A nursing therapeutics requires that nurses literally act for patients, and they do so in three domains:the physical, the psychological, and what the authors calls the "integrity of the self." Acting for the patient is a matter of inherent ethical significance. Acting for another carries the risk of instrumentality; that is, one person becomes the means to another's end. This can result in a variety of moral problems depending on who determines what the ends will be; the degree to which the ends are agreed on among nurse, patient, significant others, and physicians; and whether nurses are acting for their patients, for themselves, or for institutionalized medicine. A therapeutics exists to do something to and for another, and therefore several knowledges are relevant. While the knowledge of physiology, disease, and interventions is necessary, it is not sufficient, nor perhaps even the most important. Also required for an ethical therapeutics is the knowledge of the social and political place occupied by nurses, self-knowledge, knowledge of the person, and the knowledge of the worthiness of ends to be ends of human life.
Postdoctoral Fellow, University of California, San Francisco, San Francisco, California.
This work was supported through a National Research Service Award Predoctoral Fellowship (#F31 NR06836) from the National Institute for Nursing Research, a PEO Scholar's Award, a University of California Graduate Research Award, and a UCSF School of Nursing Century Club Research Award.