Towards a strong practice-based virtue ethics for nursing

PhD ThesisIllness creates a range of negative emotions in patients including vulnerability, powerlessness and dependence on others for help. The nursing literature is saturated with debate about a 'therapeutic' nurse-patient relationship. However, despite the current agenda regarding patient-centred care, literature concerning the development of good interpersonal responses and the view that a satisfactory nursing ethics should focus on persons and character traits rather than actions, nursing ethics is dominated by the traditional obligation, act-centred theories such as consequentialism and deontology. I critically examine these theories and the role of duty-based notions in both general ethics and nursing practice. Because of well-established flaws, I conclude that obligation-based moral theories are incomplete and inadequate for nursing practice. Instead, the moral virtues and virtue ethics provide a plausible and viable alternative for nursing practice. I develop an account of a virtue-based helping relationship and a virtue-based approach to nursing. The latter is characterized by three features: (1) exercising the moral virtues such as compassion and courage, (2) using judgment and (3) using moral wisdom - moral perception, sensitivity and imagination. Merits and problems of this approach are examined. Following Macintyre, I conceive nursing as a practice; nurses who exercise the virtues and seek the internal goods help to sustain the practice of nursing and thus prevent the marginalization of the virtues. The strong (action-guiding) practice based version of virtue ethics proposed is context-dependent, particularist and relational. Several areas for future philosophical inquiry and empirical nursing research are suggested to develop this account yet further.Department of Psychiatry, University of Newcastle upon Tyne. Catherine Cookson Bequest Bursary, 1998-2001