Nursing Ethics
Nursing Ethics A Virtue-Based Approach Alan E. Armstrong Senior Lecturer in Nursing, University of Central Lancashire, Preston, UK palgrave macmillan
* L Alan E. Armstrong 2007 Index Indexing Specialists (UK) Ltd 2007 Softcover reprint of the hardcover 1st edition 2007978-0-230-50688-6 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London wn 4LP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The author has asserted his right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2007 by PALGRAVE MACMILLAN Houndmills, Basingstoke, Hampshire RG21 6XS and 175 Fifth Avenue, NewVork, N.V. 10010 Companies and representatives throughout the world PALGRAVE MACMILLAN is the global academic imprint of the Palgrave Macmillan division of St. Martin's Press, LLC and of Palgrave Macmillan Ltd. Macmillan is a registered trademark in the United States, United Kingdom and other countries. Palgrave is a registered trademark in the European Union and other countries. ISBN 978-1-349-35316-3 DOI 10.1057/9780230206458 ISBN 978-0-230-20645-8 (ebook) This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Armstrong, Alan E., 1967- Nursing ethics: a virtue-based approach / Alan E. Armstrong. p.cm. Includes bibliographical references and index. 1. Nursing ethics. I. Title. RT85A762007 174.2-dc22 2006052517 10 9 8 7 6 5 4 3 2 16 15 14 13 12 11 10 09 08 07 Transferred to Digital Printing 2012
Contents Preface and Acknowledgements Chapter 1 Broad aim of the book Plan of the book Chapter 2 Illness, Narratives and the Value of the Nurse-Patient Relationship Illness and narratives Hospitalization and patients' emotions A brief history of the nurse-patient relationship The nurse-patient relationship in contemporary nursing and the notion of empowerment Therapeutic nurse-patient relationships The role of the nurse Barker, Jackson and Stevenson on the essential feature of mental health nursing Defining a 'good' nurse Chapter 3 The Virtues in General Ethics On 'faring well' The virtues in the history of philosophy What is a virtue? Assumptions about virtues and goodness Virtues or vices? ix 1 1 1 4 4 4 6 9 10 13 16 19 22 24 26 26 26 27 28 30 31 v
vi Contents Is it possible to provide a complete list of virtues? 31 What might determine important virtues? 32 What is a virtue? Revisited 34 Why should the virtues be valued? 35 Advantages of the virtue-based approach to morality 37 Problems with the virtues 38 39 Chapter 4 A Critique of Obligation-Based Moral Theories in General Ethics 40 40 Characterizing obligation-based moral theories 40 Consequentialism 41 Objections to act-consequentialism 44 Problems with utilitarianism 48 Merits of consequentialism 57 Rule-consequentialism 58 Consequentialism - conclusions 59 Deontology 60 Contemporary deontology 60 Deontological constraints 63 Intention and foresight in deontology 65 Problems with deontology 68 Deontology and intuitions: A response 74 Deontology: 75 75 Chapter 5 The Origins, Development and Tenets of Virtue Ethics 77 77 The origins and development of virtue ethics 77
The central tenets of virtue ethics Virtue ethics: Nomenclature Supplementary virtue ethics Strong virtue ethics Aristotle's virtue ethics Objections to Aristotle's ethics Virtue ethics and moral character Chapter 6 Common Objections to Virtue Ethics Chapter 7 A Critical Account of Obligation-Based Moral Theories in Nursing Practice Contents vii Why are obligation-based moral theories popular in nursing? 109 78 79 79 82 83 88 91 94 95 95 108 109 109 Examples of the deontic approach to moral decision-making in the nursing literature 110 Moral decision-making tools 114 The four principles approach to biomedical ethics 115 Criticisms of obligation-based moral theories in nursing 120 122 Chapter 8 Virtue-Based Moral Decision-Making in Nursing Practice Judgement and moral wisdom The virtue-based helping relationship The virtue-based approach to moral decision-making in nursing practice 125 125 126 134 141
viii Contents Merits of the virtue-based approach to moral decision-making in nursing practice Criticisms of the virtue-based approach to moral decision-making in nursing practice Chapter 9 MacIntyre's Account of the Virtues Criticisms of MacIntyre's thesis Chapter 10 MacIntyre's Account of the Virtues and the Virtue-Based Approach to Moral Decision-Making in Nursing Practice 180 180 Nursing practice, narratives and morality 180 Nursing as a practice: Its internal goods and the virtues 182 The virtue-based approach as a tradition of enquiry 186 186 Chapter 11 187 187 Criticisms of the virtue-based approach to moral decision-making in nursing practice 191 Areas for further research and enquiry 194 Merits of the virtue-based approach to moral decision-making in nursing practice 195 Teaching the virtues 197 199 Notes 201 Bibliography 224 Index 233 144 148 155 157 157 167 178
Preface and Acknowledgements This book is based on my PhD thesis, which was awarded to me by the University of Newcastle upon Tyne, UK, in 2004. My professional background as a qualified nurse motivated a deep interest in ethics, which I later studied at BA and MA level; both courses were taught using a philosophical approach to ethics. Therefore, I decided not to base my PhD thesis on an empirical research study. Instead, I attempted to propose a philosophical argument about the value of the moral virtues and apply this to contemporary nursing practice. That, in a nutshell, is the topic of this book. There is one stylistic issue worth mentioning: I have tried to be consistent with nomenclature; I use words such as 'people' and 'persons' in the Chapters dealing with general ethics and tend to use 'patient(s)' in the Chapters that deal with nursing ethics and nursing practice. There are many people that I would like to thank because without their help, this book would never have been completed. In no particular order, I thank Dr Shaun Parsons for his help in supervising my PhD thesis. The majority of this book was written while on sabbatical from my post as a senior lecturer in nursing at the University of Central Lancashire, Preston, UK. I would like to thank my divisional leader, Mrs Sheelagh Greenham, and head of department, Dr Bernard Gibbon, for their help and support over the past few years and, in particular, their help in applying for the sabbatical. I would like to thank Daniel Bunyard at Palgrave Macmillan for his help throughout the book-writing process. lowe a great deal of gratitude to my immediate family, my parents, Kenneth and Mary, my sister, Dawn and my brother-in-law, Steven. I have benefited greatly because of their love and friendship, not to mention financial help a few years ago! I would like to thank my stepdaughter, Stephanie; it is fortunate that we get on very well together, we have shared lots of laughs and she has understood how I have needed to dominate the PC! Last but certainly not least, it is difficult to express in words my gratitude and love for my wife, Carol. Since the day we met (16 April 1999), we have always enjoyed ourselves, she has helped me to understand myself more and given me more love and support than I probably have deserved. I dedicate this book to Carol, my beautiful wife. An overview of this book was published by Blackwell in 2006: Armstrong, A. E. Towards a strong virtue ethics for nursing practice, Nursing Philosophy, 7(3), 110-24. ix