Professional ethicists have traditionally sniffed at virtue ethics, regarding them as folk philosophy; intrinsically subjective and therefore worthless. They are what you fall back on when you haven’t got a proper argument. You don’t need a PhD to hold a position justified by virtue ethics, and accordingly that position is suspect.
But there seems to be a growing movement to rehabilitate virtue ethics. A recent paper by Salloch and Breitsameter in the Journal of Medical Ethics is typical. Summarising an empirical study of attitudes amongst hospice workers in Germany, it notes that ‘…the idea of virtue ethics as an appropriate basis for nursing ethics (in general as well as in palliative and hospice care) has been suggested recently by several authors. According to this discussion, obligation-based moral theories are considered to be incomplete and inadequate for nursing practice, because they lack rich accounts of moral character, personal relationships and emotions in moral life. The moral values expressed by our interview partners can be interpreted along this line as well.’
There is no reason to restrict the comments about the relevance of virtue ethics to nursing practice, or to hint at the inadequacy only of ‘obligation-based moral theories.’ The depressing and salutary fact is that much of what we, as medical ethicists and lawyers, spend our lives discussing, is wholly irrelevant at the medical coal-face. We should fear most terribly the ability of proper empirical studies in medical ethics to interfere with our ability to pay our mortgages. We have titillating conversations with each other in arcane philosophical languages. But they don’t speak those languages on the ward. Even if they did, they wouldn’t be interested in what we have to say. Onora O’Neill devastatingly demonstrated that most patients aren’t all that interested in autonomy: what they want most of all is a clinician whom they can trust. Sure, there is the occasional, icy, self-made man who really did write a life plan at the age of 16 and who is terrified about being forced to deviate from it. But he’s a pathological curiosity.
Patients want wise, kind, good, trustworthy, empathetic people around them when they are in pain or dying. For most patients, an ethically good decision will be one made in conversation with such a person. The real business of ethics, then, is not to determine whether Kant would frown on a particular decision, but to determine how to produce wise, kind etc people. And that’s much harder than understanding the Critique of Pure Reason.
Are friendly, honest, virtuous nurses better for patients though? It makes us happy that we are around pleasant people, but it may not make us any more healthier people because of it. Given the choice between a rude but excellent nurse, and a sweet but barely competent nurse, I’m sure most people would pick the nicer nurse.
And when evaluating the character of nurses, that is what most people are doing, evaluating the social character, not the moral character of a nurse. After all, how would the average patient know if a nurse is brave or honest?
I think there is a false dichotomy between professional excellence and moral character. Can a nurse, a doctor, a resident not be both technically and professionally competent and compassionate and morally sensitive?
To be sure, I think, we have been as of late caught up in the rat race of keeping pace with the breakneck advance of biomedical science. Our focus has naturally narrowed as a result. But I do not think that this necessarily has to be the case. Its not an exclusive this-or-that choice between professional excellence and virtuous character. We can and we should be both.
From your commentary, it looks like there’s a significant disconnect between trends in bioethics and ethics proper. Virtue ethics has been on the rise in Anglophone ethics at least since Anscombe’s “Modern Moral Philosophy” (1958). Do you think virtue ethics is only getting more popular in this specific area of bioethics (nursing ethics, or whatever you want to call it), or is it really the case that bioethicists in general are only now starting to take virtue ethics seriously?
I think you’re right, Q, that bioethics has been unusually sheltered from the virtuously ethical wind that has blown through other areas of ethics. I suspect the reasons for that lie more in the personalities and intellectual pedigrees of bioethicists than in any particular inability of virtue ethics to be useful in bioethics.
Wayne: Dimitri is right:I was asserting no such dichotomy, and no such dichotomy exists. There are, in any event, ample empirical grounds for thinking that happiness is therapeutically and palliatively effective. But even if there weren’t, shouldn’t professionals be under an obligation to try to make their patients happy? You can describe that obligation using lots of different languages.
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