Ethics, Ethical Comportment, and Etiquette

• DOI: 10.4037/ajcc2002.11.1.76
• Publication Date: 2019-11-26T16:55:36Z
• Authors: Lisa Day; Patricia Benner
• Keywords: Etiquette; Bioethics; Opposition (politics); Medical law

There has been discussion on how various theories of ethics are similar, they different, and each should be applied. Ethical theory, in general, presented opposition to situation-based the ethical comportment found socially based practices. Etiquette is one concept that entered these debates, only peripherally, as a negative example what healthcare practice was left with before development bioethics or part medical history.1 In contrast limited discussions, etiquette can seen way bring into dialogue rather than opposition.Because it such familiar requirement, informed consent used illustrate some intersecting ideas about ethics, etiquette, comportment. Before initiating certain procedures, enrolling patient subject research study, procuring organs for transplantation, nurses and/or physicians required obtain patient’s consent. process obtaining consent, practitioner presents information all reasonable options surrogate, surrogate decides best option. Giving means rationally evaluated chosen course action suits needs desires.Theories like any rationalist endeavor, built axioms principles provide formalized structure which decisions rightness wrongness actions made.2 The theory supports right choose more generally “doctrine consent,” includes respect persons ends themselves.3 This further developed principle-based autonomy. Asking from providers show importance individual autonomy.According tenets valid must voluntary. debate literature regarding whether this standard upheld circumstances, but takes another form: How do we make sure making an adequately choice truly voluntary? pressing questions address amount quality provided nature situation place.Theories often foundational said groundwork arises. It long held most rational when defined following rules derived theory. because demand it. view, concepts then follows.Rule practice, however, come serious question.4 Formalized rules, no matter seem, always require background knowledge interpreted Understanding rule understandings by interpret allow us recognize huge variety possible situations For example, voluntary requires high level interpretation applied real situation. To start, need set required. Once decide required, definitions “informed” “voluntary.” discussions “voluntary” begin, there already place understanding allows appear important.4 other words, relevant shared individuals practices demonstrate respect.4 These everyday comportment.5Ethical prereflective, embedded practical rational, even though not calculation (ie, formal criteria). Unlike theoretical reasoning, cannot formalized. prereflective lived embodied precepts. Because embedded, engagement sense membership social group. Comportment develops others on, constituted by, develop involved theories.4The rely representations drive them since meanings precede rules. flexibility innovation enactment combination far beyond would adherence rules.4,5 autonomy point to, remind us, our limited, objective sense, act foundation practice. Rather, its attendant meanings, precedes necessary basis at all. have telling so. We acting individual, personal complex, relational, responsive ways never fully captured rule.Etiquette related both system flexibly situations. Despite potential connection between comportment, less favorable light. contrasting Loewy6 describes progression concern outward performance (etiquette) sophisticated internal intentions (ethics). According Loewy, fosters practitioner’s concerns his her behavior perceived draws attention developing material status profession. Ethics, hand, offers guidance important inwardly acknowledged duties patients. seem manifestations good intent displayed person’s manners suspect sharp appearance may attempt marketing trustworthiness, trustworthiness does actually exist.Similar Loewy’s view 18th-century Scottish philosopher physician John Gregory’s described Maio,1 warning potentially deceptive appearance. physician’s aesthetics cover up lack skill. time, true today, practitioners possessing questionable skills were adept selling their services use manners. But unlike description stop misused.1 also external manifestation morally sound intent. Both help mutually influence brought public dialogue.Etiquette, disguise corrupt display intent, opens space. As such, provides open possibility involvement provider patient/client. much provide, it, ensure decision relationship formed (L.D., unpublished data, 1999).7 sets relationship.As Gregory out, tension two taken practice.1 instrumental attaining good, fees services, subjects project, deceive client. Maio1 gives who pay close dress order expand client base thereby establish successful lucrative physicians, career advancement. Manners gain. calculated present oneself well-bred therefore worthy authority. gain, folds become approach opening moral space meet other.Using technique interest gain keeping either nursing When run across fellow using subterfuge end, case breakdown did 18th century.1 recognition shows demonstrates reciprocal informs forms bridge putting 1999).1These connections illustrated clearly returning organ donation, nurse approaches family particular way. donation forbids undue influence, manipulation, coercion, option wishes deceased loved one. influenced cultural surrounding death, bereavement, hospital environment, specifically environment intensive care unit (ICU). Certain behaviors appropriate, while not. situation, possibilities physician. response depends interplay comportment.The quote interview working procurement organization (OPO); job approaching members offer donation. excerpt reported elsewhere.7 excerpt, she had called evaluate child donor.This error lead rendered irrelevant. concealed identity employee OPO. makes gesture. Identifying herself OPO upon first encountering opened different sort family. perceives caring primarily wanting understand Given this, initially presenting her. becomes apparent grandmother reacts negatively revelation nurse’s motive: organs. grandmother, demonstration ethically could mask covering manipulate donating. original family, include identifying representative OPO, now failure etiquette.As redefines grandmother’s disrupts comportment; rapport that, least, proved untrue. At breakdown, irrelevant common continue conversation. effectively prevented appearing grandmother. intersection demonstrated, clearer.