Caring as a slave morality: Nietzschean themes in nursing ethics

Abstract

Background. Sceptical arguments about 'caring' can be divided into three categories. First, it is suggested that, while caring is no doubt an admirable thing in itself, it is just one ideal among others. Secondly, it is claimed that caring is not really a virtue at all, and that it should be regarded as more of a vice, because it promotes favouritism, injustice, and self-deception. Thirdly, there is a worry that caring is not politically realistic, and that its advocates underestimate the powerful organizational and social structures which conspire to subvert nursing. Aim. This paper outlines a fourth, and more radical, type of scepticism, which explains why caring is subject to these drawbacks. In doing so, it considers the relation between caring, phenomenology and holism in nursing discourse, and the way in which all three fit together to form the 'caring paradigm'. Methods. The paper adopts a genealogical approach, borrowed directly from Nietzsche's Genealogy of Morality . That book argues that the values associated with caring are the expression of a profound resentment, harboured by the slaves (weak, powerless, timorous) against the nobles (strong, powerful, self-confident). Caring represents an inversion, a sort of 'fantasy revenge', in which the nobles can be portrayed as 'evil', while the slaves portray their own weakness as 'good'. Taking its cue from Nietzsche, the paper shows that the Genealogy narrative can be transposed into a modern health care context, with nurses as the 'slaves' and the medical profession as the 'nobles'. Conclusions. The ideology of caring is, in the Genealogy's terms, a slave morality. It represents an attack on the 'medical-scientific model', motivated by resentment, and designed to establish nursing's superiority. Its effects have been debilitating, and it has prevented nursing from becoming a 'noble' (that is, a properly scientific) discipline.