Relational Ethics

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).