Roberta Sala

The Value of Nurses’ Codes: European nurses’ views:

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses’ opinions of the content and function of codes and their use in nursing practice. A total of 49 focus groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be ‘paper tigers’ with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice.

Autonomy, Responsibility and the Italian Code of Deontology for Nurses

This article is a first assessment of the Italian Code of deontology for nurses (revised in 1999) on the basis of data collected from focus groups with nurses taking part in the Ethical Codes in Nursing (ECN) project. We illustrate the professional context in which the Code was introduced and explain why the 1999 revision was necessary in the light of changes affecting the Italian nursing profession. The most remarkable findings concern professional autonomy and responsibility, and how the Code is thought of as a set of guidelines for nursing practice. We discuss these issues, underlining that the 1999 Code represents a valuable instrument for ethical reflection and examination, a stimulus for putting the moral sense of the nursing profession into action, and that it represents a new era for professional nursing practice in Italy. The results of the analysis also deserve further qualitative study and future consideration.

The Regulation of Autonomy in Nursing: the Italian situation

We reflect upon the meaning of freedom and autonomy in nursing behaviour, attempting to outline the contemporary situation of nursing in Italy, where the profession is achieving important results after a long period of submission and subordination. The way to real emancipation is not easy, but a statement of law on the one hand - abolishing constraints such as the Mansionario - and professional self-regulation on the other - the recent new Deontological Code - represent a real conquest in that direction. However, no statement of law or deontology can be sufficient without deeper reflection by the profession on itself and its tasks, potentiality, social importance and self-esteem.

Industrial Action by Nurses: the Italian situation

Those who want to know anything about strike action by Italian nurses will find very little written about it. This contribution intends to show that, whatever they are prepared to admit, Italian nurses are not used to strike action because they mostly think of their profession as a form of mission. Even if we could agree with the idea of nursing as a profession subscribing to an ideal of service, we have to distinguish between a real profession and philanthropic work; vocational motivation is not enough to make a good professional. Historically, nurses perceived strikes as contradictory to human need and action; patients must never be left alone. However, Italian nurses are now interested in a dramatic transformation of many aspects of their professional life, becoming conscious of the duty to protect themselves from every kind of exploitation, even if the typical idealism and dedication of nurses makes them vulnerable.

Nurses and Requests for Female Genital Mutilation: cultural rights versus human rights

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between culture-relative values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described.

The place of unreasonable people beyond Rawls

In this article I look for an alternative way in which ‘unreasonable’ people may be included in a liberal society. Differing from Rawls, whose reasonable hope is for unreasonable people gradually to adhere to liberal institutions so that, over time, an overlapping consensus is reached, I propose the alternative way of them supporting these institutions as a special modus vivendi, which does not require them to renounce their non-reasonableness. First I detail the Rawlsian notion of reasonableness and unreasonableness; second, I discuss how the treatment of the unreasonable is addressed by Rawls; third, taking inspiration from two accounts of how to consider the ‘unreasonable’ within a liberal society, I maintain that a subset of ‘unreasonable’ (I call them ‘non-reasonable’) may be included in public debate; fourth, I propose that their way of inclusion is a stable modus vivendi.

Reasonable Values and the Value of Reasonableness. Reflections on John Rawls’ Political Liberalism

This paper aims to question the idea of reasonableness in Rawls’ account of political liberalism. My point is that reasonableness as the moral basis of the liberal society provides restrictions for differences – be they philosophical, moral, religious, cultural – to be included in the liberal society. Notwithstanding Rawls’ attempt to expand political boundaries and to include those people who do not share moral liberal justification to justice as fairness, reasonableness selects “values holders” and assigns to the so-called “reasonable” a place in the political debate. The others, the “unreasonable”, are expected to become reasonable; alternatively, they would be paid control or even coercion in all the circumstances in which they should represent a risk for political stability. I believe that Rawls gives an incomplete account of unreasonableness: there may well be persons who are not “reasonable” in Rawlsian terms but who do not necessarily represent a danger for the just society. By the fact that they do not endorse values as freedom and equality in which fair cooperation is grounded, we cannot infer that they will necessarily try to violate the terms around which cooperation is structured by imposing their values on others. I proceed as follows: a) I detail the Rawlsian political turn in defending justice as fairness; b) I focus on the idea of reasonableness as the core of political liberalism; c) I defend the thesis that political liberalism needs to revise the idea of unreasonableness if it aims to deal with pluralism as a social and political fact.