Natural Law as a Unifying Ethic MARIE T. NOLAN, DNSc,

Natural law asserts that there is an objective moral order that human intelligence can understand and that societies are bound in conscience to foiiow. In 1772, George Mason appealed to natural law in denouncing a slavery statute in Virginia. This same ethic was called on to convict Nazi war criminals of crimes against humanity In 1948. In the last decade, natural law has enjoyed a resurgence In the medical biomedical ethics literature. It has appeared less frequently in the nursing literature and has been summarily dismissed when it has appeared. Only one nurse ethicist used natural law in discussing ethical Issues (organ transplantation). Although further development of this philosophy is required, this ethic shows great promise as a guide to decision making in nursing. (Index words: Deontology; Ethics; Natural law; Teleology) J Prof Nurs 8:358-361, 1992. Copyright 0 1992 by W.B. Saunders Company

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NE OF THE FEW GLIMPSES of nurse participation in rhe Nazi holocaust appears in the

book Murderous Science (Mueller-Hill,

1788). In a brief

excerpt, nurses are described as members of a euthanasia team whose assignment was to eliminate psyof abnormal constitution, inchiatric patients “. curable mental

illness or who for other reasons, do not

pass the test of Irfe” (p. 40). The test of life rakes place daily in clinm, wards,

nurseries,

and long-term

care setrings.

medical Once

RN*

for directing shield

actions,

can guide

them from ever again

human

parricipating

derous science. This universal ligrino

defines

immutable

natural

truths

law is narural

command

law. Pelby

of the argu-

1990, p. 166). The

of this article is to define natural

law and to

discuss ICSorigin and its use in civil law, medical, nursing

and

unanimity

i.e. on the merits

ments in their behalf’ (Pelligrino, purpose

and

in a mur-

law as “a set of eternal

which

their reasonableness,

nurses

and

literature.

Origin of Natural Law Most ethicists cal (means-ends) ogies. According false dichotomy.

divide

ethical

theory into teleologi-

and deontological

(duty)

methodol-

to ethicist Finnis (1983), this is a Finnis notes that the terms duty,

obligattan, and uivtue reflect an integral

pursuit

of basic

human goods that constitute the basic ends of all rational action. Natural law theory accommodates both the teleological and deontological methodologies. Early Greek philosophers

believed

that natural

law

is instinctive to the human race (Ashley & O’Rourke, 1989). However, Thomas Aquinas refined this doctrine

during

rhe Middle

Ages.

Natural

law was no

again, nurses are part of the team. Nurses provide, withdraw, and withhold treatment and advise families

longer viewed as instinctive

but as accessible

the use of reason.

actIons

when to do the same. They experience the consequences of these decisions much more directly than other health professionals because nurses remain at the bedside long after an order has been written and physician and family have retreated. The surge of ethics articles in the nursing literature reflecrs the variety of ethical dilemmas faced by nurses and their desire for guidance. A fundamental principle, a universal law

teleological, that is, we act with a purpose or end in mind. “Good ends and means are those befitting the human agent; bad ends and means are those which are

*Nurse Researcher and member of The Ethics Committee, The Johns Hopkins Hospital, and Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, MD. Address correspondence and reprint requests to Dr Nolan: Johns Hopkins Hospw., 9ch Floor, 1830 E Monument St, Baltimore, MD 21205. Copyright 0 1772 by W.B. Saunders Company 8755-7223/72/0806-0010$03.00/O

358

Jozlrnal of Professional Nursing,

Human

through

were noted

to be

not thus fitting” (McInerny, 1987, p. 3 1). Additionally, this philosophy maintains chat there exists an objectwe moralovder that human intelligence can grasp and that societies are bound in conscience to follow (Kenealy, 1950). In the mid-18th century, by utilitarians and positivists

natural law was rejected who used utilitarianism,

social pressure, and public opinion as guiding principles. Rights were seen as extending from laws based on human consensus. As Krason ( 1990) explains: It is begging rhe question to say thar narurai rights or the notions of justice on which they are based come only from human consent. We know from experience

Vol 8, No 6 (November-December),

1992: pp 358-361

NATURAL

LAW AS A UNIFYING

359

ETHIC

that people do have a sense of justice, right behavior or wrong behavior” (p. 4). The presence

of this consistent

ports the existence

sense of justice

of a natural

impairment

on those around

sup-

Also

contrasting

law, Pellegrino

law.

Use of Natural Law in Civil Law Although

natural

law transcends nature,

called on to resolve civil disputes in the early American argued court.

against

courts.

a slavery

Mason explained

ural right stated,

and

justice

civil law because

it has been frequently both in England

and

no earthly

statute

before

a Virginia

that all laws contrary are void

to nat-

in our system.

He

power can supersede”

(Aragones,

1990, p. 23).

The use of natural law to resolve ethical dilemmas in medicine has flourished during the past decade.

