Author: Vangie Bergum and John Dossetor |
The
authors of this evocative text assert that relationships are the location for
ethical action and that human flourishing is enhanced by healthy and ethical
relationships. They also contend that professionals are characterized by
commitment to relationship – with the people they serve and with each other. In
our world of modern healthcare, however, this commitment to relationship can be
obscured by an emphasis on advanced technology, consumerism, legal liability,
bureaucracy, objective rationalism, and individual autonomy. The aim of this
book is to refocus healthcare ethics on the nature and significance of
relationship.
By
delineating a comprehensive and philosophically grounded relational ethic for
healthcare, the authors call us to attend to the art of ethics. The focus of
relational ethics is on whole people as interdependent moral agents and the
quality of the commitments between them. The space between people is defined by
the authors as the ethical space or the relational space, a space that must be nurtured
and respected if ethical practice is to be enacted. Attention is focused on the
particular, the context, the process, and the dialogue.
In the second chapter of the book, the
authors drawn from the works of Sally Gadow and Edmund Pellegrino to situate
their relational ethics approach within the context of the historical
development of bioethics knowledge and theory in the Western world. Relational
ethics is presented as a timely, progressive, necessary approach that builds
on, rather than undermines, the usefulness and importance of ethical theories,
normative ethical principles, virtue ethics, feminist ethics, and ethics of
care. The authors contend that knowledge of each of these approaches to
healthcare ethics is vital yet is insufficient without a fuller exploration of
the relationships within with the ethical moment is enacted.
Ethical principles are described as
the means by which we come to know and to attend to the bones of the person -
the general, objective part. Through a relational ethics approach, we can put
the flesh on the bones of personhood.
The ideas in this book emerged from a
Relational Ethics Research Project that started in 1994 at the University of
Alberta. An overview of the project, including its intents and purposes,
origins, methods and procedures, and outcomes, is provided in chapter one. Over
the course of this project, a group of professionals and academics, the
Interdisciplinary Research Group, regularly gathered together to discuss
prepared scenarios and ponder how to nurture ethics in health care. These
discussions were audio taped, transcribed, and analyzed for themes using
interpretive methods within the tradition of phenomenology and hermeneutics.
Excerpts from these transcripts are included throughout the text to help
illustrate the concepts presented.
In chapters three through six, the
major themes identified in the research project as describing the nature of the
ethical relation in healthcare are contemplated in depth. The authors use
engaging stories – expressions of ethical moments – to bring each theme to
life. The stories illuminate the reality of personal human experiences and the
importance of relationships, and help us understand how ethical healthcare is
practiced. The four major themes developed in the book are mutual respect,
engagement, embodiment, and environment. Mutual respect is identified as the
central theme of a relational ethic. Respect is described as interactive and
reciprocal, with an emphasis on respect for and acceptance of difference. In
coming to mutual respect, there is a need to be both respectful of others and
also respectful of oneself. The theme of engagement implores the cultivation of
a sensitivity that promotes authentic connection. True presence, personal
responsiveness, and empathy are key components of engagement. In the theme of embodiment,
the feeling body is integrated with the thinking mind. Scientific knowledge and
human compassion are given equal status and the importance of emotion and
feeling in ethical action is appropriately accredited. The theme of environment
expands the concept of the relational space beyond the individual level and
explores the web of relations that tie the individual to the health care system,
the community, the globe, and the earth. Two additional themes - freedom and
choice, and uncertainty and possibility - are explored in less depth in the
text. The authors suggest that the individualistic freedom of liberal
philosophy must be linked to responsibility to our larger community. They also
contend that the relational space is an ambiguous space without certainty and
that this uncertainty can open possibilities and contribute to good outcomes.
This text represents a significant
contribution to the body of health ethics literature, arguably the most comprehensive
overview of relational ethics published to date. While the authors concede that
the writing may be characterized by ambiguity and complexity, the inclusion of
narrative helps bring the content to life and make it more accessible to the
reader. Bergum and Dosseter have set out to offer a text that may do something
to us – encourage us to act more thoughtfully, to ask more questions, to continually reflect on how we relate to
others, and to develop an attitude of deep respect for the ethical practice of
human relations in healthcare. They have tried to open the possibility of
causing an epiphany – a sudden shift in perspective that changes the way
something is understood. To these ends, they have admirably succeeded.
