Can Doctors Maintain Good Character? An Examination of Physician Lives

Abstract

Can doctors maintain good character? This paper shifts the focus from patient care to ethical considerations that bear on the physician and impact her as a person. By decentering patient care, the paper highlights certain factors that habituate a particular way of reasoning that is not conducive to inculcating good character. Such factors include, standards of professionalism, being influenced by external monitors, and emphasis on adherence to guidelines. While such factors may benefit patients, they often adversely affect the character of physicians.

Endnotes

• 1 For detailed discussion on the teleological goals of medicine, see Edmund D. Pellegrino’s The Philosophy of Medicine Reborn (2008) that extensively explores the idea of ‘good of the patient.’ He argues this ‘good’ falls into four categories: “the patient’s concept of the ultimate good,” “biomedical and techno-medical good,” “the patient’s concept of his own good,” and “the good of patient as a person” (163-186). He further writes about the doctor-patient relationship that is geared towards ends and purposes of the relationship, where the ends of medicine “are ultimately the restoration or improvement of health, and more proximately, to heal, i.e., to cure illness and disease or, when this is not possible, to care and help the patient to live with residual pain, discomfort, or disability” (200).

• 2 I do not see this distinction of examining virtue without an emphasis on the telos of the profession necessarily in opposition to Alasdair Macintyre (2007) explication of virtue in his book, After Virtue. He states: “A virtue is an acquired human quality the possession and exercise of which tends to enable us to achieve those goods which are internal to practices and the lack of which effectively prevents us from achieving any such goods” (191). For MacIntyre, there are universal virtues to all practices (justice, courage, honesty, and history) but that each practice (such as that of being a physician) will have its own set of unique virtues as well that can be generated from the telos of the profession. However, for MacIntyre, there is no inconsistency in appealing to the requirements of a virtue (such as competitiveness nurtured amongst residents) to criticize the practice as it is done today. More importantly, there has to be “a telos which transcends the limited good of practices by constituting the good of a whole human life” (203). That is to say, while examining virtues generated through the framework of medicine is important, there still needs to be an examination of a whole human life.

• 3 For an account of eudaimonia in line with the intent of this paper, see Hursthouse (1999) where she writes that eudaimonia is the “notion of ‘true (or real) happiness’, or ‘the sort of happiness worth having’. We tend to say that someone may be happy, though not truly happy, if they are living in a fool’s paradise, or engaged in what we know is a pointless activity, or brain-damaged and leading a life of a happy child”(10).

• 4 I use the term script as Alison Bailey’s describes it as the idea of performative scripts as “a person’s gestures, language, attitudes, concept of personal space, gut reactions to certain phenomena, and body awareness” (2000, 289).

• 5 American Academy of Family Physicians (2013) cites that ‘the average net income of family physicians ($190,000) allows them to effectively pay off student loans in a reasonable amount of time and comfortably support their families.’ Family physicians are generally near the bottom of the pay scale for physician compensation, with specialist earning on average twice as much (Vaugh et al. 2010).

• 6 The U.S. Census Bureau (2014, 5) cites U.S. median household income was $53,657 in 2014. More than 90 % of the U.S. population in 2014 was below the $150,000 mark (23).

• 7 Kraus & Keltner (2013) study showed that “social class shapes essentialist conceptions of social class hierarchy that, in turn, impact endorsement of punitive judgments. In this way, social class leads to differences in the way individuals explain their rank in society and the forms of punishment they support in their everyday lives” (259). That is to say, relative to lower class, upper class individuals were more likely to believe in essentialist explanations of distribution of wealth, which in turn affected their perception of retributive justice.

  Overall, studies have also shown that people tend to discount the role of the unearned privilege they possess, in how much success they achieve. For example, in a focus group study (Gallagher 2003), it showed that people having white privilege did not think that race played a part in people’s access to opportunities. The author argued that maintaining belief that we live in a color blind society helps Whites process their own success and the failure of others.

  Another study (Castilla 2010) showed that “bias can be triggered by attempts to reduce it, particularly in organizational contexts that emphasize meritocratic values.” This is to say, that organizations that explicitly tout meritocratic values, may end up committing more harm against the already disadvantaged, all the while, maintaining their belief that bonuses and raises are awarded on basis of hard work.

• 8 Here is a sample of one such encounter of a physician with a cancer-patient faced with their impending mortality: Patient: “I don’t know what the average person does in 2 years, 3 years, a year?” Physician: “I think that … you certainly could live 2 or 3 years. I think it would be very unlikely … But I would say that an average figure would be several months to a year to a little bit more” [Encounter 2] (Morse et al. 2008).

• 9 An exception maybe when there is a medical emergency within one’s immediate family. Such a case further supports my position against compartmentalization of role-related obligations.

• 10 In an extreme display of cruelty, in South Gloucestershire, England, patients with learning disabilities were physically and psychologically abused and tortured by nurses and other staff members. In response, the Department of Health in the United Kingdom released a report that made a massive number of recommendations to avoid any future breakdown of standards (DHS 2012). The instances of abuse were egregious and a micro-level review was appropriate.

• 11 “Quality measures appear to be a small yet emerging component of total compensation for physicians....primary care physicians reported that 3 % of their total compensation was based upon measures of quality” (Medical Group Management Association Survey 2013).

• 12 “For example, in a study (Saitta & Hodge 2012) about apology by doctors for unexpected medical outcomes, authors noted that “simple apology allows physicians to remain true to their honesty and integrity while exhibiting their humanity and providing some much-needed closure to their patients and their patients’ families. It is the amelioration of this anger that leads to less costly litigation. Therefore, we believe that if a physician’s jurisdiction has the appropriate legislation, he or she should consider apologizing for an unexpected medical outcome. It may be the best medicine available to soothe the feelings of a patient or family and to avoid a malpractice lawsuit.” (emphasis mine) The integrity of the physician would then eventually take a back seat to considerations of litigation.

• 13 This is reminiscent of views on expressed in Jean Paul Sartre’s The Anti-Semite and the Jew (1995, 8). Sartre reminds us that we cannot view anti-Semitic tendencies as mere opinions or “localized” behaviors elicited by certain people. It is problematic if we view an anti-Semitic person … “as a composite whose elements can be separated, we look upon persons and characters as mosaics in which each stone coexists with the others without that coexistence affecting the nature of the whole. Thus anti-Semitic opinion appears to us to be a molecule that can enter into combination with other molecules of any origin whatsoever without undergoing any alteration. A man may be a good father and a good husband, a conscientious citizen, highly cultivated, philanthropic, and in addition an anti-Semite. …If he does not like them [Jews], we say, it is because his experience has shown him that they are bad, because statistics have taught him that they are dangerous, because certain historical factors have influenced his judgment. Thus this opinion seems to be the result of external causes, and those who wish to study it are prone to neglect the personality of the anti-Semite…” (emphasis mine).