This paper addresses two interconnected questions in healthcare ethics. First, it proposes a personal ethical theory centered on wellness promotion — encompassing physical, psychological, and environmental well-being — and examines its limitations relative to care-based ethics. Second, it surveys five major ethical frameworks (Kantian, utilitarian, casuistry, virtue, and care ethics) through the lens of nursing practice, arguing that most nurses rely primarily on casuistry supplemented by situational applications of other theories. The paper draws on the author's professional experience to ground abstract ethical concepts in real clinical and interpersonal contexts.
As a healthcare provider, I believe that wellness promotion should be at the core of every ethical system — encompassing the promotion of physical, psychological, and environmental well-being. Wellness is defined according to each patient's specific needs. Wellness promotion for a child might include providing nurturing and care, while for an adolescent it might involve the promotion of autonomy. The types of heroic medical interventions appropriate for promoting wellness at the end of life differ from those appropriate for a mature adult.
Wellness promotion is an important value to uphold in daily life. For example, while honesty is important, telling everyone "the truth" in a harsh and blunt fashion does not necessarily promote change and positive growth — it can simply hurt an individual's feelings. If a friend needs to lose weight, encouraging them to exercise and making it easier to maintain a healthy diet is more conducive to wellness than nagging.
Wellness promotion is also significant on a personal level. Taking care of oneself and not being a burden to others is important. It is personally empowering and satisfying to honor your responsibilities, strive for independence, and take positive control over your life — working to be the best version of yourself. Wellness means peace of mind and living in harmony with others; only by exhibiting compassion is a state of wellness achieved within both the self and society.
Wellness also means taking care of the environment. Not polluting, striving to live a sustainable life, and maintaining a healthy environment so that others will not suffer negative consequences — now or in years to come — is a moral obligation. Unless we honor this principle as a species, both the earth and human beings will suffer.
"Challenges of defining wellness across individuals and contexts"
The ethical systems most often invoked in the profession of nursing are utilitarian and Kantian (deontological) ethics. Utilitarianism is most often applied by healthcare organizations such as insurance companies: to keep costs down for the many, a potentially valuable treatment may be denied to an individual because it is deemed experimental or unnecessarily costly. As unpalatable as that may seem, no patient can be tested for every conceivable illness he or she might contract. Some prioritization of high-risk groups is necessary. During daily duties, a nurse may often ration her time, prioritizing where her efforts will do the greatest good for the greatest number of people based on the severity of their need.
In other instances, however, a nurse may need to deploy the categorical imperative and assert that something is clearly right or wrong, regardless of any financial calculus. A nurse must care for all patients to the best of her ability and preserve patient autonomy and privacy, unless the patient poses a risk to herself or others. The nurse must also obey both the law and the professional ethics of nursing.
"Care, virtue, and casuistry as dominant nursing frameworks"
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