Beyond norm-critique: A phenomenological and natural law approach to human dignity in nursing education

Abstract

This discussion paper responds to recent calls for norm-critical and norm-creative pedagogy in nursing education. While acknowledging the importance of addressing healthcare inequalities and recognising the value of lived experience and embodiment, the paper argues that norm-critical approaches lack empirical foundation, internal consistency and ontological depth. Drawing on phenomenology and classical natural law theory, the paper proposes an alternative ethical framework rooted in human nature. By integrating relational experience with a teleological understanding of the human person, nursing education can foster a more grounded, coherent and enduring approach to human dignity, ethical reflection, and social justice.

Introduction

The call for norm-consciousness in nursing education, as advanced by Arveklev et al., ¹ reflects a growing concern with perceived inequalities and power structures within healthcare education and practice. Their discussion paper (https://doi.org/10.1177/20571585251332186) highlights the inadequacy of modernist paradigms that separate reason from embodiment and exclude lived experience from the domain of valid knowledge (what Arveklev et al. ¹ refer to as “disembodied Western rationality”). This critique resonates with broader shifts in nursing theory, which increasingly emphasise relationality, vulnerability and the moral dimensions of care.^2-4 As a researcher and educator within nursing education, I recognise the importance of addressing marginalisation and preparing students to critically engage with social norms, power structures and ethical complexity.

However, while norm-critical and norm-creative pedagogies raise important questions, they fall short as ethical frameworks. In this paper, I argue that these approaches are limited by three key weaknesses: a lack of empirical foundation, an internal ideological tension and a disconnection from the ontological reality of the human person. The proposed pedagogy promotes reflexivity, but offers no stable ground for ethical evaluation. In the absence of a substantive account of human nature, the struggle against unjust norms risks becoming normless itself – vulnerable to relativism and fragmentation, or simply becoming a new orthodoxy under the guise of critique.

To address this, I propose an alternative path that affirms the importance of lived experience, yet moves beyond critique. Drawing on phenomenology and classical natural law theory, I argue that a more robust ethical foundation for nursing education must integrate lived relationality with an understanding of the human being as teleological and intrinsically dignified. Through this lens, the human body is not a neutral canvas for social inscription, but instead a meaningful expression of moral truth. Discrimination is not wrong merely because it is socially constructed as harmful, but because it violates the objective moral structure of what it means to be human.

This paper thus seeks to reframe the conversation: not by rejecting norm-consciousness, but by grounding it in a philosophical anthropology capable of guiding nursing education toward a more enduring commitment to human dignity, justice and ethical responsibility.

Empirical weakness

Arveklev et al. ¹ argue that norm-consciousness is essential to addressing exclusion and injustice in nursing education. However, their claims rest on broad theoretical assertions about systemic inequality, without reference to empirical studies that substantiate such injustice within nursing curricula, pedagogical practices or institutional structures. While they offer a compelling critique of how seemingly neutral norms may perpetuate discrimination and structural power, their argument is not grounded in empirical evidence. No data are presented to demonstrate how specific groups are systematically disadvantaged in the context of nursing education, nor is there evidence that norm-critical pedagogy has redressed such disadvantage. This is not to deny the possibility of discrimination, but to highlight the need for empirical clarity when advocating for pedagogical change.

This absence of empirical grounding is significant, given the educational and ethical stakes of the proposed pedagogical shift. Nursing education, similar to clinical practice, is expected to be both value-driven and evidence-informed. When educational reform is premised on claims of injustice, it is reasonable to expect those claims to be supported by data that clarify the scope, mechanisms and outcomes of the problem. Without such evidence, there is a risk that pedagogical models become self-referential – justifying themselves through their own ideological lens rather than through demonstrable impact on student learning, inclusion or care quality.

Moreover, the lack of empirical specificity leaves educators without concrete guidance. Norm-critical pedagogy calls for critical engagement with power and norms, but provides few tools for distinguishing between harmful norms and those that serve pedagogical or clinical integrity. A more grounded approach would integrate sensitivity to lived experience with empirical attentiveness to the realities of educational practice, ensuring that the struggle against injustice is not only guided by moral convictions, but also informed by practical insight into what works in educational settings.

Ideological contradiction

Norm-critical pedagogy is founded on the premise that dominant norms are socially constructed and serve to reproduce power and exclusion. Its task is to uncover, critique and dismantle normative structures, thereby creating space for alternative identities, perspectives, and practices. As suggested by Arveklev et al., ¹ this includes challenging binary oppositions such as male/female, reason/emotion and public/private, as well as questioning normative assumptions about bodies, mental health and sexuality. ¹ These efforts aim to destabilise ideas of what is considered “normal” in nursing education and practice.

