Moral Imagination

Moral Imagination

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Ethics Tip

Moral Imagination: The Practice of Ethical Decision Making

By Marsha Hughes-Rease, MSOD, MSN, RN
NKC Consultant and Educator

The American Nurses Association has proclaimed 2015 as the Year of Ethics. Given the increasing complexity of health care and the unprecedented ethical dilemmas nurses face each day, Nurses Week is an excellent time for nurse leaders to introduce the revised ANA Code of Ethics for Nurses with Interpretive Statements (the Code) and have learning conversations about the implications of the Code and decision making. In Magnet®-designated hospitals, there is an expectation that nurses use available resources to address ethical issues related to clinical practice and organizational ethical situations. In many hospitals I have visited as a consultant, clinical nurses are not always familiar with the resources available to them to help make decisions with ethical considerations.

I was introduced to a concept a few years ago that has helped me insert ethical reasoning into the decision making process. When President Obama was accepting the Nobel Peace Prize, he said, “Achieving peace and prosperity in the world requires the continued expansion of our moral imagination; an insistence that there is something irreducible that we all share.” The term “moral imagination” caught my attention, so I did a little inquiry to investigate exactly what moral imagination means.

In his 1993 book Moral Imagination, Mark Johnson defined moral imagination as "an ability to imaginatively discern various possibilities for acting in a given situation and to envision the potential help and harm that are likely to result from a given action." I would argue that it is this ability to imaginatively discern various possibilities for acting in a given situation or when facing problems with ethical implications that is the foundation of ethical decision making. However, we sometimes leave out the ethical dimension in the decision-making process. Unfortunately, there are well-known and classic examples where the lack of a vivid moral imagination during the decision-making process had fatal consequences. One of the most famous that many of us have studied is the faulty decision-making that contributed to the 1986 NASA Space Shuttle Challenger accident.

One approach to increasing moral imagination during the decision making process is to practice having "IF-THEN" conversations. Some of the IF-THEN questions to pose for a discussion include

  • IF the problem is complex and the decision has the potential for causing harm, THEN how do you reframe the problem from a variety of perspectives to get a better understanding of the situation?
  • IF you are entangled in the immediate situation, THEN how do you create a forum to discuss the problem in the context of the bigger picture?
  • IF you recognize the group is using a typical way of thinking to address an issue not faced before, THEN how do you challenge the group to use a creative approach?
  • IF you suspect an ethical conflict is present as part of the decision, THEN how do you make sure it is addressed?

Often the organizational culture contributes to the lack of moral imagination during decision-making. Given your organizational culture, what are some other IF-THEN scenarios you can discuss to create an opportunity for nurses to increase their sensitivity to the ethical implications during decision-making?

This article was originally published in May 2015.

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