The Ethics of no One Watching: Levinas, Benner and Conscience in Perioperative Nursing

Abstract

The operating room is a distinctive moral space: the patient is unconscious, the body is draped and much of what happens is never witnessed. This paper examines why a nurse does the right and safe thing when the patient is anaesthetised and no one is checking, drawing on Levinas's ethics of responsibility and Benner's concept of ethical comportment. Three arguments are advanced. First, anaesthesia does not diminish the patient's claim on the nurse but intensifies it. Second, right action is grounded not only in rules or outcomes but in an embodied practical wisdom, phronesis, accompanied by conscience. Third, this paper makes philosophically explicit an unwitnessed, non-dialogical form of patient advocacy that established conceptualisation of advocacy already permit, but that may be obscured when advocacy is primarily understood through visible and dialogical acts such as speaking up, challenging decisions or escalating concerns. This framework is then tested against two tensions: the assumption that ethical courage depends on a witnessing team climate, which sits uneasily beside a responsibility that precedes any witness, and the risk that emphasising individual conscience absolves institutions of their structural failures. Levinas's concept of the third party offers a way of holding the individual and the institutional together rather than as alternatives. Ethical comportment in unwitnessed moments is a necessary but not sufficient contributor to patient safety alongside protocols and institutional systems, and must be completed by structural reform.