For many reasons, nurses have been reluctant to embrace feminism and its ethics. One reason may be a lack of self-awareness of the biases that are adopted by nurses from dominant culture or even the medical system itself. These are biases that may perpetuate social injustices rooted in gender, racial, or class distinctions. Another reason may be the negative stereotypes that extremists have unfortunately given to all forms of feminism.

Feminists (who may be women or men) are concerned about the barriers that close doors and, thus, systematically discriminate against or devalue women as a group. Many feminists are also concerned about systematic discrimination against men. Thus, the goal of feminism for many proponents is to examine the societal values and structures that cause oppression primarily to women, but also to men on the basis of gender, and to take constructive social action against them in order
to promote better relationships between women and men and contribute to a more just society.

The shift from feminism to feminist ethics is almost seamless. According to Volbrecht: “Feminist ethics strives for social transformation that will empower all people to live freer, fuller lives” (2002, p. 162). Obviously, the societal factors listed in the new interpretive statement, such as world hunger, cultural imposition, lack of access to health care, human rights violations, homelessness, poverty, and violence, do not empower “all people to live freer, fuller lives.” Each of the preceding factors represent ethical, feminist, and nursing concerns.

Feminist ethics also focuses on the belief that the voices of women should be heard and be given due weight in any theoretical formulations or practical application of ethics. Perhaps the best known work about these voices was penned by Carol Gilligan (1982). Gilligan wrote about a theme that women’s voices address, one of responsibility for and a connection to others sustained through caring relationships.

This so-called ethics of care has had a profound influence on ethical thinking in nursing. Nurse proponents view caring as the essence of the ethical ideal of nursing. Although most often applied to individual, family, and small group relationships, one also can apply the concept of caring to the social concerns expressed in Provision 8. Although most nurses would agree that caring about patients is important, some nurses would not consider caring the essence of nursing. The reasons for this include: (a) nursing is not the only profession that cares, and (b) caring is not viewed as an empowering concept by persons in powerful positions that influence healthcare priorities and practice.

Until recently, individualism dominated ethics in most of the Western world, particularly in the United States. This individualism can be seen in the priority given the ethical principle of respect for autonomy and individual rights. However, within the past three decades, there has emerged a movement away from an excessive focus on what is good for the individual to a more balanced emphasis on what is good for the community as well. According to Beauchamp and Childress, communitarians believe that “everything fundamental in ethics derives from communal values, the common good, social goals, traditional practices, and cooperative virtues” (2001, p. 362). In other words, the good of the community—whether one’s local community or the world community—takes
precedence over the good of the individual, whether embodied by personal rights or individual autonomy. Some communitarians, however, take a more moderate stance in that they believe that the good of the community and personal rights and individual autonomy should both be considered to ensure checks and balances against the excesses of either. In keeping with the preceding stance, Provision 8, with its emphasis on “promoting community, national, and international efforts to meet health needs” (ANA, 2001; p. 23) takes note of individuals’ health needs, but emphasizes broader health needs that transcend individuals and affect the world community (e.g., hunger, poverty, violence).

For many scholars, social ethics is grounded in the discipline of sociology. Here is what two medical sociologists have to say:

Whereas much of traditional bioethics has had a more narrow focus (e.g., on clinical ethical issues), social ethics focuses on the “social bases of morality” (DeVries and Subedi, 1998; p. xiv). It applies such concepts as race, culture, roles, norms, customs, class, social institutions, and power to the social construction of moral issues within “the economic, political, religious, and institutional forces of a given historical period” (Light and McGee, 1998; p. 9).

This broad view of moral issues is integral to Provision 8. Nurses cannot holistically understand the moral issues inherent in such global healthcare problems as hunger, poverty, and violence without a strong grasp of the social forces that contribute to these problems. Herein nurses have an advantage; they are educated to understand and apply socio-cultural and ethical concepts in their practice. Provision 9 emphasizes nursing’s role in social ethics through its professional associations.

In summary, in order for readers to better understand the ethical tenets underlying Provision 8, three interrelated perspectives were briefly discussed: feminist
ethics, communitarianism, and social ethics. What all three perspectives have in common is a focus on ethics that incorporates a larger societal picture of what constitutes morality.

According to Provision 8 “… the nurse supports initiatives to address barriers to health … such as… abuse and violence” (ANA, 2001; p. 24). Abuse and violence in health care have been addressed by many authors (e.g., Berman, 2003; Diekelmann, 2002; Lee and Saeed, 2001; Mercy et al, 2003; Volbrecht, 2002) and is viewed as a form of oppression. Oppression is the use of power in an unjust manner and is often a catalyst for violence. Violence is a type of oppression that is a threat to mental, physical, social, economic, or spiritual health. It can occur at the individual, family, community, or societal levels. Violence can be vertical, which means it can be perpetrated by groups among themselves. It is blind to gender, income, race, class, age, institutions, political viewpoints, or culture.

Violence is a health problem and, when focused on populations, a public or even global threat. According to Interpretive Statement 8.2, violence presents “existing threats to health and safety” (ANA, 2001; p. 24) of a community. Violence needs to be understood broadly. According to Diekelmann: “power, violence, and oppression accompany, although inadvertently, some of the ‘best practices’ of health care” (2002, p. xviii). For example, the emphasis on cure in health care that uses the best that science and technology have to offer may do profound physical, psychological, economic, and spiritual violence to those persons who cannot be cured. We call this “harming patients in the name of quality of life” (Fletcher et al., 2002; p. 3). The phrase also can be applied to nurses, communities, or cultures.