Book/media reviews
Book/media reviews
Nursing ethics (Fourth edition)
Thompson, Ian E, Melia, Kath M, Boyd,
Kenneth M (Editors)
Churchill Livingstone, Edinburgh, 2000
ISBN: 0443061475, 404 pages
Price: £19.95
This book is a welcome addition to the shelves
of those involved in teaching ethics and to
students who wish to study the subject. It is by
no means a ‘new’ book in the sense that this is
the fourth edition and the writers are well
known in the field of ethics. It is indeed ‘new’
in the sense that it is updated and developed
way beyond the original volume first
published in 1983.
The book is aesthetically well laid out and
very reader friendly. It is written in an
accessible style and the pages are designed in
such a manner that pages of endless text do not
overwhelm the reader. The many boxes and
tables presented throughout the text help in
this respect. Each chapter clearly sets out what
the reader can expect to gain by engaging with
the material and the helpful notes on teaching
and learning methods are an important
resource to teachers. Further reading
suggestions and chapter endnotes are most
welcome. The text contains a helpful glossary
of ethical terms, appendices and a
comprehensive subject index.
Of particular personal interest is the
relegation of moral theory to the end of the
book. The authors suggest from the outset that
ethics, understood as ‘the systematic study of
the means we use to justify moral actions’ (p.
291) is different from the ‘critical study of the
theoretical underpinnings of our moral
systems, beliefs and principles’ (p. 291). The
point is made clearly that moral theory has
little or no part to play in illuminating the
choices of action in a given micro situation. The
relevance of moral theory they argue does not
become significant until it comes to
formulating policies and procedures to address
the concerns of wider society. Whilst the book
is clearly aimed at being practical and spells
0260-6917/03/$ - see front matter ª 2003 Published by Elsevier Science Ltd.
out the expectation for making well grounded,
ethically sound decisions, I would offer a plea
for consideration of the notion eloquently
expressed by Downie and Telfer (1980) using
the metaphor of music theory. In considering
the role of moral philosophy and its relevance
to practical morality the exemplar offered by
them is that the study of the structure of music
could be considered solely as a theoretical
activity. While some players may produce their
music intuitively, a performer with knowledge
of music theory will have a better overall
mastery of the music being played and
interpreted. The implication offered indicating
that moral agents with some comprehension of
moral theory will execute a more informed
awareness of morality in their actions.
Notwithstanding, the book is a valuable
resource, is competitively priced and should be
firmly on recommended reading lists.
References
Downie RS, Telfer F 1980 Caring and Curing. Methuen,
London
Althea Allison
Senior Lecturer, University of Reading,
Whiteknights, P.O. Box 217,
Reading RG6 6AH, UK
doi:10.1016/S0260-6917(02)00210-1
Practical Nursing Philosophy—The
Universal Ethical Code
David Seedhouse
John Wiley & Sons Ltd, 2000
ISBN: 0-471-49012-1, 208 pages
Price: £16:99
Contributions by David Seedhouse to the field
of health care ethics are noteworthy. As an
academic philosopher offering his insights into
the practice of health care, his output since
1985 has been prodigious: 10 textbooks and
numerous book chapters and academic papers.
Nurse Education Today (2003) 23, 159–164 159
Book/media reviews
In Practical Nursing Philosophy, Seedhouse
turns his attention to the practice of nursing
and provides a more focused development of
arguments made previously.
Seedhouse’s central argument is summarised
in the second part of the book in a chapter
entitled ‘nursing’. Nursing’s current use of
philosophy is leading the profession on endless
pursuits of definition and self-identity. Instead
of asking the question ‘what is nursing’s
essence?’, Seedhouse suggests instead posing
the question ‘what is nursing’s purpose?’ This
is, of course, a rearticulation of Karl Popper’s
essentialism/nominalism critique of Platonism
made famous in his The Open Society and Its
Enemies (V.1, 1945). For Seedhouse, the
solution lies in making nursing, and ethics in
particular, practical in a way that exposes the
redundancy of other, so-called abstract
philosophising.
What support is offered for this argument?
In the first half of the book, Seedhouse sets out
to examine what he sees as the practical failure
of nursing philosophy. Four chapters outline
and expose what Seedhouse sees as the ‘big
ideas’ of nursing: advocacy, care, dignity,
holism and separatism. Nursing philosophy is
termed ‘weak’ as a result of its loose
examination of ideas and pursuit of ‘fad’ ideas.
This is in contrast to the academic discipline of
analytical philosophy in which rigour,
precision and clarification of terms characterise
the quest for truth.
Although claiming the merits of using both
nursing philosophy and analytical philosophy,
Seedhouse’s analysis does not fully convince.
In language frequently intemperate, the
weaknesses of key schools of nursing
philosophy are critiqued and exposed. In the
chapter on advocacy, for example, the practical
insights of analytical philosophy are almost as
tendentious as the nursing philosophy
perspective which it seeks to replace.
Chapters on caring and dignity fare rather
better in their call for ‘governing theory’ of a
cognitive sort to balance out relational/
existential perspectives. Seedhouse posits a
nursing hierarchy as one way of taking the
moral ends or purposes of nursing forward.
Criticising the narrow domain in which much
ethical reasoning is to be found (the ‘Ethics
Myth’), the Universal Ethical Code focuses on a
160 Nurse Education Today (2003) 23, 159–164
simple double hierarchy of, firstly, health,
dignity and caring and, secondly, of advocacy,
research and communication.
This reviewer has two main problems with
this text. Firstly, in asking the question ‘who is
this book for?’, I think that the author actually
does a disservice to the cause which he trying
to advance. Nurse philosophers, many of
whom are in the business of clarifying and
expanding ideas relevant to practice and doing
it well (see, for example, the pages of the
journal Nursing Philosophy), will not
necessarily react well to Seedhouse’s partial
dismissal of their endeavours.
Practising nurses will struggle daily with the
issues which Seedhouse so well describes in his
case studies. But are they likely to understand
ethics better from a text which omits all
mention of philosophical language in favour of
complex grid illustrations?
Aristotle, Plato, Descartes, Kant, Mills,
Nietzsche, Popper and Wittgenstein place
considerable challenges upon curriculum
development, but their ideas are far from being
uncommunicable by able interpreters and
teachers. As an illustration, Seedhouse rightly
positions ethics within a wider moral
framework which demonstrates the limitations
of nursing as a distinct activity. However, his
discussion on relationships (in particular,
caring) would have been sharpened
considerably by recent reference to nursing as a
moral community and the contextual virtues
required for practice. Reference to philosophy
past (e.g. Aristotle, Plato) and present (e.g.
MacIntyre, Hauerwas) would have done much
to link philosophy with practice here.
Secondly, Seedhouse’s quest for a functional
view of nursing is not easily demonstrated
here. The essentialism/nominalism debate
highlighted by Popper has vast repercussions
for nursing and for nursing education.
Although Seedhouse pleads for an
understanding between nursing philosophy
and analytical philosophy, it is this reviewer’s
suspicion that this is not the text to provide it.
Andrew McKie
Lecturer in Nursing
The Robert Gordon University
Aberdeen, UK
doi:10.1016/S0260-6917(02)00134-X
ª 2003 Published by Elsevier Science Ltd.