Analysis of the American Society

Nurses live and work in a world that has become - and will remain - unequivocally pluralistic in nature and outlook. To put this another way, nurses now live and work in a world in which there is no one single reality, but many coexisting realities (multiple realities) among which they must choose. The development of a pluralistic world view has had a significant impact on our moral ways of seeing, believing and acting. The more pluralistic our world has become, the more value systems there have been available to us and the more complex our ideas about what constitutes the moral life and how best to achieve it. Little wonder then, that in the 1990s, the world in which we live, and the contexts in which we work, have all become increasingly characterized by moral indiscernability, ambiguity, uncertainty, controversy and perplexity. (Light) For some, these difficulties have been compounded by what they refer to as the 'postmodern predicament' wherein, it is assumed, 'we no longer share any common grounds to which we might appeal for the adjudication of our differences'. (Light) To add to this predicament, we continue to face moral problems in our day-to-day personal and professional lives, we continue to worry about whether the moral choices we make are 'correct', and continue to suffer the moral perplexity and distress that inevitably follows from 'not getting it right' or from being unable, for various reasons, to translate our moral reflections and judgments into action. Against this backdrop, at least two important questions can be raised: what are the implications of this scenario for the nursing profession? And how can nurses be prepared best to deal with them? In this paper I will try to discuss and analyze the American Society for Bioethics and Humanities (ASBH) - the non profit organization which makes abounded contributions to our society. Reflecting a mood that seems to be seeping through bioethics, several speakers at last years conference of the American Society for Bioethics and Humanities issued urgent calls for renewed attention to issues of justice. Many now seem to feel that bioethics has been too much concerned with medical ethics, with the way individuals render treatment to or perform research on other individuals. More important but less discussed are the societal and international questions about justice and health care.

Perhaps one good reason these large questions have drawn less attention, of course, is that they seem less susceptible to resolution. But perhaps there are other ways of approaching them, ways that will pare them down to more manageable mouthfuls.

ASBH tries to craft substantive guidance for the just allocation of health care resources within managed care organizations by drawing out the implications of some ground-level moral assumptions embraced by managed care. If the primary goal of a managed care plan should be improving the health of its participants, for example, then there is a presumption, albeit a rebuttable one, against running plans as for -profit enterprises, since such plans appear to divert resources from improving participants' health toward increasing owners' wealth. If patients and participants should have the opportunity to consent to the allocation of health care resources in their plan, then there ought to be mechanisms - participant forums or boards - by which that consent can be made meaningful. In effect, ASBH sidesteps the frustrating effort to specify justice itself by showing that at least in the context of managed care some of the issues of justice can be covered by other, arguably more easily specified less controversial values. ...



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