Healthcare virtues and professional education

Abstract

This thesis emerged from a long-standing interest in healthcare ethics and professional education and is the result of conceptual and literature-based research. It began with: a nagging doubt about the possibility of teaching professional ethics; with an interest in the gap between what is known and what is done; with an awareness that the A grade ethics student is not necessarily the exemplary nurse or doctor in practice; and with an idea that virtue ethics might be the answer. Two central and related issues are addressed: (1) ethical values and perspectives which are necessary components of healthcare ethics and (2) the implications of, and strategies for, promoting these ethical values and perspectives in the education of health professionals.
Changes within healthcare and in society urge an ongoing consideration and reevaluation of ethical values in healthcare and professional education. Contemporary approaches to health professional ethics have, for the most part, focused on duty, consequences, principles and, more recently, on rights. Such obligation-based approaches are primarily concerned with action and the cognitive realm with too little regard for the emotions and character. It will be argued that virtue ethics, which focuses on the character of the professional, goes some way towards correcting the rationalist and externalist bias of predominant approaches to healthcare ethics.
A wide array of ethical values, have been described and discussed as characterising healthcare ethics. One of the most well-known perspectives is that of Beauchamp and Childress (2001) who elucidate four biomedical ethical values, what they call principles, of autonomy, beneficence, non-maleficence and justice. Beauchamp and Childress identify but elaborate little on the virtue correlates of these principles: respectfulness, benevolence, non-malevolence and justice. In this thesis, the virtue of respectfulness will be developed. It will be argued that respectfulness and selfrespectfulness are necessary healthcare values. Respectfulness is considered both initself and as respect-for: in relation to dignity and autonomy. Respectfulness also goes some way to reinforcing and encompassing other values: if the dignity and autonomy of people are respected they will be benefited rather than harmed and they will be treated fairly. Whilst self-respectfulness and respectfulness are necessary health professional virtues, they are not sufficient. Two further necessary virtues will be discussed in relation to the health professions: courage and practical wisdom.
The more holistic approach to ethics proposed in this thesis requires attention to: technical-rational ('hard, high ground') and professional artistry ('swampy lowlands') perspectives on healthcare; to 'whole person' and common human experience
perspectives; to rationality and the emotions; to action or conduct and character; to obligations and virtues; and to empirical and theoretical ethics. These aspects should be considered in professional education. It is argued that the development of ethical competence is the overall purpose of professional ethics education. The model of ethical competence proposed comprises: ethical knowing; ethical seeing; ethical reflection; ethical doing; and ethical being A draft curriculum is suggested regarding how ethical competeiice might be promoted.