Stan van Hooft

A Socratic Dialogue on the Question ‘What is Love in Nursing?

It is the thesis of the authors that the caring ethic and moral state of being of nurses ideally suffuses their professional caring and is thus implicit in their ethical decision making. Socratic dialogue is a technique that allows such moral attitudes to be made explicit. This article describes a Socratic dialogue conducted with nurses on the topic: ‘What is love in nursing?’ The conclusions drawn were based on the belief that the current western-style health care system restricts the practice of nursing in such a way as to limit professional caring and loving possibilities. Nurses who love in the practice of caring go beyond the role definition of the duty of care; they are people who are prepared to think differently about their practice as professionals, and are identified as competent risk takers committed to the betterment of the other. From this dialogue, ‘love in nursing’ was understood as the willingness and commitment of the nurse to want the good of the other before the self, without reciprocity.

Acting from the Virtue of Caring in Nursing

The author challenges the recently argued position of Helga Kuhse that caring is merely a preparatory stage to moral action and that impartial, principled thinking is required to make action moral, by suggesting a notion of caring as virtue. If caring is a virtue then acting from that virtue will be acting well. Acting from the virtue of caring involves eight features, which include not only that of being sensitive to, and concerned about, the patient, but also that of being aware of, and sensitive to, the relevant ethical principles. In this way, caring is seen as an overarching quality that gives action its moral character. The moral character of an action does not derive only from its having been performed in the light of principles.The author challenges the recently argued position of Helga Kuhse that caring is merely a preparatory stage to moral action and that impartial, principled thinking is required to make action moral, by suggesting a notion of caring as virtue. If caring is a virtue then acting from that virtue will be acting well. Acting from the virtue of caring involves eight features, which include not only that of being sensitive to, and concerned about, the patient, but also that of being aware of, and sensitive to, the relevant ethical principles. In this way, caring is seen as an overarching quality that gives action its moral character. The moral character of an action does not derive only from its having been performed in the light of principles.

Pain and communication

It is frequently said that pain is incommunicable and even that it “destroys language”. This paper offers a phenomenological account of pain and then explores and critiques this view. It suggests not only that pain is communicable to an adequate degree for clinical purposes, but also that it is itself a form of communication through which the person in pain appeals to the empathy and ethical goodness of the clinician. To explain this latter idea and its ethical implications, reference is made to the writings of Emmanuel Levinas.It is frequently said that pain is incommunicable and even that it “destroys language”. This paper offers a phenomenological account of pain and then explores and critiques this view. It suggests not only that pain is communicable to an adequate degree for clinical purposes, but also that it is itself a form of communication through which the person in pain appeals to the empathy and ethical goodness of the clinician. To explain this latter idea and its ethical implications, reference is made to the writings of Emmanuel Levinas.

Health and subjectivity

This paper is an exploration of health as a state of subjectivity rather than as an observable condition of the body. Subjectivity is analysed as involving a pre-intentional conative dimension distinct from the biological and pragmatic dimensions of living. Using some concepts from Levinas to articulate this conative dimension, I argue that what Levinas describes as ‘love of life’– an inchoate feeling that the living of life is enjoyment and nourishment – is the pre-articulated experience of health. Health in this sense is when things go well with us in the conative mode of our subjectivity. Moreover, health in this sense is foundational to our very being as subjectivity. A professional concern for health must be sensitive to all modes of subjectivity in which health is experienced.This paper is an exploration of health as a state of subjectivity rather than as an observable condition of the body. Subjectivity is analysed as involving a pre-intentional conative dimension distinct from the biological and pragmatic dimensions of living. Using some concepts from Levinas to articulate this conative dimension, I argue that what Levinas describes as ‘love of life’– an inchoate feeling that the living of life is enjoyment and nourishment – is the pre-articulated experience of health. Health in this sense is when things go well with us in the conative mode of our subjectivity. Moreover, health in this sense is foundational to our very being as subjectivity. A professional concern for health must be sensitive to all modes of subjectivity in which health is experienced.

Caring, objectivity and justice: An integrative view

The argument of this article is framed by a debate between the principle of humanity and the principle of justice. Whereas the principle of humanity requires us to care about others and to want to help them meet their vital needs, and so to be partial towards those others, the principle of justice requires us to consider their needs without the intrusion of our subjective interests or emotions so that we can act with impartiality. I argue that a deep form of caring lies behind both approaches and so unites them. In the course of the argument, I reject Michael Slote’s sentimentalist form of an ethics of care, and expound Thomas Nagel’s moral theory, which seems to lie at the opposite end of a spectrum ranging from moral sentiments to impersonal objectivity. Nevertheless, Nagel’s theory of normative realism provides unexpected support for the thesis that a deep and subjective form of caring lies at the base of even our most objective moral reasons.The argument of this article is framed by a debate between the principle of humanity and the principle of justice. Whereas the principle of humanity requires us to care about others and to want to help them meet their vital needs, and so to be partial towards those others, the principle of justice requires us to consider their needs without the intrusion of our subjective interests or emotions so that we can act with impartiality. I argue that a deep form of caring lies behind both approaches and so unites them. In the course of the argument, I reject Michael Slote’s sentimentalist form of an ethics of care, and expound Thomas Nagel’s moral theory, which seems to lie at the opposite end of a spectrum ranging from moral sentiments to impersonal objectivity. Nevertheless, Nagel’s theory of normative realism provides unexpected support for the thesis that a deep and subjective form of caring lies at the base of even our most objective moral reasons.

