professional virtues, institutional vices
starting with Aristotle
Why talk about ‘virtues’ at all? The philosopher Aristotle saw virtues as excellences and his views about virtue remain hugely influential today. They also provide a highly effective means to organize one’s thinking about professional virtues, even though this is not a subject that directly interested Aristotle. The virtues he was interested in were moral virtues like courage.
For Aristotle, a person’s moral virtues are their moral excellences, the personal qualities that make them morally good or excellent people. By extension, their professional virtues are their professional excellences. They are the personal qualities that make them good or excellent members of their profession. How do professional virtues do that? Each profession or professional role has its own virtues. The professional virtues of medicine are those personal qualities that make it possible for doctors and other health professionals to fulfil their professional role. Professional virtues can be, but needn’t be, moral virtues.
Aristotle contrasts virtues with vices. If virtues are excellences then vices are flaws or defects. Moral vices are moral defects and professional vices are personal factors that hinder or obstruct the fulfilling of one’s professional role. Some vices, such as lack of compassion, are both moral and professional. Without compassion it is hard to be a good person or a good doctor.
Professionals don’t work in isolation. Any account of the professional virtues and vices of modern medicine also needs to take account of the institutional context. This context can help or hinder the cultivation and practice of virtue. It isn’t all about the individual, and reflecting on the virtues of a good doctor can also help us to see the strengths and weaknesses of particular ways of organizing the delivery of health care at the institutional level.
There are many institutional barriers to being a virtuous professional. The target culture and excessive bureaucratization are two obvious examples of what might be called institutional rather than personal professional vices of modern medicine. Overcoming institutional vices requires institutional change. A good way to think about the necessary institutional changes is to think about the specific ways that current arrangements are at odds with the cultivation and exercise of professional virtues.
the institutional context
let's be realistic
It’s easy to talk about the virtues of a good doctor. However, any account of professional virtues needs to take account of the real-world conditions in which professionals operate. As Christopher Dowrick notes:
‘[E]ffective person-centred care is becoming increasingly difficult to practice. The pressures on primary care to comply with a plethora of clinical guidelines and public health agendas, however well-intentioned they may be, all too often conflict with the person-oriented approach which is the hallmark of good general practice encounters’
Aside from such conflicts there are also more mundane but nonetheless hugely important human factors to consider. There are limits to what it is possible to achieve in a 10-minute consultation, especially if one is already tired and overworked. An account of professional virtues in modern medicine needs to take account of such factors. Indeed, the professional virtues of modern medicine will include the personal qualities that medical practitioners need to cope with the stresses and strains of their chosen profession. Resilience is one such virtue.
references and further reading
A good introduction to Aristotle’s conception of virtue can be found in the Stanford Encyclopedia of Philosophy: https://plato.stanford.edu/entries/ethics-virtue/
The quotation from Christopher Dowrick is from his preface to this collection of essays: https://www.routledge.com/Person-centred-Primary-Care-Searching-for-the-Self/Dowrick/p/
All the essays in this volume are highly recommended.