Medical Virtue Research Articles

Shinmi (親身): a Distinctive Japanese Medical Virtue?

In Western countries, the ideal professional and ethical attributes of healthcare providers and the ideal patient-doctor relationship have been analysed in detail. Other cultures, however, may have different norms, arising in response to diverse healthcare needs, cultural values and offering alternative perspectives. In this paper, drawing a case study, we introduce the concept of Shinmi, used in Japan to describe a desirable approach to medical care. Shinmi means kind or cordial in Japanese. In the medical context, it refers to doctors treating patients with a degree of emotional closeness as if they were the doctors’ own family. We analyse the concept of Shinmi, drawing on virtue ethics. We distinguish two different elements to a Shinmi-na attitude. As illustrated in our example, excessive Shinmi can be problematic for patients and doctors. Furthermore, elements of Shinmi may conflict with existing Western values (for example, norms that encourage emotional detachment and discourage doctors’ treatment of family members). However, if pursued appropriately, we argue that a balanced Shinmi-na approach can be conducive to the goals of medicine. The concept of Shinmi may be valuable for medical students, in Japanese and potentially other health care systems, and help them to cultivate a virtuous approach to meeting the emotional needs of patients.

Virtue Ethics in Medical Practice during the COVID-19 Pandemic

The article aims to reflect the medical virtue ethics as applied to situations related to the COVID-19 pandemic. The method of processing uses deduction, by which the article points out the use of the generally defined cardinal and theological virtues in terms of specific attitudes and concrete situations. The practical output of the article is the usability of these reflections in the prevention and therapy of stress, including burnout syndrome and post-traumatic stress disorder. Stress was a reaction commonly experienced often and in various degrees during the new and unforeseen conditions of the pandemic. The article emphasises the importance of virtue ethics as a part of contemporary bioethics.

Compound Remedies: Galenic Pharmacy from the Ancient Mediterranean to New Spain

Compound Remedies invites readers into the pharmacy of Jacinto de Herrera y Campos in late eighteenth-century Mexico City. The apothecary's medicines, equipment, and records provide a glimpse into early modern medical practice. Paula De Vos asks how Galenic medicine transformed and changed before arriving in New Spain, and how it evolved in the Americas with exposure to new environments and materia medica. In answering these questions, she challenges long-held assumptions that Latin American apothecaries tell us more about colonial than European medicine. In doing so, she embraces the global turn in the history of science. De Vos contends that the history of colonial Mexican pharmacies must include key learning centers in the Mediterranean world and beyond like Córdoba, Santander, Alexandria, Damascus, Baghdad, Cairo, Montpellier, Florence, Paris, and London (p. 15).This rich history traverses centuries of knowledge through the libraries and writings of several Mediterranean intellectuals, including Galen, Dioscorides, Paul of Aegina, Ibn Sīnā, and John Mesue. The text operates on two levels: pragmatic and intellectual. The former takes Mexico's early modern pharmacies and analyzes their inventories and technologies. De Vos contextualizes how these materials were used, understood, and applied in Western medicine. The latter level reminds readers that this art was never static—it was steeped in centuries of theoretical discourse, reflection, and revision. Nevertheless, De Vos highlights that a very small percentage of American materia medica, despite its evolving nature, was adopted and used by Iberian physicians in New Spain.One tremendous strength of the book is its geographical framing. De Vos recenters this history on the Mediterranean region and in particular Arabic scholars. This allows researchers and students to reconsider the Eurocentric roots of Western medicine and even the scientific revolution. For example, during the eleventh and twelfth centuries, a series of Arabic medical works were translated into Latin and disseminated in European learning centers like Salerno and Toledo. This corpus became “the basis for the medical curricula in newly established universities of Bologna, Paris, Montpellier, Padua, and, later, Salamanca” (p. 108).Another important intervention made by the book is its defiance of traditional chronological boundaries. Mexico's colonial medical practices simultaneously drew on ancient, medieval, and early modern medical theories. De Vos adeptly guides readers through these layers, bringing to the forefront actors like Mesue. Of note, Mesue's thirteenth-century Grabadin touted several key ideas that later shaped traditional Galenic practices. This included systematically organizing recipes by remedy type and determining how compound ingredients (several ingredients in one mixture) reacted when mixed.De Vos synthesizes the key concepts, texts, authors, materials, and practices of the Galenic pharmaceutical tradition. She addresses additional gaps in the literature by problematizing the concept of medical virtue, examining the influence of material culture and artisanal work on the science of Galenic medicine, and exploring how chemical medicines were formulated and tied to medieval alchemy.The book benefits graduate students and researchers studying medicine in Latin America and the Mediterranean. The chapters progress naturally and balance both the theory behind pharmaceutical practices and their application in the lived world. Chapter 1 examines simples (raw natural materials) and their medical uses. Chapter 2 describes how pharmacists corrected and processed simples. It highlights how Arabic scholars attempted to explain inconsistencies in Galen's work. Moreover, in the chapter De Vos traces the search for the virtue of a total substance and the subsequent “astrologization” of natural philosophy (p. 75). Chapter 3 addresses an often-overlooked area: compounding. Compounding, key to Galenic pharmacy, involved optimizing the combination and mixture of simples. Chapter 4 focuses on Nahua materia medica from the Nahua, Mixtec, Zapotec, and Maya peoples (p. 149). The chapter demonstrates that approximately 110 Indigenous substances formed the core of Nahua pharmacopoeia (p. 153). Finally, chapter 5 discusses alchemical pharmacy, which diverged from traditional Galenic medicine but nevertheless retained deep roots in the Mediterranean world and medieval medicine. Compound Remedies is an indispensable contribution to the history of medicine in Latin America. It is a text that readers will prefer to have at hand because it provides a wealth of reference information and much inspiration within its pages.

