renunciation of  these concepts. The resignations from  insistence,  during education,  on acquirement  of   excellence, effectiveness, and  right inclinations   played part in contemporary  poor state of morality.   

Probably ancient philosophers revealed aptly that   " ethics in practice " should consists   on endeavors to became " a good human "  and to " behave  in a right way ".  It means that it is indispensable   to develop own character, will, train own mentality in the recognition of truth  and ability  to love and  realization of right and good things [7].     

T. Biesaga opines,  that both, post -  Kant' ian ethics, which refer to  formal, bald  dictations  and utilitarian ethics propagating  cuteness   in arrangement of  own  advantages and benefits cannot constitute convincing basics of medical ethics [8].  First of them professed  obedience  and allegiance for  conventional principles and second one  propagated egoistic attitude. Moral development  a people was neglected. These theories were oriented towards assurance of  social  peace  and economic prosperity. They assumed that  it is not necessary to be a good man  to be a good politician, lawyer, teacher, physician. In this way,   people  acceding  to the highest posts in society feel  released  from moral requirements.   

Of course the incitement to develop the moral virtues  would be  ineffective, if a deep, social and psychological  justifications for this kind of effort didn't exist. Aristotle idea of virtue arises  from his general assumption on the nature of the World.  His metaphysics foresees  that any object of the Universe pursues  to its natural  place. So, Aristotle assumed that the moral development  is consistent with  the  natural  behavior   any human beings. Anyhow, it is a fact that  human personality change or develop during human life. From the other hand, really the incitement of right, positive moral standards probably would be ineffective without another element of the social system, which  relay  of development of the positive personality traits, it means moral virtues.    

Necessary  endeavors of  the assumed Creator of the Universe and  His  probable need  to call up a  special group of people, undertaking the mission  to care about the condition ( health) of  living human beings.   

The next step of our  inference  needs  remainder of  main theses of Hypocrites oath and,  what is more important considered  of  justifications of this swearing [ 9-11]. The mentioned  author T. Biesaga  wrote in  his another  article  that a  physician taking  an oath  in the face of gods, emphasizes  the  specificity of  the undertaken mission [9].  The representatives of  medical professions  turn out  something important and  exceptional. Undertaking of  specific commitments  requires   presence and cooperation with medical community  and  recall to supreme beings, who guide  the fate of the world.   

Medical practice, in this context occurs  to be not an ordinary job but rather the special mission, life vocation. The responsibility in the face of  people is amplified by responsibility in the face of  God…  

It is well illustrated by the  known, so called  prayer  of  Majmonides ( 1135 - 1204 ). Undertaking the  mission of a medical professionals , he declares .: ' God !  You  nominated me to watch  and care  the life and death of  Your creatures. .. So, I am ready to sustain  my vocation ' .. Then, Majmonides supplements  the declaration of   readiness  to undertake the mission  -  by the plea of  God's  assistance  in  compliance  of  this mission.  He says .: ' Endow me by the force and power  of my heart and mind  that I could  serve my medical help to rich and  poor, do good people and bad people, to friends and  enemies, that I could see  in  my patients only  somebody ( neighbor ) who suffer  ' [9]    

It seems then, that to continue our endeavor to deduce the medical ethic from some  metaphysical theories, it will be useful to consider  all metaphysical theories,  which assume that the  creation of  our Universe by Someone  really happened [12 -14]. It is important to remark that this assumption is present not only in  Jewish, Christian and Islamic monotheistic religions, which are, from other side also metaphysical  theories. The creation by hands of so called Demiurge  is assumed  also in Plato's metaphysics and in stoicism  metaphysics [12,13].   

The  creation by some kind of superior intelligence  is discussed also  by authors of modern cosmological theories  [14,15,16]. These discussion was began by the formulation of so called strong version of the Anthropic Principle [14]. The actually predominant cosmological model of so called inflationary Universe was developed  by Alan Guth [15 ]  He and Michio Kaku  argue that inflationary cosmology strongly suggests the presence of a multiverse [15,16]  Alan Guth  and Michio Kaku  speculated also  that a very advanced civilization  might create fine-tuned universes in a continuation of the evolutionary drive to exist, grow, and multiply[15,16]    

Further assumptions, related to  the act of creation  probably should  emphasizes,  that  bringing  into being  of the  Universe   it is a very difficult  and sophisticated  task. Probably the most important and essential  element of the Universe  is the phenomenon of life, biological life, living organisms. The human beings are probably  the most sophisticated elements of the Universe.   

So, if the existence of human beings is one of the most important  task in the act of creation, it is  plausible  that the Creator  looked after the special group of people,  who  would have the mission to taker care  about continuation of the life chain and the good physical and mental condition of living beings. So by this fact,  the physicians and nurses are really a very special and important group of people, realizing an essential mission.   

