Abstract
Bioethics for Nurses: A Christian Moral Vision, by Alisha N. Mack and Charles C. Camosy, offers nursing professionals and nurse educators a much needed and heretofore conspicuously absent, perspective on the intersection of nursing care and medical ethics, illuminated by the holistic Christian tradition of nursing and health care provision.
Mack is an Evangelical Christian and a seasoned Nurse Practitioner and educator who has worked in both secular and Catholic health care settings and currently teaches at a Christian nursing school. Camosy is a Roman Catholic who has previously taught medical ethics to nursing students and currently teaches theology and bioethics at a Jesuit-Catholic college. Interestingly enough, the two authors met when Camosy was teaching a bioethics course for nursing students at a secular university, where Mack was “easily the best student in his class” (p. 6). Mack and Camosy weave their distinctive, yet synergetic professional experiences neatly together to address many critical bioethical issues in nursing while emphasizing a vision of nursing care that is lived out a Christian vocation, rather than a mere occupation.
Instigated by their joint observation that modern medicine and bioethics frequently exclude the faith dimension and may even at times be hostile to practitioners who do not wish to “check their faith at the patient's door,” Mack and Camosy explore these topics in light of their “explicitly theological perspective as committed Christians” (p. 7) … who want to share their insights with Christian nursing students and practitioners about how they can, and indeed, must not check their faith at the hospital or clinic door, if they are to best serve the patients for whom they care.
The 242-page paperback is conveniently organized into three parts: Recovering a Nursing Vision, Christian Nursing Bioethics in Action, and The Future of a Profession on the Move. Each part contains several chapters that expand upon the section heading.
Recovering a Nursing Vision sets the stage for the remainder of the book by recounting the often overlooked, yet intricately linked, Christian origins of both community medical care generally and nursing care in particular. Mack and Camosy describe the history of organized care of the sick being undertaken by the first Christians who were inspired to continue Christ's healing ministry and care for the downtrodden. They outline how communal medical care emerged right alongside the nascent Catholic Church, with houses of early bishops and other wealthy Christians “expected to be houses of hospitality for the sick” (p. 16). These first attempts at housing and caring for the ill soon evolved into more formalized health care facilities by the fourth century. Mack and Camosy recount how “…by the late Middle Ages “nearly every city” in Europe had what was called a “Hospital of the Holy Ghost” that was run … by the Order of the Hospitallers of the Holy Ghost” (p. 16).
Regarding the beginnings of nursing care, the authors describe Catholic orders of “sister-nurses” which existed during the Middle Ages, predating Florence Nightingale's nursing initiatives by centuries—a fact not often acknowledged in secular versions of nursing history. Of particular note is how Nightingale's personal nursing path was deeply influenced by the Catholic Daughters of Charity in Egypt initially, and later, through her close, personal relationship with Mother Mary Clare More of the Sisters of Mercy, whose mission involved a particular focus on health care (p. 16–24). Readers will no doubt be captivated by the endearing communications quoted between Mother More and Nightingale, which played a significant influence on Nightingale's personal faith experience and her vision of contemporary nursing.
Part 1 also includes a chapter on the modern historical shift in nursing care from one consisting primarily of nurses being “…assistants or handmaidens of physicians - or servants to patients and families” (p. 28) towards a full-fledged profession that blends science-based technical skills with the art of relationship-centered patient care. Later, the authors take strong issue with the modern myth that faith, science, and health care do not and must not converge. The authors assert: “Not only is it wrong to keep such [faith] traditions out of the discussion of medicine and health care, we can’t even claim to know what medicine and health care are for in the first place without appealing to them” (emphasis not added) (p. 51).
The final section in Part 1 lays out the authors’ Christian vision for nursing bioethics, as they describe seven fundamental Christian concepts which best inform patient care and moral dilemmas in nursing. These include: (1) Humans are made in the image and likeness of God and therefore have inherent human dignity, (2) Human life begins at fertilization and ends at natural death, (3) Humans must accept death without violently ending it, (4) Christ calls us to care for the least among us, (5) We must put others before ourselves, (6) Humans require and flourish best in relationships, and (7) Spiritual care is fundamental to good medical care (p. 67) These concepts are individually addressed in Part 2 of the book.
