Virtue Ethics Theory

by Mark Hughes, MD, MA

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    00:00 So let's get a little more specific in terms of approaches to ethics.

    00:05 The first approach is going to be virtue ethics.

    00:09 So think about what you would envision to be a good clinician, a good physician, good nurse.

    00:15 What are the qualities of character that dispose that person to do the right thing for their patient? Just in your own mind think about what those qualities or traits would be.

    00:27 And when we're thinking about virtue theory, we're going to focus on the kind of person the moral agent ought to be.

    00:34 So what are the actions that a virtuist clinician would perform? Generally, in virtue, we're thinking about what it is to be excellent? So the excellence of character and the motivation of that moral agent to do the right thing.

    00:51 Those are going to be the important things.

    00:53 Rather than thinking about, you know, "Am I adhering to a rule? Am I, you know, thinking about the consequence of my action? What is my character in performing this action? Am I doing it on a virtuist way?" And the other key element of virtue theory is that "The more you do the right thing, the easier it becomes." So you develop your character over time. Each experience you have with the patient.

    01:19 If you do it the right way, in the right motivation and you know really try to adhere to these virtues, that habit of character is going to be built up over time.

    01:31 So, over, you know the lifespan of a career you're going to know how to perform an action because it's going to be part of your excellence in virtue.

    01:44 And another important element in virtue theory is the concept of the Doctrine of the Mean.

    01:48 You don't want to have too much or too little.

    01:51 Those that are familiar with the fairytale Goldilocks, you know, not too much not too little but just right.

    01:57 So in virtue theory, you don't want to have too much or too little.

    02:02 Think about courage. You know, this is a virtue that a lot of cultures, you know, would say is an important element.

    02:10 If you rush, if you just go in, guns blazing, you know without thinking about the consequences, that's too much courage.

    02:20 If you're timid and fearful and you don't know what to do, that's also not going to be right.

    02:26 You have to have the Doctrine of the Mean, the just right amount of courage so that you're not either too rush or too timid, but you're going to be courageous in terms of upholding of value that you see is important in performing an action.

    02:44 And then the other way that more recent philosophers have thought about virtue theory is this idea of "What is the aim of your activity? What is the aim of your practice?" So in medicine, our aim is the healing action, you know taking care of sick people, helping people with their illness and their vulnerability.

    03:03 So, you fulfil your role and you are virtuist in fulfilling your role when you achieve that in.

    03:09 When you actually do heal the person to make them whole again in the midst of their illness.

    03:15 So what are the virtues in medicine? What are the traits that we think are going to be important in terms of being a clinician, whether it's being a good physician, a good nurse, a good physical therapist, a good social worker. What are the things that are going to be important, those habits of character that really speak to being virtuist? Here's my top 10 list. You might have a similar list if you've been thinking about this.

    03:40 Here are the things that I think are important to being a virtuist in medicine.

    03:45 We, first of all, have to have technical competence.

    03:48 So, all of our training that's gone into whether we go to medical school or nursing school, other health professional schools, we have to learn the craft of our practice.

    04:01 We have to have technical competence. The surgeon, you know, needs to learn how to perform surgery.

    04:07 So, that's a basis. We have to apply that knowledge and that skill to then taking care of patients.

    04:13 The next is going to be intellectual honesty which also means humility.

    04:18 So we get all these great knowledge.

    04:21 We learn a lot, we know much more than a lay person does in terms of medicine and nursing and so on.

    04:28 But we also have to have the intellectual honesty to say there are things we don't know.

    04:32 That creates a need for life-long learning.

    04:35 So you learn a lot in medical school, but as a physician and even I, as a physician, need to think about things, you know, I see a new dilemma, a new clinical problem solving, I need to go back to the books and say I don't know enough about this.

    04:53 And I have to be honest with patients.

    04:55 If they ask me questions and I don't know the answer, I have to have the humility to say I don't know but I'm going to find the answer for you The next virtue I see is important is benevolence.

    05:05 At its core, it's just love, you know.

    05:09 Kindness towards another person, a sense of humanity towards the suffering of another person.

    05:16 So being benevolent is what's going to motivate us to want to take care of them.

    05:22 That also falls with compassion. So to experience with, to suffer with the patient.

    05:30 So we might have the empathy to see what they're going through and have an emotional reaction to that, but that then compels us to act compassionately toward that.

    05:39 That's going to be a virtue in medicine.

    05:42 There's going to be imperturbability, but I might call equanimity or aequanimitas.

    05:49 This idea of, yeah, you're going to feel things.

    05:53 You're going to experience things with patients.

    05:55 You're going to have your own emotions, but you also have to have imperturbability.

    06:00 Really, it's not distance, not emotional distance.

    06:02 It's being able to be in the moment with the patient in their suffering and then move to action to help them. Think of like a lighthouse.

    06:14 The waves are crashing, you know below, but the lighthouse stands firm.

    06:19 It's shining light so that, you know, there aren't shipwrecks.

    06:23 That idea of imperturbability.

    06:26 We talked a little bit about courage already.

    06:29 This idea of "Do you have the courage to talk about hard things? Do you have the ability to, you know, break bad news to a patient?" Know that it's going to cause emotional distress and then but that is important that you do.

    06:41 Do you have the courage to do so? Or you're a trauma surgeon and you know things are in crisis. Patients being rushed in.

    06:50 Have the courage to then, you know, do what needs to be done to help them. Self-effacement.

    06:57 Do you have the ability to be there for the other person? Now this has been challenging especially in times of pandemic where we do have to pay attention to our own well-being, but there also has to be this idea of you're putting yourself out there for the other person.

    07:14 So there is some giving of yourself while you're also paying attention to your own well-being, but also being there for the patient. Truthfulness, so honesty.

    07:27 So, when it's a medical error, when it's you know hard news that you have to share, being truthful in that.

    07:36 It's not, again, this Doctrine of the Mean, it's not, you know, giving everything in terms of all the information but knowing the right balance, the mean and knowledge that needs to be conveyed being truthful in doing so.

    07:51 One of the most important virtues that I see especially since medicine is practical, you know medical ethics is a practical discipline, is the idea of prudence or practical wisdom.

    08:05 This idea of now you have to integrate all of these other virtues and know for this particular case for this particular patient "How am I going to prudently act? What is the practical wisdom that I have learned through all my experience and my training and my career to now take care of this patient?" And lastly, you need to think about integrity. So what kind of person are you? Are you able to integrate all of these other virtues in terms of your actions? Do your core values, you know who you think you should be as a person? Are you fulfilling those in your actions? That is what it would mean to have integrity.

    08:47 Your whole being has this wholeness, the ability to, you know, take all these virtues, integrate them, and then be there for the patient.

    About the Lecture

    The lecture Virtue Ethics Theory by Mark Hughes, MD, MA is from the course Introduction to Clinical Ethics.

    Included Quiz Questions

    1. Looking at the character of people
    2. Respect for autonomy
    3. Justice
    4. Case-based reasoning
    5. Nonmaleficence
    1. Truthfulness
    2. Technical competence
    3. Self-effacement
    4. Prudence
    5. Integrity
    1. A virtue is a mean between the extremes of excess and deficiency.
    2. A mean virtue is difficult to accomplish.
    3. The meaning of your actions describes your virtue.
    4. The worst character trait is meanness.
    5. There is no meaning in your actions.
    1. Imperturbability
    2. Technical knowledge
    3. Intellectual honesty
    4. Courage
    5. Truthfulness

    Author of lecture Virtue Ethics Theory

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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