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The quotes listed above reflect an essential aspect of the nurse-patient relationship, an appeal to relational ethics. While we’ve discussed several different ways to make a moral decision (the best interests standard, for example), another way to arrive at a decision is through relation ethics. In its most basic form, relational ethics dictates that one makes decisions with their patients within the context of their relationship. Decisions made as such require one to view their patient in a non-oppositional way and the recognition that they do not exist disembodied and disconnected from the world. Decisions are made within the context of a relationship.
Proponents of relational ethics critique other moral theories as existing without a formal relationship with the other person, therefore deeming them inappropriate for healthcare. It is through relationships, as per relational ethics proponents, that decisions are made via reciprocal dialogue. Awareness of oneself and the other speaks to the acknowledgment of the context in which ethical issues arise. The context of any situation involves the participants engaged in the moral issue at hand. They do not exist one without the other.
Contrast this with always acting in a manner consistent with what the healthcare provider thinks is best for the patient. Such a manner of action neglects the patient as disembodied and separate from them. This failure to regard the other person (patient in this sense) can lead to an oppositional relationship between healthcare providers and patients.
The most critical aspect of relation ethics are mutual respect, engagement, embodied knowledge, environment, and uncertainty. We will cover each topic separately. Let us start with mutual respect.
Mutual respect, while a simple concept, is quite crucial for the relation ethics theory. Simply, mutual respect involves the reciprocal respect between the healthcare provider and their patient. Healthcare providers and patients demonstrate this mutual respect by acknowledging one another as persons with unique personhood. The healthcare provider and patient also recognize their interdependence. Simple recognition of the person is not enough; however, a quality relationship fosters the best chances at appropriate decision making under the auspices of relational ethics theory. Healthcare providers must dampen their tendency to assume they know what is best and, instead, engage with the patient.
Let us move to a discussion of engagement now. Put simply; the healthcare provider must position themselves with the patient and acknowledge them as a person. When a healthcare provider is fully engaged in a relationship with the patient, they recognize their patient’s perspective. The self (healthcare provider), in this theory, does not exist without the relationship with the other (patient). Engagement with the patient can begin with asking them open-ended questions at the beginning of the relationship.
Embodied knowledge refers to the multidimensional knowledge a person brings with them into a relationship. Such knowledge includes what the person “knows” academically and their emotional intelligence, and past learning. Proponents of relational ethics may argue that this approach is best to determine what is right when many factors are involved in a decision. This supposition might be true but, the use of other ethical theories may also arrive at the same answer for what is “right.” Still, different ethical theories might also arrive at a completely different interpretation of the right course of action.
The environment refers to the unique relationship between the healthcare provider and the patient. The healthcare provider and the patient, in turn, exist in the context of a larger society. Reasonable ethical discourse cannot occur, according to relational ethics, without the elements of the larger society as a whole. Within this society and certainly within the relationship between the healthcare provider and patient, uncertainty exists.
Uncertainty in the context of relational ethics refers to the difficulty in making a decision given the differences in values between the healthcare provider and the patient. Uncertainty acknowledges the differences in values, noting that the relationship between agents and humility regarding what is right is paramount. Even knowing all relevant facts of a situation, the best decision may not always be attainable given uncertainty. The knowledge one has in a given case depends on the contexts of that situation and is seldom whole. Uncertainty exists, and the healthcare provider must humbly accept it.
The videos below discuss how one could arrive at different conclusions for what is best in a scenario based on what moral theory they use for their analysis.
References:
Walker, Margaret Urban (2007). Moral understandings: a feminist study in ethics (2nd ed.). New York: Oxford University Press
Pollard CL. What is the right thing to do: Use of a relation ethic framework to guide clinical decision making. International Journal of Caring Sciences. 2015; 8(2)
Upasen R. Relational ethics and nurses-client relationship in nursing practice: Literature review. Mental Health and Human Resilience International Journal. 2017; 1(1)
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