Good motherhood practices from a bioethical perspective: a contribution to pediatric nursing

Benedita Maria Rêgo Deusdará Rodrigues^I; Patrícia Lima Pereira Peres^II; Sandra Teixeira de Araújo Pacheco^III

^I Professor at the Mother and Child Nursing Department of the Nursing School of the State University of Rio de Janeiro. Brazil. E-mail: benedeusdara@gmail.com
^II Assistant Professor of the Mother and Child Nursing Department of the Nursing School of the State University of Rio de Janeiro. Brazil. E-mail: patricia.uerj@hotmail.com
^III Associate Professor at the Mother and Child Nursing Department of the Nursing School of the State University of Rio de Janeiro. Brazil. E-mail: stapacheco@yahoo.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2015.18944

ABSTRACT

This study aimed to encourage thinking about good motherhood practices in the day-to-day practice of professionals who deal daily with mothers and babies, including fathers and necessarily families in giving care, with a view to their comfort and well-being. This is an exciting subject that poses challenges, considering the professional activity involved in the context of everyday human relationships. This is the concrete reality of care, its essential characteristic as a way of being human that cares and wants to be cared for. Accordingly, it is an approach to care that involves the ethical and bioethical perspective. In this regard, motherhood comprises humanized care that requires more than acting on others or for others, but respects the autonomy of the subjects involved (caregiver, child and family), enabling all participants to position themselves as agents in reciprocal relationships.

Keywords: Ethics; bioethics; family; neonatal/pediatric nursing.

INTRODUCTION

Care from the perspective of good motherhood practices are much more than biological aspect of this process, transcending the symptoms of the problems presented by the child, covering all their family and social context, since it is taking care of these people guiding them and placing them in the care action aimed at their comfort and well-being. In this way the person is perceived as a unique human being, whose individual needs can be captured by oral, body, written or symbolic language, by the feelings and attitudes¹.

This is an exciting topic that gives opportunity of challenges because while it seems complex, it is essentially simple, when referring to professional activities involving the context of everyday human relationships. This present article aimed to promote reflection about good motherhood practices in everyday professionals who deal daily with the mother, the child, including his father and, necessarily, the family in care actions, for their comfort and welfare.

The topic raises deep reflections, after all we are talking to whom we should direct. Are we talking about a mother, father, son, the family caregiver? Including the different professionals of the multidisciplinary team. In this sense, we should not be exempt from the contemporary context in which it is necessary a more comprehensive look to the motherhood of who actually performs it.

However, for the changes happening in the field of health practices, it is necessary to change professional attitudes guided in human relationships. Therefore, in the care humanization process that focuses on the person.

The aim is the ethics of unconditional respect for people. To understand the person as a human being, as a subject of inalienable rights, in an era in which the techno-science is always more self-referential, technical generates technique with less and less human interference².

Thus, we must respect the relationships established in current family compositions, many of the traditional core, for example, homo-affective relationships, avoiding guided discrimination on personal values, which are often characterized by intolerance and do not allow the caring human perspective.

Here we can ask a few questions: What really are we talking about? And in which bioethical concepts do we want to support us?

These questions remind us to Leonardo Boff³ in his work Knowing to care: the human ethics - compassion for the earth when calls our attention on the tamagochi and care. He points out that contemporary society called knowledge and communication society, is creating, paradoxically, increasingly non-communication and loneliness among people. For example, the Internet can connect us with millions of people we need without leaving home or find someone. Through the internet we know the world, pay bills, work and ask several things to meet our needs and all without speaking to anyone, which brings us some difficulties because the relationship with the concrete reality, with its smells, colors, cold, heat, weight, resistance and contradictions is mediated, often only by the virtual image.

For him, the virtual world has created a new habitat for human beings, characterized by encapsulating by themselves and the lack of touch and human contact. He adds that the anti-reality affects human life in what it has of more fundamental: the care and com-passion. Care is the human essence. The care is the fundamental ethos of the human. That mean, in care we identified the principles, values and attitudes that make life a good life and actions a straight act³.

And we, nurses, professional nursing staff, academics and other professionals within the multidisciplinary health team can support in the thought of Boff³.

In this work, he highlights the care, which appears in our society as something very ordinary, almost ridiculous, but extremely relevant: the case of essential care for the tamagochi because without care, the toy, a pet could die. The care for that pet denounced the solitude in which man lives of the rising communication society.

He announces also that although much of dehumanization in our culture, the human essence is not lost. For him, care "[...] is more than an act; it is an attitude. [...] it covers more than a moment of attention, zeal and devotion. It represents an attitude of occupation, concern, responsibility and affective involvement with the other^3:80.

THE ETHICAL AND BIOETHICAL CARE

From the foregoing, we highlight the increasingly need to guide direct care for a professional do from interpersonal relationships, valuing the existential context. To help understand this phenomenon - the care in its concrete reality, its essential characteristic, it is necessary to devise a way of being human that cares and wants to be cared, respecting the dignity, freedom, autonomy and other rights citizenship, in a perspective that involves the ethical and bioethical character.

