The Jubilee Centre’s new report, Virtuous Medical Practice, examines the place of character and values in the medical profession in Britain today. Its findings are drawn from a UK-focused multi-methods study of 549 doctors and aspiring doctors at three career stages, first and final year students and experienced doctors.

Research on moral judgment has been dominated by rationalist models, in which moral judgment is thought to be caused by moral reasoning. The author gives 4 reasons for considering the hypothesis that moral reasoning does not cause moral judgment; rather, moral reasoning is usually a post hoc construction, generated after a judgment has been reached. The social intuitionist model is presented as an alternative to rationalist models. The model is a social model in that it deemphasizes the private reasoning done (...) by individuals and emphasizes instead the importance of social and cultural influences. The model is an intuitionist model in that it states that moral judgment is generally the result of quick, automatic evaluations (intuitions). The model is more consistent than rationalist models with recent findings in social, cultural, evolutionary, and biological psychology, as well as in anthropology and primatology. (shrink)

As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)

Virtue ethics is perhaps the most important development within late twentieth-century moral philosophy. Rosalind Hursthouse, who has made notable contributions to this development, here presents a full exposition and defense of her neo-Aristotelian version of virtue ethics. She shows how virtue ethics can provide guidance for action, illuminate moral dilemmas, and bring out the moral significance of the emotions.

In recent years, virtue theories have enjoyed a renaissance of interest among general and medical ethicists. This book offers a virtue-based ethic for medicine, the health professions, and health care. Beginning with a historical account of the concept of virtue, the authors construct a theory of the place of the virtues in medical practice. Their theory is grounded in the nature and ends of medicine as a special kind of human activity. The concepts of virtue, the virtues, and the virtuous (...) physician are examined along with the place of the virtues of trust, compassion, prudence, justice, courage, temperance, and effacement of self-interest in medicine. The authors discuss the relationship between and among principles, rules, virtues, and the philosophy of medicine. They also address the difference virtue-based ethics makes in confronting such practical problems as care of the poor, research with human subjects, and the conduct of the healing relationship. This book woith the author's previous volumes, A Philosophical Basis of Medical Practice and For the Patient's Good, are part of their continuing project of developing a coherent moral philosophy of medicine. (shrink)

This book is a provocative contribution to contemporary ethical theory challenging foundational conceptions of character that date back to Aristotle. John Doris draws on behavioral science, especially social psychology, to argue that we misattribute the causes of behavior to personality traits and other fixed aspects of character rather than to the situational context. More often than not it is the situation not the nature of the personality that really counts. The author elaborates the philosophical consequences of this research for a (...) whole array of ethical theories and shows that, once rid of the misleading conception of motivation, moral psychology can support more robust ethical theories and more humane ethical practices. (shrink)

This paper examines the implications of certain social psychological experiments for moral theory—specifically, for virtue theory. Gilbert Harman and John Doris have recently argued that the empirical evidence offered by ‘situationism’ demonstrates that there is no such thing as a character trait. I dispute this conclusion. My discussion focuses on the proper interpretation of the experimental data—the data themselves I grant for the sake of argument. I develop three criticisms of the anti-trait position. Of these, the central criticism concerns three (...) respects in which the experimental situations employed to test someone's character trait are inadequate to the task. First, they do not take account of the subject's own construal of the situation. Second, they include behaviour that is only marginally relevant to the trait in question. Third, they disregard the normative character of the responses in which virtue theory is interested. Given these inadequacies in situationism's operationalized conception of a ‘character trait’, I argue that situationism does not really address the proposition that people have ‘character traits’, properly understood. A fortiori, the social psychological evidence does not refute that proposition. I also adduce some limited experimental evidence in favour of character traits and distil two lessons we can nevertheless learn from situationism. (shrink)

In this article, I argue that the character traits conceived of and debunked by situationist social psychological studies have very little to do with character as it is conceived of in traditional virtue ethics. Traditional virtue ethics offers a conception of character far superior to the one under attack by situationism; in addition to clarifying the differences, I suggest ways in which social psychology might investigate character on the virtue ethics conception. Briefly, the so‐called character traits that the situationist experiments (...) test for are independently functioning dispositions to behave in stereotypical ways, dispositions that are isolated from how people reason. We should not be surprised by evidence that entities such as these are not responsible for much of our behavior. By contrast, the conception of character in virtue ethics is holistic and inclusive of how we reason: it is a person’s character as a whole (rather than isolated character traits), that explains her actions, and this character is a more‐or‐less consistent, more‐or‐less integrated, set of motivations, including the person’s desires, beliefs about the world, and ultimate goals and values. The virtuous character that virtue ethics holds up as an ideal is one in which these motivations are organized so that they do not conflict, but support one another. Such an organization would be an achievement of practical reason, and its behavioral manifestation would be cross‐situational consistency (in a sense somewhat different from the situationists’). Traditional virtue ethics explains behavioral inconsistency as a result of the cognitive and motivational obstacles to this achievement of practical reason rather than as the result of the absence of character traits. (shrink)

