Anne H. Simmonds

A couple weeks ago, I attended a seminar run by the Joint Centre for Bioethics at University of Toronto (see more of their seminars here). Simmonds, a nurse and PhD from the Maritimes, is a bioethicist who seeks to remove ethics from its pedestal and bring it back down to practical and applied use on the Nursing Units.

In her paper, she explored the professional code of ethics framework and pointed out that, in her area of work (Perinatal nursing), the obligations of Autonomy and Advocacy are often ambiguous or even conflicting in practice. The idea of coming up with a prescriptive law governing moral actions is unrealistic and disregards the need for continued questioning and evaluation of individual situations.

Much of the ethics seen in a health care system is that of the “golden rule,” that is the utilitarian philosophy of the greatest good for the greatest number (this concept always makes me think of a factory line where you throw out all the duds), which governs many public health policies, such as vaccination campaigns, where individual issues or reactions are considered negligible when considering the health of the whole population. You can see how this quickly falls apart, when you consider outliers, minorities and oppressed populations whose voices are drowned out by the greatest number.

Perinatal Nursing in itself does not bode well in the medical system as the population has unique attributes:

1. Generally healthy, they do not follow the illness and treatment medical model (but seriously, what does?)

2. Birth is predictably unpredictable, gaining a sense of control in this situation is difficult even for the most experienced health practitioner

3. The concept of informed decision-making is already complex enough for one person but labouring women are often considered in relation to others, there are so many tightly knit perspectives at stake; such as her unborn child’s and her own. This makes it difficult to consider her decision making as an individual (Consider there’s probably no such thing as making an individual decision, all decisions are rooted in an important social context, more on that later.)

"Nurses and midwives also experienced some distress as they struggled to reconcile the ‘ideal’ of enabling informed choice with the realities of practicing in an environment where they felt that their agency was constrained."

This passage reminded me of a midwife friend who told me that she sometimes struggles when she takes on a new patient and because a large portion of her caseload are people who not eligible for healthcare, she wonders whether they would rather go to a hospital but can only afford the services of a midwife at home. Their agency is restrained by the political climate and poverty.

Advocacy & Autonomy

"Advocacy is thought to involve actions taken to promote the patient’s best interests, ideally coinciding with the interests expressed by the patient […] This conception of advocacy fits with more traditional notions of autonomy, where rights are tied to an individualistic notion of self, and people pursue their own interests separately from one another."

But what about unborn children? Spouses? Doctors? Nurses? Institutions? How does this meet their needs? How does this respect their rights?

So, this calls for Feminist Ethics: Relational Autonomy

"A feminist ethics lens focuses on the interdependent, unequal and emotionally charged relationships that shape relatedness, and includes a political perspective that attempts to uncover the patterns of dominance and oppression that shape these interactions. A feminist understanding of advocacy is grounded in relationship."




Simmonds AH. Autonomy and Advocacy in Perinatal Nursing Practice. In Nursing Ethics (2008), volume 15, issue 3