Bioethics for Nurses

A Christian Moral Vision

Alisha N. Mack, Charles C. Camosy

• Publisher: Eerdmans
• Year: 2022
• ISBN:
  9781467465441
• Topic: Medicine
• Subtopic: Nursing

Recovering the foundation of faith in a profession enduring the pressures of a rapidly changing health-care system. If you are one of the millions of Christian nurses or nursing students in the United States, you already know that there is no real way to separate your faith commitments from your professional vocation—nor would you want to. Especially amid the bedlam of the COVID-19 pandemic, faith has given countless nurses the strength to carry on and be there for their patients, one exhausting shift after another. Bioethics for Nurses, the first book of its kind, is for nurses and nurses in training who still believe in treating the whole person—not just their medical condition. It is for those committed to living out the love of Jesus Christ through the warm, relational care they provide for all hurting and vulnerable people—including those in underserved populations—each of whom has the dignity of a human being made in the image of God. It is also for those who rightly see themselves as crucial members of medical teams alongside doctors (and sometimes without doctors present at all), empowered to exercise professional judgment while protecting their consciences. With the combined wisdom of Alisha Mack, a professor of nursing with many years of clinical experience, and Charles Camosy, an award-winning bioethicist and theologian, Bioethics for Nurses advances a vision for a holistic Christian notion of health care with practical applications for everyday relevance on the job. Through a series of case studies in the second part of the book, Mack and Camosy explore the ethics of specific situations with far-reaching implications for nurses working in a range of fields. In the last part, the authors reflect on the future of nursing after COVID-19, making this an especially timely book for a pivotal moment in the history of the profession. Now, more than ever before, the wisdom of the ancient tradition of Christianity is needed to speak into the profound contemporary realities we are facing together as a culture.

PART ONE

Recovering a Nursing Vision

1

THE CHRISTIAN ORIGINS OF CONTEMPORARY NURSING

It is such a blessing to have been called, however unworthy, to be the handmaid of the Lord.

— Florence Nightingale

The popular imagination often thinks of the practice of Western health care as secular. Maybe even hyper-secular. Religion and science “don’t mix” in the minds of many influential people in medicine. But this view is difficult to reconcile with history. As with most institutions in the developed Western world, our health-care practices come directly out of an explicitly Christian culture and from explicitly Christian ideals and practices. This is true when we look at the history of hospitals, when we look at the history of doctoring, and especially when we look at the history of nursing.

But wait, aren’t nursing students taught that nursing begins with a data-driven, secular pioneer named Florence Nightingale? This is an important myth to bust early in this book, and for two reasons. First, Florence Nightingale was anything but secular. As Mary Sullivan points out in her book on Nightingale’s correspondence with Mother Mary Clare Moore of the Sisters of Mercy, this nursing pioneer “was deeply engaged in the religious and philosophical thought of her time and that the primary aim of her life was not to reform social institutions but to serve God.”¹ Indeed, her calling as a nurse no doubt has much in common with many of those reading this book. Second, as is made clear through her relationship with the Sisters of Mercy and other religious orders, Nightingale was learning from and building upon an already well-established Christian foundation for the practice of nursing. As significant as she was for the development of nursing today, the practice predates Nightingale by hundreds of years.

We will explore more about why this is the case in chapter 3, but one frustrating aspect of many contemporary discussions of Western-style health care is the near erasure of its Christian historical foundations. Especially given the primary audience we have in mind for this book, but also for those who simply want an authentic understanding of how nursing came to be what it is today, we are actively working against the erasure of this history. To that end, we will begin this chapter by focusing on the Christian origins of Western health care more broadly, and then pivot to the development of Christian nursing especially as a practice of women religious. Finally, we will show how women religious deeply influenced Florence Nightingale—and, by extension, what nursing would become after her.

CHRISTIAN ORIGINS OF WESTERN HEALTH CARE

In Charlie’s previous book, which was on the relationship between contemporary secular medicine and losing our sense that all human beings are fundamentally equal, he also shows how much of our modern understanding of health care comes explicitly out of a Christian context.² We will say more about this in chapter 4, but one major reason Christianity had such a focus on health and healing was because this was such a priority for Christ himself. The following passage, Matthew 11:2–5, is just one of dozens of relevant examples we could have cited from the Gospels:

When John the Baptist heard in prison what the Christ was doing, he sent word by his disciples and said to him, “Are you the one who is to come, or are we to wait for another?” Jesus answered them, “Go and tell John what you hear and see: the blind receive their sight, the lame walk, the lepers are cleansed, the deaf hear, the dead are raised, and the poor have good news brought to them.” (NRSV)

When Jesus was pressed by the disciples of John the Baptist to give an account of himself so they could determine whether or not he was the Messiah, the chosen one of God, he did not speak of violent revolutions wrought by his great power. Nor did he speak of political change or invoke a regal status. Instead, he focused on the fact that sick people came to him for help—and were made whole. It is no accident that one of Jesus’s most important monikers is “the Great Physician,” for he directly and analogously thought of his work in precisely these terms. Significantly, Jesus often explicitly connected the physical health of a person with their spiritual health and tried to address the fullness of the needy person in front of him.

