Alasdair Madntyre and the Professional Practice of Nursing 31
Whether or not they succeed in corrupting the prac-
tice will only be determined in retrospect, and accord-
ing to MacIntyre, a practice in good order will be able
to resist such forces because those persons engaged
with the practice will draw upon and use the virtues
necessary to maintain that practice.
Miller’s distinction is useful in so far as it distin-
guishes games or self-contained practices from other
types of practice. Nursing might well be purposive in
the sense in which Miller uses that term but to define
it only in terms of its purpose is to offer only a narrow
picture of nursing. Miller talks of ‘productive activity
like architecture’ and ‘intellectual activity like
physics’ (Miller, 1994, p. 250) but beyond suggesting
that medicine has a wider social purpose he only hints
that medicine is a productive activity and, as with
nursing, it is possible to define medicine in this way.
If he were to consider nursing (and I point out here
that he does not) I imagine that he would include it
in the same type of purposive practice as he places
medicine. He seems to suggest that a purposive prac-
tice is one that has an end product (although physics
would not appear to fit this model), thus for farming
or architecture there is a tangible end product about
which the person outside of the practice can make an
informed judgement. I can know if a building meets
certain criteria and I can place a value on a crop of
turnips, but what I cannot know is whether or not the
architect or the farmer has engaged the practice of
architecture or of farming during the production of
those products, and in Miller’s terms it seems that I
have no need to know.
The claim that internal goods are observable and
measurable by those not engaged in the practice is
not proven by external judgements of the ends of that
practice, regardless of the social construction of those
ends. To judge the internal goods in this way is to fail
to recognize the distinction between the ends of pro-
duction (or purposes) on the one hand and the means
of that production on the other. The internal goods of
a practice are, by definition, only available to those
who are engaged with the practice. To judge the archi-
tect’s building or of a farmer’s turnips is not to judge
the process of achieving those ends. Thus it would
seem not to matter whether the architect or the
farmer has been, as it would be in the chess example,
‘cheating in order to win’ and thus precluded from the
internal goods. That is to say that while it may be
appropriate to observe and make a judgement about
the ends of a practice this does not of itself provide a
route by which the internal goods of that practice may
be measured. Indeed, if one were to make a judge-
ment on this basis there would seem to be no way to
distinguish simulacra from the real thing.
Nursing shares with medicine socially constructed
ends, but like medicine those ends are only part of
what defines nursing. It is true as Miller states that the
standards of excellence can be appreciated by those
not engaged in the practice, but in the case of nursing
the group of persons not engaged with the practice
itself who have a legitimate claim to judge the stan-
dards of excellence are those who are in some way
the recipients of the professional practice of nursing.
While there are similarities in the distinctions that
Miller and I make, I think that my intention in dis-
tinguishing between different types of practice is not
to identify a purpose for any given practice, which
seems to be Miller’s concern, but to consider the
nature of a specific group of practices (the group that
I have described as professional practices), and I
believe this to be more consistent with the thrust of
MacIntyre’s project.
For MacIntyre the identification of a practice is
only the first step in determining a virtue. Attributes
can be identified as necessary for any activity but for
MacIntyre such attributes identified within a practice
can only be classed as virtues if they have the poten-
tial to contribute to the narrative unity of an individ-
ual life (effectively a contribution to the good life),
and if they are consistent with the moral traditions of
that practice.This means that as well as making a case
for nursing to be considered as a practice it is neces-
sary to identify whether or not those dispositions
necessary for nursing contribute to the good life and
are logically developed from the moral traditions of
nursing.
For example, if an activity related to some aspect
of business requires a certain ruthlessness together
with a requirement for economy with the truth then
in MacIntyre’s terms the next phase would be to
consider whether these attributes so necessary for
success in the business activity are consistent with the
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