Anyone who has ever prepared a college of nursing catalogue has had to engage, if only briefly and superficially, in the development of a philosophy of nursing. I would like to carry that activity a little further here in order to propose and develop a particular philosophy of nursing.

I will describe what could be called the self care philosophy. But an important distinction must be made at the outset. “Self care” usually suggests the lay revolt against professional care; often, self care is billed as an alternative to rather than a philosophy of professional health care. What then do we mean by self care as a philosophy of nursing? The philosophy is this: that nursing have as its primary ideal active assistance to individuals, families, and communities in the development and exercise of their autonomy in health matters. The concept of self care, or patient autonomy, involves two dimensions, action and agency, and the nurse provides assistance in both of these. Self care action is the health behavior that is performed.

In an extraordinary and highly controversial 5-4 decision, the United States Supreme Court decided on June 30, 1980, that the United States Constitution does not require either the federal government or the individual states to fund medically necessary abortions for poor women who qualify for Medicaid.

At issue in this case is the constitutionality of the Hyde Amendment. The applicable 1980 version provides:

What happens when a nurse is ordered to do something illegal or unethical? What should a nurse do when ordered to falsify a patient's record? Is her behavior justified because she is following orders from a superior?

These important and troubling questions were raised but left unanswered by a recent Connecticut malpractice case. The case has received much attention because the verdict awarded the plaintiff— $3.6 million — is the largest in the history of the state. The case should interest nurses, not because of the record-making verdict, but because of ethical problems raised by the behavior of the attending staff.