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

For those who seem not have the capacity for independent practical reasoning it is
difficult to imagine how they might be said to flourish. Thus there may be some about
whom we must say flourishing is not possible. Those in persistent vegetative state, those
pronounced dead but kept functioning at a biological level for the purposes of organ
donation, and those bom without the neuro-biology considered necessary for
independent human life would seem to be candidates for humans unable to flourish qua
humans. Yet such examples are rare. There are, however, many examples of individuals
whose capacities for independent practical reasoning are diminished to the degree that
they are unable to make the kinds of choices MacIntyre claims necessary for human
flourishing. Unable, that is, to separate themselves from their desires and thus they
remain in a ‘childlike’ state (in terms of independent practical reasoning) in which the
satisfaction of immediate desires precludes the possibility of engaging in practices. He
says:

Independent practical reasoners contribute to the formation and sustaining of
their social relationships, as infants do not, and to Ieam how to become an
independent practical reasoner is to Ieam how to cooperate with others in
forming and sustaining those same relationships that make possible the
achievement of common goods by independent practical reasoners

(MacIntyre 1999 p. 74)

Given that a significant number of nurses work with persons whose capacity for
independent practical reasoning is challenged and given that nursing work generally
aims to enable human flourishing, MacIntyre’s account fails to satisfy. It fails to satisfy
because his account implies that human flourishing is a case of all or nothing. Yet, for
nursing and nurses, particularly for those working with patients whose capacity for
independent practical reasoning is (temporarily or permanently) reduced, it is important
to understand human flourishing as constituted by the degree to which an individual can
exercise her or his independent practical reasoning. In some cases this capacity is
compromised (as in, for example, the child with severe learning difficulties) to such an
extent that on MacIntyre’s account the person cannot be distinguished from non-human
animals. On this account not only is the idea of nursing as a response to human (rather
than animal) vulnerability undermined but also many of those who are the recipients of
nursing practice will be excluded from the possibility of flourishing qua humans. In the
nursing context in particular, it is important to understand that the ability to engage in
independent practical reasoning can be partial as this helps to ensure that patients with
minimal or compromised rational capacities are understood and cared for as human
beings.

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