ࡱ> 574@ u-jbjb -6u'lNNNNN ZN zzzzz,  ^zzzzz ","n kNN Z Z Nursing Ethics Vol. 8 No. 6 (2001)  Editorial 8.6 Reading the last page first in a book is a well-known habit. Knowing the outcome is important. The last article in this issue is certainly of immense significance. All the others are too, but the work by Astrid Norberg, Monica Bergsten and Berit Lundman has a quality that needs reflection; hence to put it last is for the purpose to leave readers in a thoughtful frame. Norberg and her colleagues describe how listening to oneself and others can change the experience of suffering. Listening is a fundamental activity, especially in nursing, and in one way and another, all the other articles also demand that patients be listened to, at every level of their contact with health care. The listening described in the other articles is of a more immediate and practically-oriented nature. The first two articles form an interesting constellation. Fehime Zlfikar and Filiz Ulusoy from Turkey, and Koula Merakou and her colleagues from Greece all write about patients rights. If this journal can be a vehicle for ethics to reach the parts that politics sometimes cannot, then this can only be welcomed. The concern with patients rights in both countries demonstrates a brave attempt by the authors to educate not only patients, but especially nursing staff, in the skills of ethical work, justice and dignity. Sarah Breier Mackie demonstrates elegantly how a clear understanding of autonomy can help nurses and physicians to work more closely with patients. The skills of listening are again the important components in achieving this. The three Finnish colleagues, Maritta Vlimki, Johanna Taipale and Riittakerttu Kaliala-Heino, consider the situation of psychiatric patients who are deprived of their liberty from both the patients and the staffs point of view. They are particularly concerned with the attitudes of staff to this situation, in order to create a humane culture in psychiatric wards. The patients have to be listened to by the staff; the staff have to be listened to by management. Similarly, the elderly people surveyed in the study by Eun-Shim Nahm and Barbara Resnick, have to be listened to and heard. It is the fact of being heard that guarantees being respected as a person. This is vital for elderly persons in particular, whose dignity is too easily compromised. The articles are about rights, autonomy, wishes, liberty, and suffering, but the common need is to be listened to and heard, respected and accepted. Verena Tschudin  Contents 8.6 Editorial Interview with Lin Ju Ying Articles Are patients aware of their rights? A Turkish study F Zlfikar and MF Ulusoy Satisfying patients rights: A hospital patients survey K Merakou, P Dalla-Vorgia, T Garanis-Papadatos, J Kourea-Kremastinou Patient autonomy and medical paternity: can nurses help doctors to listen? S Breier Mackie Deprivation of liberty in psychiatric treatment a Finnish perspective M Vlimki, J Taipale, R Kaliala-Heino End-of-life treatment preferences among older adults E-S Nahm and B Resnick A model of consolation A Norberg,M Bergsten, B Lundman Report of the World Health Assembly 2001 AJ Davis Case study Informed consent, surrogate decision makers, conflict of autonomy and a paternalistic approach H Dogan Comment D Olsen Letter to the editor C Ustun Codes and Declarations Life-and-death care Book reviews Webb P, Ethical issues in palliative care; reflections and considerations (reviewer: M Sque) Engelhardt HT, The foundations of christian bioethics (reviewer: K Kendrick) Manara DF, Verso una teoria dei besogni dell-assistenza infermeristica (reviewer: G Hunt) Books received News Calendar of events Reviewers of articles received and printed in 2001  Editorial comment Anders Lindseth When discussing nursing ethics we clearly think that professional nursing needs ethics. Ethics is important in nursing. But have we considered the opposite: that ethics can benefit from the experiences of nursing? I shall try to demonstrate that nursing provides experiences fundamental to all ethics. In his famous lectures on ethics (from 1929 or 1930) Ludwig Wittgenstein uses an example to illustrate what ethics is about. If someone says that I play tennis badly, I can reply that I know I do, but that I do not want to play any better. All the other man could say, according to Wittgenstein, would be "Ah then that's all right." But suppose I had told one of you a preposterous lie and he came up to me and said "You're behaving like a beast" and then I were to say "I know I behaved badly, but then I don't want to behave any better." Could he then say "Ah then that's all right"? Certainly not: he would say "Well, you ought to want to behave better". That I ought to want to behave better is an absolute judgement of value. This will be so under all circumstances. That I do not want to play tennis better is a relative judgement of value; it has validity in relation to my life and preferences. Aristotle writes that Socrates founded ethics by looking for a common good which would also be good for individuals. Socrates