The early church, unsurprisingly, took its cues from Jesus the Great Physician by putting care of the sick and disabled, especially the untouchable sick and disabled who were discarded by the dominant culture, at the center of its ministry. Rodney Stark, Distinguished Professor of the Social Sciences at Baylor University, has argued this kind of care contributed significantly to the improbable growth of a small religious sect into what would become the official religion of the Roman Empire. Stark argues that care for (and even adoption of) the sick, disabled, and female infants who were typically exposed and left for dead (or, at best, slavery/prostitution), along with a refusal to abandon the sick during plagues, were significant factors in making the Christian witness deeply attractive to converts.³ His research, for instance, found that after the Antonine plague (second century), the Cyprian plague (third century), and the Justinian plague (sixth century) there were significantly higher conversion rates to Christianity.

The houses of bishops and other wealthy/important Christians in the early Church were expected to be houses of hospitality for the sick. Eventually these would develop into formal hospital and nursing facilities, especially when Christianity become an accepted practice in the fourth century. There was a dramatic early instance of this in the work of Saint Ephrem who, during a plague at Edessa in 375, provided hundreds of beds for the afflicted. But perhaps the most famous early example of a hospital was that of Saint Basil at Caesarea in Cappadocia in 369. It “took on the dimensions of a city”: boasting organized systems of regular streets, buildings for different kinds of patients, and even living spaces for health-care providers.⁴

The Rule of Saint Benedict, written in the early fifth century, insisted that “care of the sick is to be placed above and before every other duty.”⁵ The research of Andrew Crislip shows that many of these monasteries focused so intensely on health care that they eventually and naturally became full-time hospitals.⁶ This set of values and practices for those who follow Jesus would prove to be deeply influential for the Christendom of the Middle Ages, which saw a dramatic increase in the numbers of hospitals and also schools for the training of health-care providers. Driven by a parallel increase in the founding of religious and military orders devoted to ministering to the sick, by the late Middle Ages “nearly every city” in Europe had what was called a “Hospital of the Holy Ghost” that was run (either in fact or in spirit) by the Order of the Hospitallers of the Holy Ghost.⁷

CHRISTIAN RELIGIOUS ORDERS AND THE FIRST NURSES

Though the contemporary distinction between nurses and doctors was not as stark as it is today, the monks and nuns who founded and ran the hospitals of the ancient and medieval worlds mentioned above were much more like what we might think of as nurses, caring for the fullness of the whole person (as Jesus Christ did), than like specialized doctors focusing on physical systems of organic plumbing. For instance, the Hospitallers of the Holy Ghost were often religious monks or nuns who took vows from the Rule of Saint Augustine—with a dual focus on the “corporal works of mercy” (which include things like caring for the sick, offering hospitality to strangers, and burying the dead) and the “spiritual works of mercy” (which include things like comforting the afflicted, praying for others, and counseling the doubtful).

By the end of the Middle Ages, and into the early modern period, orders of sister-nurses were very well established and spread throughout Europe. The Daughters of the Holy Spirit, for instance, was an important order of women religious that was founded in 1706 “to serve God by serving the poor, the sick, and the children.”⁸ Care for the fullness of the needs of the people they served didn’t keep them from delivering excellent and thorough medical care. Indeed, especially if they were being sent to minister in rural settings where they weren’t seen as competition for doctors, these sister-nurses would be trained in their mother house to practice a wide variety of medicine. Research done by Tim McHugh on this order’s work in rural France, for instance, found that they were taught “to diagnose, to prescribe treatment, and to prepare medications.” From the records of contracts that still exist to this day, we learn that these nuns considered “active medical intervention through the providing of remedies or through the services commonly offered by surgeons of equal importance as their nursing and spiritual consoling of the sick.”⁹

Another very significant group of sister-nurses were the Daughters of Charity of St. Vincent de Paul. In the mid-1800s, Sister Mathilde Coskery wrote the first comprehensive document on nursing, which she called Advices on Care of the Sick. Significantly, these sisters saw their role as not only bringing physical healing to their patients, but spiritual healing as well. Indeed, Mother Mary Xavier Clark said that their patient should be able to say, when a sister leaves his bedside, “That Sister is more like an angel than a human being. The very sight of her makes me think of God and love him.”¹⁰ And though they had a focus on the spiritual, like the Daughters of the Holy Spirit before them, the Daughters of Charity were also expert in the practice of caring for the physical bodies of their patients. Florence Nightingale’s encounter with a nursing mission run by the Daughters of Charity in Alexandria, Egypt, was deeply influential on her own journey toward nursing (significant for our discussion below).

