Responsibility as a meta-virtue: truth-telling, deliberation and wisdom in medical professionalism
- Dr Y M Barilan, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; ymbarilan{at}gmail.com
- Received 21 April 2008
- Revised 24 July 2008
- Accepted 14 August 2008
Abstract
The article examines the new discourse on medical professionalism and responsibility through the prism of conflicts among moral values, especially with regard to truth-telling.
The discussion is anchored in the renaissance of English-language writing on medical ethics in the 18th century, which paralleled the rise of humanitarianism and the advent of the word “responsibility”.
Following an analysis of the meanings of the value of responsibility in general and in medical practice in particular, it is argued that, similarly to the Aristotelian notion of equity, responsibility of care is a second-order value, which corrects virtues, laws and norms in exceptional circumstances.
Virtues and practices of the second order, such as responsibility and deliberation, bear especially on professional doctoring, which includes a commitment to give priority to the good of the patient over one’s own good.
It is argued that, in situations of conflict, and particularly conflicts between personal moral identity and the good of patients, the fundamental professional commitment is to critical and rational deliberation and to the cultivation of psycho-moral flexibility. This leads indirectly to moral growth and strengthening of professional character.
Footnotes
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Competing interests: None.
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↵i The Hebrew roots for the concepts involved are B-Q-Š (search, request) and Â-R-B (get involved)—Genesis, 31:39 and 43:9. In Modern Hebrew responsibility is rendered by the root A-H-R ( = other).
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↵ii Jonas spoke of life and the environment sustaining it as the targets of substantive responsibility. I place them under the title of antecedent responsibility.
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↵iii Grotius divided “the duties with regard to another” into three: keeping faith, making amends and a general duty of benevolence.
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↵iv Dworkin proposes a similar model, dividing ethical and political systems into “duty-oriented”, “goal-oriented” and “right-oriented”. Only the latter is dedicated to the well-being or dignity of individual humans.11
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↵v For the sake of brevity, I am omitting mid-positions, such as other-centred ethics with self-related limitations and permissions.12
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↵vi The Bible hints that other-centred questions of responsibility (“where is thy brother?”) lead to self-centred questions of accountability and identity, rather than vice versa. Cf. Genesis, 4:9-10 dealing with interpersonal conduct to 3:9-11 dealing with religious taboos.
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↵vii Explorations of virtue-related issues does not necessarily imply a meta-ethical commitment to “virtue ethics”.
