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The desired moral attitude of the physician: (III) care

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Abstract

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 moral attitude of physicians. In a series of three articles, three of the discussed concepts are presented in an interpretation that is meant to characterise the morally emotional part of this attitude: “empathy”, “compassion” and “care”. In the first article of the series, “empathy” has been developed as a mainly cognitive and morally neutral capacity of understanding. In the second article, the emotional and virtuous core of the desired professional attitude—compassion—has been presented. Compassion as a professional attitude has been distinguished from a spontaneous feeling of compassion, and has been related to a general idea of man as vulnerable and solidary being. Thus, the dignity of the patient is safeguarded in spite of the asymmetry of compassion. In this article, the third concept of the triad—“care”—is presented. Care is conceived as an attitude as well as an activity which can be directed to different objects: if it is directed to another sentient being, it is regarded as intrinsically morally valuable; implying (1) the acceptance of being addressed, (2) a benevolent inclination to help and to foster, and (3) activity to realize this. There are different forms of benevolence that can underlie caring. With regard to the professional physician’s ethos, the attitude of empathic compassion as developed in the two previous articles is proposed to be the adequate underlying attitude of care which demands the right balance between closeness and professionalism and the right form of attention to the person of the patient. ‘Empathic compassionate care’ does not, however, describe the whole of the desired attitude of a physician, but focuses on the morally-emotive aspects. In order to get also the cognitive and practical aspects of biomedicine into the picture, ‘empathic compassionate care’ has to be combined with an attitude of responsibility that is more directed to decision-making and outcome than a caring attitude alone can be. The reconstruction of the desired professional attitude in terms of “empathic compassionate care” and “responsibility” is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions.

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Notes

  1. I am aware that sometimes one speaks of the “call of the nation”, for example, in order to invoke national responsibilities (e.g. in a war, but we could also use this more harmlessly as a reminder to go to an election). But who is it who calls there? Usually, they are some persons who have a certain interest, not the nation itself. Thus it seems this is again a figurative way of speaking, derived from and analogical to the more genuine concept of the moral appeal another person directs to me.

  2. Empathy (in the clinical context), as another possible candidate, is understood as a mainly cognitive skill of understanding the inner processes of the other there, and the identifying, emotional and warm aspects that are often ascribed to empathy, are understood as sympathy.

  3. I will not go in detail here, but identifying care ethics because of particularistic elements with anti-principlism is not convincing, for example, even if some feminist authors may invite this. As easily as implementing an additional principle of care to principlism as Rudnick suggests (or even easier), care ethics could and can use the classical biomedical principles as supplement. (Verkerk 2001; Sharpe 1992) Also the rejection of virtue ethics because it does not pass the paternalism test is near the point. Principles do not pass the motivation test and the personality test. A meta-ethical investigation must have a broader basis than the favourite topics of one special type of theory. Apart from that, the refusal of emotions as element of morality with the reason that they would be morally neutral is just a matter of opinion (or, put friendlier: of definition), no striking argument.

  4. Interestingly the first and highest robot law can be interpreted as the activity of caring for human beings: not injuring a human being, or by inactivity allowing that someone suffers harm.

  5. Actually a misnomer in this perspective, as the lacking acceptance of ‘fatherly’ duties is exactly the presupposition of the dominance.

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Acknowledgments

I wish to thank Rolf Ahlzén (University of Karlstad, Sweden) and two anonymous reviewers for valuable comments and immense patience. I am also grateful to the readers who share this patience of reading three articles that belong so tightly together, and to the editor who agreed to open the stage for this experiment.

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Correspondence to Petra Gelhaus.

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Gelhaus, P. The desired moral attitude of the physician: (III) care. Med Health Care and Philos 16, 125–139 (2013). https://doi.org/10.1007/s11019-012-9380-1

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