There is little in the way of an ethical analysis or racism in the bioethical literature. Nor is there anything on racism that incorporates identity-grounded ethics in a bioethical analysis. Even more damning is the fact that racism, sexism, and classism (land ownership) are embedded in US Constitution and bioethics has yet to come to grips with this malignant and intractable issue.

Since the inception of the Colonies as the United States, the US has been exclusionary, codifying a privileged group.  We the people meant white, male, freeholder, over 21, excluding and disabling all others from any domain of power. Nussbaum and others make the argument that, beyond race, ethnicity, and sex, the Constitution/social contract also excludes persons with disabilities and a range of other vulnerable persons and groups. Racism, sexism, and bigotry were written into the founding architecture of the nation. However acute we feel these –isms to be today, they have never not been acute. And, more to the point, they have been present in nursing, also from its start. It is time for an ethical reckoning within the profession, both to address past injustices but also to prepare for a future that is both morally better and does good.

Nursing Ethics…ethically different, but … : Nursing ethics, from the inception of modern nursing, has had a commitment to social ethics, to social criticism and social change, in the direction of justice, equity, fairness, well-being, health, dignity, respect, and the common good.  It had a vision of the good society, a healthy nation and a healthy people—and a good profession (good meaning morally good).  And yet, nursing does not have clean hands; it has failed, at points spectacularly so, to enact its moral values, vision and ideals. It is not nursing ethics that is flawed, it is nursing’s enactment of its ethics that is flawed. Racism within nursing is an abject failure of nursing ethics.  There is hope, though. However imperfectly nursing’s social vision has been pursued, and however imperfectly nursing has engaged in self-examination, however darkened nursing’s vision has been by the scales over its eyes, however racist some of its members are, to whatever degree nursing has failed in relation to racism, and other -isms—social concern has nonetheless remained a moral norm and understanding of nursing’s ethics. The moral task before us is to bring the real into conformity with the ideal. I believe that the apparatus of bioethics is not serviceable for nursing in this endeavor—bioethics’ conception of justice is that of an a priori, abstract, rationalist principle of distributive justice based in social contract theory, the same social contract that is as exclusive as the US Constitution.  As long as nursing continues to use bioethics to address racism it will fail.  Rooted in nursing experience, and in the community, narrative, tradition and practices of nursing, nursing ethics’, not bioethics, has the practice-based relational knowledge that can address the lived experiences of woundedness and oppression that is part of the lives of our patients — and many of our colleagues. Nursing must take a hard look within, at its own failures and complicities.  Nursing must reclaim and renew its own relational ethics, looking inward and outward, in order to address seemingly intractable social issues such as racism, poverty, sexism, hunger, illness, environmental justice, and more.

Identity-grounded ethics as essential to nursing’s ethical analysis: In addition to reclaiming nursing ethics, a second issue is that in attempting to employ bioethics’ abstract, a priori, rationalist, Eurocentric perspectives on justice, we effectively (by its intentional methodological design) silence the subjective lived experience of personal and social suffering attendant to race, sex, gender, class, disability, their intersections, and more, from the perspective of those most intensely affected.[1] It is not simply or solely their woundedness that is silenced and that must be heard, but nursing must also hear the core, collective values of the peoples and communities society has harmed. Nursing ethicists must hear the values incorporated in the community’s way of being in the world, their own vision of a good society and the common good, and the collective interpretive ethical lens that the community employs. Nursing bioethics has not done this; it has not reached into the identity-grounded, identity-informed ethics of these communities to become informed by the community itself in its own ethics.

Nursing Ethics and Identity-grounded ethics: A shared methodology: Nursing ethics is rooted in the community experiences of nursing which comprise the referent for its ethical norms, its core values, and the expression of those norms and values.  The values are stable but find renewed expression as the community grows in ethical awareness and its practices change, as well as those of the surrounding society. It is, thus and in itself, an identity-grounded ethics that arises from within a community, its narrative, tradition, and lived experiences of its members and is, consequently, methodologically similar to the identity-grounded ethics of many diverse, shared-identity groups that also draw their ethics from community, tradition, narrative, and experience.