Moreover the  realization of this mission  would be not effective, if this selected group of people will be not characterized not only by  possession   of knowledge about  anatomy, physiology, diagnostics and treatment methods, but also by the fact that they  develop all the set of  right  moral virtues. T. Biesaga  enumerates  among these essential moral virtues  such characteristics like.:  fulfill of  promises,  avoid  unfair advantages,  intellectual honesty,  compassion, preoccupation about others,  courage, justice,  discernment [8].    

The presented inference is valid  independently  of assumed concept of the creation of the Universe. Our arguments function well not only  in the context of cosmogony of  most wide - spread    monotheistic religions, but also in the context of  Plato's metaphysics, metaphysics of stoicism, Hegel's concepts and even in the light of  Spinoza's pantheistic vision of the Universe. The argumentation  is  compliant also with recent  new cosmological visions of the cyclic reproduction  of  the  Universes  incited end tuned by habitants  of  former version of the universe.[19,20]   It is  a separate question if  there are another  favorite  groups  of  people, who undertake special missions  important for the success of the act of creation.   

Metaphysic rationale for  the significance of human dignity  

The authors of   normative medical  ethics, claims that medical professionals, doctors and nurses  should abide human dignity. The review of manuals and publications seldom discuss  sources  or justifications  of human dignity.  Simple question arises  .: " Why we should respect or even cherish dignity of any humans? " These authors  refer sometime to the school  of XX century philosophy  called " personalism ".  Borden Parker Bowne,  one of  founders of  this  philosophical branch of liberal theology stated that  " it is impossible for the entire universe to exist apart from a person to experience it. Ontologically speaking, the person is “larger” than the universe because the universe is but one small aspect of the person who experiences it…".   

It seems that  it is easier to search for  sources of human dignity, taking into account.:

1. relative recent,  in Earth history occurrence of self-awareness ( consciousness),

2. interaction  between our medical ( physician, nurse) observer's   consciousness and  patient's consciousness,

3. participation of  any human beings in the creation of so called collective consciousness.    

If we will reconcile  syncretic attitude probably the "personalism" could by enhanced  by ideas proposed by Pierre Teilhard de Chardin [17].  He  presented in  his famous, posthumously published book " The Phenomenon of Man "  the theory of the formation of noogenesis. This term denotes  the emergence of collective  mind, which  follows geogenesis (beginning of Earth), biogenesis (beginning of life) and anthropogenesis (beginning of humanity). According to Teilhard, the process of noogenesis moves from mind through spirit and converges to an ultimate goal, which  he describes as the Omega Point.   

In another words,  Teihard was the proponent of so called  orthogenesis, the idea that evolution occurs in a directional, goal driven way. To Teilhard, evolution unfolded from cell to organism from  planet,  solar system to whole-universe, according to the concept of Gaia theory. He postulated  a goal to the process of evolution. He understood the drive to reach the Omega Point as " Christogenesis ", the genesis of the "total Christ", or the pleroma. People according to him are the constituent elements of this process.  The theories formulated by Pierre Teilhard de Chardin, however controversial but anyhow develop considerations of the essence of  a person, of the human.   

The concept of  Omega Point Theory  was bring together  with modern physics and cosmology  by Frank Tipler,  one of author of so called Anthropic Principle [14].   

Frank Tipler is  also the author of the book sub title: " The physics of immortality - Modern cosmology, God and the Resurrection of the Dead " [18].  He presents in this book a trial to search for meaning of the human life. His vision of cosmological development foresees that the descendants of people will build, in the far future, the huge macro - cyber system ( information processing system )  based on the matter of the collapsing universe. It will enable the emulation ( reconstruction, in fact resurrection ) of all people who lived before.   

From other hand, the cyclic cosmological model leads to conclusion, that the former version of the Universe could be the creator of the next realization of the Universe or  sub - universe.   

The authors of so called strong version of the Anthropic Principle pay attention that the universe can be "tuned" in a way to enable the occurrence of biological life and conscious people. Moreover, the universe can be "fine tuned" to force it to arise in a particular shape and form with particular, desirable features.   

The hypothesis was proposed  that descendant of the inhabitants of the present Universe will participate in the tuning of the next version of the sub-universe.[19,20] Of course this concept determines the important and difficult tasks for living people and by this way explain the meaning of their life. This hypothesis assigns different kinds of life missions for various professions or people of various human mentalities and life styles.   

By this way,  it is possible to consider basic religious ideas in a rational way. It is possible to propose a kind of integration of reasoning leading to the theory indicating the possible meaning for the human existence.   

The status and importance  of any human beings is conceived  yet greater in view of mentioned theories of " fine tuned Universe ", when we will assume that anybody of us is participating in the re -creation of  new version  of the Universe.     

References    

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      [ see also   http://www.angelfire.com/ga3/gean/cosmolife.htm ]  

20. Gardner J Biocosm:the new scientific theory of evolution: intelligent life is the architect

      of the universe", Makawao, Maui, Inner Ocean Publishing Inc., distributed by Publishers

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