HEC Forum

, Volume 24, Issue 4, pp 257–272 | Cite as

How Virtue Ethics Informs Medical Professionalism

Article

Abstract

We argue that a turn toward virtue ethics as a way of understanding medical professionalism represents both a valuable corrective and a missed opportunity. We look at three ways in which a closer appeal to virtue ethics could help address current problems or issues in professionalism education—first, balancing professionalism training with demands for professional virtues as a prerequisite; second, preventing demands for the demonstrable achievement of competencies from working against ideal professionalism education as lifelong learning; and third, avoiding temptations to dismiss moral distress as a mere “hidden curriculum” problem. As a further demonstration of how best to approach a lifelong practice of medical virtue, we will examine altruism as a mean between the extremes of self-sacrifice and selfishness.

Keywords

Virtue ethics Medical professionalism Moral distress Altruism 

References

  1. Andre, J., Foglio, J., & Brody, H. (2000). Moral growth, spirituality, and activism: The humanities in medical education. In D. Wear & J. Bickel (Eds.), Educating for professionalism: Creating a culture of humanism in medical education (pp. 81–94). Iowa: University of Iowa Press.Google Scholar
  2. Aristotle, 1893. The Nichomachean Ethics of Aristotle, trans. F.H. Peters. 5th edn. Kegan Paul, Trench, Truebner & Co. Ltd., London.Google Scholar
  3. Austin, W., Lemermeyer, G., Goldberg, L., Bergum, V., & Johnson, M. S. (2005). Moral distress in healthcare practice: The situation of nurses. HEC Forum, 17, 33–48.CrossRefGoogle Scholar
  4. Beck, E. (2005). The UCSD student-run free clinic project: Transdisciplinary health professional education. Journal of Health Care for the Poor and Underserved, 16, 207–219.CrossRefGoogle Scholar
  5. Bleakley, A. (2006). A common body of care: The ethics and politics of teamwork in the operating theater are inseparable. Journal of Medicine and Philosophy, 31, 305–322.CrossRefGoogle Scholar
  6. Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of educational objectives: The classification of educational goals; handbook I: Cognitive domain. New York: Longmans Green.Google Scholar
  7. Brainard, A. H., & Brislen, H. C. (2007). Viewpoint: Learning professionalism: A view from the trenches. Academic Medicine, 82, 1010–1014.CrossRefGoogle Scholar
  8. Branch, W. T, Jr. (2000). The ethics of caring and medical education. Academic Medicine, 75, 127–132.CrossRefGoogle Scholar
  9. Brody, H. (1992). The healer’s power. New Haven: Yale University Press.Google Scholar
  10. Brody, H. (2003). Stories of sickness. New York: Oxford University Press.Google Scholar
  11. Brody, H. (2009). Pay for performance, in the future of bioethics. Oxford: Oxford University Press.Google Scholar
  12. Bryan, C. S. (2011). Medical professionalism meets generation X: A perfect storm? Texas Heart Institute Journal, 38, 465–470.Google Scholar
  13. Bryan, C. S., & Babelay, A. M. (2009). Building character: A model for reflective practice. Academic Medicine, 84, 1283–1288.CrossRefGoogle Scholar
  14. Buchanan, D., & Witlen, R. (2006). Balancing service and education: Ethical management of student-run clinics. Journal of Health Care for the Poor and Underserved, 17, 477–485.CrossRefGoogle Scholar
  15. Chervenak, F. A., & McCullough, L. B. (2001). The moral foundation of medical leadership: The professional virtues of the physician as fiduciary of the patient. American Journal of Obstetrics and Gynecology, 184, 875–879.CrossRefGoogle Scholar
  16. Cook, N. L., Hicks, L. S., O’Malley, A. J., Keegan, T., Guadagnoli, E., et al. (2007). Access to specialty care and medical services in community health centers. Health Affairs (Millwood), 26, 1459–1468.CrossRefGoogle Scholar
  17. Crandall, S. J., Reboussin, B. A., Michielutte, R., Anthony, J. E., & Naughton, M. J. (2007). Medical students’ attitudes toward underserved patients: A longitudinal comparison of problem-based and traditional medical curricula. Advances in Health Sciences Education, Theory, Practical, 12, 71–86.CrossRefGoogle Scholar
  18. Daaleman, T. P., Kinghorn, W. A., Newton, W. P., & Meador, K. G. (2011). Rethinking professionalism in medical education through formation. Family Medicine, 43, 325–329.Google Scholar
  19. Doukas, D. J. (2004). Returning to professionalism: The re-emergence of medicine’s art. American Journal of Bioethics, 4, 18–19.Google Scholar
  20. Downie, R. S. (2002). Supererogation and altruism: A comment. Journal of Medical Ethics, 28, 75–76.CrossRefGoogle Scholar
