In his attempt to explain and draw together disparate aspects of the tradition of the virtues MacIntyre develops a complex and specific concept that he terms a practice. By a practice he means to describe certain types of activities in which excellences can be pursued and that offer those engaged in a practice access to the goods internal to that practice.Sellman and Wainwright have both suggested that there are advantages to be had in understanding nursing as a practice in this (...) MacIntyrean sense. This paper suggests that nursing should be considered as a particular type of MacIntyrean practice, and I have used the term a professional practice to identify this species.This paper also considers some of the implications of such a perspective and suggests that one benefit of thinking of nursing as a professional practice is that it may offer a route by which the virtues necessary for nursing can be identified. (shrink)

This paper analyses the question what other healthcare professions should learn from nursing ethics, e.g. what should medical ethics learn from nursing ethics. I first analyse and reject all strong versions of the claim that nursing ethics is unique, because nursing is a unique practice. I then move to the question of whether the link between nursing ethics and nursing theory can be a model for other areas of healthcare ethics. I provide an analysis of the possibility of creating a (...) theory of medicine and find that there cannot be a theory of medicine, and I argue briefly that this finding is also applicable to nursing. If there cannot be a theory of nursing, this entails that nursing ethics cannot be justifiably based on such a theory. In the final section, I then analyse the success of nursing ethics in resisting certain of the vices of Anglo‐American analytic ethics, in particular the reductionism and individualism that characterizes much of healthcare ethics. I conclude that other healthcare ethics could usefully learn from this aspect of nursing ethics. (shrink)

This classic and controversial book examines the roots of the idea of virtue, diagnoses the reasons for its absence in modern life, and proposes a path for its recovery.

Moral Realism is a systematic defence of the idea that there are objective moral standards. Russ Shafer-Landau argues that there are moral principles that are true independently of what anyone, anywhere, happens to think of them. His central thesis, as well as the many novel supporting arguments used to defend it, will spark much controversy among those concerned with the foundations of ethics.

Written over the last two decades, John McDowell's papers, as a whole, deal with issues of philosophy. Specifically, separate groups of essays look at the ethical writings of Aristotle and Plato; moral questions regarding the Greek tradition; interpretations of Wittgenstein's work; and, finally, questions about personal identity and the character of first-person thought and speech.

In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life determinations, (...) the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient 's values. In order to act in the patient 's best interests, or the patient 's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient 's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient 's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician- patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today. (shrink)

After distinguishing two different meanings of the notion of a morality internal to medicine and considering a hypothetical case of a society that relied on its surgeons to eunuchize priest/cantors to permit them to play an important religious/cultural role, this paper examines three reasons why morality cannot be derived from reflection on the ends of the practice of medicine: (1) there exist many medical roles and these have different ends or purposes, (2) even within any given medical role, there exists (...) multiple, sometimes conflicting ends, and, most critically, (3) the ends of any practice such as medicine must come from outside the practice, that is, from the basic ends or purposes of human living. The paper concludes by considering whether these ends external to medicine are universally part of the moral reality or whether they are socially constructed. The paper argues that, even if various cultural accounts of the common, universal morality are socially constructed, they may, nevertheless, be reflections, however, imperfect, of a more universal common morality that should be thought of as real. Therefore, the morality of medicine must come from a more fundamental morality external to medicine. That external morality will be socially constructed, but may nevertheless reflect an underlying common morality. (shrink)

Moral absolutes have little or no moral standing in our morally diverse modern society. Moral relativism is far more palatable for most ethicists and to the public at large. Yet, when pressed, every moral relativist will finally admit that there are some things which ought never be done. It is the rarest of moral relativists that will take rape, murder, theft, child sacrifice as morally neutral choices. In general ethics, the list of those things that must never be done will (...) vary from person to person. In clinical ethics, however, the nature of the physician–patient relationship is such that certain moral absolutes are essential to the attainment of the good of the patient – the end of the relationship itself. These are all derivatives of the first moral absolute of all morality: Do good and avoid evil. In the clinical encounter, this absolute entails several subsidiary absolutes – act for the good of the patient, do not kill, keep promises, protect the dignity of the patient, do not lie, avoid complicity with evil. Each absolute is intrinsic to the healing and helping ends of the clinical encounter. (shrink)

