Caring, Virtue Theory, and a Foundation for Nursing Ethics
Salsberry, Pamela J. Rn, PhD, Scholarly Inquiry for Nursing Practice
The purpose of this paper is to critically examine the use of a framework of virtue theory as a foundation for a nursing ethic embodied in the caring ideal. The first section summarizes the problems identified with traditional moral theory as a foundation for a nursing ethic based on the caring ideal. From these problems, adequacy conditions that a foundation must meet are identified. In section two, the basic ideas of virtue theory are sketched and an account of how virtue theory can be used as a foundation for a nursing ethic based on the caring ideal is discussed. Finally, virtue theory as a foundation for a nursing ethic a la caring is assessed against the adequacy conditions delineated in section one. The conclusion of this paper is that virtue theory does not offer a viable alternative to duty-based theories. While virtue theory provides promise in meeting the identified adequacy conditions, serious secondary issues arise that can not be immediately nor easily resolved.
"The virtues of man also will be the state of character which makes a man good and which makes him do his own work well." Aristotle, Ethica Nicomachea, II, 6:22-24, McKeon translation.
During the past few years there has been a shift in the nursing ethics literature from a concern about ethical actions to a broader concern about the character of the practitioner (Fry, 1989; Muggins & Scalzi, 1988; Packard & Ferra, 1988; Yarling & McElmurry, 1986). As this shift has occurred, there has been a recognition that the traditional ethical foundations used in bioethics that focus on actions and obligations are insufficient as foundations for an ethical theory grounded in the character of the practitioner. Moreover, there is a renewed interest in a nursing ethic that can accommodate an emphasis on the nurse-patient relationship as morally fundamental (Cooper, 1988). Fry (1989) argues that traditional philosophical theory and analysis used within bioethics are not directly applicable to the development of an ethical theory for nursing. She maintains:
Present theories of medical ethics tend to support theoretical and methodologic views of ethical argumentation and moral justification that do not fit in with the practical realities of nurses' decision making in patient care and that, as a result, tend to deplete the moral agency of nursing practice rather than enhance it (p. 20).
Furthermore this shift has been encouraged by writings in nursing by Leininger (1984,1989) and Watson (1985,1989), and works by Gilligan (1983) and Noddings (1984) on the moral development of women. These works have not only influenced the shift to a character-based ethic, placing new emphasis on the patientnurse relationship, but have influenced the ethic toward a particular ideal-that is, that the moral ideal for nursing should be/is caring and that nursing is fundamentally a caring relationship (Watson, 1989).
This conceptual shift raises the issue of an ethical grounding for such a position, especially given the recent skepticism toward traditional ethical theory. Some writers in nursing (see discussion between Brody, 1988, and Fry, 1988) have begun to examine virtue theory as one way to ground this new approach. There has been a resurgence of interest in virtue theory within the philosophical community since the publication of Maclntyre's After Virtues (1981). Maclntyre argues that moral philosophy and morality are in disarray in our culture, partially because we have lost sight of the fact that any morality must be understood within its social embodiment in a culture. Furthermore, Maclntyre argues that traditional moral theory, in the form of consequentialist and deontological theories, has failed because there is no longer a foundation with which to ground these approaches.
The purpose of this paper is to critically examine the use of a framework of virtue theory as a foundation for nursing ethics embodied in the caring ideal. …