The practice of medicine involves continual change, driven by a constant stream of developments in the understanding of biological structure and function relevant to human diseases, and the parallel improvements in pharmacologic and other technological interventions. This change is also driven by evolving social philosophies, ethical trends, and lifestyles. As products of society, doctors absorb contemporary values and norms. Indeed, it would appear that the ethical norms and standards of medical practice are flexible, and that the characteristics of medical practice (...) at any particular point in history may reflect the mores of the times rather than any enduring moral imperatives.However, a common perception .. (shrink)

This paper argues that doctors' ethical challenges can be usefully conceptualised as role virtue conflicts. The hospital environment requires doctors to be simultaneously good doctors, good team members, good learners and good employees. I articulate a possible set of role virtues for each of these four roles, as a basis for a virtue ethics approach to analysing doctors' ethical challenges. Using one junior doctor's story, I argue that understanding doctors' ethical challenges as role virtue conflicts enables recognition of important moral (...) considerations that are overlooked by other approaches to ethical analysis. (shrink)

Background Undergraduate medical education is beginning to concern itself with educating students about professional attributes as well as about clinical knowledge and skills. Defining these characteristics, and in particular seeking the help of the students themselves to define them, can be a useful starting point when considering how to incorporate aspects of professional behaviour into the medical curricula. Method This study explores the views of first-year medical students at Kocaeli University Faculty of Medicine in the 2007–8 academic year. The students (...) were asked the open-ended question: ‘What, in your opinion, are the attributes a good physician should have?’ Four topics were defined by researchers based on the undergraduate and graduate education projects. The attributes expressed by the students were evaluated by the researchers according to these topics and compared with the topics covered in the undergraduate and graduate education projects. Results A total of 127 students responded, and between them suggested 756 attributes. The majority of these attributes (54.6%) were concerned with interpersonal relations and communication, whereas the category representing the fewest attributes (12.3%) was that involving scientific knowledge and medical practice. In general, students' perception corresponded to the concept of the ‘competent physician’ as described in the professionalism projects, but attributes reflecting their world-view were also expressed. Conclusion Experience suggests that the active participation of students in determining which attributes are necessary for a good physician is a positive way of ensuring they embrace the importance of such qualities and attributes in themselves. (shrink)

Acting for the good of the patient is the most fundamental and universally acknowledged principle of medical ethics. However, given the complexity of modern medicine as well as the moral fragmentation of contemporary society, determining the good is far from simple. In his philosophy of medicine, Edmund Pellegrino develops a conception of the good that is derived from the internal morality of medicine via the physician-patient relationship. It is through this healing relationship that rights, duties, and privileges are defined for (...) both physicians and patients. Moreover, this relationship determines the characteristics or virtues that are necessary to engage in the medical telos. This paper addresses the role of the moral virtues in clinical medicine and the physician-patient relationship. First, it provides a brief background of the Aristotelian foundations of virtue-ethics. Second, it delves into Pellegrino’s philosophy of medicine understood as a practice oriented towards a teleological goal. Third, it relates the telos of medicine to the notion of the medical community as a fundamentally moral community. Finally, it concludes with a section that creates a dialogue between virtue ethics and principlism. (shrink)

This article is presented as a defence of voluntary active euthanasia from a virtue perspective and it is written with the objective of generating debate and challenging the assumption that killing is necessarily vicious in all circumstances. Practitioners are often torn between acting from virtue and acting from duty. In the case presented the physician was governed by compassion and this illustrates how good people may have the courage to sacrifice their own security in the interests of virtue. The doctor's (...) action created huge tensions for the nurse, who was governed by the code of conduct and relevant laws. Appraising active euthanasia from a virtue perspective can offer a more compassionate approach to the predicament of practitioners and clients. The tensions arising from the virtue versus rules debate generates irreconcilable difficulties for nurses. A shift towards virtue would help to resolve this problem and support the call for a change in the law. The controversial nature of this position is acknowledged. The argument is put forward on the understanding that many practitioners will not agree with the conclusions reached. (shrink)

Medical professionals are a community of highly educated individuals with a commitment to a core set of ideals and principles. This community provides both technical and ethical socialization. The ideal physician is confident, empathic, forthright, respectful, and thorough. These ideals allow us to define broadly "the excellence" of being a physician. At the core of these ideals is the ability to be empathic. Empathy exhibits itself in attributes of an individual's moral character and also in actions that actualize and support (...) communal life. Empathy, however, can be diminished or even lost and must be nurtured on an ongoing basis. The development of ethical physicians is strongly linked to experiences in the training period. Moral traits are situation-sensitive psychological and behavioral dispositions. The clinical environment of medical training programs can be so intense as to lead to conditions that may actually deprofessionalize trainees. Creating a clinical environment that is ethically nurturing and sustaining is an indispensable component of practicing medicine. (shrink)

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the (...) claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves. (shrink)