Nursing ethics is equipped and methodologically consistent with other identity-grounded ethical processes found in, for example, Black ethics, Latina/o ethics, and Feminist ethics.  These approaches to ethics invariably contain notions of justice, equity, suffering, the common good and a vision for a good society. These notions arise (as with nursing) from the community, and its narrative, tradition, and lived experiences of their members.

Take, for example, Miguel A. De La Torre’s Latina/o Social Ethics: Moving Beyond Eurocentric Moral thinking (2010). De La Torre offers nursing a methodology that is surprisingly compatible with nursing ethics’ own methodology. His intent is to formulate an ethics that encompasses the lives of Latinas/os as experienced by the community, including its experiences of structural oppressions and marginalization. He calls for ethics en lo cotidiano (in the everyday) that is “unapologetically anchored in the autobiographical stories and testimonies of the disenfranchised,”[2] an ethics of daily relationships and social relations.[3] His notion of nepantla is one of an ethics “with a preferential option for those living on the hyphen in Hispanic-America” of the poor, “the culturally oppressed and socially dispossessed,” as persons between marginality and acceptance, regarded as neither truly Latino nor as truly American.[4] His development of an ethics para la lucha (for the struggle, the fight to survive).[5] The concept of an ethics en conjunto “means ‘in conjunction with,’ or ‘conjoined in,’ implying the coming together in a deep collaboration.[6] An ethics de acompañamiento “is a praxis of being present alongside disenfranchised latina/o communidades en lo cotidiano and en la lucha.” An ethics of accompaniment is, in many ways, a more informed and engaged ethics than that of advocacy. These are ethical concepts, that together, create a beginning social ethics drawn from within la commmunidad, the Latina/o community, to address issues of oppression and marginalization. They are also, as in nursing ethics, deeply relational.

De La Torre’s methodological reconceptualization of social ethics for his Latina/o community is a voice that nursing needs to hear (in both content and method) as nursing addresses racism within the profession. His methodology has something profound to teach nursing ethics about uncovering and addressing particular oppressions.  Nursing can learn, and needs to learn, and needs to act by hearing the voices of all those individuals and communities who are oppressed, marginalized, neglected, stigmatized, shunned, or forgotten, and needs to embrace the heart, soul, and flavor of the community’s own ethics.[7]

Nursing’s Ethical Analysis of Racism: There is a significant need for an ethical analysis of racism-and-nursing, in all its parameters.  This would require a deep collaboration among individuals who situate themselves within specific identity-communities.  However, that alone is not sufficient. Identity must combine with identity-grounded ethical reflection as well.  Nursing ethicists must collaborate with persons who have expertise in the identity-grounded ethics of those communities – such as Latina/o ethics; Feminist, Womanist, Feminista ethics; Black ethics, Black Radical Feminist ethics; Native American Ethics; Disability ethics; Gender ethics; various religious ethics; and more.  Nurses in ethics must engage with identity-grounded ethics to be well positioned to aid the profession in an ethical analysis, and a more comprehensive ethical analysis of the -isms that plague our society and profession.

Hearing voices: A few suggestions for reading in identity-grounded ethics

Nursing ethicists, and those who teach nursing ethics in nursing schools, ought to draw upon the varied identity-grounded ethics available in the literature. These voices need to be heard now for our ethics work in the present, but also to prepare students who are the future practitioners of nursing and ethics in nursing.  I would suggest that these works, (see below), among many others, can serve to provoke thinking, deepen discourse, and challenge the received bioethics in order to create a more inclusive vision for nursing and health care ethics. An ethics against oppression cannot be formulated without an ethics de acompañamiento (accompaniment) with those affected, and it is their voices that can guide in these particulars. The community of moral discourse needs to be a whole and authentic community.

A sampling of voices for us to hear and listen to…

Katie Canon. Black Womanist Ethics.

Stacey Floyd-Thomas and Katie Cannon. Mining the Motherlode: Methods in Womanist Ethics.

