Carol Taylor was interviewed by NNEC Planning Committee Member Brian P. Cyr, MSN, RN-BC.

The theme for the conference this year is “Everyday Ethics Rooted in Trust.” When you think about
“everyday ethics” in your various capacities as a nurse, as an educator, what comes to mind for you?
What has your experience been in keeping ethics front and center in your practice?

I always think about ethics as the formal study of who we ought to be in light of our identity. In that
sense, everyday ethics is about being what is reasonable for others to expect of us. That might be as a
human being, as a parent, or as a professional nurse. Our Code describes what is reasonable for the
public to expect of us. I worked with a group of nurse leaders once who said a good nurse is a
competent, compassionate, collaborative advocate for patients, families and communities. They’re
known for doing and making the critical difference. That’s a tall order, but that is what links me to the
conference theme. Can we be trusted to be that every day, speaking up when somebody’s not getting
the care that they need? Pretty simple, but still not easy.
I’ve been incredibly blessed because I did my PhD in Philosophy at Georgetown University and then was
invited to help start the Center for Clinical Bioethics for the Medical Center. That has kept me focused
on ethics as part of my everyday responsibilities. For 10 years, I directed the Center, so directed the
ethics consultation service design, the ethics curriculum for the medical school, and now I am teaching
full time in the School of Nursing and all my courses are on leadership and ethics. I am blessed to be able
to do that.

What advice would you give nurse leaders around building trust and trying to live up to that ideal?

The leadership course I designed was for DNP students and we really want them to be capable of
system-level change. One of the exercises that I had them do was to identify an ethics quality gap. It
might be our staffing never reaches appropriate standards to allow quality care. I expect the leaders to
fight for appropriate staffing to meet standards, and they have to describe how they were going to
assess it using Kotter’s ways to implement change effectively. What were the strategies they would use
to address the gap and bring things to a better place and sustain it. It was very practically designed.
From my very first nursing job, the chief nurse sold nurses out because part of being in the C-suite was
being a “yes” person and not standing up for nursing. I was appalled. That was one of my early
experiences of leadership, and I thought this cannot work. That is why I always say leadership really matters because if leaders don’t get it, you get ground underfoot pretty easily. It’s why people like you
are so important in the work that you do, to listen. Move it upwards with the people that are
experiencing the challenges.

The pandemic tested a sense of trust not only in healthcare, but in science itself. Moving forward, we
know that public health is a critical dimension in promoting wellness. How can we help to instill
amongst the public an awareness of both individual and community obligation to this ethical
endeavor?

This lack of trust in science really disturbs me. The extensiveness of it is relatively new. With the polio
pandemic, everybody knew what to do to eradicate it. Parents brought their children. Everybody was
vaccinated. Good people can reason differently about what ought to be done, but the purposeful spread
of misinformation is unconscionable to me.
I think we have to speak up whenever we hear statements that don’t comply with reputable science.
Pam Grace wrote an article about nurses and misinformation, and there are nurse leaders who are
trying to work through state boards to hold nurses accountable. We have nurse influencers on social
media sites, and we have to try to not be argumentative but persuasive

You shared the critical nature of nurses being vulnerable is needed to engender trust in the patients
and communities we serve. How does vulnerability fit into generating trust?

When Georgetown faculty articulated those four basic principles of bioethics – autonomy, beneficence,
non-maleficence, and justice – strikingly absent is vulnerability. It wasn’t until many years later that
when the European society identified their principles, they included things like vulnerability and dignity.
I was fortunate that a mentor for me was Dr. Edmund Pellegrino. He grounded the moral obligations of
healthcare professionals in three realities. The first was vulnerability. If people didn’t have healthcare
needs, they wouldn’t need nurses and physicians, right? If they could take care of themselves, they
aren’t contractual relationships. A nurse-patient relationship is not a contract among equals. It’s a
fiduciary relationship. I have to be worthy of the trust that the public places in me. I say to my students
all the time, most patients don’t choose their nurse. I go into labor. I present at the hospital. I get the
nurse that’s on that day. I get the nurse to whom I’m assigned. We need to be trustworthy. Patients
know right away if they can trust us or not or if they feel comfortable.
My husband was big on saying to people, “Tell me your story.” When you listen to people’s stories,
they’re pretty powerful. For example, right now there is so much in the literature about why black
maternal infant outcomes are so poor in the U.S. It’s not just socioeconomic status. Wealthy black
families have worse maternal infant outcomes. They learn quickly that they can’t trust the healthcare
system. It might be that institutional structural systemic bias that makes U.S. drug test black women
more often or makes us escort black men out of the hospital when they question the care that their
loved ones receive, and we think they’re being dangerous. All that makes trust so critical. Pellegrino’s
thing was grounding our moral obligations in vulnerability. The promise we make to work with people,
to be trustworthy, to help them improve their outcomes. Then actually working toward healing. That’s
been fundamental to me.

What advice would you give to frontline staff to develop and maintain trust among patients, families,
communities and other health disciplines?

Be willing to speak the truth. Speak truth to power. That can take us out of our comfort zone, but we’ve
got to do it, and it gets easier with practice. If a plan of care is not working for a patient, we need to
speak up. Our Code is big on nurses having a voice. I was giving a talk somewhere, and I’ll never forget
the nurse who said, “If you bring up a problem, you become the problem. So most of us try to fly under
the radar. You get paid the same for flying under the radar as you do for showing up and trying to be
that critical difference.” I was floored. If that’s the norm, that kind of thing rubs off. We expect you to
speak up. We did that with safety issues around medical errors. You see it. You say something and
you’re firm, even if you’re wrong. Whether it’s speaking up about racism or speaking up about a profit
motive or compromising the plan of care. This is our job!

Our choice of words can change the meaning of what we are attempting to convey. A good example is
discussing “withdrawing care.” Clinicians are aware that we never withdraw care at the end of life.
Adjusting that language to withdrawal of technology or treatment that is harmful or no longer
beneficial changes the conversation. Can you think of other examples of language that creates
misunderstanding?

I notice that none of my students talk about a patient “dying” or being “dead.” They always are
“passing” or they “passed.” What did they pass? Papers, gas? What does passing mean? Is that part of
our death denying culture that we can’t use the word the patient is dying? Last night, I was looking at
the November Hastings Center Report and there was a very interesting piece on medical assistance in
dying language and the acronym MAID. It is a way of referring to physician assisted dying. Other
countries like Belgium, Norway and Scandinavia have longer established practices where they refer to it
as assisted suicide, euthanasia or both. Far fewer deaths occur this way. That blew me away. If we call it
medically assisted dying, is that somehow just another way to die? It’s not. Physicians are writing lethal
prescriptions or administering lethal doses that cause the death. Language is incredibly important.