This book provides a reconstruction of Aristotelian character education, shedding new light on what moral character really is, and how it can be highlighted, measured, nurtured and taught in current schooling. Arguing that many recent approaches to character education understand character in exclusively amoral, instrumentalist terms, Kristjánsson proposes a coherent, plausible and up-to-date concept, retaining the overall structure of Aristotelian character education. After discussing and debunking popular myths about Aristotelian character education, subsequent chapters focus on the practical ramifications and methodologies (...) of character education. These include measuring virtue and morality, asking whether Aristotelian character education can salvage the effects of bad upbringing, and considering implications for teacher training and classroom practice. The book rejuvenates time-honoured principles of the development of virtues in young people, at a time when 'character' features prominently in educational agendas and parental concerns over school education systems. Offering an interdisciplinary perspective which draws from the disciplines of education, psychology, philosophy and sociology, this book will appeal to researchers, academics and students wanting a greater insight into character education. (shrink)

Professionals, it is said, have no use for simple lists of virtues and vices. The complexities and constraints of professional roles create peculiar moral demands on the people who occupy them, and traits that are vices in ordinary life are praised as virtues in the context of professional roles. Should this disturb us, or is it naive to presume that things should be otherwise? Taking medical and legal practice as key examples, Justin Oakley and Dean Cocking develop a rigorous articulation (...) and defence of virtue ethics, contrasting it with other types of character-based ethical theories and showing that it offers a promising new approach to the ethics of professional roles. They provide insights into the central notions of professional detachment, professional integrity, and moral character in professional life, and demonstrate how a virtue-based approach can help us better understand what ethical professional-client relationships would be like. (shrink)

Ordinary moral thought often commits what social psychologists call 'the fundamental attribution error '. This is the error of ignoring situational factors and overconfidently assuming that distinctive behaviour or patterns of behaviour are due to an agent's distinctive character traits. In fact, there is no evidence that people have character traits in the relevant sense. Since attribution of character traits leads to much evil, we should try to educate ourselves and others to stop doing it.

Objectives: To characterise UK undergraduate medical ethics curricula and to identify opportunities and threats to teaching and learning.Design: Postal questionnaire survey of UK medical schools enquiring about teaching and assessment, including future perspectives.Participants: The lead for teaching and learning at each medical school was invited to complete a questionnaire.Results: Completed responses were received from 22/28 schools . Seventeen respondents deemed their aims for ethics teaching to be successful. Twenty felt ethics should be learnt throughout the course and 13 said ethics (...) teaching and learning should be fully integrated horizontally. Twenty felt variety in assessment was important and three tools was the preferred number. A shortfall in ethics core competencies did not preclude graduation in 15 schools. The most successful aspects of courses were perceived to be their integrated nature and the small group teaching; weaknesses were described as a need for still greater integration and the heavily theoretical aspects of ethics. The major concerns about how ethics would be taught in the future related to staffing and staff development.Conclusions: This study describes how ethics was taught and assessed in 2004. The findings show that, although ethics now has an accepted place in the curriculum, more can be done to ensure that the recommended content is taught and assessed optimally. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

Empathy is generally regarded as important and positive. However, descriptions of empathy are often inadequate and deceptive. Furthermore, there is a widespread lack of critical attention to such deficiencies. This critical review of the medical discourse of empathy shows that tendencies to evade and misrepresent the understanding subject are common. The understanding subject’s contributions to the empathic process are often neglected or described as something that can and should be avoided or controlled. Furthermore, the intrinsic and closely interwoven relationship between (...) medical understanding and empathy is generally not explored. Instead of challenging objectivistic and instrumental ideals, the medical discourse of empathy tends to accommodate to inadequate ideals of objectivity and instrumentalism. Thus, important aspects of physician’s rationality, understanding, and morality are neglected and important opportunities for reflection, dialogue, and critique are forfeited. Both the critical and constructive parts of this paper are heavily inspired by philosophical hermeneutic insights, e.g. that physician’s empathy is always historically situated and part of a moral commitment. At the end of this paper, an alternative description of empathy - i.e. appropriate understanding of another human being - is outlined to facilitate the inclusion of hermeneutic insights and accentuate the inherent relationship between empathy and morality. (shrink)