Virtue Ethics and Public Policy: Upholding Medical Virtue in Therapeutic Relationships as a Case Study

Virtue Ethics and Public Policy: Upholding Medical Virtue in Therapeutic Relationships as a Case Study

On the fragility of medical virtue in a neoliberal context: the case of commercial conflicts of interest in reproductive medicine.

Social, political, and economic environments play an active role in nurturing professional virtue. Yet, these environments can also lead to the erosion of virtue. As such, professional virtue is fragile and vulnerable to environmental shifts. While physicians are often considered to be among the most virtuous of professional groups, concern has also always existed about the impact of commercial arrangements on physicians' willingness and capacity to enact their professional virtues. This article examines the ways in which commercial arrangements have been negotiated to secure medical virtue from real or perceived threats of erosion. In particular, we focus on the concern surrounding conflicts of interest arising from commercial arrangements that have developed as a result of neoliberal economic and social policies. The deregulation of medical markets and privatization of services have produced new commercial relationships that are often misunderstood by patients, publics, and physicians themselves. 'Conflicts of interest' policies have been introduced in an attempt to safeguard ethical conduct and medical practice. However, a number of virtue ethicists have critiqued these policies as inadequate for securing virtue. We examine the ways in which commercial arrangements have been seen to impact upon medical virtue, both historically and in the context of modern medicine (using the example of fertility services in Australia). We then describe and critique current efforts to restore clinical virtue through both conflict of interest policies and through virtue ethics. Finally, we suggest some possible ways of addressing the corrosive effects of neoliberalism on medical virtue.

Diagnosing true virtue? Remote scenarios, warranted virtue attributions, and virtuous medical practice.

Immanuel Kant argues in the Foundations that remote scenarios are diagnostic of genuine virtue. When agents commonly thought to have a particular virtue fail to exhibit that virtue in an extreme situation, he argues, they do not truly have the virtue at all, and our propensities to fail in such ways indicate that true virtue might never have existed. Kant's suggestion that failure to show, say, courage in extraordinary circumstances necessarily silences one's claim to have genuine courage seems to rely on an implausibly demanding standard for warranted virtue attributions. In contrast to this approach, some philosophers-such as Robert Adams and John Doris-have argued for probabilistic accounts of warranted virtue attributions. But despite the initial plausibility of such accounts, I argue that a sole reliance on probabilistic approaches is inadequate, as they are insufficiently sensitive to considerations of credit and fault, which emerge when agents have developed various insurance strategies and protective capacities against their responding poorly to particular eventualities. I also argue that medical graduates should develop the sorts of virtuous dispositions necessary to protect patient welfare against various countervailing influences (even where such influences might be encountered only rarely), and that repeated failures to uphold the proper goals of medicine in emergency scenarios might indeed be diagnostic of whether an individual practitioner does have the relevant medical virtue. In closing, I consider the dispositions involved in friendship. I seek to develop a principled way of determining when remote scenarios can be illuminating of genuine friendship and genuine virtue.

