Canada, Code, Consent, and a Carpenter

From Nursing Ethics, 1880s to the Present (p. 391-393)
Used by permission 2024 © Marsha Fowler
Chapter 11 Notes

Never in a million years would I have thought I would be working at the Canadian Nurses Association as lead nurse for revising the Code of Ethics for Registered Nurses 2017. But there I was and thankful for the opportunity to be so involved. The first page of this Code also contains a lovely acknowledgment of my work over the years. (Be assured that I did not write this tribute!)

A special thank you goes to Janet Storch, RN, PhD, for her expertise, ongoing work and support in the development of the CNA code of ethics over many years. Through more than two decades of development and refinement to the CNA code of ethics, she has generously lent her exemplary scholarship, care- ful judgment and sage advice to strengthen this vital resource for nurses across Canada.²⁹

My academic focus was health‑care ethics throughout my long period of learning. I studied at the University of Alberta where, at the time, there was limited access to a formal study of health-care ethics, but there were a couple of health ethics faculty members who tutored me along the way.

Dr. Shirley Stinson was key to my launch into ethics. “Shirl” was President of the Canadian Nurses Association when I first formally encountered her and I was a beginning graduate student when I chose her as one of my mentors. At our first meeting she encouraged my pursuit of nursing ethics. On my way out of her office she handed me a package of nursing ethics papers to review, which turned out to be a draft of CNA’s first accepted code of ethics, urging me to report back to her my response to the draft.

Another precious mentor of mine was Dr. John Dossetor, a renal transplant surgeon. I met him when I was doing some interviews in Alberta for the Faculty of Law in Edmonton, with the goal of preparing health-care ethics resources for stu- dents at the University of Alberta and throughout the Province of Alberta.

I first found John in a lower‑level room (i.e., the basement of the hospital) where he was working on his transplant research. My assigned task was to learn what resources he had as well as his level of interest in clinical ethics. As I sat there, John had stories to tell. One of his favorite stories was about doing research in India while serving in the army during the war, and how easy it was as a physician to simply tell recruits and others waiting in line to see him to engage in medical testing, because they were captive. From my own early learning, my first question was, “Did you get consent from them?” He looked at me in amazement and said, “Why would I get consent?” That interview began a long period of John and I co‑learning more about health-care ethics, medical ethics, and nursing ethics. We jointly, and with others, helped grow a Bioethics Center at the University of Alberta as well as the national Canadian Bioethics Society, both of which continue today.

One of my early ventures was to write a book about health‑care ethics which I called Patients’ Rights: Ethical and Legal Issues in Health Care and Nursing (1982).³⁰ That book was undertaken in my master’s in health services administra- tion program and was based upon my thinking of specific patient rights to include, i.e., the right to be informed, to be respected, to participate, and to equal access to care. With few other Canadian resources available to students, this book was pub- lished by McGraw‑Hill Ryerson and it was released at a helpful time.

As my own sense of ownership of health ethics developed, I tried to attend eth- ics seminars in the US and in Canada, offered by Tom Beauchamp and James Childress, and by Edmund Pellegrino. I utilized their books extensively. I also visited their Ethics Centre in New York and later I spent a semester in Washington, DC as a guest of their Ethics Centre, with Dr. Pellegrino serving as my mentor. These won- derful opportunities often had me working overtime to keep abreast of the rapidly growing faculty responsibilities and the rapidly growing program of nursing ethics. This meant I was often working overtime.

One evening as I was working late, a young man with a large drill arrived to fix the door of my office. He viewed my desk loaded with papers and asked me what I was reading. I told him I was studying various codes of ethics for health professionals to see if the nurses’ code was missing something important. He responded immediately to say that his “profession” should have a code of ethics, and they did not have one. He then asked if he could borrow some of the papers. I told him I could not let any of the papers go, but they could be copied. His response was that he would very much like to copy them, and he was set to go to the copier which was one floor above. I told him again that, unfortunately, I could not give any of the papers to him because many were irreplaceable and I did not know what I would do if he failed to bring them back. For that excuse, he had a solution. He said he would leave his drill on my desk until he returned. He did so, and “we had a deal.”

Learning about health‑care ethics from the above sources, and as my confidence grew, I began a more focused program of reading and meeting nurses involved in clinical ethics and nursing ethics. I had the good fortune to meet Verena Tschudin in Vancouver as I arrived at the International Nursing Conference in Vancouver, BC. She was setting up a display for the new journal called Nursing Ethics.³¹ Later, Verena invited me to serve on the Editorial Review Board, which was a delight.

I have been so blessed to have happenstances that have connected me to “ethics involved people” seemingly by chance. Through Anne Davis, I became involved in ten days at the Rockefeller Center in Bellagio, Italy, to work on a book titled Ethics, Women and Incarceration.

My move to British Columbia in 1990 brought me into close working relation- ships with Dr. Paddy Rodney and Dr. Rosalie Starzomski, who had recently joined the faculty at the University of Victoria. Having known them through involvement in ethics seminars and other engagements across Canada, we quickly formed a three-some to develop health and nursing ethics resources, and to date we have published two editions of texts, with invited guests, called Toward a Moral Hori- zon: Nursing Ethics for Leadership and Practice³² (2004, 2018). We have recently finalized the third edition of our Open Access text so that our students and others will not have to pay “an arm and a leg” for this book.