Response to "Caring, Virtue Theory, and a Foundation for Nursing Ethics"
Watson, Jean Rn, PhD, Faan, Scholarly Inquiry for Nursing Practice
Salsberry has presented a critical analysis of some key issues that provide another conceptual twist to the scholarly inquiry toward a caring ideal and ethical shift in nursing and ethics circles. In juxtaposition to the recent work of Brody (1988) and Cooper (1990), who critiqued traditional moral theory from a reconceptualized caring perspective (drawing upon feminist critique and virtue ethics), Salsberry now offers another intellectual hook to keep the dialectic and the dialogue alive in further explicating and elucidating a nursing ethic a la caring.
The new contribution to the discussion in the literature is a further critique of virtue ethics. Salsberry identifies some positive contributions, while also clearly highlighting the limitations of virtue ethics toward developing an ethical foundation for nursing within a caring paradigm.
While some of the earlier arguments and insights of Brody (with Fry as respondent, 1988) and Cooper helped to introduce a credible, historical alternative to the traditional ethical theories (deontological, utilitarian), they also introduced a caring value and moral feminist component to the discourse. Salsberry now offers an extended analysis of a virtue ethics and its ability to offer a caring, values-based moral foundation for nursing ethics. (I wonder if we shouldn't also be doing it the other way around.)
What still remains as part of the discourse are the following: lack of closure on the ethic-of-virtue/ethic-of-duty pendulum around caring; the need to acknowledge the ambiguity of the justice-to-virtue theoretical movement; the need for relational-ontology clarity within both traditional bioethical discourse, as well as in caring ethic development in nursing. Salsberry highlights the notion that while virtue ethic is concerned primarily with the nature of the practitioner, nursing professionals must be, and are, concerned with both the nature of right action and the development of ethical practitioners. Thus, Salsberry takes an approach that blends the strengths and weaknesses of both traditional and virtue frameworks in considering a nursing ethic of caring. Nevertheless, the above issues hang in the dialectic air.
As has been pointed out, there are strong theoretical precedents for the caring perspective in nursing ethics. While virtue ethics doesn't necessarily solve the caring ethic pursuit, it helps to move it along the continuum in addressing some of the dilemma in nursing ethics. For example, even Aristotelian virtue consisted in "dispositions to passion as well as action, feeling the right emotions at the right times, with reference to the right objects, towards the right people, with the right motive and in the right way" (Nichomachean Ethics, 1106b21 -3,1109b30 quoted in Carse, 1991, p. 18).
I believe what remains underdeveloped is caring as a moral ideal that encompasses a relational ontological aspect of nursing ethics a la caring. As Carse (1991) put it, "both the methodological and normative implications of the caring ethic perspective suggest that the differences dividing the traditional and the caring concern much more than emphasis: they concern our conception of the most fundamental elements of moral life; moral judgment, the nature of the moral self, and our responsibilities as individuals to each other" (p. 18). The caring ethic orientation still remains different from both the principle-based and virtue-based perspective; in caring as a moral ideal, there still remains a focus and commitment to the particular (experience of specific persons in concrete circumstance within a living context wherein intersubjective sensitivities are evoked and engaged. Both traditional ethical theory and virtue ethic still rely upon a language of abstract rights and principles, and on conceptions of obligation formulated independent of particular contexts (Carse, 1991). …