Professional Values in Modern Clinical Practice

Abstract

How are professional values defined and applied in actual practice of modern medicine? Let me begin to answer that question by reviewing virtues that number of scholars regard as central professional values in medicine. James Drane considers beneficience, that is, good work doctor does for persons who are ill, to be fundamental ethical standard, and benevolence to be virtue that disposes doctors to provide medical help.[1] He also includes as cardinal virtues for physicians respect and concern for patients, truthfulness, friendliness, and justice. Pellegrino and Thomasma take medicine to be human activity with specific telos or goal: a right and good action for particular patient.[2] Drawing on Aristotelian concept of phronesis, often defined as practical wisdom or prudence, they take clinical judgment to be medicine's indispensable virtue.[3] Pellegrino and Thomasma relate phronesis, the state of character which makes person good and which makes person do his or her work well, to ethical principle of beneficence, principle that they believe to be heart of medical and physician's primary obligation to (p. 53). Although they identify other essential virtues--including trustworthiness, respect for persons, compassion, justice, integrity, and self-effacement--they stress that in clinical context of relationships these traits should be subsumed within pivotal virtue of phronesis or prudence. Pellegrino, moreover, has argued that principle-based and virtue-based medical should be closely linked to the universality of phenomena of illness and healing and should be grounded in reality of physician-patient relationship.[4] Clinical Medical Ethics How do physicians move between realms of values and philosophical theories, on one hand, and clinical realities of medical practice, on other? Pellegrino has argued that discipline of clinical bioethics--clinical medical ethics as I prefer to call it[5]--represents one approach for linking professional and ethical values with practice. It is field that on clinical realities of moral choices as they are confronted in day-to-day health and medical care.[6] Clinical medical is practical and applied discipline that aims to improve patient care and patient outcomes by focusing on reaching right and good decision in individual cases. It does so by identifying, analyzing, and contributing to resolution of ethical problems that arise in practice of medicine. It focuses on doctor-patient relationship and takes account of ethical and legal issues that patients, doctors, and hospitals must address to reach good decisions for individual patients. Clinical emphasizes that in practicing good clinical medicine, physicians must combine scientific and technical abilities with ethical concerns for personal values of patients who seek their help. The content of clinical includes specific issues such as truth-telling, informed consent, end of life care, palliative care, allocation of clinical resources, and of medical research. Clinical also includes at its core study of doctor-patient relationship, including such issues as honesty, competence, integrity, and respect for persons. Thus clinical includes focus on ethos of professional and on character and virtues of physician, whom public expects to demonstrate these qualities. Albert Jonsen, William Winslade, and I have suggested that in analysis of any ethical issues following factors must be considered: medical and scientific facts; preferences, values, and goals of both physician and patient; and external constraints, such as cost, limited resources, and legal duties, that may shape or limit choices. …