Thus, this is an issue of utmost importance for the action of the health professional as we work on behalf of human beings, that the ontological point of view, thus existential, comprises a concrete and singular dimension of being in the world. Existence is a way of being of each one. Thus, we need to deal with this man-subject of our professional actions, the rigor of the word imposes on us and no less than this, with the same seriousness and creativity.

Thus, we emphasize that we human professionals as raw material for the profession, the man himself and all his existential peculiarity, whatever it may be. The main concern here is the availability to the other, not trying to predict or even pre-conceptualize their needs. Here it is necessary face to face interaction between the nurse and the person being cared, with a view to capturing and jointly plan what should be done for their good. What is expressed in care, without determining a priori, without marginalizing, enabling a respectful and autonomous respect the other who is included and interact to define their best choices.

Many times, we take care of the other without any reflection on this process, predicting their possibilities and limitations and acting like we know everything, characterizing a great contradiction in the care we do on a daily basis.

This contradiction raised by the very clear topic when we act for convenience and obeying without any critical evaluation, pre-established criteria for all, in which the institutional routine turns, generally for universal determinations.

In this sense, Cegonha Network⁴ proposes the following concept of humanized care:

[...] it involves a set of knowledge, practices and attitudes aimed at [...] ensure that the health team performs proven beneficial procedures for the woman and the baby, avoiding unnecessary interventions and to preserve the privacy and autonomy of these subjects^4:9.

In this way, it is expected to limit the action of the professional over the other in the sense

of superiority and control. Preserving the privacy and autonomy is to understand that we

are co-participants in care, that the other´s body does not belong to me, their choices, their

fears must be respected and therefore when we impose our care we are actually neglecting.

This perspective, which finds support in bioethics needs to be built not only by Cegonha

Network⁴ as a public policy, but throughout the professional act (ethical?).

It is worth to emphasize that:

Bioethics is a neologism derived from the Greek words bios (life) and ethike (ethics). It ca be defined as the systematic study of the moral dimensions - including vision, decision, conduct and moral norms - the life and health sciences, using a variety of ethical methodologies in an interdisciplinary context ^5:319.

Therefore, basing on the principlism or bioethics principles⁶, it is important to note that autonomy is a word derived from the Greek autos (meaning self) and nomos (or rule, government or law), self-government rights of freedom, privacy, individual choice, freedom of will, be the engine of the behavior and belong to himself. It should be noted that virtually all theories of autonomy consider two essential conditions: freedom - independence from controlling influences - and quality of the moral agent, ability to act intentionally. Violating the autonomy of a person is to treat it merely as a means, in accordance with the objectives of others, regardless of the person´s own goals. People with autonomy are their own aim, able to determine the sixth destiny⁶.

Also, the principle of beneficence is the action taken for the benefit of others. It is the moral obligation to act seeking the good. Many acts of beneficence are not mandatory, but any principle of beneficence expresses an obligation to help others, promoting its legitimate interests and inalienable rights⁶.

HEALTH HUMANIZATION PERSPECTIVE

It should be noted that humanization is a process that confirms the man some essential features, such as the exercise of reflection, the acquisition of knowledge, a willingness to understand the other, the refinement of the sensitivity, the ability to capture and contextualize the problems of life, the perceived complexity of the world and of human beings, a sense of humor and the ability to adapt the knowledge to different socio-cultural realities, respecting human rights^7:249.

To emphasize the context of these reflections:

[...] take care of someone else, in the most significant sense, is to help growing and be held. The care when help each other grow and achieve, it is a process, a way of relating to someone, which implies development in the same way that the friendship can emerge only over time, through mutual trust, and a deepening and a qualitative transformation of the relationship^8:24.

As caring, we are helping each other to grow and perform, providing them some essential characteristics that enable their development and their ability to exercise autonomy.

Thus, to participate is an action of the subjects involved in a given care situation and not only an innovative speech. Here is one of the main challenges of bioethics: to treat subjects (competent) as equal, respecting their dignity.

Therefore, the elementary and fundamental bases of ethics are the very existence and experience of the human being who is able to think and be guided to live according to their mode of existence, which is a conscious and reflected mode. Each one lives revealing their own way of being in the world, born of their own biographical situation, contextualized by the opportunities and existential choices.

Thus, to care someone, it is necessary to know who is that one, what their potential and limitations are, and what drives their growth; how to respond to their needs, many times reflections of their own powers and limitations of the professional. We do not know in advance the other one, predicting their boundaries to act.

Caring involves dedication, patience, sincerity, trust, humility, hope, courage. These characteristics are essential for a human care.

Human care and care are seen as the moral ideal of nursing, that is, a style, their own way of taking care, in which the nurse is co-participant in a process of interaction which is realized in intersubjetivity⁹. Care understood as an interaction between two or more subjects is aimed at relieving suffering or extent of their welfare¹⁰.

In this context, bioethics is not simply use the knowledge of other sciences, but creates an interdisciplinary forum for dialogue, that is, collaboration and interaction of different areas of knowledge. From this perspective, the decisions cannot be made based on only in the everyday facts that arise in the field of health practices. This can be misleading because it has to be considered the uniqueness of the people involved in action to care.

