A Sydney nurse took an explicit photo of a schoolteacher who was under anaesthetic and awaiting surgery.

The teacher said, “I am a larger woman. To me, it’s obvious she took it to make fun of fat people.” The teacher is campaigning for legal reform to protect other patients from suffering in similar ways and to see the nurse punished for a criminal offence.

Obviously what this nurse did was wrong. It objectified another human being, treating her as an object of ridicule and subject to the whimsical mood of the nurse. What’s more, the nurse violated the contract of trust that underpins the relationship between patients and the medical profession.

By photographing her naked the nurse also subjected the teacher to deep and ongoing humiliation about her body and usually private sexual organs. The photograph also creates the possibility for further exploitation, distribution, and humiliation.

The teacher said, “I felt like my world was exploding. I felt I was in great peril that this photo was going to destroy my life, my career and that my son would find out.” It seems the psychological ramifications have been severe.

The act was intrinsically wrong. It violated notions of trust, the inherent dignity with which people ought to be treated, and undermined the values that inform the profession of nursing.

But independently of the consequences, the act was intrinsically wrong. It violated notions of trust, the inherent dignity with which people ought to be treated, and undermined the values that inform the profession of nursing.

It will be distressing to learn that there is currently no law in NSW forbidding behaviour like this. A loophole in the law means that because the photo was not motivated by sexual deviancy, but by the desire to make fun of the patient, no legal recourse was available. It seems reasonable to call for legal reform. This is precisely what Fiona McLay, the teacher’s lawyer, is doing.

The act was incontrovertibly unethical regardless of its legal standing and yet this nurse still felt empowered to take the photo. And worse, the nurse is still practising without restrictions or supervision, having apologised and found to have shown “the appropriate level of contrition”.

Despite all this, the instinct to turn to law as a way to amend or prevent unethical behaviour is misguided. What is required is for the nursing profession to demonstrate this behaviour will not be tolerated and is directly against the values nursing stands for.

Making such photographs illegal will do little to return trust – patients will still be vulnerable before surgery occurs and nurses will still have the opportunity to take such photos. Making photographs illegal will do little more than allow wrongdoers to be sent to prison.

Law is a clumsy instrument for enforcing ethical behaviour.

For us to trust nurses in spite of a story like this the profession must uniformly state their disapproval for the conduct and demonstrate willingness to enforce its own ethical standards. Law is a clumsy instrument for enforcing ethical behaviour. Re-committing as a profession and as individual professionals to the core values of the field – trust, respect for persons and patient care – is much more likely to avoid instances like this in the future.

There is no reason to excuse the nurse’s behaviour in this case. However, it is worth understanding this incident occurred in a context where crass jokes may well be the norm.

Jokes help us get through the day and although this one went seriously awry we should recognise the context in which it was made. Nursing is a tough field. It’s demanding on the body and the mind, and sometimes errors of judgement – including insensitive, invasive jokes – are a possibility.

As the old saying goes, sometimes you have to laugh to keep from crying.

Humour is a matter of taste, and much relies on pushing against ordinary modes of thinking – including moral norms. Of late there has been heated debate regarding the place and value of racist and sexist humour in comedy. Regardless of the view we take on that particular subject, we should agree that any form of humour that trades off the humiliation of a particular individual, or is done in ways that can have lasting and severe consequences for a person’s wellbeing will be unethical – even if funny to some.

It’s great that Australian schools want to encourage their students to help others and gain perspective on their privilege. But visits to orphanages overseas are not the answer. To quote from the Friends International campaign, “Children are not tourist attractions”.

The first thing to understand is that orphanage life is damaging to children.

Children in orphanages are cared for as a group rather than as individuals. Life is regimented – each child has many different caregivers and little individual attention. Such care hurts children and may result in psychological damage and developmental delays.

Rates of physical and sexual abuse are also high in orphanages. The detrimental impact of institutional care closed all orphanages in Australia decades ago.

Short-term orphanage volunteers who play with and care for children are just adding to this harm. They increase the number of caregivers a child experiences and are just more people who abandon them.

Most children living in orphanages around the world have at least one living parent.

Visiting students may not see these harms. Necessity has forced children in orphanages to act cute to get scarce attention – something called “indiscriminate affection”. School students easily mistake this for genuine happiness. Some of those who run orphanages will also encourage children to be friendly to the visitors in the hope this will increase donations.

Donations are a big problem. In some cases “orphans” are actually created by unscrupulous organisations who pay families to hand over their children in order to collect visitor donations. In Cambodia, orphanage numbers have doubled during a time when the number of children without parents has declined.

Australian schools sometimes seek to improve conditions in orphanages by funding education or medical resources. This can also draw children into orphanages. It’s a dire state of affairs when a loving family sends their child away because an orphanage is the only option for their child to go to school or get medical care.

This is what happened in Aceh, Indonesia where 17 new orphanages were built for “tsunami orphans”. However, 98% of the children in these orphanages had families and had been placed there to gain an education.

Most children living in orphanages around the world have at least one living parent.

Child protection authorities in Australia would not allow school students to go into the homes of vulnerable children so that they could gain an understanding of their situation. Schools should not take advantage of lower standards in other places to give their students a good experience.

What I know from talking to those involved in orphanage volunteering is that they often believe what they are doing is somehow exempt from these problems. Is it possible for school orphanage volunteering trips to be OK? What might harm mitigation look like?

Due diligence may reduce the possibility of working with orphanages that are exploiting children for financial gain.

