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Derek Sellman
In the context of practices (in the MacIntyrean
sense) I am using the term ‘professional’ to encom-
pass these commitments - commitments that call
attention to the virtues required to sustain those com-
mitments and that have the potential to influence the
narrative unity of the life of a given individual if for
no other reason than the investment of time given to
that practice.
Those engaged with nursing as a professional prac-
tice as I have defined it exhibit the range of commit-
ments as outlined above. Engaging with nursing as a
professional practice does not necessarily require that
a given individual be in paid employment as a nurse
because the defining aspect of the professional prac-
tice of nursing involves acceptance of the range of
commitments as described. Nonetheless there are
those who are paid to nurse and there is no reason to
suppose that nursing as paid employment has any
specific bearing on nursing as a professional practice.
It is entirely reasonable to assume that there are
those who nurse merely as a means to obtain the
external reward of money and would then by defini-
tion preclude themselves from nursing as a profes-
sional practice, although there is no reason why those
same individuals might not find themselves drawn to
engaging with nursing as a practice. Similarly, there is
no reason to suppose that individuals engaged with
nursing as a professional practice must be in paid
employment as a nurse. It would seem appropriate to
point out here that those who are engaged in the pro-
fessional practice of nursing and are paid to nurse are
enabled to participate in the wider social world as it
is constructed in the early 21st century. For those who
do not posses an inheritance, nor a jackpot win from
the national lottery it remains an inescapable reality
that the need to earn requires us to choose an activ-
ity that leads to the external reward of money. Given
that we have the opportunity to choose the way in
which we obtain that external good T would suggest
that many of those who choose nursing do so pre-
cisely because it offers internal goods associated with
a practice while at the same time providing a means
of obtaining the external good of money.
David Miller (1994) makes a distinction of a similar
kind, he talks of ‘self-contained’ practices on the one
hand and on the other of ‘purposive’ practices. In the
former category he places examples such as chess
because its '... raison detre consists entirely in the
internal goods achieved by the participants ...’ and
he contrasts this with those practices ‘... which exist
to serve social ends beyond themselves (Miller, 1994,
p. 250).
Miller distinguishes different types of practices as
part of an attack on MacIntyre’s thesis. He insists that
MacIntyre’s failure to distinguish these two specific
and fundamentally different types of practice is a fatal
flaw because the vision of the virtues that MacIntyre
develops from the premise of a practice does so from
the self-contained rather than the purposive practice.
All that is claimed from the example of chess fails to
recognize the additional complexity that purposive
practices reveal. The virtues are played out not in the
self-contained practice for these represent merely a
diversion, but in the real world of purposive practices
where the internal goods are observable and measur-
able by those external to the practice itself.
Miller considers purposive practices as having
socially constructed ends and nursing can clearly be
placed in that category. However Miller goes on to
say that it is the ends of the practice that can be
judged in terms of excellence by those not actively
engaged in the practice itself. He provides an example
from medicine and he appears to say that a practice
is likely to be deformed by those engaged in it if there
is no external accountability. He suggests by way of
an illustration that:
. . . the medical community [may] come to attach special
weight to the capacity to perform certain spectacular oper-
ations whose long-term efficacy is doubtful - the practice has
fallen victim to professional deformation. A good practice
here is one whose standards of excellence are related
directly to its wider purpose. (1994, pp. 250-251)
The final sentiment expressed in this passage would
seem to be consistent with MacIntyre’s thesis but
Miller appears to have failed to perceive that the
valuing of an activity within a practice makes it
neither an internal good nor a standard of excellence.
My own response to this and I think it is largely in
accord with MacIntyre is that (purposive) practices
necessarily have forces within them and out with
them that make such deformations a possibility.
© Blackwell Science Ltd 2000 Nursing Philosophy, I, pp. 26-33
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