The moral authority for professional ethics in medicine customarily rests in some source external to medicine, i.e., a pre-existing philosophical system of ethics or some form of social construction, like consensus or dialogue. Rather, internal morality is grounded in the phenomena of medicine, i.e., in the nature of the clinical encounter between physician and patient. From this, a philosophy of medicine is derived which gives moral force to the duties, virtues and obligations of physicians qua physicians. Similarly, an ethic specific (...) to the other healing professions, law, teaching or ministry, can be derived from the specific ends to telos of each of these professions, which like medicine, are focused on a special type of human relationship. (shrink)

A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of the common morality to medicine or whether some of these norms are internal or proper to medicine. In this article we describe and defend an evolutionary perspective on the internal morality of medicine that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these (...) goals. This perspective is developed by means of a critical examination of the essentialist conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp. (shrink)

I begin this commentary with an expanded typology of theories that endorse an internal morality of medicine. I then subject these theories to a philosophical critique. I argue that the more robust claims for an internal morality fail to establish a stand-alone method for bioethics because they ignore crucial non-medical values, violate norms of justice and fail to establish the normativity of medical values. I then argue that weaker versions of internalism avoid such problems, but at the cost of failing (...) to provide a clear sense in which their moral norms are internal or can ground a comprehensive approach to moral problems. Finally, I explore various functions that an internal morality might serve, concluding with the observation that, while there may be a core of good sense to the notion of an internal morality of medicine, our expectations for it must be drastically lowered. (shrink)

In an earlier article, it was found that the terms of preference utilitarianism are insufficiently sound for guiding nursing activity in general, including in relation to nursing involvement in euthanasia. In this article, I shall examine the terms of a more traditional philosophical approach in order to determine the moral legitimacy, or otherwise, of nursing engagement in measures intended to end the lives of patients. In attempting this task, nursing practice is considered in light of what I shall call a (...) ‘nursing‐as‐healing‐praxis’ approach which includes an account of the moral purpose of nursing and the virtues necessary for realizing that purpose. Ultimately, it is concluded that the terms of this approach rule out the involvement of nurses in euthanasia such that if euthanasia can be justified at all, those outside the nursing profession must provide for its administration. (shrink)

This paper explores the issue of life and its relevance to nursing, through Aristotle's philosophy and an Aristotelian interpretation of Nightingale's Notes on Nursing. Life as process and becoming has ontological status in Aristotle's philosophy and this dynamism is particularly relevant for nursing. The paper presents aspects of Aristotle's philosophy of life: his account of life as inherent powers of the individual, his analysis of change and time, and his understanding of sickness and health as qualitative states of living beings. (...) It is shown how the Greek medical‐philosophical tradition, continued by Galenic medicine and hygiene into modern time, influenced Nightingale's nursing. Individuals' life‐maintaining metabolic relations to their surroundings are investigated through Aristotle and modern philosophy of biology and through Nightingale's nursing emphasis on the patient's relation to her or his immediate surroundings. It is argued that Nightingale's concern is really the processes of individual life, which in sickness necessitate temporally continuous nursing observation. Humans' radical dependency on their surroundings is actualized as interpersonal interdependency. The paper argues that the end of nursing care, the telos for which sake it is practised, is inherent in the individual course of the patients' life. When life processes are affected by sickness, infirmity, medical interventions or mental suffering, individuals need competent help to live – and to live as well as possible. It is suggested that the special responsibility of nursing is to facilitate, relieve and protect individual life continuously during such times. (shrink)

