Foreword

IN 2008, I HAD THE PLEASURE of attending the 12th International Nursing Philosophy conference in Boston. Eminent nurse ethicist Dr. Anne Davis, a native of Boston, offered to escort me and another nurse ethicist, Dr. Joan McCarthy, on a visit to Salem as we had expressed interest in learning more about the 17th-century Salem witch trials.¹ We arranged to meet at Boston harbour to catch the Salem ferry. I arrived at the appointed time to find Anne and Joan waiting and with a question: “Have you taken your sea sickness medication?” My response? It was along the lines of, “No need, thank you, I’m a fisherman’s daughter.” My recollection of the rough ride that followed comprised repeated instructions to “look at the horizon”; a disconcerting awareness that the “horizon” alternated between a turbulent sea and an angry sky; and the experience of severe sea sickness. I am pleased to report that my fellow travellers agreed that we could take the train back to Boston.

I was reminded of this “humility story” as I read the chapters of this edition of Toward a Moral Horizon: Nursing Ethics for Leadership and Practice. The first edition of this wonderful book, published in 2004, predated my Boston adventure and much has changed since then. The metaphor, however, of nursing ethics as a journey toward a moral horizon remains pertinent and current. The idea of navigation and of nurse leaders being the moral compass for nurses, “using their power as a positive force to promote, provide and sustain quality practice environments for safe, competent, and ethical practice” (Storch et al. 2002, p. 7, as cited in the lead-in quote for Chapter 1 of this new third edition) remains powerful and inspiring.

This third edition of the book comes at a time characterized by crisis, conflict, and complexity. “Crisis” is ever-present in discussions of global phenomena that impact health and care. We are emerging from the SARs-CoV-2 pandemic, which resulted in the deaths of millions of people, including nurses and other caregivers. We are in the midst of a climate emergency, whereby our environment is ravaged and irreparably damaged by human activity. We also have a significant care crisis with needs for health and social care escalating and the availability and sustainability of the care workforce in jeopardy (Buchan et al., 2022). In addition, we have war in Ukraine and political unrest and conflict in other parts of the globe, resulting in great suffering, strain on health services, and stress for nurses. Whilst we can be proud and appreciative of increased longevity in many parts of the world, this brings with it increased complexity and inequities and the need for agile, responsive health systems in which care providers are sensitive to individual and community diversity and committed to addressing inequities. The authors of this book make explicit the what, why and how of nurse leaders’ critical contributions to responses to crisis, conflict, and complexity.

It is argued in this third edition that “an ethical goal for nurses in advanced practice roles is to understand, and ultimately address, the cumulative effects of inequities at individual (micro), organizational (meso), and larger societal (macro) levels” (Chapter 1). Another goal, as stated in the Introduction of this text, is enabling nurses and other health care providers to become “ethically fit.” The authors draw on the work of Kidder (2009), who reminds us that ethics is not promoted by one-off inoculations but rather, like physical exercise, requires repeated committed activity, albeit with the addition of critical thinking and reflection. The complexity of ethical or moral competence in nurse leadership is implied with a range of rich insights shared regarding how the “oughtness” of health care practice can be conceptualized. The starting point for the authors’ approach to nursing ethics is the centrality of relationality in understandings of persons and perspectives on social justice which accommodate an ethics of care. The inclusion of Indigenous voices in this third edition enables new areas of wisdom to be integrated into the field of nursing ethics. These Indigenous voices remind us that we should “walk softly on the land,” (Chapter 5), take ethical responsibility to interrogate our positions, and commit to safeguarding our environment.

The breadth and depth of ethical issues explored, the frameworks discussed, and the extended range of topics included, make this third edition, now in an open access, digital format, an invaluable resource for nurse leaders, practitioners, educators, and researchers. Although the authors focus on the Canadian context, the three sections of the book have international appeal. The first section, “Mapping the moral climate for health care and nursing ethics,” for example, sets the scene with discussions of the professional and social context of nursing practice, research ethics, public health, and Indigenous perspectives. The second section, “Pursuing equity in diverse populations” is where the focus is on important debates in relation to nurse education, the promotion of equity, addressing structural inequities, mental health, reproductive justice, the moral agency of young people, home health care, care of people with disabilities, care of older adults, and care of those at the end of life. In the third and final section, “Navigating horizons for health care and nursing ethics,” the authors explore some of the most challenging ethical issues relating to current and future developments affecting health care, such as genetics, xenotransplantation, digital health technologies, and globalization.

The abundance of scholarly riches in this book is made possible by the experience, expertise, and wisdom of three nurse ethicists with exemplary international reputations. Their scholarship, over many years, illuminates many pressing issues relating to bioethics, health care, and nursing. We can be grateful for their decision making, which resulted in the inclusion of 32 additional expert authors with diverse, wide-ranging, and enriching perspectives.

This Foreword opened with a story relating to a boat journey—a journey scuppered by over-confidence and unpreparedness—a journey with a turbulent sea and a less than clear horizon upon which to focus. It is a story resulting in a less than positive outcome which required an alternative resolution strategy. The story serves as a humbling metaphor for nursing ethics in this time of crisis, conflict, and complexity, where journeying toward a moral horizon requires acute sensitivity to individual and collective differences, humility to listen to and learn from others and, critically, clarity regarding the nature of the horizon one is travelling toward.

The aspiration, detailed in the Conclusion chapter, to “promote ethical fitness and to provide hope for all of us in the nursing profession” is laudable and heartening. So, too, the authors hope that readers will “step boldly into shaping the future of health care” and “make ethical and political choices knowingly and wisely.” The authors’ confidence that the practice, scholarship, and political action of nurses will lead to a future where health becomes a reality for “all people on our planet” is confidence that nurses and advanced practice nurse leaders need to commit to and share. If nurse leaders, other nurses, and students of nursing lack the will and capability to shape the future, to redress health inequities, and to challenge social injustice, much-needed change will not occur. This reminds readers that nurses everywhere need to commit to caring always, abandoning never, and advocating courageously for all in need of health and social care.

Ann Gallagher, PhD, PGCEA, MA, BSc, RMN, RGN, FRCN

Editor-in-Chief

Nursing Ethics

Head of Health Sciences

Brunel University

London, UK

Endnotes

1 See Salem Witch Museum. (n.d.).