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15 C on f er en ce 20 Professionalism – an example of Virtue Ethics BG S Sp rin g Stephen Louw 15 er en ce 20 Exercise Think of a kind/wise person you know ……….was each instance the same person? Was the person a doctor or a nurse? BG S Sp rin g C on f 15 er en Whilst we ‘cure’ patients at an unprecedented level – the NHS is deeply and widely criticised for a lack of ‘care’ C on f ce 20 Context and aim of this talk BG S Sp rin g – Francis Report – Ray Tallis 15 ce 20 Context and aim of this talk er en Ray Tallis: C on f “I believe that medicine is in danger of being irrevocably corrupted….” BG S Sp rin g “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 15 ce 20 Context and aim of this talk Also in the USA: “Medical science and technology have produced, during the twentieth century “miraculous” cures…and yet patients are dissatisfied with modern medicine.” Sp rin g C on f er en BG S James A Marcum The epistemically virtuous clinician Theor Med Bioeth 2009;30:249-265 15 ce 20 Context and aim of this talk er en Francis Report on Mid-Staffordshire BG S Sp rin g C on f “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…...” 15 er en ce 20 Aim of this talk C on f To expand on Francis’ recommendations in an ethical context – specifically ‘virtue ethics’ BG S Sp rin g 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”. 15 ce 20 Disclaimer BG S Sp rin g C on f er en I am not setting myself up as an example of a ‘virtuous physician”! My inspiration derives from: Albert Schweitzer Anthony Barker Solomon Benatar 15 Most of us think of “the four principles” BG S Sp rin g C on f er en ce 20 When we think about ‘ethics’… Tom L Beauchamp & James F Childress Principles of Biomedical Ethics 5th Ed 15 er en BG S on f C rin g 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) Sp ce 20 When we think about ‘ethics’… er en ce 20 15 Virtue ethics - seems to be more fundamental BG S Sp rin g C on f “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 15 20 er en What motivates the person you thought of as being “kind”? on f ce What motivates us? Sp rin g C – Deontology (because it is her duty to be kind?!) – Consequentialism (because it yields good outcomes to be kind?!) BG S – Because it is in their character to be kind. 15 ce 20 Virtue ethics - definition A person’s actions are evaluated in terms of that person’s normative character traits, exemplified by those actions. (rather than simply with reference to either their commitment to duty or being motivated by the consequences of their acts) BG S Sp rin g C on f er en 15 ce 20 Virtue ethics - definition “A virtue is a trait of character that is socially valuable “A moral virtue is a morally valuable trait of character.” BG S Sp rin g C on f er en Beauchamp & Childress Fifth Edition Principles of Biomedical Ethics p28 OUP 2001 15 ce 20 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. As with other goals in our education, moral character and achievement is developed through self-cultivation and aspiration. BG S Sp rin g C on f er en 15 er en ce 20 The Intellectual virtues C on f Intellectual virtues are generally divided into two types rin g oReliabilist BG S Sp oResponsibilist Marcum ibid 20 15 Reliabilist professional virtues These are ‘innate’, but require training er en ce - motivated by the desire to acquire knowledge BG S Sp rin g C on f – Observing astutely – Memory – Intuition – Inferential reasoning – Insight Marcum ibid 15 Responsibilist professional virtues rin g C on f Honesty Courage Open-mindedness Humility Fairness Integrity Wisdom BG S – – – – – – – er en These are acquired and developed over the professional’s lifetime: Sp ce 20 - motivated by the desire to know the truth Marcum ibid 15 Now that we know what we mean by ‘virtue ethics’…how is this relevant to our job tomorrow morning? BG S Sp rin g C on f er en ce 20 Application 15 20 ce The Francis Report The entire Volume 3 of the Report is about professional standards Francis places emphasis on C on f er en BG S Sp rin g – Importance of developing a culture of compassion in the NHS – Nolan principles – 6Cs 15 20 The Nolan Principles BG S Sp rin g C on f er en Selflessness Integrity Objectivity Accountability Openness Honesty Leadership ce Committee on Standards in Public Life (1994) 15 20 Francis places emphasis on er en ce The Francis Report BG S Sp rin g C on f – Importance of developing a culture of compassion in the NHS – Nolan principles – 6Cs Beauchamp and Childress er en ce 20 15 “Compassion” unpacked BG S Sp rin g C on f “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 ce 20 15 “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…” BG S Sp rin g C on f er en Principles of Biomedical Ethics 5th Ed p32 BG S Sp rin g C – warmth – generosity – sympathy – compassion er en Intelligent kindness on f ce 20 15 “Compassion” unpacked John Ballatt and Penelope Campling, Intelligent Kindness R Coll Psych Publ 2012 Intelligent kindness er en ce 20 15 “Compassion” unpacked on f Leads to: rin g C • a trusting relationship with our patients BG S Sp • building a therapeutic alliance (demonstrated to yield better outcomes) John Ballatt and Penelope Campling, 15 Aristotle er en ce 20 How do we become virtuous? BG S Sp rin g C on f • 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 . 15 ce 20 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 2. Ethical virtues, for example courage, honesty, humility, compassion, empathy, integrity, fairness, open-mindedness, and tenacity 3. A passionate desire for the pursuit of knowledge and wisdom (both theoretical and practical) in its application BG S Sp rin g C on f er en After James A Marcum ce 20 15 An emphasis for our time - in the context of Francis report Compassion Honesty and Courage Reverence for life BG S Sp rin g C on f er en 15 Now that we know what we mean by ‘virtue ethics’…how is this relevant to our job tomorrow morning? BG S Sp rin g C on f er en ce 20 Application 15 ce er en BG S Sp rin g C 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. on f 20 Application 15 ce 20 Conclusion rin g C on f er en 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 BG S Sp o less in setting new ‘moral targets’ o more in inculcating habits of virtuous behaviour.