  21. Drane, J. (1988). Becoming a good doctor: The place of virtue and character in medical ethics. Kansas City: Sheed and Ward.Google Scholar
  22. Dreyfus, S.E. & Dreyfus, H.L. A five-stage model of the mental activities involved in directed skill acquisition. 1980. California University Berkeley Operations Research Center, http://www.dtic.mil/dtic/index.html, Accessed 26 January, 2012.
  23. Dyrbye, L. N., Massie, F. S, Jr, Eacker, A., Harper, W., Power, D., et al. (2010). Relationship between burnout and professional conduct and attitudes among US medical students. JAMA, 304, 1173–1180.CrossRefGoogle Scholar
  24. Foot, P. (1978). Virtues and vices. Berkeley: University of California Press.Google Scholar
  25. Fryer-Edwards, K., Pinsky, L. E., & Robins, L. (2006). The Use of portfolios to assess professionalism. In D. Stern (Ed.), Measuring medical professionalism (pp. 213–234). New York: Oxford University Press.Google Scholar
  26. Geller, S., Taylor, B. M., & Scott, H. D. (2004). Free clinics helping to patch the safety net. Journal of Health Care for the Poor and Underserved, 15, 42–51.CrossRefGoogle Scholar
  27. Ginsburg, S., & Stern, D. (2004). The professionalism movement: Behaviors are the key to progress. American Journal of Bioethics, 4, 14–15.Google Scholar
  28. Glannon, W., & Ross, L. F. (2002). Are doctors altruistic? Journal of Medical Ethics, 28, 68–69.CrossRefGoogle Scholar
  29. Hafferty, F. W. (1998). Beyond curriculum reform: Confronting medicine’s hidden curriculum. Academic Medicine, 73, 403–407.CrossRefGoogle Scholar
  30. Hafferty, F. W. (2000). In search of a lost cord: Professionalism and medical education’s hidden curriculum. In D. Wear & J. Bickel (Eds.), Educating for professionalism: Creating a culture of humanism in medical education (pp. 11–34). Iowa: University of Iowa Press.Google Scholar
  31. Hafferty, F. (2006). Measuring professionalism: A commentary. In D. T. Stern (Ed.), Measuring medical professionalism (pp. 281–306). New York: Oxford University Press.Google Scholar
  32. Hafferty, F. W., & Franks, R. (1994). The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine, 69, 861–871.CrossRefGoogle Scholar
  33. Hafferty, F. W., & Levinson, D. (2008). Moving beyond nostalgia and motives: Towards a complexity science view of medical professionalism. Perspectives in Biology and Medicine, 51, 599–615.CrossRefGoogle Scholar
  34. Heller, J. C. (2001). Organizational ethics in Catholic healthcare: Conduct, character, and conditions. HEC Forum, 13, 132–137.CrossRefGoogle Scholar
  35. Jonsen, A. R. (1983). Watching the doctor. The New England Journal of Medicine, 308, 1531–1535.CrossRefGoogle Scholar
  36. Kinghorn, W. A. (2010). Medical education as moral formation: An Aristotelian account of medical professionalism. Perspectives in Biology and Medicine, 53, 87–105.CrossRefGoogle Scholar
  37. MacIntyre, A. (1981). After virtue: A study in moral theory. London: Duckworth.Google Scholar
  38. McCarthy, J., & Deady, R. (2008). Moral distress reconsidered. Nursing Ethics, 15, 254–262.CrossRefGoogle Scholar
  39. McCullough, L. B. (1993). The physician’s virtues and legitimate self-interest in the patient-physician contract. The Mount Sinai Journal of Medicine, 60, 11–14.Google Scholar
  40. Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65, S63–S67.CrossRefGoogle Scholar
  41. Oxford English Dictionary. (2011). Oxford University Press. http://www.oed.com/viewdictionaryentry/Entry/5857. Accessed February 3, 2012.
  42. Pellegrino, E. D., & Thomasma, D. C. (1993). The virtues in medical practice. New York: Oxford University Press.Google Scholar
  43. Pentz, R. D. (1998). Expanding into organizational ethics: The experience of one clinical ethics committee. HEC Forum, 10, 213–221.CrossRefGoogle Scholar
  44. Rabow, M. W., Wrubel, J., & Remen, R. N. (2009). Promise of professionalism: Personal mission statements among a national cohort of medical students. The Annals of Family Medicine, 7, 336–342.CrossRefGoogle Scholar
  45. Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. New York: Scribner.Google Scholar
  46. Shay, J. (2011). Casualties. Daedalus, 140, 179–188.CrossRefGoogle Scholar
  47. Shem, S. (1978). The house of god. New York: Dell.Google Scholar
  48. Wiggleton, C. E., Petrusa, K., Loomis, J., Tarpley, M., Tarpley, et al. (2010). Medical students’ experiences of moral distress: Development of a web-based survey. Academic Medicine, 85, 111–117.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  1. 1.Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Medical BranchGalvestonUSA
  2. 2.Institute for the Medical HumanitiesUniversity of Texas Medical BranchGalvestonUSA

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