In Defence of Selflessness: A Philosophical Analysis of a Central Virtue in Professional Caring Practices
Cusveller, Bart, Ethics & Medicine
The virtue of selflessness (unselfishness) does not seem to grip the imagination of many professional nurses. This seems a remarkable contrast to traditional speech in nursing. In this paper, the nature and importance of this virtue is defended as a quality that professional nurses are required to exhibit by the practice of nursing care as such. The nature and structural conditions of professional nursing as a social practice are explored in a philosophical way - using terminology developed by ethicist Alasdair MacIntyre -as well as the importance of selflessness in such a social practice. If one understands professional nursing as a social practice with the well-being of others in need as a central value, there is good reason to believe that a value like selflessness is required by the nature of nursing itself. The interest of the patient may be at peril when sight is lost of the professional virtue of selflessness.
Key words: ethics, virtues, beneficence, selflessness, social practice
The face of health care has obviously changed over the last decades. We have come to know new notions such as "advanced practitioners", cost-effectiveness control, a flurry of research and theories, new strategies for empowerment and influence, and much more. This development could be summarized as one of health care workers becoming more professional. At the same time, some emphasise that such professional development ought to be balanced with compassion and caring (Benner 1998; see also entire thematic sections in Nursing Ethics 9 (1999) 3 and 5). The question arises, however: to what extent is it really realistic to balance professionalism with compassion and care? The system of health care delivery sometimes seems to force care professionals in the other direction - that of indifference and formality - resulting in frustration and burnout among committed workers who aim for compassion and care.
There is also a deeper question to be asked, however. This question is "to what extent is a balance of a professional system with compassion and care possible in the first place? To what extent is such a balance an option one can choose and start developing? Are compassion and care required at all by the professional practice of nursing care itself? Or does the practice of care professionals recommend or even require its own balance of professionalism on the one hand and care and compassion on the other? This is not a question of preferences or opportunities but one of structural conditions - i.e., a philosophical question.
If this is the case, we should perhaps distinguish between the actual caring and compassionate conduct of nurses and the attitude which caring practices themselves require nurses to exhibit in their actual conduct. If we know what is required by caring practices as such, we may know what the balance in professional caring should be like. What is required is to be prepared to show care and compassion in one's professional practice when needed or appropriate. To have a word for it, I will follow traditional speech and call it "selflessness". It is the aim of this paper to ask what the notion of selflessness as a professional attitude for care workers is and to what extent it ought to be expressed in their professional practice.
To accomplish this, I will first discuss the nature and structure of nursing practice as exemplary for our topic (next section), and, secondly, I will discuss selflessness itself (last section). As this discussion involves the analysis of concepts, argumentations, and structural conditions in nursing, it will appropriately be an exercise in moral philosophy (applied to nursing).
Nursing Care as a Social Practice
In seminal studies (Bishop & Scudder 1990; Gastmans et al. 1998; Sellman 2000), nursing care has been described as a 'social practice' in the sense recaptured from Aristotelian moral philosophy by American philosopher Alasdair Maclntyre (1983). …