Strand 2: Holiness
Strand 3: Wisdom
Strand 4: Prophecy
We start, as shown in step 1 above, with four colored strings or strands—purple, green, red and gold. When we interweave those strands, as shown successively in steps 2 through 5, we get a braid. Now the canon of Christian Scripture is like the completed braid. If we then ask how it tries to shape the character and conduct of its readers, we discover that it does so in four somewhat different ways. Sometimes the Bible lays down laws (Strand 1). Sometimes it promotes virtuous habits or morally praiseworthy character traits (Strand 2). Sometimes it recommends sensible strategies for making decisions, solving problems and interacting with others (Strand 3). Sometimes it sharply criticizes behaviors and social institutions that cause people to forget God or oppress others (Strand 4). Different as these modes of moral instruction may seem, however, they all serve a common purpose: to increase readers’ love of God and neighbor. To grasp the Bible’s overall moral vision, therefore, we must not merely analyze its separate strands of moral discourse: we must correlate and coordinate their respective concerns and insights. We must let the Bible’s rich complexities, subtle nuances and diverse perspectives all have their say in shaping our character and conduct. In chapters 1–4, we take the four strands one by one; then, in chapter 5, we put the four strands into direct conversation with each other. We argue that people attain moral maturity when they hold the distinctive approaches of all four strands in dynamic tension, allowing each strand to have its say, and braiding them together into a strong, supple, integral whole.
Fourth, we sometimes distinguish between the ethics of conduct and the ethics of character, as shown in Table 0.2 below. Strands 1 and 4, which emphasize what people should do and how they should act, represent conduct-focused ethics. In contrast, Strands 2 and 3, which emphasize who people are as moral agents, represent character-based ethics. This distinction between conduct-focused and character-based ethics is also discernible in the Code (ANA, 2015). Thus, Provisions 1, 2, 3, 8, and 9 (which correlate with Strands 1 and 4, as shown in Table 0.1 above) stress the personal and professional conduct of nurses, whereas Provisions 4, 5, 6, and 7 (which correlate with Strands 2 and 3) focus on their moral virtues and professional skills. Yet it is important not to push the distinction between conduct-focused and character-based ethics too far. People’s behavior usually reflects their selfhood in its entirety, and their selfhood is only knowable to others (and often to themselves) by their concrete actions in the world. We may distinguish character and conduct for purposes of ethical analysis, yet we recognize that they are really aspects or dimensions of the moral life in its entirety.
| Table 0.2. Conduct-Focused Ethics vs. Character-Focused Ethics | |
| Conduct-Focused Ethics: Emphasis on laws, regulations, rules, policies, procedures or protocols | Character-Focused Ethics: Emphasis on virtues, habits, skills, disposition, motives, moral sentiments, emotional intelligence |
| Strand 1: Law | Strand 2: Holiness |
| Strand 4: Prophecy | Strand 3: Wisdom |
Fifth, as previously noted, we argue in this book that ethical nursing practice involves obedience to laws, regulations and protocols; the cultivation of virtuous habits; decision-making procedures based on evidence, insight and experience; and advocacy for the rights and needs of patients, and that these differing emphases parallel the dominant themes of the four strands of biblical moral discourse, respectively. True, the Code of Ethics for Nurses with Interpretive Statements (ANA, 2015) does not explicitly invoke the Bible as a moral authority, nor does it imply that a person must be a Christian in order to practice nursing ethically. Yet the norms for the character and conduct of nurses set by the Code do correspond closely to the overall picture of godly living delineated in the four strands of biblical moral discourse, and our task is to explore these parallels. The way in which the four biblical strands and the major objectives of the corresponding provisions in the Code collectively contribute to moral maturity in Christian nurses is illustrated in Figure 0.3.
Figure 0.3. Moral maturity and the four strands
Our sixth clarification has to do with how we refer to “the nurse.” We acknowledge that the history of modern nursing has been heavily female-dominated, but the 2017 National Nursing Workforce Study (Smiley et al., 2018) reports a welcome, steady increase in the numbers of men in the nursing profession. Additionally, we acknowledge that there is now much dialogue about gender identity and the use of preferred pronouns, which may apply to some of our readers (Turner, 2014). In view of these facts, we generally speak of “nurses” in the plural. Wherever we must refer to “the nurse” in the singular, we alternate the usage of male and female pronouns, rather than constantly using awkward or ungrammatical constructions such as “he or she,” “s/he,” or “they” in a singular sense. We ask the reader to understand that such singular pronouns are intended to apply to every nurse, regardless of gender or sexual orientation.
Two Cautionary Notes
Here we must interject two cautions. First, we raise the possibility that Christian nurses might experience a conflict of conscience when reading the Code (ANA, 2015), which regards itself as the “nonnegotiable” (p. vii) ethical standard of the profession. We assume that the supreme moral authority for every Christian is the Bible and that one of the chief ways in which thoughtful Christians put their respect for the Bible’s moral authority into effect in their personal and professional lives is by using it to test the adequacy of any other proposed moral standard. As it happens, we see nothing in the Code that flatly contradicts the moral teachings of the Bible, such that Christian nurses would be obliged in conscience to disobey the former in order to remain faithful to the latter. Nevertheless, Christian nurses cannot accept the Code’s claim to be “nonnegotiable in any setting,” if that implies that its text is perfectly unambiguous throughout, that its implications for clinical practice are always self-evident, or that questions can never be raised about its adequacy and relevance to specific cases. Yet we presume that the ANA does not intend its members to regard the Code in such a “fundamentalist” fashion. For the Code itself has a long history of development, which reflects the changes that have taken place in health care and in American society generally over the past century (pp. xi–xiii; Fowler, 2015, pp. vii–ix). Nurses have been asking tough questions of their Code since they first had one, and we presume that the ANA intends them to keep doing so. In that case, the Code serves as an indispensable working norm for nursing practice, a norm that should not be violated by individual nurses in their daily work but that is always subject to constructive critique, and that can be revised as necessary through due process by the ANA. No Christian nurse should have trouble accepting that.
Second, even if Christian nurses can accept the Code (ANA, 2015) as morally binding upon their character and conduct, given that the Code itself is always revisable and that—for Christian nurses, at least—its moral authority is always subordinate to that of the Bible, there remains another problem. The ethical texts of the Bible are not always self-evident in meaning, nor is the precise manner of their application in specific cases always clear. Thus, although the moral teachings of the Bible are certainly indispensable for Christian nurses in interpreting the Code, those teachings themselves require careful theological interpretation and ethical reflection. The method we use here for interpreting our chosen biblical passages is both theological and historical-critical. A few words about these two features of our method are in order.
On the one hand, we read the Bible theologically, that is, as Christian Scripture. The church throughout the ages has regarded the Bible as God’s authoritative word for God’s faithful people, as a testimony to God’s sovereign love and redemptive power in (or “behind”) human affairs. We are not committed to any particular theory of how the human authors of the Bible derived or experienced divine “inspiration.” We do, however, affirm that the church, under the guidance of the Holy Spirit, has recognized the voice of God in (or, again, “behind”) the writings included within the Bible and regards these writings as uniquely “useful for teaching, rebuking, correcting and training in righteousness” (2 Tim 3:16). Furthermore, we are guided in our reading of the church’s sacred book by the church’s rule of faith, that is, the cluster of doctrines and religious practices deemed orthodox by the ancient