However, this project is not value-neutral. While it positions itself as a critique of normativity, it simultaneously advances a normative agenda – one that privileges values such as inclusivity, deconstruction and resistance to hierarchy. These values are grounded in specific philosophical and political traditions, including feminist theory, queer theory and critical disability studies.^5-7

This raises a tension at the heart of the approach: can a critique of norms avoid establishing its own normative framework? If norm-critical pedagogy rejects the possibility of objective or shared standards, on what grounds does it affirm its own ethical priorities? The risk is that it becomes ideologically self-enclosed – discrediting other moral frameworks as oppressive, while presenting its own ideals as emancipatory without offering a deeper ethical justification. ⁸

Moreover, by decentring claims to objective or universally valid moral truths, norm-critical pedagogy may erode the very basis upon which human dignity and justice can be defended. This tendency reflects the poststructuralist orientation of norm-critical pedagogy, which regards moral norms as contingent and constructed. ⁹ While it foregrounds values such as inclusion and social justice, it offers no stable moral reference point from which to evaluate or justify these priorities. As a result, the struggle against injustice becomes vulnerable to relativism and fragmentation. In seeking to liberate education from oppressive norms, the pedagogy may inadvertently create a new orthodoxy – one that resists critique and imposes its own vision of justice, inclusion or ethical care.

Ontological disconnection: a modern legacy

Arveklev et al.¹ rightly criticise the dominance of disembodied Western rationality in nursing education – a form of knowledge production that separates reason from embodiment and marginalises lived experience. ¹ This critique echoes wider concerns about the way traditional health education has excluded bodily, relational and situated forms of knowing. ¹⁰ In clinical practice, this disconnection has had tangible consequences: patients’ experiences are often dismissed as “subjective” and less valid than measurable data; the body is approached as a technical object to be treated rather than as an expression of personal meaning. This critique is both timely and important. However, what Arveklev et al.¹ fail to acknowledge is that the norm-critical pedagogy they propose does not resolve this disconnection. Rather, it continues it – by sustaining the same separation of experience from embodiment, albeit under a different philosophical framework.

Norm-critical pedagogy is rooted in poststructuralist theory, which continues rather than resolves the modernist rupture between body and meaning. While it seeks to challenge oppressive norms and binaries, it does so on the basis of an anthropology that strips the body of any intrinsic significance. Norms are viewed as mechanisms of power, and the body as a canvas upon which social forces inscribe meaning. Queer theory, Crip theory and similar approaches aim to destabilise fixed categories,^5,8 but they offer no ontological account of what it means to be human. Identity becomes fluid and liberation is framed as the unmaking of form. In other words, the postmodern approach shares the same fundamental premise as the modernism it seeks to overcome: the assumption that the body is void of inherent meaning.

In modernism, the body is a morally neutral object – biological material to be measured, standardised and managed. In postmodernism, it is a construct – an empty surface shaped by discourse and social context. ⁹ What unites these two paradigms is an underlying anthropology in which the body is (meaning)less: devoid of purpose, structure or moral significance. As a result, ethics becomes unanchored from reality. Norms are reduced to expressions of ideology or power, not recognitions of truth. Dignity becomes contingent on shifting perceptions, rather than grounded in what it means to be human.

This ontological vacuum has direct implications for nursing education. A pedagogy that trains students to deconstruct norms without offering any vision of the human person cannot sustain ethical reflection. Without a clear understanding of what the human body is and what it expresses, students may be left with critical tools but no moral compass. In practice, this could mean recognising social inequalities without the capacity to discern which norms serve human flourishing and which do not. Ethical discernment requires more than reflexivity; it requires an anthropology that affirms the moral significance of embodiment.

From experience to being: reclaiming human nature in ethics

To move beyond both the clinical objectivism of modernism and the deconstructive relativism of postmodernism, we need a more integrated ethical vision – one that begins in experience but is rooted in being. Phenomenology offers an essential starting point. It reminds us that ethical reflection does not originate in abstract reasoning, but in the lived encounter with another person. ¹¹ In this encounter, we do not merely observe the other as a physical body or clinical case – we are personally affected by their presence. We experience their vulnerability, and, even before we can fully explain it, we sense that we are responsible. ¹²

The fact that we find ourselves in relation to another person places us in a position of asymmetrical power and thus in a position of moral obligation. This demand is not externally imposed or derived from ideology; it arises spontaneously from the immediacy of the encounter. ¹² This relational dynamic is not only ethically significant – it is also epistemologically important. Through such encounters, we recognise the individual in their particularity. The ethical demand that emerges is not abstract or general, but personal. It calls for attentiveness, responsiveness, and the moral discernment necessary for truly person-centred care.