After World the Nuremburg

War II, natural law was called on in trial of 1945 to convict war criminals

of crimes against humanity. Later, in 1948, the United Nations adopted the Charter of Human Rights

based on the nature

of man (Vargg,

1984).

Civil law’s dependance on natural law continued after World War II (Kenealy, 1950) and continues today (Aragones,

1990).

in medicine

law to resolve ethical

has flourished

about

the greatest

causes the physician.

French geneticist

during

good.

Lejeune (1989) appeals to natural

law when he explains

what ought to be our treatment

of the frozen human

embryo.

Natural morality teaches us young as he might be, fragile as he might he, the human embryo is a member of our species and by that fact ought to be protected from exploitation. He is not a stock of spare parts to be drawn on at need. He is not a consumer good for sale or exchange. He is quite precisely our neighbor, our likeness, our brother” (p. 27). Professor

a unifying

Drane ethic

(1986)

recommends

for practicing

natural

physicians.

law as

He notes:

Deontological theories focus on duty, right and wrong, and moral imperatives. Teleological theories, on the other hand talk more about goods, results, satisfactions, and common welfare. Comprehensive ethical systems like Natural Law have a place for all of the above elements” (p. 37).

Drane proposes that natural law provides us with an idea of what it means to be human. “Based on this account

certain

acts could be seen as promoting

man flourishing ing the human”

and others as diminishing (p. 38).

hu-

or violat-

Natural Law in Nursing dilemmas

the past decade.

Theology professor May (1982) contrasts natural law with consequentialism, a form of teleological ethics. Consequentialists choose alternatives that promise to bring

natural that con-

The patient’s choice is good simply because she decides it. To do good for the patient, we should do the good she desires. [This ethic] permits the patient to choose a course even when it may seem wrong to a reasonable observer, so long as the consequences are not harmful to others” (p. 74).

Natural Law in Medicine The use of natural

with

notes the problems

In 1772, George Mason

“The laws of nature are the laws of God, whose

authority

consequentialism

(1988)

sequentialism

it is based on human

them or on society may

once again become the test of life.

The difficulty

May

The appearance

of natural

law in the nursing

ature of the past decade is much less common

literthan its

appearance in medical literature. The American Nurses Association’s (1985) Code for Nurses with Interpretive Statements seems to allude to natural law by stating that nurses base their decisions on “univer-

identifies with this ethic in health care occurs when its proponents examine an act or treatment in terms of

sal moral principles.” But the most fundamental principle is presented as “respect persons.” Other princi-

the number of persons who will benefit from or be burdened by it. The goods of the individual human person (life, health, truth, justice, etc) may be abandoned if they are viewed as outweighed by the goods

ples, such as autonomy, beneficence, etc, are identified as stemming from this fundamental principle. It is unclear whether these principles are ultimately grounded in natural law or simply based on human consensus. Many nursing articles concerning ethical theory

of others. In cases of an unborn children afflicted with genetic disorders, handicapped newborns, and the neurologically impaired elderly, the impact of their

simply

describe

an assortment

of these theories

and

360

MARIE T. NOLAN

direct the reader to select whichever be suitable. available

and

framework

concludes

that

should be guided

the framework maker.

he or she finds to

Fry (1989) lists several ethical frameworks

and their

Benjamin

the

selection

by the implicit

importance

and Curtis

values of

to the decision

(1986) present

four eth-

ical theories:

utilitarian,

intuitionist.

The authors

do not recommend

to guide

decision

these theories

duty based, right based, and ethical

each has its strengths

nesses.

is invited

commitment

any of

making,

they do note that The reader

of the

but

and weak-

to make a provisional

to one of the frameworks

and to put it to

use. During proposed

the past decade several nurse theorists that

caring

is a concept

(Boykin

as a guide

& Schoenhofer,

1989). As an ethical

however,

the weak-

tions of caring, the components of care, or the process of caring” (p. 2). Similarly, the application of caring making

has been quite

moral order would

sistent with the natural law ethic,

further

diverse.

Valentine (1989) explained that caring is important to guide health care resource allocation and added that caring is context specific and may have different meanings to different groups. This interpretation suggests that caring is an ethic of relativism containing no universal principles.

Adoption

make caring

con-

law ethic. As with the natural

development

of the ethic of caring

should be focused on its further definition

and clinical

application. Although

natural

law has been

clinically

useful

in medicine,

dismissed

rather

summarily

demonstrated

natural when

law in their book of nursing

making

an objective

moral order, or is it an ethic of relativism?

natural

torff, and Johnson (1990) concluded that, “There is no consensus in the literature regarding the defini-

decision

Does the ethic of caring support

of an objective

ethical

remain to be clearly

the

ness of the concept of caring is that it remains illdefined. After conducting a thorough review of the literature on caring, Morse, Solberg, Neander, Bot-

in ethical

defined.

Key ethical concepts

literature.