Schools should resource orphanages in a way that avoids drawing children away from their families. They can do this by making the education programs or medical care they fund equally available to poor children in the community.

Schools can ensure their students do not interact with children. This prevents the harm to children arising from having too many caregivers. Students can instead take on tasks that free up caregivers to spend more time with children, such as cooking, cleaning or maintenance work.

Child protection authorities in Australia would not allow school students to go into the homes of vulnerable children so they could gain an understanding of their situation.

When visiting the orphanages, school staff might educate their students about orphanages. They might talk about children having at least one parent who could care for them if given support.

Perhaps they could discuss the high rates of physical and sexual abuse within orphanages. Or explain child development principles and the importance of one-on-one care for young children. They can help their students understand why keeping children in families and out of orphanages is important.

Theoretically, it might be possible for schools to do all of these things but I am not aware of any school that has. In particular, not allowing students to interact with children removes what schools seem to consider an essential component of these trips.

Schools should develop sister-school relationships with overseas schools or even schools in disadvantaged communities in Australia. It’s great to see that some schools are already leading the way on this front.

Such arrangements foster understanding in a situation where there is more equality in the relationships and fewer pitfalls. If Australian schools are genuine about cross-cultural exchange, they shouldn’t be fostering last century’s model of child welfare.

Read Rev Dr Richard Umbers‘ counter-argument here.

In the flurry of emotion and analysis that followed the fatal shooting of police accountant Curtis Cheng in Parramatta by 15-year-old Farhad Jabar on 2 October 2015, one fact was more or less overlooked.

A child had been killed.

One of the tragedies of extremism is the way it can make us contemplate or perform acts that ordinarily are unthinkable. The police constable who shot and killed Jabar probably never imagined having to kill a child. And yet on that Friday afternoon, the unthinkable occurred.

Farhad Jabar didn’t seem like your typical kid. He shot a man in cold blood. It’s alleged he was reciting “Allahu Akbar” in the gunfight preceding his death, and a letter containing extremist rantings was reportedly found in his backpack.

We shouldn’t forget the fact of Jabar’s childhood. The police constable who killed him won’t – killing a child is arguably the ultimate moral line in the sand.

But Jabar was a child. At his death he was effectively a child soldier – having allegedly been radicalised by extremist groups in Sydney.

We know how groups abroad use child soldiers, but we’ve rarely been confronted by it directly. We don’t see child soldiers in Australia. The context in this case – extremism, the murder of police staff and allegations of terrorism – made us less sensitive to the fact Jabar was a child.

This insensitivity needn’t be the subject of public cultural haranguing but we shouldn’t forget the fact of Jabar’s childhood. The police constable who killed him won’t – killing a child is arguably the ultimate moral line in the sand.

Even  the “American Sniper” Chris Kyle revolted at the idea of killing a child. Although the American Sniper film depicts Bradley Cooper’s Kyle taking the shot, the actual sniper never did so. In his book he writes, “I wasn’t going to kill a kid, innocent or not”.

Jabar was not innocent in any morally relevant sense. His actions meant he had forfeited his right not to be attacked – he had already killed one person and intended to kill several more.

The moral responsibility of the police officers was to neutralise the threat, and it’s reasonable to assume that no less harmful means were available. Killing may well have been the only option.

The constable was innocent of any wrongdoing. It was not the constable’s fault Jabar murdered a man in cold blood. Nor that there were no other means of neutralising him as a threat. In this sense, the constable was duty-bound to shoot Jabar.

But knowing that you’ve done your duty is likely to be cold comfort.

In my experience researching moral psychology among soldiers and veterans, I’ve learned that certain actions “stick” to the psyche more than others. The “stickiest” among them are acts that transgress deeply held moral and cultural norms.

These acts needn’t be crimes, either. Surviving when comrades did not, training accidents and collateral damage can all produce profound moral and psychological distress. In his book What it is Like to Go to War, veteran Karl Marlantes writes:

“Killing someone without splitting oneself from the feelings that the act engenders requires an effort of supreme consciousness that, quite frankly, is beyond most humans.”

How much worse is the killing of a child?

In similarly tragic cases, the military sphere has forms of counselling that aim to do one of two things. They might ignore the moral question altogether and treat this trauma as basic PTSD – Post Traumatic Stress Disorder – which it isn’t. Or they might explain the moral error in judgement – “you think you’ve done something wrong, but you actually haven’t”.

Neither would likely be helpful in a case like this.

Trauma related to the moral character of one’s actions isn’t PTSD in the standard sense. PTSD is about fear for one’s safety. This form of trauma, which I and others refer to as moral injury, is about guilt. Jonathan Shay, the psychiatrist who coined the term, calls this kind of trauma a “soul wound”.

“It’s not your fault” is well intended but – especially when repeated insistently – it can invalidate laudable moral emotions.

Pointing out the error in judgement will probably be equally ineffective. “It’s not your fault” is well intended but – especially when repeated insistently – it can invalidate laudable moral emotions. To feel remorse at having killed a child – even a child soldier like Jabar – is to accurately grasp the tragedy of what has transpired.

Australian philosopher Rai Gaita suggests cases like this reveal the problems with our concept of responsibility. He writes, it is “wrong to say that we should concern ourselves with what we did rather than with the fact that we did it”.

Gaita tells us remorse “is a kind of dying to the world”. We don’t yet know with certainty the best ways to address remorse in therapy, but a likely starting point is for us as a community to recognise the tragedy of what transpired in Parramatta.

A child was killed. And a good person was forced to kill him.