So let's get a little more specific
in terms of approaches to ethics.
The first approach is going
to be virtue ethics.
So think about what you would envision to be a
good clinician, a good physician, good nurse.
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.
And when we're thinking
about virtue theory,
we're going to focus on the kind of
person the moral agent ought to be.
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.
Those are going to be
the important things.
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.
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.
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.
And another important element in virtue theory
is the concept of the Doctrine of the Mean.
You don't want to have
too much or too little.
Those that are familiar with the fairytale Goldilocks,
you know, not too much not too little but just right.
So in virtue theory, you don't want
to have too much or too little.
Think about courage. You know, this
is a virtue that a lot of cultures,
you know, would say is
an important element.
If you rush, if you just go
in, guns blazing, you know
without thinking about the
consequences, that's too much courage.
If you're timid and fearful and you don't know
what to do, that's also not going to be right.
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.
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.
So, you fulfil your role and you are virtuist in
fulfilling your role when you achieve that in.
When you actually do heal the person to make
them whole again in the midst of their illness.
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.
Here are the things that I think are
important to being a virtuist in medicine.
We, first of all, have to
have technical competence.
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.
We have to have technical competence. The surgeon,
you know, needs to learn how to perform surgery.
So, that's a basis. We have to apply that knowledge
and that skill to then taking care of patients.
The next is going to be intellectual
honesty which also means humility.
So we get all these
We learn a lot, we know much more than a lay person
does in terms of medicine and nursing and so on.
But we also have to have the intellectual
honesty to say there are things we don't know.
That creates a need for
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.
And I have to be
honest with patients.
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.
At its core, it's
just love, you know.
Kindness towards another person, a sense of
humanity towards the suffering of another person.
So being benevolent is what's going to
motivate us to want to take care of them.
That also falls with compassion. So to
experience with, to suffer with the patient.
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.
That's going to be a
virtue in medicine.
There's going to be imperturbability, but
I might call equanimity or aequanimitas.
This idea of, yeah, you're
going to feel things.
You're going to experience
things with patients.
You're going to have your own emotions, but
you also have to have imperturbability.
Really, it's not distance,
not emotional distance.
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.
The waves are crashing, you know
below, but the lighthouse stands firm.
It's shining light so that, you
know, there aren't shipwrecks.
That idea of imperturbability.
We talked a little bit
about courage already.
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.
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.
Have the courage to then, you know, do what
needs to be done to help them. Self-effacement.
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.
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.
So, when it's a medical
error, when it's you know
hard news that you have to
share, being truthful in that.
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.
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.
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.
Your whole being has this wholeness,
the ability to, you know,
take all these virtues, integrate them,
and then be there for the patient.