The exclusion of the other: challenges to the ethics of closeness

Abstract

There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, 'including the experienced Other', which is Nortvedt's position; (b) trying to bring the distant, non-experienced others closer, 'including the Third'; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in need of help, 'including the Other at the expense of the Third'. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non-experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one-sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position?

Ethical sensitivity in professional practice: concept analysis

“…The client perspectives of suffering and vulnerability and professional perspectives of uncertainty, receptivity, responsiveness and courage come together. Through this close relationship, ethical sensitivity develops (Myhrvoid, 2003) and professionals recognize the unique, irreplaceable characteristics of clients (Simpson & Garrison 1995). Without such connection, indifference to the specific concerns of the client often results (Vetlesen 1994, Nortvedt 2001).…”

The encounter with the unknown: Nurses lived experiences of their responsibility for the care of the patient in the Swedish ambulance service

“…The caring aspect of nursing involves the encounter with the patient as a unique human being (Gastmas, 1999). This caring encounter focuses on several ethical and moral dimensions emerging from closeness to the patient, and goes beyond the ethical boundaries that are related to medical care and nursing skills (Liaschenko & Peter, 2004; Myhrvold, 2003). …”

Beyond empathy: clinical intimacy in nursing practice

“…Empathy lies at the heart of moral perception in Scott’s (2000) analysis of Vetlesen (1994) for the teaching and practice of nursing in this journal’s first volume. Myhrvold’s (2003) critique of an ethics of closeness draws heavily on the conceptualizations of empathy in Travelbee (1971) and Vetlesen (1994). A change in empathy is of central concern in Herdman’s (2004) application of Městrović’s (1997) notion of ‘postemotional society’ to nursing.…”