Biomedical ethics has been dominated for over three decades by the central principles of autonomy, beneficence, nonmaleficence, and justice. These form the pillars of the principles- based ethical framework developed and promoted by Tom Beauchamp and James Childress. Despite its dominance, this framework for bioethical thinking, discourse, and decision-making has been widely criticized by bioethicists from many belief traditions. Such criticism has often focused on its minimalist preoccupation with procedural clarity, its lack of moral content, and its inattentiveness to relational aspects of biomedical ethics. For Christian bioethicists, its lack of grounding in Scripture and in the relationship between God and humankind are particularly problematic. Some Christian ethicists have suggested that the biblical notion of covenant gives normative direction to medical relationships as well as extratemporal, presuppositional grounding for meaningful bioethical thinking and action. The biblical covenantal theme describes the relationship that God established with human beings at creation as one that is a common relational link for all human relationships. Just as God offered his gift of covenantal promise and binding relationship in return for obedience to him, human relationships can develop and flourish if modeled after such covenantal giving toward fellow human beings. A biblical covenantal ethic recontextualizes bioethical principles within the relationality inherent in medicine. Patient autonomy is transformed into birelational sensitivity and giving, beneficence becomes a principle of care as the core of medicine, the minimalist necessity for nonmaleficence disappears, and justice is grounded in the claim that every human being deserves selfless care as an image-bearer of God. This covenantal ethic can fulfill the search for covenantal relationships in medicine, providing deeper understanding of true beneficence by meeting the needs of other vulnerable human beings.

This thesis offers a social theoretical development of Bourdieu' s habitus in order that it might be used to 'take education seriously'. It is conducted from within the later Wittgenstein's view of language and according to a Winchean methodology for 'doing social theory'. The context used for this theoretical exercise in UK medical education, particularly ethics education. The first aim of the thesis is to develop a more cognitive aspect to the habitus and to this end I draw on the idea of 'thinking dispositions.' I argue that 'thinking dispositions' should be considered the product of enculturation rather than socialisation and that former is implied by Bourdieu's construal of this latter process as a 'collective process of inculcation.' I then give a historical account of the development of medical education in the UK over the past 30-40 years making particular reference to the General Medical Councils document Tomorrow's Doctors (1993, revised 2003, 2009). Subsequentially I return to the more theoretical ground which is the central concern of this thesis and attempt to give more definition to the idea of a cognitive habitus through a consideration of the reflective practice and education of medical professionals, the concept of meta-cognition (drawn from science education research), and the idea of a cognitive apprenticeship emerging from socio-cultural learning theory, a branch of Vygotskian psychology. The final chapter returns to Bourdieuan grounds and considers the relationship between enculturation, a cognitive apprenticeship and the habitus. In the conclusion I consider some reflexive implications of my thesis for medical ethics education delivered as part of a medical education and for applied ethics considered as a branch of philosophy which seeks to extend its insights beyond its disciplinary borders as, for example, in medical ethics education.

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Illness creates a range of negative emotions in patients including vulnerability, powerlessness and dependence on others for help. The nursing literature is saturated with debate about a 'therapeutic' nurse-patient relationship. However, despite the current agenda regarding patient-centred care, literature concerning the development of good interpersonal responses and the view that a satisfactory nursing ethics should focus on persons and character traits rather than actions, nursing ethics is dominated by the traditional obligation, act-centred theories such as consequentialism and deontology. I critically examine these theories and the role of duty-based notions in both general ethics and nursing practice. Because of well-established flaws, I conclude that obligation-based moral theories are incomplete and inadequate for nursing practice. Instead, the moral virtues and virtue ethics provide a plausible and viable alternative for nursing practice. I develop an account of a virtue-based helping relationship and a virtue-based approach to nursing. The latter is characterized by three features: (1) exercising the moral virtues such as compassion and courage, (2) using judgment and (3) using moral wisdom - moral perception, sensitivity and imagination. Merits and problems of this approach are examined. Following Macintyre, I conceive nursing as a practice; nurses who exercise the virtues and seek the internal goods help to sustain the practice of nursing and thus prevent the marginalization of the virtues. The strong (action-guiding) practice based version of virtue ethics proposed is context-dependent, particularist and relational. Several areas for future philosophical inquiry and empirical nursing research are suggested to develop this account yet further.

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