what is a professional virtue?
Consider a humble everyday object like a knife. What makes a knife a ‘good’ knife? That depends on the function of a knife. If the primary function of a knife is to cut, then a good knife is one that is sharp enough to cut well. Of course, there are many other things one might look for in a good knife: how pleasing it is to look at, how easy to grip, and so on, but if cutting is the primary function of a knife then sharpness is its primary virtue or excellence. In the words of the philosopher Philippa Foot, where a thing has a function, the primary criterion for the goodness of that thing will be ‘that it fulfils its function well’.
Perhaps, a knife can be too sharp, that is, so sharp that it endangers its user. So, an excellent knife will be one that is sharp enough to cut well but not so sharp as to be dangerous. Just the right degree of sharpness is, as one might call it, a knifely virtue. For Aristotle, a virtue is the mean between having too little of something and too much of it. In a knife, the right degree of sharpness is the mean between a deficiency (being too blunt to cut) and an excess (being too sharp to use safely).
professional virtues and professional roles
What does this example tell us about professional virtues? Doctors and other professionals don’t have ‘functions’ in the way that things like knives have functions. Furthermore, virtues in the strict Aristotelian sense are personal qualities. Indeed, for Aristotle, virtues are not just personal qualities but traits of character. It’s not clear that he is right about this but the account of the ‘knifely’ virtues is obviously going to have to be adapted if it is to apply to things that do not have functions.
What professionals have is not functions but roles, goals and challenges. This suggests a relatively straightforward way of thinking about professional virtues: the virtues of a given profession are those qualities that enable members of that profession to fulfil their professional role well, to achieve the goals of their profession, and to meet their professional challenges. As Peter Toon puts it, ‘professionals must be equipped with the virtues they need to face the challenges of their professional role, which has important implications for professional education and training’.
What this brings out is that identifying the professional virtues of medicine means identifying the distinctive roles, goals and challenges of the medical profession. This is not an easy task since the medical profession is not one thing. Health professionals do many different things. The professional virtues of a generalist might be different from those of a specialist, and the professional virtues of one type of specialist may well be different from those of another. Generalism is the focus of this toolkit. In the words of Sally and George Hull, ‘the expert GP has acquired and manifests a distinctive set of virtues’. The challenge is to identify these virtues by reflecting on the nature of medical generalism, and on the goals and challenges of the generalist as distinct from the specialist.
Approaching the subject in this way has one major advantage. Over the years, a great deal has been written about the medical virtues. Many lists of such virtues have been proposed, but what is not clear is the basis on which particular virtues are included or excluded. There is a distinct air of arbitrariness about the various lists that have been proposed, and no obvious basis for preferring one list of virtues to another. This is the fundamental problem to which a solution is needed.
This toolkit develops a solution to this problem. The basic idea of this toolkit is to reflect on the professional role of the medical generalist and then derive the generalist virtues from a reflective understanding of that professional role. Our understanding of the specific virtues of generalist medicine must be shaped by a proper understanding of the nature of generalism, of its goals and challenges. If we can identify the objectives of generalist medicine, it should then be relatively straightforward to identify the specific personal qualities that make it possible to attain those objectives.
references and further reading
The quotation from Philippa Foot is from ‘Goodness and Choice’, a paper which appears in her book Virtues and Vices and other essays in moral philosophy:
The quotation from Peter Toon is from his book A Flourishing Practice?
Another interesting and useful book is Virtue Ethics and Professional Roles by Justin Oakley and Dean Cocking:
Also well worth reading is this paper by Preston Stovall on professional virtues in a different context: https://www.ncbi.nlm.nih.gov/pubmed/19915957
The quotation from Sally and George Hull is from their paper ‘Recovering general practice from epistemic disadvantage’, which appears in this extremely useful book edited by Christopher Dowrick: https://www.routledge.com/Person-centred-Primary-Care-Searching-for-the-Self/Dowrick/p/