Questions of ethics and morality are extremely important to the nursing profession since by nature it is concerned with helping others. It is essential for nurses to be aware of the primary theories related to these issues. Ethics theories also are essential in nursing education. All graduates of nursing schools should understand the main theories and how they can be applied. Theorists in the area of moral development have researched how individuals decide what they would do if placed in a given moral dilemma. The best-known theorists are Kohlberg and Gilligan (Jorgensen, 2006).
Kohlberg created his justice theory of moral development by studying boys at various ages, presenting them with moral dilemmas and examining their reactions and reasoning. He identified three levels, each of which contains two stages. The three levels are preconventional, conventional, and postconventional; he found that most individuals do not reach the third level. He also discovered that age was not closely linked with the stages, but that stages were usually completed sequentially (Baxter & Boblin, 2007). Rest and colleagues produced a neo-Kohlbergian theory that retained the cognitive aspect of the ethics of justice but featured a different progression of stages (Jorgensen, 2006).
Gilligan presented significant critiques of Kohlberg’s work, the most notable being his reliance on males. She postulated that females have a unique form of moral evaluation and that therefore they did not follow the same stages as males. She identified the ethics of care as a typically female point of view, while the ethics of justice was associated with males (Jorgensen, 2006). She questioned the validity of Kohlberg’s findings based on gender issues as well as methodological considerations (cross-sectional research rather than longitudinal research) (Wildermuth, Souza, & Kazitza, 2017).
Botes (2000) evaluated the ethics of justice and the ethics of care in order to compare them as they are used by health care professionals. The author pointed out that any team of health care providers must work together well, and if they do not have a shared concept of ethics, there will be conflicts. Cooperation by team members will suffer (Sorbello, 2008). Therefore, they must develop their concept based primarily on the attributes of the two types of ethics. According to Botes (2000), the ethics of justice is based on the equality of all, impartiality, fairness, the use of universally applied rules, and the principles of individual self-rule and objectivity; the ethics of care involves personal relationships, empathy, contextual needs, and a holistic evaluation of the patient.
Many people see these two types of ethics as mutually exclusive and antagonistic. However, it is possible to harmonize them. Botes (2000) cites the work of Loewy and Edwards who advise making ethical decisions using rules (justice) along with empathy (care). This is more difficult, however, than simply using one or the other. To merge the two requires ongoing thought and consideration in the context of every nursing situation (Botes, 2000). While it acknowledges the need for standards, it also provides for individual differences. For example, pain is a very individualized problem, so it is important for nurses to carefully evaluate the patient’s pain; however, it is equally crucial to have a pain management protocol as a guide that the nurse can use following the assessment.
As mentioned above, the ethics of justice theory is based on cognition or rationality, while the ethics of caring relies on empathy and emotion (Robertson et al., 2007). Another way to merge the two in the context of nursing is to identify key concepts and conditions that guide ethical practice, then modify them to promote a harmonious relationship between nurse and patient (de Casterle, Roelens, & Gastman, 1998).