Developing a Relational Ethic |
According this http://www.slideshare.net/psychbuilder/relational-ethics, there positive ethics and remedial
ethics. Positive Ethics is an
ethics as a movement away from the punishment and anxiety - producing
components of ethics, fulfill their highest ideals and a means to help
interpret and apply ethics standards. Remedial Ethics is overemphasis on
regulations and enforceable standards,” thou
shall not” oriented, minimum standards or the “ethical floor” and incomplete view of ethics. Relational Ethics –
occurs within the therapeutic relationship, commitment to the relationship and
high quality of care and pulling together the code, your training, and current
professional role within the context of the relationship with patient. Ethics
happens within the relationship, active approach to ethics, the relationship,
and decision – making and combines psychologist factors with clinical features.
Competence- as on example: Remedial – acquiring
and maintaining minimal formal qualifications. Positive – striving for highest standards includes self- awareness
and self – care and emotional competence.
According to http://en.wikipedia.org/wiki/Ethics#Relational_ethics,
Relational ethics are related to an ethics of care. They are used in
qualitative research, especially ethnography and authoethnography. Researchers
who employ relational ethics value and respect the connection between
themselves and the people they study, and "between researchers and the
communities in which they live and work" (Ellis, 2007, p. 4). Relational
ethics also help researchers understand difficult issues such as conducting
research on intimate others that have died and developing friendships with
their participants. Relational ethics in close personal relationships form
a central concept of contextual therapy.
Friendship |
According to http://www.onlineethics.org/cms/9004.aspx#ethics,
for the past two decades, ethical decisions regarding research with human
subjects have been guided by the three fundamental principles set forth by the
Belmont Report (DHEW, 1978): respect for persons, beneficence, and justice.
Although few dispute the importance of these principles, there is no consensus
on how to prioritize one's obligations when specific ethical problems place the
principles in conflict. From a relational standpoint, achieving such consensus
might actually decrease the adequacy of moral procedures. Consensus among IRBs,
bioethicists, and investigators risks promoting universal application of a
presumed hierarchy of values across contexts differing in their moral
requirements that would reflect the values of the scientific and scholarly
communities without consideration of participant values. Co-learning approaches
can help situate decisions surrounding conflicting ethical principles within
specific research contexts and the perspectives of the specific population
considered for investigation.
A major
assumption of relational ethics is that co-learning enhances the moral
development of scientists and participants through a better understanding of
the reciprocal relationship between the participant's expectations and the
researcher's obligations. Relational ethics views scientist and participant
alike as moral agents joined in partnership to construct research goals and
procedures that produce knowledge carrying social value and scientific
validity. In viewing autonomy as a social construction, it proposes that
respect for personhood must be rooted in scientist-participant dialogues aimed
at discovering shared and unshared values in a process of mutual influencing
through which fair and caring ethical procedures are derived.
Teaching and Learning |
Teaching and Learning:
A relational ethic seeks
to develop methods of ethics-in-science decision making sensitive to both the
justice-based dimension of equality and inequality and the care-based dimension
of attachment and detachment (Clement, 1996). It assumes both scientist and
participant come to the research enterprise as experts: The researcher brings
expertise about the scientific method and extant empirical knowledge base and
the prospective participant brings expertise about the fears, hopes, and wishes
the community brings towards the prospect of research.
A cornerstone
of relational ethics is that the roles of teacher and student are assumed by both
investigator and participant throughout the process of exchanging views. For
example, to begin a dialogue by asking prospective participants open-ended
questions concerning research ethics is sometimes problematic since it asks
individuals to provide spontaneous and decontextualized responses to moral
questions which require informed deliberation on issues of scientific concern
that most participants have not previously considered. Investigators can use co
learning procedures to share with prospective participants their views on how
and why it is important to apply the scientific method to examine questions of
societal import and to debates underlying areas of current ethical concern. In
turn, the prospective participants, their families, or community representatives
can apply their moral perspectives to critique the scientific and social value
of a proposed study and share with investigators the value orientations guiding
their reactions to the planned procedures.
Through the
uncovering of common and unshared dimensions of ethical attitudes toward the
integrity of scientific research, co-learning joins scientist, prospective
participants, and community members in partnership to discover previously
unidentified areas of moral concern and to construct a scientific enterprise
based upon mutual respect, accommodation, and trust. Researchers employing
co-learning welcome differing points of views as checks against the risk of
confusing scientific self-interest with social beneficence. They forge ongoing
partnerships with prospective participants, gaining community input at the
design, implementation, interpretation, and dissemination stages of research
(Higgins-D'Alessandro, Fisher, and Hamilton, 1998).