Do you agree with Gordon and Turner’s arguments that principlism is an inherently

western notion that does not apply to other cultures or communities or do you think that
the values enshrined in it (e.g., autonomy, beneficence, and justice) are universal?

Nurses play a pivotal role in the advocacy of clients in promoting standard quality care. The idea
of principalism is based on four ethical commitments - respect for autonomy, beneficence, non-
maleficence, and justice. This paper will discuss on the Gordon and Turner’s arguments on how
western perspective on principalism is not applicable to non-western communities. In my
opinion, although the standard ethical framework of principalism has been considered universal,
the ethnicity factors do play a predominant role in delivery of quality care to the people.
Nurses as health care providers are agents in promoting the principle of autonomy .nurses are
taught to value and respect the beliefs of an individual that aid in ethical decision making.
For instance ,John-Stewart Gordon states that “the principle of autonomy, in regards to the idea
of individual informed consent has a strong Western bias, and hence cannot be applied to non-
Western countries such as China, Japan, and most African states in which family- or community-
informed consent is prevalent” (Gordon, 2011). The above argument that Gordon argues is true,
as not one ethical principle can be implemented without taking into consideration the facts of
ethnicity of a group.
Perihan et al 2017 has emphasized in the research paper on the ethical dilemma emerging from
the argument on the principal differences on the concept of respect for the autonomy of
individuals in different cultures and religions. Some communities prioritize the consent of
community leaders or the head of family – usually men – over the voluntary and free consent of
the individual.
CNPS 2009 states that Nurses,
along with other health-care providers and substitute decision makers, consider and respect the
best interests of the person receiving care and any previously known wishes or advance care
planning that applies in the situation (CNPS, 2009).
Most ethical decisions in regards to medical intervention is considered to be a collective process
rather than an individualistic one. For instance, according to the African Ubuntu philosophy,
disclosing health information to the patient on the critical stage of disease, instead of informing
relatives, would be considered offensive behavior that might impact the patient’s desire to
survive, whereas in Western culture, it is regarded as showing respect to the autonomy of the
patient.
On the contrary, in Western culture, it is a violation of privacy and confidentiality if the patient
participation in a research trial was disclosed to his kin without his consent.
A similar family approach to ethical decision making is seen in Japanese Asian community. For
example, the Japan Medical Association 2009, states that many families in Japan have strong ties
among members, and the patient and his/her family support each other which requires the health
care provider to give detailed explanation of the disease name and condition to family members
as well. If the family objects to the disease name and condition being disclosed to the patient, the
physician should try to persuade the family to understand the need for explanation to the patient,
unless the physician considers such disclosure is detrimental to the patient.” (Japan Medical
Association, 2009) .The western perspective might critique the Japanese approach as it
contradicts the individual’s right to self-determination of autonomy.

In addition, Leigh Turner,2003 argues that the principalist ethical model heeds less attention to
the historical analysis of cultural norms and religious commitments” and instead focused on what
“‘ought’ to be done than attending to how an individual’s such as patient, family members of
patients, health care providers, and administrators understood and experienced specific topics
and situations” (Turner, 2003). The result of the more recent “anthropological turn in bioethics”
is the revelation of “cross cultural variation in understandings of what constitutes ‘reasonable,’
morally defensible social practices. What is interpreted as responsible, caring conduct within one
community is sometimes regarded as callous and cruel behavior by individuals encultured into
different moral norms and patterns of social life” (Turner 2003).
Furthermore, it clearly arises from the fact that nurses as health care providers has the power to
galvanize ethics into action. Nurses are accountable to uphold principles of justice in
safeguarding human rights, equity and fairness and to promote public good.
For instance, Madeleine Dion Stout, RN (2015), worked to address the need for Indigenous
population to develop their own determinants of health, than accept the values of the colonizer
society. She stated how the Indigenous people will move forward to reclaim their health and
well-being. In her words (Cree and English):
“kaskitamasowin miýw-āyāwin is health and wellness we have conjured up and created for
ourselves. kaskitamasowin miýw-āyāwin means achieving health status that we wish upon
ourselves and for our families, communities and nations. We achieve kaskitamasowin miýw-
āyāwin with our own will and abilities and with the resources we have at our immediate
disposal. kaskitamasowin miýw-āyāwin comes from our inner strength, inner forces, and inner
voices (p. 145)”.
In conclusion, the idea of principalism: four basic prima facie moral commitments : respect for
autonomy, beneficence, non-maleficence, and justice cannot be implemented without
considering the intercultural, social, spiritual aspects of diverse ethnic communities . Nurses,
play an intrinsic role in delivering standard access to health care service to the people. Therefore
standard of ethics in nursing practice are inevitable in regards to ethnicity of diverse
communities.
Bibliography:
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