This paper will examine a claim that nursing is united by its moral stance. The claim is that there are moral constraints on nurses' actions as people practising nursing and that they are in some way different from both what for now can be called standard morality and also different from the person's own moral views who also happens to be a nurse, hence the defining and unifying factor for nursing. I will begin by situating the claim within the broader (...) area about the need for a definition to state features that are essential to all and only members of its class. This will highlight the fact that there are two distinct types of definition used by authors seeking to find a unity for nursing. One type of definition has to do with goals or purposes given to nursing and the other with ends discovered as nursing. But even if there are ends waiting to be discovered a particular practical concern is how we can have knowledge of them. I will suggest that knowledge by intuition is plausible but that as things currently stand in moral epistemology it will not provide the unifying ground for nursing. Then I will argue that in the latter approach to definition a certain account of human nature has been advanced in order to provide features that are there to be discovered and so not dependent on human beings for the definition or classification. However, such an attempt to define nursing cannot do what is wanted. Rather than the account of human nature grounding morality and doing so for nursing, the account of human nature itself relies upon a prior account of morality. Because of this it loses its supposed ground of unity for the profession. Nursing is not united by its moral stance especially if this is understood in a strong sense as unique moral stance, but as things currently stand in moral epistemology this is not necessarily a bad thing for practitioners or patients. (shrink)

It is known that people have been getting distressed for a long‐time and healthcare workers, like the military, seem to fit criteria for being at particular risk. Fairly recently a term of art, moral distress, has been added to types of distress at work, though not restricted to work, they can suffer. There are recognized scales that measure psychological distress such as the General Health Questionnaire and the Kessler scales but moral distress it is claimed is different warranting its own (...) scale. This seems to be because of both the intensity and nature of moral problems encountered at work that is so powerful and so destructive of moral agency and integrity. This paper will focus on how, if at all, moral distress is different by examining the idea of moral normativity. Moral normativity is understood as roughly the sort of thing that all rational persons would endorse regardless of his interests, having an “automatic reason giving force” and is likely to also require an overriding force. Specifically, it will examine how this force of moral claims seems to be needed for moral distress to be so destructive of healthcare professional's moral agency and integrity. This is related to the idea of warrantedness of the reaction of distress. Even if morality had such a strong normativity, one can still ask is distress the correct or warranted reaction? It seems plausible that if distress is a correct response for it to be both moral and warranted it needs a strong account of moral normativity. The idea of a distinct form of distress as moral distress may be true in theory but is too contested both ontologically and epistemologically for a useful practice of measurement at present. (shrink)

Within the nursing ethics literature, there has for some time now been a focus on the role and importance of character for nursing. An overarching rationale for this is the need to examine the sort of person one must be if one is to nurse well or be a good nurse. How one should be to live well or live a/the good life and to nurse well or be a good nurse seems to necessitate a focus on an agent's character (...) as well as actions because character is (for the most part) expressed in action (e.g. see Laird). This paper will give an overview of the reasons for the role and importance of character in nursing practice and explain its relation to nursing's frequent use of virtue ethics in order to recommend caution. While the paper agrees that the role of character is important in nursing caution is needed in both how much moral and thus normative, emphasis is being placed on the psychology of character and on the drift to virtue ethics. The psychological which may be explanatory needs to be linked with the normative, and a justification for the normative is needed. A justification as virtue ethics is contested, and nursing practice does not need to take on this explanatory and justificatory burden.A tentative proposal raised but not discussed in depth in this paper is that when an ultimate explanation or explanatory ground is needed, nursing practice leads quite naturally to a form of consequentialism as well as a realist metaethic. On this account, there are two levels of moral thinking, and nursing practice entails the virtues at one level and leads quite naturally to moral thinking at another more critical level of the criterion of what makes something right and good independently of character. (shrink)