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)

_Virtue as Social Intelligence: An Empirically Grounded Theory_ takes on the claims of philosophical situationism, the ethical theory that is skeptical about the possibility of human virtue. Influenced by social psychological studies, philosophical situationists argue that human personality is too fluid and fragmented to support a stable set of virtues. They claim that virtue cannot be grounded in empirical psychology. This book argues otherwise. Drawing on the work of psychologists Walter Mischel and Yuichi Shoda, Nancy E. Snow argues that the (...) social psychological experiments that philosophical situationists rely on look at the wrong kinds of situations to test for behavioral consistency. Rather than looking at situations that are objectively similar, researchers need to compare situations that have similar meanings _for the subject_. When this is done, subjects exhibit behavioral consistencies that warrant the attribution of enduring traits, and virtues are a subset of these traits. Virtue can therefore be empirically grounded and virtue ethics has nothing to fear from philosophical situationism. (shrink)

BackgroundMost medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning (...) between school years among medical students and residents.MethodsQuestionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan.ResultsPIT results showed an increase in moral sensitivity in 4th and 5th year students followed by a decrease in 6th year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires.ConclusionThis study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan. (shrink)

Over the past 15 years, medical schools have paid some attention to the importance of developing students' communication skills as part of their medical education. Over the past decade, medical ethics has been added to the curriculum of most U.S. medical schools, at least on paper. More recently, there has been growing discussion of the importance of professionalism in medical education. Yet, the nature and content of these fields and their relationship to one another remains confused and vague, and that (...) lack of clarity, in turn, impairs the effectiveness of medical education. This ambiguity invites serious contention over who should design and teach the curriculum as well as when, where, and how it should be taught. (shrink)

Clinical decision making is a challenging task that requires practical wisdom—the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. The author draws from Aristotle and Aquinas to describe the virtue of practical wisdom and compare it with clinical judgement. From this comparison, the author suggests that a more complete understanding of clinical judgement (...) requires its explicit integration with goals of care and ethical values. Although clinicians may be justified in assuming that goals of care and ethical values are implicit in routine decision making, it remains important for training purposes to encourage habits of clinical judgement that are consciously goal-directed and ethically informed. By connecting clinical judgement to patients' goals and values, clinical decisions are more likely to stay focused on the particular interests of individual patients. To cultivate wise clinical judgement among trainees, educational efforts should aim at the integration of clinical judgement, communication with patients about goals of care, and ethical reasoning. But ultimately, training in wise clinical judgement will take years of practice in the company of experienced clinicians who are able to demonstrate practical wisdom by example. By helping trainees develop clinical judgement that incorporates patients' goals of care and ethical reasoning, we may help lessen the risk that ‘clinical judgement’ will merely express ‘the clinician's judgement.’. (shrink)

This paper explores some general considerations bearing on the question of whether virtue can be measured. What is moral virtue? What are measurement and evaluation, and what do they presuppose about the nature of what is measured or evaluated? What are the prospective contexts of, and purposes for, measuring or evaluating virtue, and how would these shape the legitimacy, methods, and likely success of measurement and evaluation? We contrast the realist presuppositions of virtue and measurement of virtue with the behavioral (...) operationalism of a common conception of measurement in psychometrics. We suggest a realist and non-reductive conceptualization of the measurability of virtue. We then discuss three possible educational contexts in which the measurement of virtue might be pursued: high-stakes testing and accountability schemes, the evaluation of programs in character education, and routine student evaluation. We argue that high-stakes testing of virtue would be ill-advised and counterproductive. We make some suggestions for how program evaluation in character education might proceed, and offer some examples of evaluation of student virtue-related learning. We conclude that virtue acquisition might be measured in a population of students accurately enough for program evaluation, while also arguing that student and program evaluation do not require comprehensive evaluations of how virtuous individual students are. Routine student evaluation will typically focus on specific aspects of virtue acquisition, and program evaluations can measure the aggregate progress of virtue acquisition in all its aspects while evaluating only limited aspects of the learning of individual students. (shrink)