1990; Fry, 1988; Valentine,

framework,

frameworks.

ethic has been con-

with a variety of conflicting

nursing

that captures

to ethical decision

it seems that the caring

sidered consistent

have

essence of nursing (Benner & Wrubel, 1989; Lein1988). Caring has also inger , 1984, 1988; Watson, been suggested

others,

as

law has been

it appears

in the

Davis and Aroskar (1978) mention

fault it for its dependence

on human

ethics,

but they

reason,

explain-

ing that there is no way to settle disputes when one person’s reasoning conflicts with another’s. The authors take a subjective view of ethics explaining that “ . . . rights are not to be viewed as something to be discovered as true or false, but as language used to promote change and social and legislative reform” (p. 48). In one critique of natural law that represents a radical departure from other descriptions of this theory, Thompson and Thompson (1985) link natural law to a resurgence of social biology. They describe how this line of thinking may attribute behavior to genetic factors such as an altruistic

and a selfish gene if carried

to its extreme. As it is more commonly accepted, however, natural law is predicated on the view of the human as a rational being in control of his or her own actions. Thompson and Thompson’s “biology determines behavior” example is not consistent with this ethic.

. . . the weakness of the concept of caring is that it remains i//-defined.

Only one nursing article was noted that based ethical reasoning on natural law. In her review of the ethical implications of transplantation, O’Connell (199 1) comments that some of the classic principles in health care such as “first, do no harm,” and “good is to be done and evil avoided”

Caring is presented as a virtue-based ethic by Boykin and Schoenhofer (1990), who reviewed the writings of several theorists on caring. They conclude that within the caring ethic, conscience directs one’s moral behavior and that “conscience grows out of the experience of valuing” (p. 152). The caring ethic most closely resembles the natural law ethic as it is described by Fry (1988) as a universal value that must be applied to all persons in similar circumstances and that must consider the flourishing of others. After reviewing the comments of Fry and

are based on natural

law.

Using this ethic, O’Connell considers the use of anencephalic infants as donors and notes that these infants are not born dead but dying and therefore must be accorded full human rights.

Future Developments The use of natural law by nurse ethicist O’Connell to examine ethical issues in transplantation and by geneticist Lejeune to examine issues in embryology makes an important point. They demonstrate that natural law serves to guide ethical decision making as

NATURAL

LAW AS A UNIFYING

tremendous

advances

health care. Indeed, our understanding

361

ETHIC

are made advances

of natural

in technology

and

are also being

made in

law. As medical

ethicist

Ashley (1987) points out, “our knowledge of the natural law is not static, but constantly developing, and can be helped sciences,

by many

history,

literature

disciplines:

philosophy,

the

and art, etc” (p. 2). Ash-

to bring all the knowledge available in our times to a better understanding of what it is to be truly and fully human (p. 2).

Natural

of human

called on to protect

destruction.

aged, the handicapped-those

jectively

face the test of life.

by striving

Today

the vulnerable,

When we disagree about particular points of the natural law, it is possible to discuss our differences oband to arrive at greater consensus

as a unifying

ethic

of the teleological and deontological traditions. history, it has been called on in the punishment prevention

ley concludes,

law shows great promise

it may

the young,

In and be

the

in our care who again

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Leininger, M. M. (1988). History, issues and trends in the discovery and uses of care in nursing. In M. M. Leininger (Ed.), Care, discoveryand uses in clinical and community nursing. Thorofare, NJ: Slack. Lejeune, J. ( 1989). Is there a natural morality? Linacre Quarterly,

1, 23-29.

May, W. E. (1982). Meeting ethical dilemmas in health care: Some basic criteria. Linacre Quarterly, 3, 248-261. McInerny, R. (1987). Aquinas’s moral theory. Journal of Medical Ethics, 13, 31-33. Morse, J. M., Solberg, S. M., Neander, W. L., Bottorff, J. L., &Johnson, J. (1990). Concepts of caring and caring as a concept. Advances in Nursing Science, I, l- 14. Muller-Hill, B. (1988). Murderous science: Elimination by scientific selection of jews, gypsies, and others Germany 1933-1945 (G. Fraser, Trans.). New York: Oxford University Press. O’Connell, D. A. (1991). Ethical implications of organ transplantation. Critical Care Nurstng Quarterly, 4, l-7. Pellegrino, E. D. (1988). For the patient’s good: The restoration of beneficencein health care. New York: Oxford University Press. Pelligrino, E., Harvey, J., & Langan, J. (Eds.). (1990). The gift of life. Washington, DC: Georgetown University Press. Thompson, J., & Thompson, H. ( 1985). Bioetbical derision making for nurses. Norwalk, CT: Appleton-CenturyCrofts. Valentine, K. (1989). Caring is more than kindness: Modeling its complexities. Journal of Nursing Administration, 11, 28-34. Vargg, A. C. (1984). The main issues in bioethics (Rev. Ed.). New York: Paulist. Watson, J. (1988). Nursing: Human science and human care, a theory of nursing. New York: National League for Nursing.

Natural law as a unifying ethic.

Natural law asserts that there is an objective moral order that human intelligence can understand and that societies are bound in conscience to follow...
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