Philosophical reflection:The technological approach in healthcare has often taken precedence over the spirit of care that involves treating the patient as a whole person with a life story rather than the locus of a technical problem. To care, morally care requires convergence of competence with compassion. Ethical discernment has become increasingly complex. The dilemmas faced are contextualised and embedded within caring relation wherein we face our ethical responsibility to the other. Searching for rational solutions within our duty to care we find only partial solution because we dwell on the sense of duty, attempting to apply problem-solving rationales to essentially complex situations. Necessary as they are, they take us only so far. We realise that the most replete solution is recognition that care understood not as duty but as gift extinguishes the dilemma.

The paper proposes that an appropriate means of arriving at ethical decisions cannot be restricted to exclusively utilitarian values or universal principles but must acknowledge the context within which ethical dilemmas arise and the impact they have upon the unfolding narrative of peoples’ lives.

Conclusion:The framework for ethical decision-making emerging from the inquiry encompasses an existential and compassionate awareness of the person, principles to enable rather than determine life choice and, dialogic communicative action between self and other in living moments of care.

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Sigma Theta Tau International
July 22-24, 2004