Trevor Hussey

It is argued that philosophical realism is well suited to serve as a perspective from which to understand nursing, and that it should be considered as an alternative to positivist, interpretivist, hermeneutical and phenomenological approaches. However, existing forms of realism, including theory and entity realism are shown to be faced with serious problems. In response, an alternative form ‘constraint realism’ is outlined, and shown to be apposite for illuminating the rule or convention governed behaviour characteristic of human beings. A brief sketch is offered of its application to the social practice of nursing

Those matters that are judged to be spiritual are seen as especially valuable and important. For this reason it is claimed that nurses need to be able to offer spiritual care when appropriate and, to aid them in this, nurse theorists have discussed the nature of spirituality. In a recent debate John Paley has argued that nurses should adopt a naturalistic stance which would enable them to employ the insights of modern science. Barbara Pesut has criticized this thesis, especially as it is applied to palliative care. This paper re-examines this debate with particular attention to the meaning of 'spirituality' and the justification for accepting spiritual and religious theories. It is argued that when we take into consideration the great diversity among religious and spiritual ideas, the lack of rational means of deciding between them when they conflict, and the practicalities of nursing, we find that a spiritual viewpoint is less useful than a naturalistic one, when offering palliative care.

This paper is concerned with the debate in evolutionary epistemology about the nature of the evolutionary process at work in the development of science: whether it is Darwinian or Lamarckian. It is claimed that if we are to make progress through the many arguments that have grown up around this issue, we must return to an examination of the concepts of change and evolution, and examine the basic kinds of mechanism capable of bringing evolution about. This examination results in two kinds of processes being identified, dubbed direct and indirect, and these are claimed to exhaust all possibilities. These ideas are then applied to a selection of the debates within evolutionary epistemology. It is shown that while arguments about the pattern and rate of evolutionary change are necessarily inconclusive, those concerning the origin of novel variations and the mode of inheritance can be resolved by means of the distinctions made here. It is claimed that the process of selection in the evolution of science can also be clarified. The conclusion is that the main process producing the evolution of science is a direct or Lamarckian one although, if realism is correct, an indirect or Darwinian process plays a vital role.

Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: ‘Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.’ This thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society.

Nurses, like many other professional and semiprofessional groups, have a code of con duct. This raises important philosophical questions about the point of including nursing ethics in nursing education and about the content and methods of such teaching. This paper identifies seven functions that might be fulfilled by professional codes; it discusses the philosophical issues these raise and the implications for teaching professional ethics. It is argued that, far from codes rendering the teaching of ethics unnecessary, they pro vide additional reasons for its inclusion. An enhanced ability to make moral decisions helps to overcome the shortcomings of the codes, enables a profession to be autonomous in the development of its code, enables individuals to be authentic moral agents, and is essential in matters concerning the disciplinary function of the codes. The role of emo tions, feelings and attitudes in ethics also presents philosophical problems that moral edu cation can help to resolve

In this paper it is argued that we have three dispositions, each of which is very laudable in itself: a preference for the positive, constructive and creative aspects of human endeavours; a desire to be open‐minded and tolerant concerning ideas and beliefs; and an admiration of profundity. I have suggested that these dispositions can, if exaggerated or employed uncritically, seduce us into intellectual positions that are very dubious. These arguments are applied to some of the debates within the philosophy of nursing.

Evolutionary theory has been a very popular topic in recent years and it has been claimed that it can make a major contribution to the advance of several sciences such as medicine, psychology, psychopathology and sociology: even providing them with new paradigms. This paper explores the possibility that nursing could benefit similarly by adopting an evolutionary perspective. After sketching the scientific and philosophical background to the recent developments concerning evolution, and briefly mentioning the chief features of evolutionary theory, the paper discusses whether it makes sense to talk of ‘evolutionary nursing’, and whether there are any benefits in doing so. It uses a comparison with Darwinian medicine and evolutionary psychology. Several problems and objections are considered. The modest conclusion is reached that nurses need to adopt an evolutionary perspective to serve as a guide for some of their research and a source for research hypotheses. They also need to be informed about evolutionary ideas so as to be aware of the developments in the disciplines with which they work, and this understanding will assist them in maintaining vigilance against the misuse of science, religion and politics on behalf of their patients.

What is consciousness? What is its importance and how is it to be described? The paper looks at some of the principal theories and their attempts to solve the “hard problem” of how consciousness is produced by nervous tissue, and attempts to close the “explanatory gap” between such (apparently) profoundly different things as subjective awareness and a physical brain. It ends with a tentative suggestion that, despite centuries of philosophical frustration, recent appeals to quantum physics may offer a glimmer of hope.

It is argued that philosophical realism is well suited to serve as a perspective from which to understand nursing, and that it should be considered as an alternative to positivist, interpretivist, hermeneutical and phenomenological approaches. However, existing forms of realism, including theory and entity realism are shown to be faced with serious problems. In response, an alternative form ‘constraint realism’ is outlined, and shown to be apposite for illuminating the rule or convention governed behaviour characteristic of human beings. A brief sketch is offered of its application to the social practice of nursing.