James Cone. A Black Theology of Liberation

Angela Davis. Women, Race & Class

Judith Butler. Gender Trouble: Feminism and the Subversion of Identity

bell hooks. Feminist Theory: From Margin to Center 3rd Edition

Emilie Townes. Womanist Ethics and the Cultural Production of Evil
and Breaking the Fine Rain of Death: African American Health Issues and a Womanist Ethic of Care

Cornel West. The American Evasion of Philosophy;
and Race Matters and Democracy Matters: Winning the Fight Against Imperialism

Kimberle Crenshaw, Neil Gotanda, Gary Peller, and Kendall Thomas. Critical Race Theory: The Key Writings That Formed the Movement

George C. L. Cummings. A Common Journey: Black Theology (USA) and Latin American Liberation Theology

Gustavo Gutiérrez. A Theology of Liberation

Gustavo Gutiérrez and Gerhard Muller. On the Side of the Poor

Enrique Dussel. Ethics of Liberation: In the Age of Globalization and Exclusion

Ada Maria Isasi-Diaz. Mujerista Theology: A Theology for the Twenty-First Century

Victoria Camps Cervera. Virtudes públicas: Por una ética pública, optimista y feminista

Mary Streufert. Transformative Lutheran Theologies: Feminist, Womanist, and Mujerista Perspectives

Margaret Walker.  Moral Understandings: A Feminist Study in Ethics.

Hilde Lindemann. An Invitation to Feminist Ethics.

David Novak. Jewish Social Ethics.

Elliot Dorff. Jewish Choices, Jewish Voices: Social Justice

Shmuly Yanklowitz. Jewish Ethics and Social Justice.

M. Therese Lysaught, Michael McCarthy, and Lisa Sowle Cahill . Catholic Bioethics and Social Justice

Nazim Qayoom Rather. Islamic Social Ethics and Response to Evil.

Irfaan Jaffer and Liyakat Takim. Traditional Islamic Ethics.

Margaret Farley. Just Love: A Framework for Christian Sexual Ethics.

Richard Peddicord. Gay & Lesbian Rights: A Question: Sexual Ethics or Social Justice?

Akwesasne Notes. Basic Call to Consciousness

Vine Deloria, Jr. Red Earth, White Lies: Native Americans and the Myth of Scientific Fact;  and The Metaphysics of Modern Existence

David Martinez. Life of the Indigenous Mind: Vine Deloria Jr. and the Birth of the Red Power Movement

Brian Burkhart. Indigenizing Philosophy through the Land: A Trickster Methodology for Decolonizing Environmental Ethics and Indigenous Futures

Russell Means and Bayard Johnson . If You’ve Forgotten the Names of Clouds, You’ve Lost Your Way: An Introduction to American Indian Thought and Philosophy

Licia Carlson. The Faces of Intellectual Disability: Philosophical Reflections

Joel Michael Reynolds. A Life Worth Living: Disability, Pain, and Morality

Amos Yong. Theology and Down Syndrome: Reimagining Disability in Late Modernity

Advancing nursing ethics more inclusively and more reflectively requires hearing voices long silenced. Nursing must understand the full expression of woundedness inflicted by social oppressions, specifically racism and its consequences. That woundedness has found expression in a range of identity-ethical theories that have not found their way into nursing ethics, or nursing curriculum, except piecemeal. A wholistic nursing ethics must be as inclusive as possible, as authentically repentant as warranted, and as visionary as necessary to the healing and health of society.

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[1] Clare Mac Cumhaill and Rachael Wiseman, Metaphysical Animals: How Four Women Brought Philosophy Back to Life (New York: Doubleday, 2022).

[2] Miguel A. De La Torre, Latina/o Social Ethics, 71.

[3] María Pilar Aquino, Our Cry for Life: Feminist Theology from Latin America, (Maryknoll, NY: Orbis, 1993).

[4] Miguel A. De La Torre, Latina/o Social Ethics, 72.

[5] María Pilar Aquino, Our Cry for Life: Feminist Theology from Latin America, (Maryknoll, NY: Orbis, 1993),168, as cited in Miguel A. De La Torre, Latina/o Social Ethics, 74.

[6] Miguel A. De La Torre, Latina/o Social Ethics, 76.

[7] Fowler, Marsha. Nursing Ethics, 1880s to the Present: An Archeology of Lost Wisdom and Identity. (London: Routledge, 2024).