From virtue to value : nursing ethics in modern China

(Uncorrected OCR) Abstract 'From virtue to value' characterises the two main lines of inquiry of this thesis in making sense of nursing ethics in modern China. The first line of inquiry examined the prescribed set of moral virtues that were required of nurses over the past century. The second line of inquiry was an empirical venture focusing on the nurses' evaluations of their ethical responsibilities in current practice. The particular viewpoints that nurses brought to their appraisal of the patient care situations where ethical practice was in question were examined. Three essential virtues have been identified, not only in academic writing or official documents, but also in the opinions of nurses themselves. They are a sense of socialist responsibility, excellence in practice and sincerity in relating to patients. These virtues have their roots in traditional Chinese medical ethics but expressed within the ideological framework of 'socialist humanism', in which Mao's mandate 'rescue the dying and heal the wounded, serve the people wholeheartedly' is promulgated as the fundamental principle. Embedded in this mandate is an advocacy of respect for life that demands a positive duty on the part of health-care workers to protect life and treat patients with altruistic motives. Over the past ten years, education and management measures have been instituted to foster these virtues in nurses. In reviewing contemporary issues in the health care system, population policies and euthanasia movement, I argue that another set of values based on the notion of 'quality of life' is promulgated by the Party leadership, which directly poses challenges to the adequacy of the mandate in informing practice. The empirical findings do not support a transition from virtue to value. Instead, it discloses a tension between the valuing of traditional virtues and the valuing of the virtues of the market economy. The three pairs of contrasted rankings emerged from the pattern of nurses' rankings of their multiple role responsibilities suggest that nurses in China inevitably experience moral dilemmas that emerge from three sources of conflicting values in practice situations that hold them from taking virtues seriously. They are typified in difficult care situations regarding information disclosure, withdrawal of treatment, requests for euthanasia, unmet needs of a demanding patient, and unmet needs of a silent patient. The first source derives from the emergent values that emphasise treating the patient as an individual and quality of care, but encounter the constraints posed by the value of protectiveness, which is predominant in the existing system of medical care. The second source emerges from the role requirement of having a sense of socialist responsibility in practice, but meeting with the constraints of the medical system, which is operated under the mechanism of market economy. The third source comes from nurses' emergent sense of professional care, meeting with traditional care values that emphasise family responsibility and institutional policies that require nurses to conform to rules and regulations. Drawing upon traditional ethical outlooks, international norms, and the actual experiences of nurses as they face ethically difficult situations, the thesis concludes with recommendations for improving the quality of nursing in contemporary China