This paper addresses two foundational questions in nursing ethics: whether a nurse who identifies as an ethical egoist should be reported to a supervisor, and whether utilitarianism is an adequate philosophical framework for governing medicine and healthcare. The paper argues that the term "ethical egoist" requires careful definitional scrutiny before any action is taken, drawing on Socratic conceptions of self-interest as a counterpoint to purely self-serving interpretations. It then evaluates utilitarianism's strengths as a practical, common-good framework for healthcare while acknowledging its limitations when applied across culturally diverse contexts without supplemental ethical frameworks.
A nurse who identifies as an ethical egoist should not automatically be reported, because the definition of what is meant by "good" has not yet been established. For example, Socrates could be considered an ethical egoist because he held the position that persons of intelligence always act in their own self-interest — that is, for their own personal good — but what he meant by this was that they do good to others and to a higher spiritual being, and in doing so, do good for themselves. However, another person might define the good as something that provides any passing benefit whatsoever, such as pleasure or monetary gain. This conception of the good would not meet Socrates' approval; he would not call it good at all. Yet this same person might also identify as an ethical egoist. It is therefore important that the meanings, definitions, and labels we apply to ourselves and others be accurately assessed before any formal report is made (Ethical Egoism, n.d.).
In this situation, the appropriate first step is to clarify what the nurse means by "ethical egoist." If the nurse's views align more closely with Socrates, there is no problem, because the Socratic conception of the good is a high and principled one. If, however, the moral principle underlying the nurse's ethical egoism is relativistic rather than universal and objective — as Socrates' was — then there may be cause for concern, since that nurse might seek personal gain at the expense of others. In short, the nurse's behavior should be monitored, but no formal complaint should be made until these issues can be resolved with greater clarity.
Utilitarianism is another concept that requires the notion of the good to be clarified. In utilitarianism, the greatest good is understood as that which benefits the common good of all (Bennett, 2010). It seeks a practical, pragmatic solution, but defining what constitutes the common good is a problem that the utilitarian framework alone cannot solve. It must appeal to other ethical models of a more transcendent nature — some will appeal to a relativistic or subjective model, while others will appeal to a universal, objective model, and this distinction makes all the difference. Acting for the common good is a commonsense approach to life, and in this respect utilitarianism is a sound philosophy for governing medicine and healthcare. However, because differences of opinion about what is good exist — especially across different cultures — it cannot be applied in isolation, since some will not view certain actions as beneficial for all, while others will.
"Cultural differences complicate utilitarian application"
Both ethical egoism and utilitarianism require careful definitional grounding before they can be responsibly applied in nursing and healthcare contexts. The key question in each case is how "good" is defined — whether relativistically or universally — and that question must be answered before either framework can guide ethical decision-making in practice.
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