Bioethics, considered an ethical applied to behaviors moral agents that influence the quality of life of other living human beings, admittedly has a dual task: to describe and understand the conflicts of interests and values between agents and moral patients and prescribing the correct behavior based on any moral theory¹¹.

Bioethics gives us the opportunity to rethink nursing in a more humane and shared way, in which all involved are active subjects of the process ¹².

Thus, the dialogue established between the professional and the person and/or family is the main instrument for inter-subjective relationship that permeates the individual caring and therefore more suitable at the time. To this end, interdisciplinary work, supported by the intersubjective project of action, of which the person is part, is indispensable for making decisions. Thus, the multiple and wary look is essential for the individual, that is, centered on a professional one not giving account of this reality.

Ethics is not invented by a sage or a saint: it originates in the living relationship between me and you or between two people¹³. Therefore, ethics is relational. It surges in people and communities living together. Interpersonal reciprocity establishes the ethics of our behavior and actions.

Considering the motherhood and bioethics, it is necessary to rethink the care, which requires more than the action on the other or to the other, it is a care that, respecting the autonomy of the subject, caregiver, child and family, allows all involved to be as agent for a reciprocal relationship.

This relationship is beyond the discussion of the legal child as incapable issue and therefore not independent. Here, we showed autonomy as a human characteristic. From this perspective, even in the face of a newborn or infant, I look as an autonomous, free, rational potential, since a man is always becoming and therefore should be respected as such.

However, our society still has difficulty in giving voice to the child, to understand it as a subject with rights, reflecting the historical construction of childhood in Brazil. Thus, the motherhood remains to be built, assimilated.

our attitudes, choices and practices are related to our positionality. Positional perspectives rooted in care of asymmetric practices, in particular those involving the child and the family, need to be removed, leading to practices between humans that is, between equals¹⁴.

FINAL CONSIDERATIONS

Care from the perspective of good motherhood practices and bioethics indicates a humanized professional performance, without determining a priori, without marginalizing, and especially from the perspective of a respectful and autonomous relationship of the other which is included in the process and interact to define their better choices. However, our society still has difficulty in giving voice to the child, to understand it as a subject of rights, the historical construction of childhood reflection in Brazil and therefore the motherhood remains to be built, assimilated. This relationship is beyond the discussion of the legal child as incapable and therefore without autonomy. From this perspective, even in the face of a newborn or infant, I should see it as an autonomous, free, rational potential and, in this sense, man is always a human being to be respected as such.

REFERENCES

1.Pegoraro O, Rodrigues BMRD, Nunes MGS. Bioética em feridas. In: Blanck M; Giannini T, organizadoras. Úlceras e feridas: as feridas têm alma. Rio de Janeiro: Di Livros Editora LTDA; 2014. p. 5-15.

2. Pegoraro O, Rodrigues BMRD, Nunes MGS. Bioética em feridas. In: Blanck M; Giannini T, organizadoras. Úlceras e feridas: as feridas têm alma. Rio de Janeiro: Di Livros Editora LTDA; 2014. p. 5-15.

3.Boff L. Saber cuidar: ética do humano, compaixão pela terra. 7 ^a ed. Rio de Janeiro: Vozes; 2001.

4.Ministério da Saúde (Br). Manual prático para a implementação da Rede Cegonha. 2011 [citado em 09 nov 2014] Disponível em manual-pratico-rede-cegonha-[444-090312-SES-MT]%20(3).pdf

5.Reich WT. Encyclopedia of Bioethics. The word bioethics: its birth and the legacies of those who shaped it, in Kennedy Instiute of Ethics Journal, 1994; 4: 319-35.

6.Beauchamp TL, Childress JF. Princípios de Ética Biomédica. Tradução de Luciana Pudenzi. São Paulo: Edições Loyola; 2002.

7.Cândido A. Vários escritos. São Paulo: Duas Cidades; 1995.

8.Mayeroff M. A arte de servir ao próximo para servir a si mesmo. Rio de Janeiro: Editora Record; 1971.

9.Waldow VR, Borges RF. Cuidar e humanizar: relações e significados. Acta Paul Enferm 2011; 24:414-8.

10.Costa VGS, Rodrigues BMRD, Pacheco STA. As relações interpessoais no cuidar do cliente em espaço Onco-hematológico: uma contribuição do enfermeiro. Rev enferm UERJ. 2012; 20:209-14.

11.Schramm FR. Existem boas razões para se temer a biotecnociência? Revista BIOETHIKOS. 2010;4:189-97.

12.Rodrigues BMRD, Santana JS de, Pacheco STA, Ciuffo LL, Gomes APR Rosa JS Cardoso JMRM. A ética no cuidar em enfermagem: contribuições da fenomenologia sociológica de Alfred Schütz. Rev enferm UERJ. 2011; 19:236-41.

13.Pegoraro O. Introdução à ética contemporânea. Rio de janeiro: Uapê; 2005.

14.Sen A. A ideia de justiça. São Paulo: Companhia das Letras; 2011.