A new volume of philosophical essays by Bernard Williams. The book is a successor to Problems of the Self, but whereas that volume dealt mainly with questions of personal identity, Moral Luck centres on questions of moral philosophy and the theory of rational action. That whole area has of course been strikingly reinvigorated over the last deacde, and philosophers have both broadened and deepened their concerns in a way that now makes much earlier moral and political philosophy look sterile and (...) trivial. Moral Luck contains a number of essays that have contributed influentially to this development. Among the recurring themes are the moral and philosophical limitations of utilitarianism, the notion of integrity, relativism, and problems of moral conflict and rational choice. The work presented here is marked by a high degree of imagination and acuity, and also conveys a strong sense of psychological reality. The volume will be a stimulating source of ideas and arguments for all philosophers and a wide range of other readers. (shrink)

An argument against the participation of physicians in capital punishment by means of lethal injection.

As each week beings more stories of doctors, lawyers and other professionals abusing their powers, while clients demand extra services as at a time of shrinking resources; it is imperative that all practising professionals have an understanding of professional ethics. In _The Ground of Profesional Ethics_, Daryl Koehn discusses the practical issues in depth, such as the level of service clients can justifiably expect from professionals, when service to a client may be legitimately terminated and circumstances in which client confidences (...) can be broken. She argues that, while clients may legitimately expect professionals to promote their interests, professionals are not morally bound to do whatever a client wants. _The Ground of Professional Ethics_ is important reading for all practising professionals, as well as those who study or have an interest in the subject of professional ethics. (shrink)

This article gives an overview of the nursing ethics arguments on euthanasia in general, and on nurses' involvement in euthanasia in particular, through an argument-based literature review. An in-depth study of these arguments in this literature will enable nurses to engage in the euthanasia debate. We critically appraised 41 publications published between January 1987 and June 2007. Nursing ethics arguments on (nurses' involvement in) euthanasia are guided primarily by the principles of respect for autonomy, nonmaleficence, beneficence and justice. Ethical arguments (...) related to the nursing profession are described. From a care perspective, we discuss arguments that evaluate to what degree euthanasia can be considered positively or negatively as a form of good nursing care. Most arguments in the principle-, profession- and care-orientated approaches to nursing ethics are used both pro and contra euthanasia in general, and nurses' involvement in euthanasia in particular. (shrink)

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)

In Reasons and the Good Roger Crisp answers some of the oldest questions in moral philosophy. Fundamental to ethics, he claims, is the idea of ultimate reasons for action; and he argues controversially that these reasons do not depend on moral concepts. He investigates the nature of reasons themselves, and how we come to know them. He defends a hedonistic theory of well-being and an account of practical reason according to which we can give some, though not overriding, priority to (...) our own good over that of others. (shrink)

If particularism is right, the broad moral claims we make are usually riddled with exceptions. But such generalizations can still be a useful, even necessary part of moral life. They help us show what we should do, and they are essential for understanding why we should do it.

A careful reading of Aristotle's Nicomachean Ethics focusing on his treatment of politics reveals a multifaceted discipline with political science, legislation, practice and ethics. These aspects of the discipline bear clear resemblance to the multiple conceptions of nursing. The potential that nursing is a multifaceted discipline, with nursing science as just one facet challenges the author's own conception of nursing as a practical science. Aristotle's discussion would seem to argue that nursing science is nursing, but nursing is more. Nursing is (...) also ethical practice, or art, and legislative for health. The multifaceted discipline of politics is united by the end, the common good, a just community that makes human happiness possible. Reasoning in this way, nursing is unified by its end, health of individuals and communities. Since nursing is not unique in having health as its end, this discussion ends with the question of where its uniqueness lies, i.e. within the activities or the personal presence of its practitioners. This discussion also contains some of the contemporary ethical and legislative challenges with which nursing is confronted. (shrink)

This response to Kevin WildesÕs article in the previous issue of the Kennedy Institute of Ethics Journal addresses several major points of disagreement between Pellegrino and Wildes regarding the nature and scope of a philosophy of medicine, in particular how it is derived and by what method of philosophical enquiry it is best pursued.

