Understanding Virtuous Person-Centred Nursing Care: A Neo-Aristotelean Perspective

Professional codes of ethics for nurses and midwives and the pedagogies they inform are often intellectualist; they assume implicitly that impartial practical reasoning selects the goal of moral deliberation as well as the means to its achievement. In this paper we argue that while the intellectual virtues and impartial moral deliberation are involved in moral decision-making in mature adults, the end is determined by a professional nurse's character, that is, by the influence of non-rational virtues. Such virtues include distinct nursing dispositions, excellences and regulative ideals which are triggered almost automatically in response to certain morally salient situations. Practical wisdom (phronesis) selects and guides the means to the aim and is ontologically interdependent with virtue and is guided by virtue. Although codes of ethics are useful, they often indicate that developers have misconstrued the nature of phronesis and its relationship to virtue. As such, many promote the development of technical expertise at the expense of holistic ethically sensitive person-centred care. Using insights from contemporary neo-Aristotelian interpretations we explicate these concepts and their relationship to show that the end of moral deliberation is non-negotiable. We argue that while person-centred care requires distinct technical competence and knowledge development it also includes an ineliminable emotional or affective component. Person centred patient care is most effective when practitioner thought and feeling operate as one. We use features of Irurita's typology of hands (soft, firm, hard and rough) to illustrate this claim. We conclude by briefly comparing virtue ethics with deontological and consequentialist moral theories and argue that truly ethical deontological and consequentialist responses also presuppose virtuous moral character.