Suffering and the goals of medicine

Taking as its starting point a recent statement of the Goals of Medicine published by the Hastings Centre, this paper argues against the dualistic distinction between pain and suffering. It uses an Aristotelian conception of the person to suggest that malady, pain, and disablement are objective forms of suffering not dependent upon any state of consciousness of the victim. As a result, medicine effectively relieves suffering when it cures malady and relieves pain. There is no medical mission to confront the spiritual condition of the patient.Taking as its starting point a recent statement of the Goals of Medicine published by the Hastings Centre, this paper argues against the dualistic distinction between pain and suffering. It uses an Aristotelian conception of the person to suggest that malady, pain, and disablement are objective forms of suffering not dependent upon any state of consciousness of the victim. As a result, medicine effectively relieves suffering when it cures malady and relieves pain. There is no medical mission to confront the spiritual condition of the patient.

Caring About Health

Presenting a philosophical exploration of the ideas central to health care practice this book explores such concepts as caring, health, disease, suffering and pain from a phenomenological perspective. With deep philosophical insight this book draws out, not only the ethical demands that arise when one encounters these phenomena, but also the forms of ethical education that would help health care workers respond to those demands. This is a book which explores the grounds for ethical living rather than enunciating ethical principles. Van Hooft argues that ethical responses arise from sensitive and insightful awareness of what is salient in clinical and other health care settings. This book draws upon thinkers from the classical canon, the Anglo-American tradition and from continental philosophical ideas.

The Suffering Body

Our conceptions of suffering and of pain are vitiated by dualistic ways of thinking. For example, Eric Cassell’s definition of suffering implies that it is a psychological accompaniment to pain. This article challenges this approach by positing an Aristotelian conception of the human person and defining suffering as the frustration of the internal tendencies of all aspects of the person. In this way suffering can be seen as an objective condition irrespective of the mental states of the victim. Further, on this conception, suffering can be attributed to animals and other organisms.Our conceptions of suffering and of pain are vitiated by dualistic ways of thinking. For example, Eric Cassell’s definition of suffering implies that it is a psychological accompaniment to pain. This article challenges this approach by positing an Aristotelian conception of the human person and defining suffering as the frustration of the internal tendencies of all aspects of the person. In this way suffering can be seen as an objective condition irrespective of the mental states of the victim. Further, on this conception, suffering can be attributed to animals and other organisms.

Judgement, decision, and integrity

Although Aristotle did not mention it, integrity can be understood in an Aristotelian framework. Seeing it in these terms will show that it is an executive virtue which concerns the existential well being of an agent. This analysis is not offered as an exegesis of Aristotles text, but as an attempt to use an Aristotelian framework to understand a virtue deemed important today. This account will have the benefit of solving some problems relating to motivational internalism and, as such, will contribute to that recent current of thought which has been highlighting the importance of virtue thinking in moral theory. I will distinguish moral judgement from decision and show that moral judgement is dependent upon virtue more strongly than it is upon impartial rationality. I will suggest that integrity is the virtue to which moral judgement gives expression and is the virtue which links judgement to decision so as to overcome akrasia.Although Aristotle did not mention it, integrity can be understood in an Aristotelian framework. Seeing it in these terms will show that it is an executive virtue which concerns the existential well being of an agent. This analysis is not offered as an exegesis of Aristotles text, but as an attempt to use an Aristotelian framework to understand a virtue deemed important today. This account will have the benefit of solving some problems relating to motivational internalism and, as such, will contribute to that recent current of thought which has been highlighting the importance of virtue thinking in moral theory. I will distinguish moral judgement from decision and show that moral judgement is dependent upon virtue more strongly than it is upon impartial rationality. I will suggest that integrity is the virtue to which moral judgement gives expression and is the virtue which links judgement to decision so as to overcome akrasia.

Cosmopolitanism as virtue

This paper explores cosmopolitanism, not as a position within political philosophy or international relations, but as a virtuous stance taken by individuals who see their responsibilities as extending globally. Taking as its cue some recent writing by Kwame Anthony Appiah, it argues for a number of virtues that are inherent in, and required by, such a stance. It is critical of what it sees as a limited scope in Appiahs conception and enriches it with Nigel Dowers concept of ‘global citizenship’. It then seeks to overcome a distinction that Appiah draws between a ‘thin’ moral conception of justice and a ‘thick’ ethical conception of our obligations to those with whom we have identity-forming relationships. It argues that a richer conception of the virtue of justice, as suggested by Raimond Gaita, can fully articulate the ideals of cosmopolitanism.This paper explores cosmopolitanism, not as a position within political philosophy or international relations, but as a virtuous stance taken by individuals who see their responsibilities as extending globally. Taking as its cue some recent writing by Kwame Anthony Appiah, it argues for a number of virtues that are inherent in, and required by, such a stance. It is critical of what it sees as a limited scope in Appiahs conception and enriches it with Nigel Dowers concept of ‘global citizenship’. It then seeks to overcome a distinction that Appiah draws between a ‘thin’ moral conception of justice and a ‘thick’ ethical conception of our obligations to those with whom we have identity-forming relationships. It argues that a richer conception of the virtue of justice, as suggested by Raimond Gaita, can fully articulate the ideals of cosmopolitanism.