Communication and the Interpretive Principle of Charity in Nurse-Patient Interaction

A widespread view in nursing literature is that it is important for nurses to understand how patients experience states of disease and illness. To appear to patients as an empathetic practitioner involves more than identifying beliefs patients have about their conditions of ill health; it is also necessary to understand how illness experiences affect patients' well-being and quality of life. This article elucidates this condition of successful nurse-patient interaction by analyzing it in light of an influential theory of charitable interpretation from the philosophy of mind and language. According to this theoretical perspective, successful communication in caring practice presupposes that nurses apply a methodological principle of charity: They need to understand how patients think that they are entitled to their own idiosyncratic perspectives on their states of ill health. Setting the principle of charity aside can be legitimate but only when contextual limitations make it impossible to uncover patients' subjective horizons. Moreover, the methodological ideal of charitable interpretation is inconsistent with the idea that nurses and patients can understand each other even though they have incommensurable beliefs. Instead, the principle implies that primary understanding rests on interpersonal coherence and agreement about norms of rational reasoning. The last part of this article uses case studies to clarify these implications and show how they have striking applications in caring practice.