The exclusion of the other: challenges to the ethics of closeness.

There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, 'including the experienced Other', which is Nortvedt's position; (b) trying to bring the distant, non-experienced others closer, 'including the Third'; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in need of help, 'including the Other at the expense of the Third'. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non-experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one-sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position?