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Professionalism – an
example of Virtue Ethics
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Stephen Louw
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Exercise
Think of a kind/wise person you know
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……….was each instance the same
person?
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Was the person a doctor or a nurse?
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Whilst we ‘cure’ patients at an
unprecedented level – the NHS is
deeply and widely criticised for a lack of
‘care’
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Context and aim of this talk
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– Francis Report
– Ray Tallis
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Ray Tallis:
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“I believe that medicine is in danger of being
irrevocably corrupted….”
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“If we are not careful, the patient-as-client will
receive service-with-a-smile from a ‘customer-aware’
self-protecting doctor delivering strictly on contract.”
Hippocratic Oaths p2.
Atlantic Books London 2004
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Context and aim of this talk
Also in the USA:
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“Medical science and technology have
produced, during the twentieth century
“miraculous” cures…and yet patients
are dissatisfied with modern medicine.”
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James A Marcum The epistemically virtuous clinician
Theor Med Bioeth 2009;30:249-265
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Context and aim of this talk
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Francis Report on Mid-Staffordshire
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“The story it (the Report) tells is first and foremost of appalling
suffering of many patients. This was primarily caused by a
serious failure on the part of a provider Trust Board. It did not
listen sufficiently to its patients and staff or ensure the
correction of deficiencies brought to the Trust’s attention. Above
all, it failed to tackle an insidious negative culture involving a
tolerance of poor standards…...”
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Aim of this talk
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To expand on Francis’ recommendations in
an ethical context – specifically ‘virtue ethics’
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To suggest that as professionals we are not
really motivated by ethical theories or
principles – but by the desire to be virtuous
in our jobs, i.e. “professionals”.
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Disclaimer
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I am not setting myself up
as an example of a
‘virtuous physician”!
My inspiration derives
from:
Albert Schweitzer
Anthony Barker
Solomon Benatar
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Most of us think of “the four principles”
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When we think about ‘ethics’…
Tom L Beauchamp & James F Childress
Principles of Biomedical Ethics 5th Ed
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Virtue Ethics (virtues & moral character)
Consequentialism (the best outcomes)
Kantianism (obligations, duties & rules)
Liberal individualism (Rights-based theory)
Communitarianism (Community-based)
Ethics of Care (relationship-based)
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When we think about ‘ethics’…
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Virtue ethics
- seems to be more fundamental
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“The notions of virtue…are more basic than the
notions at the heart of utilitarian or Kantian
theory.”
Elizabeth Anscombe
in Virtue Ethics
Eds R Crisp, M Slote. OUP 1997
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What motivates the person you thought
of as being “kind”?
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What motivates us?
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– Deontology (because it is her duty to be
kind?!)
– Consequentialism (because it yields good
outcomes to be kind?!)
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– Because it is in their character to be kind.
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Virtue ethics - definition
A person’s actions are evaluated in
terms of that person’s normative
character traits, exemplified by those
actions.
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(rather than simply with reference to either their
commitment to duty or being motivated by the
consequences of their acts)
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Virtue ethics - definition
“A virtue is a trait of character that is socially valuable
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“A moral virtue is a morally valuable trait of
character.”
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Beauchamp & Childress
Fifth Edition Principles of Biomedical Ethics p28
OUP 2001
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Aristotle’s virtues as professionalism
Aristotle’s Virtue as Excellence may be seen
as a way of life – comprising mode of
behaviour and character that is committed to
excellence as the internal purpose of the
professional role.
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As with other goals in our education, moral
character and achievement is developed
through self-cultivation and aspiration.
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The Intellectual virtues
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 Intellectual virtues are generally divided
into two types
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oReliabilist
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oResponsibilist
Marcum ibid
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Reliabilist professional virtues
These are ‘innate’, but require training
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- motivated by the desire to acquire knowledge
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– Observing astutely
– Memory
– Intuition
– Inferential reasoning
– Insight
Marcum ibid
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Responsibilist professional virtues
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Honesty
Courage
Open-mindedness
Humility
Fairness
Integrity
Wisdom
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These are acquired and developed over
the professional’s lifetime:
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- motivated by the desire to know the truth
Marcum ibid
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Now that we know what we mean by
‘virtue ethics’…how is this relevant to
our job tomorrow morning?
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Application
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The Francis Report
The entire Volume 3 of the Report is
about professional standards
 Francis places emphasis on
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– Importance of developing a culture of
compassion in the NHS
– Nolan principles
– 6Cs
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The Nolan Principles
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Selflessness
 Integrity
 Objectivity
 Accountability
 Openness
 Honesty
 Leadership
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Committee on Standards in Public Life (1994)
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Francis places emphasis on
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The Francis Report
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– Importance of developing a culture of
compassion in the NHS
– Nolan principles
– 6Cs
Beauchamp and Childress
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“Compassion” unpacked
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“The virtue of compassion is a trait that
combines an attitude of active regard for
another’s welfare with an imaginative
awareness and emotional response of deep
sympathy, tenderness and discomfort at
another’s misfortune or suffering.”
Principles of Biomedical Ethics 5th Ed p32
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“Compassion” unpacked
Beauchamp and Childress
“Physicians and nurses who express
no emotion in their behaviour often fail to
provide what patients most need…(they
have) a moral weakness…”
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Principles of Biomedical Ethics 5th Ed p32
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– warmth
– generosity
– sympathy
– compassion
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Intelligent kindness
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“Compassion” unpacked
John Ballatt and Penelope Campling,
Intelligent Kindness R Coll Psych Publ 2012
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“Compassion” unpacked
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Leads to:
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• a trusting relationship with our patients
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• building a therapeutic alliance
(demonstrated to yield better outcomes)
John Ballatt and Penelope Campling,
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How do we become virtuous?
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• Practicing the ‘external acts of virtue’ over
time will cultivate the internal states of
virtue
• And, by cultivating those internal states, we
thereby make the external actions of virtue
easier to perform.
• Diana Mertz Hsieh
The habits of Aristotle. Aristotle (Phil 5081), Robinson
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The generally accepted healthcare
professional virtues
Cognitive/Intellectual virtues such as rigour and objectivity in
perception and reasoning; intellectual curiosity; and the
intellectual capacity to discern and apply relevant, appropriate
knowledge to clinical care
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2. Ethical virtues, for example courage, honesty, humility,
compassion, empathy, integrity, fairness, open-mindedness, and
tenacity
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3. A passionate desire for the pursuit of knowledge and wisdom
(both theoretical and practical) in its application
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After James A Marcum
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An emphasis for our time
- in the context of Francis report
Compassion
 Honesty and Courage
 Reverence for life
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Now that we know what we mean by
‘virtue ethics’…how is this relevant to
our job tomorrow morning?
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Application
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Now that we know what we mean by ‘virtue
ethics’…how is this relevant to our job tomorrow
morning?
Notice and applaud those around you who display
virtuous behaviour
Blow the whistle with courage when there is
institutionalised obstacles to virtuous professionalism
When you comment on the ‘Professionalism’ of a
junior doctor – consider this domain in the context of
Virtue Ethics.
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Application
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Conclusion
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Medicine is in crisis (see Francis Report)
 A new emphasis on ‘being fully human’ needs
to be found in the midst of our hubristic
scientific success
 Perhaps the answer lies
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o less in setting new ‘moral targets’
o more in inculcating habits of virtuous behaviour.