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
0
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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