Nursing researcher shines light on ethical blind spot

At one point early in her career as a nurse, Deakin’s Chair of Nursing, Professor Megan-Jane Johnstone considered giving up the profession. She was unable to give a name to the issues she encountered.

It was only when she went to university and discovered “Philosophy 101” that she had her Eureka moment and realised that ethics had been the “elephant in the room.”

“I had always had a strong sense of justice,” she said. “Once I discovered ethics, I realised I wanted to make the field of ethics visible and accessible to nurses and to make the ethical issues nurses had to grapple with every day visible to the public.

"I have now been working on that quest for almost 31 years – which I suspect will remain a lifelong project.”

There can be no doubt about her success in achieving this goal. Professor Johnstone is now one of the most respected nurse ethicists in the world. She has just edited a three-volume Sage Major Reference Work, “Nursing Ethics” – the first of its kind.

She has also just prepared a revised sixth edition of her landmark work “Bioethics: a nursing perspective,” which was first published in 1989 and was the first book on nursing bioethics ever to be written from an Australian perspective. Both works have just been released for worldwide distribution.

In its review of “Nursing Ethics,” the International Council of Nurses (ICN) stated that the Sage major work would “serve as an important resource for ethicists, researchers and nurses in all fields, and is the first of its kind to bring together the foundational ethical articles of the nursing profession.”

The three-volume work includes leading articles that have influenced the international development of nursing ethics and also details the history of the development of the “ICN Code of Ethics for Nurses,” which “guides action, based on social values and needs and serves as the standard for nurses worldwide."

“Bioethics 6” will be launched at a nursing conference in Adelaide by Lee Thomas, Federal Secretary of the Australian Nursing and Midwifery Federation.

“The fact that Bioethics: A nursing perspective” is still in print 27 years after the first edition is remarkable,” said Professor Johnstone.

“I never imagined it would be. The chapter I am most proud of is completely new: ‘Ethics, dehumanisation and vulnerable populations’.”

“The past 125 years of writing on this topic offers a fascinating insight into how nursing as a profession has developed over time and reacted to the ethical questions raised around the role of nurses and their interactions with patients.”

Professor Johnstone suggests that, at one level, the ethical issues faced by nurses remain unchanged. For example, “debate is ongoing about nursing codes of ethics – what their content should be and what role they should have in terms of guiding and censuring professional nursing conduct.”

On another level, many ethical issues are emerging as a result of 21st century developments, such as the health impacts of climate change, peak petroleum, anti-microbial resistance, growing health inequalities across the globe and the tough moral decisions that will have to be made in relation to these things.

Like the pioneering US nursing scholar and social activist, Lavinia Dock, co-founder of the International Council of Nurses (circa 1899), who wrote a foundational essay “Ethics – or a code of Ethics?” decades ahead of its time in 1900, Prof Johnstone is passionate about continuing to improve the calibre and authority of nursing ethics.

“It does concern me that some nurses have lost sight of the broader issues, despite intellectual developments in the field,” she said.

“Some nurses still make decisions based on their personal values and beliefs, rather than through systematic inquiry. Yet people can be mistaken. For instance, people once believed that the world was square and if you sailed to the edge you could fall off it. Although sincerely held, that belief was clearly wrong.

“Educators and researchers have a responsibility to challenge conventional thinking on nursing ethics in undergraduate, postgraduate and professional development programs.

"Also, thinking needs to extend beyond the issues emerging within the ‘bricks and mortar’ environment of hospitals, to include broader social justice and humanitarian concerns.”

In addition to other books, book chapters and many journal articles published over the years, in 2013 Professor Johnstone published “Alzheimers disease, media presentations and the politics of euthanasia: constructing risk and selling death in an aging society.”  This highly provocative and trailblazing work has received glowing reviews in a range of leading journals, including the prestigious US-based journal “Gerontology”