BackgroundMedical professionalism is a core aspect of medical education and practice worldwide. Medical professionalism must be reinterpreted to adapt to different social/cultural/historical contexts. We conducted a survey to examine the current understanding and perceived value of medical professionalism among Korean physicians.MethodsThe survey was distributed to 950 physicians nationwide; 721 completed surveys were returned between 1 April and 31 July 2011.ResultsIn their practice, Korean physicians prioritized the values and virtues of medical professionalism in the following order: veracity, respect for patient autonomy, (...) integrity, responsibility, altruism, and honesty. Approximately two-thirds of physicians responded that medical professionalism is an element of their vocation. When asked to choose the most important sets of attributes or virtues of medical professionalism from a provided list, the top three sets were: “responsibility and duty,” “veracity, integrity, and honesty,” and “rapport with patients and conversational skill.”ConclusionsKorean physicians value moral duties, such as responsibility and veracity, more than they do moral virtues, such as altruism and honesty with patients. It is presumed that physicians are under pressure due to governmental regulation of the national healthcare system and have difficulty exercising their autonomy. (shrink)

In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired underlying attitude of physicians. In this article, one of them—empathy—is presented in an interpretation that is meant to depicture (together with the two additional concepts compassion and care) this attitude. Therefore empathy in the clinical context is defined as the adequate understanding of the inner processes (...) of the patient concerning his health-related problems. Adequacy is scrutinized on behalf of the emotional and subjective involvement of he physician, and on the necessary dependence on medical—moral—goals. In the present interpretation, empathy alone is no guarantee of the right moral attitude, but a necessary instrumental skill in order to perceive and treat a patient as an individual person. The concepts of compassion and care that will be discussed in two forthcoming articles are necessary parts to describe the desired moral attitude of the physician more completely. (shrink)

Alisdair MacIntyre argues that the virtues necessary for good work are everywhere and always embodied by particular communities of practice. As a general surgeon, MacIntyre’s work has deeply influenced my own understanding of the practice of good surgery. The task of this essay is to describe how the guild of surgeons functions as a more-or-less coherent tradition of moral enquiry, embodying and transmitting the virtues necessary for the practice of good surgery. Beginning with an example of surgeons engaged in a (...) process of moral discernment, I describe how the practice of surgery depends on the cultivation of a certain kind of practical wisdom (phronesis) that effectively orders the techniques of surgery toward particular notions of human flourishing within the limits of what is possible with the particular body on which the surgeon operates. I then argue that one reason why surgeons train in an apprenticeship model of "residency" is to cultivate not only the technical skill but also the practical wisdom to perform good surgery. I conclude by noting that the surgical profession is enduring necessary, but unprecedented, changes in the way it practices and transmits its art; and without deliberate and sustained attention to the character formation of surgeons, the profession runs the risk of creating excellent technicians who are nonetheless ill-equipped to practice wise and good surgery. (shrink)

The central role of the virtue of compassion in the shaping of the professional character of healthcare providers is a well-emphasized fact. On the other hand, the utmost obligation of physicians is to alleviate or eliminate human suffering. Traditionally, according to the Aristotelian understanding of virtues and virtue ethics, human virtues have been associated with masculinity. In recent decades, the founders of the ethics of care have introduced a set of virtues with feminine nature. This paper analyzes the notion of (...) compassion as a common virtue between the traditional/masculine and care/feminine sets of virtues and shows that compassion is a reunion and merging point of both sets of human virtues. This role can be actualized through the development and promotion of compassion as an important part of the character of an ideal physician/healthcare provider. In addition, this paper argues that the notion of compassion can shed light on some important aspects of the contemporary debates on healthcare provider-patient relationship and medical futility. Despite the recent technological and scientific transformations in medicine, the interpersonal relationship between healthcare providers and patients still plays a vital role in pursuing the goals of healthcare. The virtue of compassion plays a central role in the establishment of a trust-based physician-patient relationship. This central role is discernible in the debate of medical futility in which making difficult decisions, depends largely on trust and rapport which are achievable by compassion in the physician and the recognition of this compassion by the patients and their surrogate decision makers. (shrink)

BackgroundMedical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care.DiscussionThe Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, Temperance, Bravery, (...) and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses.SummaryPracticing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit. (shrink)

In his story entitled "Toenails," the surgeon Richard Selzer (1982) warns readers that total immersion in medicine is wrongheaded. Rather, to ensure their own health, doctors should discover other passions that permit them periodically to disconnect from medical practice. Selzer's surgeon character devotes his Wednesday afternoons to the public library, where he joins "a subculture of elderly men and women who gather … to read or sleep beneath the world's newspapers" (p. 69). Among these often eccentric personages is Neckerchief, an (...) arthritic man in his 80s who suffers from severe foot pain. His toenails, never trimmed because of his inability to reach them, have grown so long that they curve beneath his toes and .. (shrink)

In our time there is growing interest in developing a systematic approach to oncologic patients and end-of-life care. An important goal within this domain is to identify the values and ethical norms that guide physicians’ decisions and their recourse to technological aids to preserve life. Though crucial, this objective is not easy to achieve.

Edmund Pellegrino considered medicine as a skill, art, and perhaps most importantly, a moral enterprise. In this essay, I attempt to exemplify how the legacy and contributions of Edmund Pellegrino, as a teacher and a physician, could allow for a renaissance of medical practice in which physicians engage intellectual and moral virtue to both effect sound care, and do so in a humanitarian way, rather than in simple accordance with a business model of medicine. The virtues are viewed in a (...) renewed light as being key characteristics of physicians, and important to patient centered care. (shrink)