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



game in such a way as to pursue excellence in playing chess. This emphasis on the
availability of internal goods is crucial to the idea of a practice as MacIntyre conceives
it as the internal goods of chess are only available to those who engage with chess (or
with some similar species of game) as a practice, whereas external rewards might be
obtained in myriad other ways. This is to say that to receive cash for playing chess
would be to receive an external reward and an external reward of this type can be
achieved in numerous other ways; for example, by winning a lucky dip, by selling
groceries, or by being in paid employment. Some critics have taken this distinction
between internal and external rewards to be a separation but this is to mistake
MacIntyre’s purpose. MacIntyre does not say that internal and external goods are
entirely separate or necessarily separable, rather he claims that one of the features of a
practice (and one that distinguishes an activity as a practice) is that those engaged with
the practice have access to the internal goods in a way that those not engaged with it do
not.

In his later work MacIntyre uses the terms ‘goods of excellence’ and ‘goods of
effectiveness’ in place of internal and external goods respectively. By so doing, Knight
(1998) suggests MacIntyre avoids some of the difficulties that follow from attempts to
separate internal from external goods. Like internal goods, goods of excellence are those
goods that are only available to the individuals who participate in a practice
as a
practice
whereas goods of effectiveness can be obtained elsewhere and relate to, for
example, organisational or institutional goals. MacIntyre notes that there is an inevitable
tension between institutions on the one hand and practices on the other. Institutions
necessarily place an emphasis on the goods of effectiveness for it is only by, for
example, maintaining a viable financial base that an institution can function in the
modem world. And if practices are to survive at all then they need the security the
institution provides, especially if the practices operating within that institution are
practices that are not wealth producing. So farming, which is wealth producing, may
share some of the goods of effectiveness with the institutions under which farming is
currently made possible. Whereas nursing (if it is a practice) is less likely to share in the
general idea of goods of effectiveness and, if the institution in which nursing takes place
fails to value the goods of excellence, nursing will be hard pressed to survive as a
practice. This is to say that not only are practices dependent for their very existence on
institutions but that they are also vulnerable to the internal and external forces that affect
the institutions themselves. The institution may serve
inter alia to protect practice(s) but

66



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