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, necessarily, a standard
of excellence. MacIntyre would, I think, say that all practices necessarily have forces
within them and out with them that make such deformations a distinct possibility.
Whether or not they succeed in corrupting (or deforming) the practice will only be
determined in retrospect, and according to MacIntyre, a practice in good order will be
able to resist such corrupting influences while those persons engaged with the practice
draw upon and use the virtues necessary to maintain that practice.
Miller’s claim that contra MacIntyre excellence can be assessed from without by
reference to the ends of a (purposive) practice needs further consideration. He claims,
for example, that for architecture or farming there is a tangible end product about which
a person outside of the practice can make an Informedjudgement. As an outsider I can
judge a building in relation to specified criteria and I can assess the quality of a crop of
turnips. What I cannot know, unless I have observed the production process, is whether
or not the architect or the farmer has engaged with architecture or farming as a practice
during production. In Miller’s terms it seems that I have no need to know this and yet
for MacIntyre this is essentially relevant. Miller wants to judge the ends without
reference to means. For MacIntyre this is further evidence of the pernicious nature of
modernity. The tendency to imagine that excellence is to be found in an object
regardless of the means of its production is to confirm the fragmentary nature of our
present condition; it is to separate ourselves artificially from our capacities and our
potential to achieve excellence. Nevertheless, MacIntyre’s own claim that excellence
can only be determined from within the traditions of a practice is perhaps a claim that is
too strong. Care, which might be claimed as an excellence of nursing as a practice, is
something that can be regarded and judged properly by those not engaged in nursing.
The recipients of nursing are perhaps amongst those well placed to judge the standards
of care, and this is not just in terms of ends, but also of means. It is not uncommon for
patients to be aware of the individual approaches of different nurses and, important as
technical competence is, patients will often find the technical ability of nurses difficult
to assess but will recognise very readily the difference between the nurse who merely
provides care and the nurse with a caring attitude.
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