The French revolution—and succeeding secular and anti-Catholic trends of the Enlightenment—encouraged the Daughters of the Holy Spirit and the Daughters of Charity to take up residence in the United States where they were afforded religious freedom to pursue their ministry.¹¹ They would join several other orders of women religious who focused on nursing and health care in the US, including the Sisters of Mercy, another group of sister-nurses who would have a profound influence on Florence Nightingale.

THE SISTERS OF MERCY

The Sisters of Mercy were founded in 1831 by Catherine McAuley in a poverty- and epidemic-stricken Dublin, Ireland. She explicitly focused the order’s contemplative and spiritual life into direct service to the poor and marginalized, particularly homeless girls and women. Especially as they saw the infuriatingly strong connections between poverty and illness, they would soon adopt a particular focus on health care, one that would blossom into a philosophy they would call “careful nursing.” This philosophy was built by McAuley directly out of her sense of Jesus Christ’s “great tenderness for the sick.”¹² Indeed, their commitment to having “great tenderness in all things” was at the heart of the Sisters of Mercy motivation for moving into nursing in the first place. Their first goal in caring for any patient—at least when death as not an imminent risk—was to relieve, as best they could, whatever was causing their patient’s distress. Again, the fullness of the good of the person in front of them was at the heart of how they ministered to their patients’ needs.

Nurses with the Sisters of Mercy gained a reputation for having “unconditional patience, generosity, kindness and compassion towards patients and one another. This was understood to encompass a calm manner and respect for inherent human dig nity.”¹³ Eventually, they would come to specify a general philosophy of careful nursing into specific principles and practices. Here are a few of the most important ones:¹⁴

• Contagious calmness. Quiet self-confidence exuded from these sisters as they went about their nursing tasks. Their gentle and tender manner reflected an inner calm and peace that would be further reflected in their communal environment more generally and to the patient specifically.
• Disinterested love. The Sisters of Mercy insisted on loving everyone—including each other, but especially their patients—based on their common relationship with God. The “disinterested” adjective here refers to an intentionally unbiased and impartial love to each person, regardless of their characteristics.
• “Perfect” skill development. Nursing was a kind of art for the Sisters of Mercy, but it was also very much a skilled craft to be honed and perfected. It involved close and continual observation of their patients, with meticulous attention to detail and lightning-quick responses to their needs. Particular focus was given to patients who were dying to ensure that they received every possible comfort and consolation.
• Self-care. In part because the job of a nurse is so difficult, especially when connected to the sufferings and deaths of so many patients, the Sisters of Mercy insisted on a robust self-care program. This included an insistence on eating the best foods available, getting plenty of rest and exercise, and making time for social and recreational activities. In addition to maintaining an inner sense of calm and disinterested love, part of their understanding of self-care involved encouraging nurses to have a sense of humor and quick wit—with their patients, yes, but also with each other.
• Power from service. Jesus Christ inverted typical power dynamics. You want to be first? Put others before you. You want power? Die to self and embrace your weakness. You want glory? Embrace humility and even humiliation. The Sisters of Mercy knew that any authentic power they had came from putting the love of the marginalized ahead of their personal interests.

As we will see below, when these Sisters were called on to serve under the leadership of Florence Nightingale during the Crimean War, they immediately moved to do their work in the background willingly and without complaint. Despite this less visible role, and despite having three strikes against them (being women, Catholic, and Irish), the Sisters of Mercy ended up playing pivotal roles in almost every significant crisis Nightingale faced. They developed a sterling reputation for responding immediately, calmly, and effectively.

Florence Nightingale had a particularly transformative relationship with Mother Mary Clare Moore, who was an important partner to Catherine McAuley. We will now examine the lasting impact their relationship had on the origins of contemporary nursing.

MOTHER MARY CLARE MOORE AND FLORENCE NIGHTINGALE

Mary Clare Moore worked most closely with Catherine McCauley in coming up with The Rule and Constitutions for the Sisters of Mercy. Though also born Irish, Moore was assigned by McCauley to be the first Mother Superior of their new convent in Lon...