In January, a small group of NMADE members set sail from New Orleans, LA, on board Norwegian Cruise Line’s ship, the Spirit. We met for learning sessions at six different times on our 7-day voyage that sailed to Costa Maya, Belize, Guatemala, and Cozumel.

Susan Foley Pierce, PhD, RN, presented one of the most beneficial and inspiring programs I have ever attended. Susan guided us with her knowledge, wisdom, and gentle spirit as we first discussed the philosophical aspects of ethics, including morality, moral problems, and moral judgments. She led by first teaching, and then allowing open discussions of all of her material throughout every learning session.

Our first and second sessions were held during the first day at sea – 2 hours in the morning and 2 hours in the late afternoon. We learned about autonomy and beneficence derivatives by gaining an understanding of three moral rules: veracity, confidentiality, and informed consent. Susan presented major ethical theories from Western, historical moral philosophy – the “mainstream, malestream” – Deontological and Teleogical theories; and, the “femalestream” and Feminist Moral Theory, Ethic of Care. We reviewed a case study and ended with a very insightful group discussion.

On day 2 of the cruise, many of us went our separate ways to discover our first port of call – Costa Maya. When we returned that evening, before dinner, we had another 2-hour session. During that session we discussed ethical rights and responsibilities including: engagement vs. advocacy; consent for treatment decisions in the growing child; ethical issues when a young adolescent is dying; and, moral vs. legal decision making. As Susan guided us through our learning process, members of the group shared examples of their own personal situations. The discussions were very engaging and enlightening as we all learned so much through each other.

The next day was a full day spent on shore excursions and roaming around on the ship finding so much to do – especially socializing with new friends, participating in onboard activities, eating, and spending time at newly found favorite spots on the ship.

During our third session, Susan introduced us to Bioethics for the New Millennium. The session started out by providing staggering statistics that identified the problem that surrounds social justice in the delivery of health care. For example, 47+ million Americans lack health insurance with the majority of these people being mostly young males in the South. She pointed out that the Balanced Budget Amendment pays only 65-70% of costs and that 47% of public hospitals have turned away uninsured patients. The introduction of justice vs distributive justice led to discussions about equality, with many human considerations including: need, desire, merit, effort, ability, and social contributions. Nozick’s Libertarian Entitlement Theory, the Utilitarian Theory, John Rawl’s Egalitarian “community of fairness” and Aristotle’s Justice were key theories presented to and discussed by the group members.

Our last two sessions focused on matters of life and death. Specifically, we learned about ethical issues in end-of-life care and addressed the nurse’s role in addressing ethical issues. Susan presented a section on the moral framework that included the ethical principles of autonomy and respect for persons, beneficence/non-maleficence, and justice. She shared the main areas of care that generate ethical issues. Some of which are communication and decision-making, withholding/withdrawing treatments, assisted suicide, and euthanasia. Advance care planning, and The Patient Self-Determination Act.

Susan Foley Pierce, PhD, RN, is Professor Emeritus at the University of North Carolina, Chapel Hill. She also serves as the Secretary for the American Nurses Association. We were honored to have her as our speaker and leader this year for our BioEthics – Ethical Decision Making Conference and look forward to inviting her back next year to guide us through another program.

Nurses Making A Difference Everyday is a non-profit organization designed to meet the special needs of patients, families, and caregivers who are faced with a diagnosis of a life-changing illness or injury. We are committed to providing valuable educational sessions, appropriate referrals for services and resources that prepare individuals and families with information needed to enhance their quality of life. NMADE offers professional networking and educational opportunities throughout the year by providing continuing education opportunities and meetings for members of the healthcare team.