Part 2, Christian Nursing Bioethics in Action, delivers the bulk of the book's content, dedicating a chapter to each of the seven concepts previously identified as informing a Christian vision of nursing bioethics. Relevant contemporary and historic bioethical cases are interspersed throughout, many of which involve moral dilemmas specific to nursing. Popular philosophical theories such as Judith Jarvis Thomson's famous violinist argument to support abortion (p. 95), and Peter Singer's view on infanticide due to the lack of newborns having moral status (p. 133), are incorporated, with their shortcomings exposed. Additionally, stories drawn from the authors’ personal experiences are interwoven, providing the reader with rich and thought-provoking content. One poignant but practical observation recommends that nurses should not sideline their faith at the patient bedside, but should use prudential judgment when doing so, in order to avoid professional repercussions (p. 161). Throughout this section, numerous pertinent ethical topics are analyzed, including abortion, euthanasia, withdrawing/withholding treatments, informed consent, patient confidentiality, boutique medical care, and others.
The last section, The Future of a Profession on the Move, gives consideration to conscience protections for nurses, the need for nurses to be included in health-care teams, and addresses issues specific to the COVID-19 pandemic. Among these, the conscience protection chapter is noteworthy, citing contemporary attacks on protections for nurses while stressing the importance of nurses following their informed consciences.
A useful characteristic of the book lies in its special features. “Discussion Questions” follow each chapter, and a “Further Reading” section augments the material. Additionally, the book is well-referenced, with an extensive “Notes” section specifying citations in a chapter-by-chapter format. Each of these features lends itself readily to the nursing classroom. The thought-provoking “Discussion Questions” could stimulate student discussion either in-class or as part of online discussion forums. The “Notes” and “Further Reading” sections provide accessible background and important supplemental materials for students who will be writing course essays or making topical presentations.
One notable limitation of the book is its nominal index, a clear disadvantage for nursing students and inquisitive readers alike. Future editions would benefit from a more comprehensive topical index.
Catholic readers looking for treatment of certain theological topics may be disappointed at times. For example, little or no mention is made of ethical issues in relation to natural law, human sexuality, or sacramental marriage. Similarly lacking is discussion of fundamental bioethical principles arising from the Catholic tradition, such as double effect, cooperation with evil, and extra/ordinary care. Treatment of ethical topics upon which there is a lack of consensus between Christian denominations and Catholics is generally avoided altogether, including in vitro fertilization, surrogate pregnancy, and artificial contraception, among others. In the authors’ defense, some of these concepts are tangentially mentioned, although not in a consequential way, while others are entirely absent, perhaps owing to space limitations, although it is not unreasonable to conject that some topics were intentionally avoided to avoid straying into the ethical “dead man's zone” separating Catholics and non-Catholic Christians, lessening the book's broad Christian appeal. Even so, the material contains nothing contrary to authentic Catholic teaching, even while it avoids some divisive ethical issues.
Although not sufficiently comprehensive to serve as a primary text for a medical ethics nursing course, Bioethics for Nurses: A Christian Moral Vision could serve as a valuable supplement to traditional nursing ethics textbooks, which lack the Christian perspective. It will be particularly useful in Catholic and Christian-based nursing programs but could also serve as a supplemental resource in secular nursing courses which seek to expose students to a more detailed history of Christianity's role in both health care provision and nursing care.
Overall, Bioethics for Nurses: A Christian Moral Vision fills a void in helping Christian nurses of both Protestant and Catholic persuasion to better grasp how fundamental Christian theological concepts informs and improves delivery of patient care, as well as assists nurses in navigating ethical dilemmas they may face. Most importantly, perhaps, Mack and Camosy provide a much-needed vision for Christian nurses to more clearly view their role in caregiving as a Christian vocation, rather than a mere occupation.
