Philosophical Perspectives on Trustworthiness and Open-mindedness as Professional Virtues for the Practice of Nursing: Implications for he Moral Education of Nurses

our paratrooper and nurse might be consistent with moral behaviour but the extent to
which they are being moral is, at best, disputable. To act morally is to act intentionally
and implies a freedom to choose to act in one rather than in other possible ways.

Training of the kind to which our paratrooper and nurse have been subjected seems to
compromise moral agency as it is not clear that actions bom of such training fall into
the sphere of freely chosen moral actions. Of course we might say that those whose
actions result from mere obedience have failed as moral agents and where such persons
allow their actions to be used for unethical purposes we can, and indeed do, hold them
accountable for failing to recognise the immorality of those acts. And this forms the
basis of legal rulings under which merely ‘following orders’ does not constitute an
acceptable defence. After all, our paratrooper and our nurse are both morally culpable
insofar as they are free to refuse to follow orders, and morally speaking we require them
to refuse to follow orders that are immoral in terms of means or ends.

Following this line of argument it is tempting to think that training does not have a
moral component but this would be to fail to recognise the moral agency inherent in a
human capacity to recognise ‘immoral’ orders and to refuse to act in immoral ways
(although there are of course situations where individuals might be coerced to comply
with immoral commands). Yet the idea of training for moral behaviour or moral training
is one fraught with logical and conceptual difficulties. The idea of training people to act
in morally acceptable ways is a paradox for it implies a training in obedience and mere
unthinking obedience to authority denies the possibility of moral agency. In this sense
moral training is a form of indoctrination and as pointed out in Chapter 1, indoctrination
is inconsistent with education for citizenship in liberal democracies. It is also
inconsistent with an education that purports to enable nurses to use their capacity for
independent practical reasoning in the pursuit of safe, competent and ethical care of
patients. So insofar as nurses are trained to do certain things training cannot neglect
moral agency. Even apparently simple tasks such as measuring blood pressure or
transferring a person from bed to chair may take on moral significance in clinical
practice. Not only is it possible that a student may have to choose between measuring
one patient’s blood pressure and transferring a different patient from bed to chair but the
choice may turn out to be of great consequence if for example there are reasons why
neither of those things ought to be done to a patient because of some change in their
condition that the student has failed to observe.

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