The great variousness and plurality of goodness has given comfort to general scepticism about values and a multitude of metaethical attitudes or predilections. But is this variousness and plurality really the hotch-potch it has appeared? The paper recapitulates and expands von Wright's typology of the varieties of goodness and looks to explain the order or system that underlies the phenomena by developing and extending a conjecture of Aristotle's, the so-called 'focal hypothesis', and combining there-with a suggestion of von Wright's, to (...) the effect that the central case of something good is the faring well of a being. By means of focal hypothesis, one may account fairly well for medical, technical, instrumental, beneficial and utilitarian goodness. Other varieties such as hedonic and ethical goodness complicate the picture, as also do all cases where it seems that an antecedent kind of goodness impinges upon a being. These complications mirror in part the finding that the human scale of values is not a scale exclusively of human values. (shrink)

Abstract Truth-telling is a key issue within the nurse–patient relationship. Nurses make decisions on a daily basis regarding what information to tell patients. This paper analyses truth-telling within an end of life scenario. Virtue ethics provides a useful philosophical approach for exploring decisions on information disclosure in more detail. Virtue ethics allows appropriate examination of the moral character of the nurse involved, their intention, ability to use wisdom and judgement when making decisions and the virtue of truth-telling. It is appropriate (...) to discuss nursing as a 'practice' in relation to virtue ethics. This is achieved through consideration of the implications of arguments made by Alasdair MacIntyre who believes that qualities such as honesty, courage and justice are virtues because they enable us to achieve the internal goods of practices. (shrink)

It is argued that philosophical realism is well suited to serve as a perspective from which to understand nursing, and that it should be considered as an alternative to positivist, interpretivist, hermeneutical and phenomenological approaches. However, existing forms of realism, including theory and entity realism are shown to be faced with serious problems. In response, an alternative form ‘constraint realism’ is outlined, and shown to be apposite for illuminating the rule or convention governed behaviour characteristic of human beings. A brief (...) sketch is offered of its application to the social practice of nursing. (shrink)

This discussion is grounded in Aristotelian–Thomistic realism and takes the position that nursing is a practical science. As an exposition of the title statement, distinctions are made between opinion and truth, and the speculative, productive and practical sciences. Sources of opinion and truth are described and a discussion follows that truth can be achieved through knowing principles and causes of the natural kind behind phenomena. It is proposed that humans are the natural kind behind nursing phenomena. Thus, human nature provides (...) proper principles (the truth) of nursing practice. (shrink)

What grounds and justifies conclusions in medical ethics? Is the source external or internal to medicine? Thee influential types of answer have appeared in recent literature: an internal account, an external account, and a mixed internal / external account. The first defends an ethic derived from either the ends of medicine or professional practice standards. The second maintains that precepts in medical ethics rely upon and require justification by external standards such as those of public opinion, law, religious ethics, or (...) philosophical ethics. The third claims that distinct medical ethics have emerged from distinct cultural frameworks, each with norms that govern physicians. There is merit in each perspective, but each overreaches its supporting arguments and fails to appreciate what is legitimate in the theses of its competitors. I propose a fourth account that offers a way to escape limitations of the other three, while retaining their most attractive features. (shrink)

Gerald Dworkin has argued that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection. He does this by proposing a principle by which we are to judge whether an action is consistent with the proper ends of medicine. I argue: (a) that this principle, if valid, does not show that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection; (...) and (b) that this principle is not valid, and this is because it mistakenly views the promotion of patient autonomy as one of the proper ends of medicine. Rather, I propose, we should view respect for a patient's autonomy as a constraint on the pursuit of the proper ends of medicine, rather than as one of the proper ends itself. With this revised understanding of the proper ends of medicine, we can conclude that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection. (shrink)