Phenomenological ethics therefore provides a powerful lens for understanding the foundations of person-centred care. To care well for another human being, we must first be willing to perceive them – not as a category, identity or diagnosis, but as a singular, embodied life. We must meet the person before we can meet the need. ¹¹

However, while phenomenology captures the depth of moral experience, it does not provide a normative framework for evaluating what is right or just in broader terms. It tells us that we are ethically called, but not how we ought to live in accordance with the human good. For that, we must turn to a deeper account of what it means to be human.

Classical natural law offers such an account by grounding ethics in the nature and purpose of the human person. In this tradition, first articulated by Aristotle ¹³ and further developed by Aquinas, ¹⁴ everything in nature has an inherent form and a natural end (telos). The human being is no exception. Our nature is not morally neutral, and our body is not a passive surface onto which meaning is externally imposed. Rather, it is a bearer of meaning – a kind of language through which our nature speaks. Its structure, rhythms and vulnerabilities express something about how we are meant to live, what we are made for and what constitutes our flourishing. ¹⁴

The body's language also testifies to a deeper truth: that our very existence carries meaning. We have not brought ourselves into being, and this givenness – whether understood as the act of a Creator or as a generative force – grounds our dignity at its most fundamental level. We are not self-made and therefore cannot be self-valued. ¹⁴ Our worth does not arise from achievement, identity or societal recognition, but from the sheer reality that we are.

This dignity becomes morally intelligible when we recognise that human life is directed toward specific forms of flourishing – such as seeking truth, cultivating friendship, exercising care, engaging in meaningful work and living in integrity with one's body and relationships. When we understand what the human person is for (telos), we also understand what it means to treat them well. Ethical norms, then, are not constraints imposed from outside, but moral signposts that align us with what we are. To live ethically is to honour the structure and purpose inscribed in our very existence. ¹⁴

This view is echoed in the work of contemporary natural law theorist Budziszewski, ¹⁵ who argues that there are certain moral truths we “can’t not know”. These include fundamental principles such as the wrongness of murder, the value of justice and the responsibility to care for the vulnerable. Such truths are not the product of ideological construction, but reflections of the moral structure embedded in human nature. They are accessible to reason and affirmed in experience.

By integrating lived experience with an ontological understanding of the human person, natural law provides a framework that is both empirically grounded and normatively stable. This is especially relevant for nursing, where ethical practice must navigate complex realities without losing sight of the patient's inherent worth.

Nursing, as a profession, is built on the principle that all people have equal value and deserve care that respects their dignity, regardless of background, identity or lifestyle. ¹⁶ A natural law framework reinforces this commitment by grounding it not in social consensus or political theory, but in the moral meaning of the human person. It strengthens the ethical foundation of nursing by affirming that human dignity is not contingent, but constant.

This is not merely a philosophical preference – it is a moral necessity. Without a stable understanding of what it means to be human, the principle of equal dignity loses its grounding. Postmodern approaches, such as the one advanced by Arveklev et al., ¹ aim to promote justice and inclusion, but they lack the ontological resources to explain why all people deserve care in the first place. When norms are treated as social constructions, and the body is seen as a blank canvas for identity, the basis for unconditional respect becomes unstable.

By contrast, natural law provides a deeper justification. It affirms that dignity is not assigned by society, but arises from our nature as rational and relational beings with an inherent purpose. Nursing education, if it is to form practitioners committed to justice and human dignity, must begin here: in the recognition of what the human person is, and the moral clarity that flows from this truth.

Conclusions

Norm-critical pedagogy raises important questions about power, exclusion and the role of norms in healthcare education. However, as this paper has argued, it lacks empirical grounding, internal coherence, and ontological depth. By contrast, an ethical framework rooted in phenomenology and natural law offers a more stable foundation – one that begins in lived experience and is anchored in the moral reality of the human person.

Such a perspective affirms that all people possess inherent dignity, not because of who they are socially, but because of what they are ontologically. This has profound implications for nursing education, which must prepare students to meet others not as objects of care or categories of identity, but as persons with a nature and purpose. By reclaiming a vision of ethics that unites experience with being, nursing education can cultivate professionals who care wisely, justly and with unwavering respect for the dignity of all human beings.