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Cork Lives
"How, colder and more isolated would all of our lives be without this work that nurses and midwives do; this labour of mind, body, heart and spirit," says Dr Joan McCarthy
"How, colder and more isolated would all of our lives be without this work that nurses and midwives do; this labour of mind, body, heart and spirit," says Dr Joan McCarthy
SOCIAL BOOKMARKS

A stranger held my father’s hand as he died... I will always be grateful

‘NURSES don’t need to think’, was the comment of one of the reviewers of a book proposal on nursing ethics that my colleague, Dr. Dolores Dooley, and myself had sent back in 2005.

Thankfully, our other reviewers and the publishers begged to differ with this very traditional perspective on what nurses do and our book got written, published and reprinted several times in the intervening years.

Today, as ever, nurses and midwives are called upon to undertake many onerous and demanding responsibilities all of which certainly require thinking as well as moral, emotional, psychological and physical labour. I am privileged and honoured in the job that I do because, as a lecturer in health care ethics in the School of Nursing and Midwifery, University College Cork, I have the opportunity to discuss all the various aspects of the challenging ethical work that nurses and midwives do when I meet them in class as undergraduate students learning the fundamentals of nursing and midwifery knowledge, research, and clinical practice, or as highly skilled and experienced professionals, who are honing their craft, enhancing their leadership capabilities, or developing their research expertise.

In the 20 years that I have been teaching in the School of Nursing and Midwifery, I have heard about the many different, complex, life and death ethical quandaries as well as the everyday ethical challenges that nurses and midwives must navigate. For example, a nurse or midwife might ponder: ‘How will I answer the question; am I going to die nurse?’ Or, ‘What will I do if a patient refuses treatment or care e.g. medication or a bed bath which I believe will benefit them?’ She or he might worry about the level of involvement in decision-making the family of a patient may have or the number of interventions a neonate should receive at the request of anxious parents. Or, they might spend many sleepless nights reflecting on the extent of their professional and legal responsibilities when they are faced with a colleague who does not seem to be practicing competently or ethically.

It is a fundamental part of the everyday work of nurses and midwives to care for people whose bodies and minds elude their own control. I recall with gratitude how, in 2001, the two nurses in the South Infirmary in Cork city cared for my father as he lay dying, his body exhausted from end-stage lung cancer and his mind confused from the lack of oxygen and his strange surroundings. One day, as the nurse specialist explained to my sister and myself about the equipment and support we would need to care for dad at home, all my years teaching about death and dying were like the years of some other person’s life. I found myself just the daughter, the sister, the relative, shocked and numb, fearful at the prospect that we would be taking dad home to care for him ourselves in his final days. That night, however, another nurse on duty phoned me to tell me that he had ‘taken a turn’. Rushing into the quiet and darkened ward that dad shared with six other patients, my sister and I learned that he had died shortly before we arrived. Wondering and worrying about his final struggles and thinking that he had probably “raged, raged against the dying of the light”, the nurse reassured me that his final moments were peaceful. “I wasn’t sure if he was a religious man or not, but I held his hand and said a silent prayer as he slipped away.” All the articles, books, and theses that I have read, all the insights from all the conferences, lectures and podcasts, I have attended about determining “what is the right thing to do” in such situations cannot displace the power of that simple gesture. A stranger held my father’s hand as he lay dying, without judgement, and with a prayer that wished him well. My family and I will be forever grateful to her for that.

Dr Joan McCarthy, Lecturer, Healthcare Ethics, UCC
Dr Joan McCarthy, Lecturer, Healthcare Ethics, UCC

How, colder and more isolated would all of our lives be without this work that nurses and midwives do; this labour of mind, body, heart and spirit. In ethics, a principle that best captures this work is that of solidarity. It suggests the idea that we are “fellow travellers” and we have a duty to support and help one another. The South African Ubuntu theology, articulated by Bishop Desmond Tutu, captures the idea of solidarity in the phrase translated as: “a person is a person through other people”. Or, the Irish language refers to the notion that we rely on each other for shelter, “Ar scath a chéile a mhaireann na daoine”. The philosopher, Emmanuel Levinas, suggests that witnessing the face of another person can conjure “nakedness and destitution”, “extreme exposure”, “defencelessness”, “vulnerability itself”. For him, it is the human face, or, the “wounded Other”, that calls for some kind of ethical response; it marks who I am: “The Other becomes my neighbour precisely through the way the face summons me, calls for me, begs for me, and in so doing recalls my responsibility.” For family members and the nurses and midwives who support us, meeting this responsibility is not always easy. As Irish nurse ethicist, Anne Clancy, puts it when she talks about the work of public health nurses: “There are no boundary markers or cornerstones for nurses or anyone else in ethical responsibility. The door to the Other is always ajar.”

Whether it is a community nurse who is helping a son give his father a bed bath or a nurse supporting a young client with intellectual disabilities to learn to go shopping; whether it is a mental health nurse sitting with a patient who is deeply depressed, a midwife sitting with a woman who is grieving her lost child, or a clinical nurse specialist sitting with a patient in a critical care unit, for what turns out to be that person’s last day on earth – these nurses and midwives are relating with, and caring for, our relatives and friends when they are at their most vulnerable. They meet their anger and shame, their despair and hope, their resolve and humour… and more. The temptation to run and hide from looking at all of that, to numb out, to distance, to detach, to ignore must be overwhelming at times. Alternatively, to stay human and humane in the face of the naked humanity of others, takes true moral courage. However, it is clear that the moral terrain that Irish nurses and midwives must traverse is becoming increasingly more treacherous. Developing professional, educational and institutional strategies and policies that are socially, emotionally and politically more intelligent and informed would make acting ethically more achievable and the personal cost of doing so to the well-being of health professionals and the patients in their care more bearable.

A groundbreaking conference on nursing ethics will be held in UCC, on September 1 to 2. I am proud to be part of a team from the School of Nursing and Midwifery who have invited leading international and national experts in the field of nursing and healthcare ethics to present on a range of challenging topics related to the caring role, professional education, nursing and care practices in a wide range of settings including older persons and dementia care, end-of-life care and acute care.

For more on the conference see http://inec2018.ucc.ie/ @inec2018 #inecc2018