and Plato opposed the Sophists who taught that individuals can find happiness on their own and often at the expense of others. Socrates (and Wittgenstein) points out that life contains an absolute normative dimension. Something matters in life independently of the individual's subjective intentions. Yet each of us must find out what life's absolute demands represent, and be responsible in life. If we have morals that do not allow scope for individual responsible action, we pervert morality. Ethical life is challenged by two typically opposite dangers: relativism, which does not accept any absolute demand; and fundamentalism, which establishes a doctrine, or norms and traditions, making reverence and responsibility for human concerns secondary to the doctrines and norms themselves. Such fundamentalism is moralistic, and easily becomes fanatical and violent. Ethics' great theme is how to understand lifes absolute normative dimension. The urgency of this question relates to the fact that it is impossible to engage the absolute within a particular doctrine or teaching. How does this absolute manifest itself in life? As understanding of the idea of Good? Or as practical reasoning, as Gods voice in the person, as conscience, as the spirit of forgiveness, as awareness of an absolute duty, as a natural demand for personal satisfaction, as a demand from our neighbour to be recognised, as an appeal emanating from the Others face? There are many possible perspectives and it is important to understand them. In order to understand what ethics is about we need to take a closer look at our experiences in life. In this, ethics can benefit from the experiences of nursing, as the following narrative shows. A female nurse in her fifties comes on duty one morning and is asked to care for two men who have both had heart attacks. One of them had suffered only a minor attack. She helps him to get out of bed and he leaves the room. The other, a man approximately her own age, had suffered a worse attack and is very depressed and lies immobile in his bed. The stubble of his beard is getting long, and his look is empty. The nurse goes about her business in the room for a while before she walks up to the bed and says: "Tell you what, I'm very good at shaving men in the old-fashioned way with a brush and razor. I'd like to shave your face." The man does not reply, nor does he seem to object. She prepares the brush and razor, soap and hot water. With care she soaps his face and shaves him. She dries his face after shaving and applies cream to moisturize the skin. Then she suggests that she should wash his hands. She leaves each of his hands in a bowl with soap and warm water for some minutes before drying them and applying moisturizer. Finding the result to her satisfaction, she looks at the patient who is still immobile. She leaves him to rest but goes about her business on the ward for as long as she is on duty. The following day she works at the ICU and does not meet her patient again. However, four weeks later she runs into him in town. He recognizes her and comes up to her. I think you saved my life the day you shaved me and washed my hands, he says. You made me feel that life was worth living after all. Wittgensteins example shows that life contains an absolute normative dimension by referring to a situation we recognize as unacceptable. Our little narrative from nursing also appeals to instant recognition but it has a positive message. Therefore it is educational. This situation was positive because the nurse had the courage and initiative to meet the patient in his depression and to provide some of her own positive abundance. She does something good on her own initiative as a responsive action to what his condition tells her. This action is not a recipe for how nurses should act in similar situations. Had she acted from a fixed concept, her involvement might have become an infringement. In which case she would not have done something for the man, but rather something to him. She would have done something about his condition, believing that she should or ought to. She would have imposed on him and been self-centered. This action becomes an ethical action and a response to an ethical demand because the nurse senses that the depressed and vulnerable man places something of his life in her hands. She accepts the challenge emanating from him and responds to it with an abundance of compassion. All ethics can benefit from nursings experiences. The most important learning from these experiences is perhaps that Good in life is under threat if we try to bring ethics as a given (conclusive) knowledge into already established situations and relations. We must allow Good to happen by way of our attentive and acknowledging encounter with the Other's vulnerable life. References L. Wittgenstein, "A lecture on Ethics", p. 6. The Philosophical Review, 1965, 74, 3-12. Aristotle, Metaphysics, 987b1. "$%&3hr$;Gu-jCJUmH6CJCJ5CJ jUmHCJ5B*CJph$&56F`+<4^ht$a$$a$$a$$&56F`+<4^ht&;I?Sci},,,T-t-u-3&;I?Sci},,,T-t-u-$a$+0P. 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