Christian Ethics and Nursing Practice

Richard B. Steele, Heidi A. Monroe

• Publisher: Cascade Books
• Year: 2020
• Print ISBN: 9781532665042, 9781532665059
• eBook ISBN: 9781532665066
• Topic: Theology & Religion
• Subtopic: Christian Theology

Christian Ethics and Nursing Practice shows how the religious and moral teachings of the Christian Bible compare, contrast, and correlate with the ethical standards of modern nursing, as stated in the Code of Ethics for Nurses. It describes four main strands of moral discourse in the Bible--law, holiness, wisdom, and prophecy--and shows the relevance of those strands for contemporary bedside and advanced practice nursing. The work could serve as a textbook for courses in nursing ethics at Christian colleges and universities or as a guidebook for practicing nurses, who have devoted their lives to caring for the sick, the injured, the elderly, the disabled, and the dying as a way of living out their commitment to Jesus Christ.

1

The Nurse as Citizen, Professional and Public Servant

The Legal Strand: “Keep the commandments . . . for your own well-being”

Deut 10:13

Joe Jefferson works in the cardiac care unit of Good Samaritan Hospital. He graduated from nursing school with high honors a year ago and had no difficulty landing his dream job. The learning curve has been steep and the challenges great, but he has loved his work and is highly regarded by his colleagues and patients. One of Nurse Jefferson’s favorite patients is Juana Suarez, who suffers from congestive heart failure and has been in and out of the hospital many times this year. Mrs. Suarez is a model patient: she eats a heart-healthy diet, exercises regularly, takes her meds on schedule, and maintains a cheerful disposition through thick and thin. But the end is now near, and she knows it. Nurse Jefferson walks into her room, and she smiles warmly at him, as she always does. Then she tells him, a bit shyly, that she has a special request. She wonders if she can spend what will probably be the last day of her earthly life with Beatriz, the toy poodle who has been her pride and joy for the past ten years. Her family wants to bring Beatriz into the hospital that afternoon and will stay in the room the whole time to assure that the dog is properly cared for. What should Joe say to this request—so reasonable and so touching, and yet so flatly contrary to the state health code and hospital policy?

If you had asked Joe yesterday to describe his role as a nurse, he might have said, “Well, as an American citizen, I am responsible for knowing and obeying the law, especially national, state and local healthcare law. As a professional, I am responsible for knowing and obeying the specific policies and procedures of Good Samaritan Hospital, and beyond that, for knowing and heeding the basic principles of bioethics and the ANA Code of Ethics for Nurses. As a public servant, I am responsible for meeting the physical and emotional needs of my patients and their families. And as a Christian, I am responsible for following Jesus—which for me means being a good citizen, a model professional and a faithful public servant, but which extends further and runs deeper than all of those other roles.” That was yesterday’s answer, when the specific responsibilities of his four roles seemed perfectly compatible—as, indeed, they usually are. But this is today, when “clinical judgment” and “patient care” seem to demand different answers to Mrs. Suarez’s request (Benner, Tanner, & Chesla, 1996), and when the law of the land prohibits what the “law of Christ” seems to demand (Gal 6:2). It is one thing to advocate for “radical transformation” (Benner, Sutphen, Leonard, & Day, 2010) in healthcare practice and policy for the sake of a beloved patient, but quite another to pursue a course of action that might cost you your job, and indeed, might jeopardize the welfare of other patients on the unit.

The present chapter does not resolve Joe’s dilemma. But it does explore the topic of law and its relevance for the practice of Christian nursing. It assumes that the respective responsibilities of citizenship, professionalism, public service and Christian discipleship are indeed generally in close alignment, as Joe has long believed, and leaves to subsequent chapters the question of how to handle the occasional tensions among them. It proceeds by distinguishing three types of law: divine law, positive law and physical law; by exploring the relationships among them; and by showing how each individually, and all three together, inform our understanding of the vocation of Christian nursing and account for the close intersectionality among the roles of citizen, professional, public servant and Christian disciple.

In section 1, we examine divine law as attested in Christian Scripture. First, we look at the Ten Commandments, which are foundational to the legal thinking of the Bible. Then we examine two other legal texts, Deuteronomy 10:12–21 and Luke 10:25–37, which clarify the purpose of divine law and reveal that God intends the law for our “well-being” (Deut 10:13). In section 2 we turn to positive law, which comprises the vast array of laws made by human beings to regulate their conduct and relationships. We include in the category of positive law both civil laws, especially those pertaining to health care, and the rules, regulations, protocols and standard operating procedures of healthcare institutions. We show how Provisions 1–3 of the Code (ANA, 2015) provide the moral rationale for obedience to these positive laws. In section 3, we turn to physical law, which refers to the observable patterns and cycles in nature. We show how Florence Nightingale, the founder of modern nursing, applied the concept of the physical law to health care and nursing practice. Section 4 comprises several reflections by our students on the relationship between law and nursing. The chapter concludes with various teaching/learning helps (Sections 5–7).

Law in Christian Scripture

In studying the Bible’s concept of divine law, we must bear three things in mind. First, the terms for law in the Christian Scriptures (Hebrew = torah; Greek = nomos) have important connotations that are often missing in the English equivalent (Harrelson, 1962, p. 77). Torah (or nomos) can certainly refer to legislation in the narrow sense, that is, to the specific rules and regulations that govern God’s people’s public life. But torah is more than legislation; it is also instruction. When God commands, God teaches, and the sovereignty exercised by God as the sovereign Lawgiver is tempered by the warmth and loving-kindness displayed by a devoted parent to her children or a dedicated teacher to her pupils. Conversely, when God teaches, God commands, and God’s instructions have the force of law. The biblical word for the relationship between God and God’s people is “covenant” (Hebrew = berith; Greek = diathēkē), a word that represents a reciprocal bond of love, trust and commitment, but that always recalls God’s role as the “senior partner.” Torah thus represents the “terms” of the berith that God established with his people, and which God faithfully and mercifully continues to uphold, even when his people fail to do their part. Thus, the word torah is often used by Jews to refer to the story of the relationship between God and God’s people, particularly that part of the story told in the first five books of the Bible. These books—Genesis, Exodus, Leviticus, Numbers and Deuteronomy, sometimes known collectively as the Pentateuch (Greek pente = “five” + teuchos = “scroll”)—contain plenty of legislation, as we shall see. Yet that legislation is embedded in the story of the covenant relationship between God and God’s people; and the purpose of that legislation is to keep the story going—that is, to keep the relationship intact. It is wo...

Table of contents

• Title Page
• Figures
• Tables
• Foreword
• Acknowledgments
• Abbreviations
• Introduction
• Chapter 1: The Nurse as Citizen, Professional and Public Servant
• Chapter 2: The Nurse as Healing Presence
• Chapter 3: The Nurse as Savvy Problem-Solver
• Chapter 4: The Nurse as Patient Advocate and Social Critic
• Chapter 5: Moral Maturity in Christian Nursing
• References