It has been claimed that there are certain acts that nurses as people practising nursing must never do because they are nurses and this is regardless of what the same agent should do; that certain actions are not part of proper nursing practice. The concept of an internal morality has been discussed in relation to medicine and has been used to ground the actions proper to medicine in a realist tradition. Although the concept of an internal morality of nursing is (...) not explicitly mentioned in the literature the underpinning ideas about the proper practice of nursing based on philosophical realism I argue equate with it and a discussion of the method of an internal morality can help to understand how arguments against euthanasia related to the profession of nursing are far from clear. Ultimately, although the idea of particular acts proper to nurses qua nurses is not clear, the concept of an internal morality can help to get practitioners to see how the profession is tightly linked to moral actions, even so the hard problems in bioethics such as the morality of euthanasia remain hard for all and the easy ones easy for all. (shrink)

As in many other fields of practical ethics, virtue ethics is increasingly of interest within nursing ethics. Nevertheless, the virtue ethics literature in nursing ethics remains relatively small and underdeveloped. This article aims to categorize which broad theoretical approaches to virtue have been taken, to undertake some initial comparative assessment of their relative merits given the peculiar ethical dilemmas facing nurse practitioners, and to highlight the prob- lem areas for virtue ethics in the nursing context. We find the most common (...) approaches fall into care approaches grounded in sentimentalist or feminist ethics, eudaimonist approaches grounded in neo-Aristotelianism, and those grounded in MacIntyre’s practice theory. Our initial assessment is that the eudaimonist approach fares best in terms of merit and relative to criticisms of virtue ethics. But an outstanding issue concerns the motivational psychology of virtuous nursing and whether virtue ethical accounts of right action are self-effacing, i.e. justify an act on grounds that cannot function as the agent’s reason for doing it if she is to act well. One of us, Newham, believes that a virtue consequentialist approach is the best response to these issues. Some form of pluralistic theory, such as Christine Swanton’s, may be needed to explain the many competing values and goods involved in ethical nursing. (shrink)

Philosophical and empirical work on the nature of the emotions is extensive, and there are many theories of emotions. However, all agree that emotions are not knee jerk reactions to stimuli and are open to rational assessment or warrant. This paper's focus is on the condition or conditions for compassion as an emotion and the likelihood that it or they can be met in nursing practice. Thus, it is attempting to keep, as far as possible, compassion as an emotion separate (...) from both moral norms and professional norms. This is because empirical or causal conditions that can make experiencing and acting out of compassion difficult seem especially relevant in nursing practice. I consider how theories of emotion in general and of compassion in particular are somewhat contested, but all recent accounts agree that emotions are not totally immune to reason. Then, using accounts of constitutive conditions of the emotion of compassion, I will show how they are often likely to be quite fragile or unstable in practice and particularly so within much nursing practice. In addition, some of the conditions for compassion will be shown to be problematic for nursing practice. It is difficult to keep ideas of compassion separate from morality, and this connection is noticeable in the claims made of compassion for nursing and so I will briefly highlight one such connection that of the need for normative theory to give an account of the value that emotions such as compassion presume and that compassionate motivation is separate from moral motivation and may conflict with it. The fragility or instability of the emotion of compassion in practice has implications for both what can be expected and what should be expected of compassion; at least if what is wanted is a realist rather than idealist account of “should.”. (shrink)

This paper's philosophical ideas are developed from a General Nursing Council for England and Wales Trust‐funded study to explore nursing knowledge and wisdom and ways in which these can be translated into clinical practice and fostered in junior nurses. Participants using Carper's (1978) ways of knowing as a framework experienced difficulty conceptualizing a link between the empirics and ethics of nursing. The philosophical problem is how to understand praxis as a moral entity with intrinsic value when so much of value (...) seems to be technical and extrinsic depending on desired ends. Using the Aristotelian terms poesis and praxis can articulate the concerns that the participants as well as Carper (1978) and Dreyfus (in Flyvbjerg, 1991) among others share that certain actions or ways of knowing important for nursing are being devalued and deformed by the importance placed on quantitative data and measurable outcomes. The sense of praxis is a moralized one and most of what nurses do is plausibly on any account of normative ethics a morally good thing; the articulation of the idea of praxis can go some way in showing how it is a part of the discipline of nursing. Nursing's acts as poesis can be a part of how practitioners come to have praxis as phronesis or practical wisdom. So to be a wise nurse, one needs be a wise person. (shrink)