Ethical Dilemmas and Nursing Practice, ed 2. Davis AJ and Aroskar MA. Norwalk, Conn, Appleton-Century-Crofts, 1983, 226 pages.
This text consists of 13 chapters written by two nurses, well qualified in the area of healthcare ethics. Both authors are former Kennedy Fellows in medical ethics at Harvard University.
The book is intended to make nurses in areas of education and practice more aware of ethical dilemmas in the healthcare field and to provide a theoretical base for addressing dilemmas specific to the nursing role. This goal is accomplished to an exemplary degree throughout the book.
The format of the book lends itself nicely to the aforementioned goal. The authors begin by providing an introduction to the branch of ethics specific to health care, discussing ethics in relation to the law, and defining ethical dilemmas. In addition, samples of health professionals' oaths and codes of ethics are reprinted and discussed from a historical perspective.
One of the new sections added to this second edition of the text is an important chapter titled "Value Clarification and Moral Development." These two concepts are well presented with clear rationale given for their importance to nursing dilemmas. A weakness in the chapter is the lack of definition of the terms "value" and "moral." Later in the text (chapter 12), "value" is succinctly defined, but the term "moral" remains undefined throughout the book.
Next, ethical principles and approaches are presented in a practical, down-to-earth way that should aid the novice reader. Numerous examples from health care are used to add clarity to complex subject matter. A general discussion of selected ethical theories or approaches such as egoism, deontology, and utilitarianism as well as the principles such as beneficence and justice provide a framework for the reader to think through ethical issues such as death and dying, behavior control, informed consent, and abortion, which are presented later in the text.
It was disappointing that the second edition did not address such timely issues as organ transplants and reproductive technology. According to the authors, these were not included for "pragmatic reasons." This is a serious deficiency in a 1983 text on ethical dilemmas and nursing practice.
The book concludes with a chapter presenting case studies involving ethical dilemmas. These case studies relate specifically to topics previously addressed and each is followed by thought-provoking questions for discussion.
For one who is easily overwhelmed by a voluminous text, the size of the book is perfect. All chapters are divided by subheadings and are well documented by almost 700 references to the literature. It would be helpful to the reader, however, if chapters ended with summaries or conclusions. References are interesting in that many are from literature other than nursing. The book does include an author and a subject index, each of which is thorough and a definite asset. The book would be strengthened if a separate bibliography were included for readers wanting a summary of other materials relevant to the topic area.
For the reader who has little or no background in ethical approaches, this book should provide a basic, thorough introduction to ethical approaches and dilemmas in nursing practice.