The foundation of the virtues needed for medical professions

I recently read the article “Codes of Ethics in Health Care: Virtues Versus Rules” by Dennis Sansom in the summer edition of Ethics and Medicine and it started me thinking (as a good journal article should do). When people hear the word “ethics” many of them think of a set of rules that they are being expected to follow. What they commonly mean when they say ethics is a code of ethics. When I use the word ethics that is not usually what I mean. When I use the word “ethics” I am thinking about how we make decisions about how to live and how we decide what is right and wrong. That includes our understanding of basic moral principles and moral virtues. For me those principles and virtues are grounded in the nature of God and what he has revealed to us both generally in deep conscience and more specifically through scripture and his son Jesus. Ethics may contain rules, but it is much more than a set of rules.

But even though ethics is much broader than codes of ethics it is worthwhile to think about the role that codes of ethics play in a profession such as medicine and Sansom has some interesting thoughts about that. In our pluralistic society that has lost sight of objective moral values a code of ethics for a profession such as medicine is seen as a set of agreed upon rules by which we can guide our professional activity. If those in the profession who are seeking a consensus on a code of ethics have diverse moral understandings with no objective moral values, then the resulting code will be a relatively weak set of rules and procedural standards that serve to protect the profession and those the profession serves from the worst forms of abuse of the trust of those served. Such a code of ethics becomes a defensive mechanism, but plays little role in motivating those in the profession in the direction of what is good. Sansom suggests that this is not enough.

He suggests that by the nature of the medical profession it requires virtues to be able to practice medicine. He describes medicine as being a tragic profession. We are committed to the healing of those with diseases, but that is something which will always eventually fail as every one of our patients is mortal and will eventually die no matter what we do to attempt to cure their diseases. To persevere in medicine in spite of its tragic nature requires virtues. Sansom says that the code of ethics for the medical profession needs to promote those virtues for medicine to be a viable profession. He suggests that “the codes of ethics for the medical professions should be treated as the necessary virtues needed to fulfill the purposes of the professions.” While a pluralistic society lacks the consensus to support such virtues, he would suggest that those virtues can be supported by the common values of those within the profession who have entered into a covenant relationship with society and those they serve within the society.

I would suggest that such a covenant relationship cannot exist without a moral foundation of its own. Underlying the concept of covenant is the virtue of faithfulness. A covenant means nothing if those who make the covenant are not faithful to their commitment to each other. This need for foundational moral values and principles is universal to all moral endeavors. That foundation cannot be found in human consensus. It must be an objective moral truth that transcends our human agreements and consensus. In our pluralistic society that must come from some understanding of common morality, the basic moral principles and virtues that are common to all human societies. Without that we cannot have any valid morality. While we who are Christian understand common morality to be grounded in the nature of God and communicated through general revelation, it must be present, no matter how it is understood, for us to have the virtues needed to function in a tragic profession such as medicine.

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Susan Haack
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Susan Haack

What jumped out at me in your post, Steve, was the concept of faithfulness. While the broader concept of virtue is in itself lacking in our culture, even more so the idea of faithfulness. Other than being “true” or “faithful” to ourselves, the concept is neither nurtured nor promoted in contemporary society. In medicine this is further confounded by the “object” of that faithfulness–while in a fiduciary relationship it should be the patient, increasingly the object of faithfulness is an employer, a system, society, or oneself (production, reputation, lifestyle, etc.). Without being grounded in a transcendent source, any concept of… Read more »

Jon Holmlund
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Jon Holmlund

Indeed–and to make a different but related point, how, practically, can medicine’s professional virtues best be cultivated, and the covenantal relationship with the patient be maintained, as physicians increasingly become employees of large organizations? Are we talking about a special kind of business ethic for the physician, that can be articulated in a way that subordinates duty to the employer and, for lack of a better phrase, “customer-based” codes to the more fundamental physician-patient fiduciary relationship? I believe that Susan has posted on this in the past–to wit, the watering down of the concept of the “professional.” How best to… Read more »

Mark McQuain
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Mark McQuain

While I agree that faithfulness is important to the integrity of any covenantal relationship, the other important component of a doctor-patient covenant such as the Hippocratic Oath is the actual oath itself. The covenant was sandwiched between an oath to transcendent beings who presumably had the power over the physician to bless or punish him based upon how well he kept his covenantal vow. I am not enough of a historian to know just how pluralistic was the ancient world at the time of Hippocrates, but I suspect that most everyone believed in transcendental gods or powers that could in… Read more »