Towards an Empirically Informed Account of Phronesis in Medicine.

In the field of medical virtue ethics, the concept of phronesis, or practical wisdom, plays a crucial role. In recent years a number of important theoretical questions have been identified in this regard: (1) is phronesis more akin to thinking or theorizing, or to feeling and intuiting? (2) can phronesis be communicated and explained, or is it individual and personal? and (3) is phronesis needed in all decision-making in medicine, or only in the making of decisions that are ethically fraught? In this paper we argue that, while these questions have received attention on the theoretical level, empirical investigation has the potential to shed light on these questions from the perspective of medical practice in the real world. Indeed, because virtue ethics insists that virtuous action can only be understood properly in the context of real decisions (and not in the abstract), there are good grounds for thinking that understanding phronesis must involve attention to real-world particulars. Empirical investigation, involving in-depth narrative interviewing and analysis, has the potential to shed light on these theoretical questions relating to phronesis.

Respect for patient autonomy as a medical virtue.

Respect for patient autonomy is an important and indispensable principle in the ethical practice of clinical medicine. Legal tenets recognise the centrality of this principle and the inherent right of patients of sound mind - properly informed - to make their own personal medical decisions. In the course of everyday medical practice, however, challenging cases may result in ethical dilemmas for the patient, the physician, and society. Resolution of these dilemmas requires a thorough understanding of the underlying principles that allow the clinician to make informed decisions and to offer considered therapeutic options to the patient. We argue in this paper that there is also need for a transition of moral competency from understanding principles to attaining virtue in the classic Aristotelian tradition. Achieving moral virtue is based on a lifetime of learning, practising, and watching how others, who have achieved virtue, act and perform their duties. We further claim that learning moral virtue in medical practice is best realised by incorporating the lessons learnt during daily rounds where frank discussions and considered resolutions can occur under the leadership of senior practitioners who have achieved a semblance of moral excellence.

Good medical ethics, from the inside out—and back again

I argue here that good medical ethics requires an empirically-informed moral psychology of medical virtue along with sound action-guiding prescriptions for virtuous medical practice. After distinguishing between three levels of...

How Virtue Ethics Informs Medical Professionalism

We argue that a turn toward virtue ethics as a way of understanding medical professionalism represents both a valuable corrective and a missed opportunity. We look at three ways in which a closer appeal to virtue ethics could help address current problems or issues in professionalism education-first, balancing professionalism training with demands for professional virtues as a prerequisite; second, preventing demands for the demonstrable achievement of competencies from working against ideal professionalism education as lifelong learning; and third, avoiding temptations to dismiss moral distress as a mere "hidden curriculum" problem. As a further demonstration of how best to approach a lifelong practice of medical virtue, we will examine altruism as a mean between the extremes of self-sacrifice and selfishness.

"A Gentle and Humane Temper": Humility in Medicine

Humility is the medical virtue most difficult to understand and practice. This is especially true in contemporary medicine, which has developed a culture more characterized by arrogance and entitlement than by self-effacement and moderation. In such a culture, humility suggests weakness, indecisiveness, or even deception, as in false modesty. Nonetheless, an operational definition of medical humility includes four distinct but closely related personal characteristics that are central to good doctoring: unpretentious openness, honest self-disclosure, avoidance of arrogance, and modulation of self-interest. Humility, like other virtues, is best taught by means of narrative and role modeling. We may rightly be proud of contemporary medical advances, while at the same time experiencing gratitude and humility as healers.

Carbon Nanotubes Filled with a Chemotherapeutic Agent: A Nanocarrier Mediates Inhibition of Tumor Cell Growth

In this paper, carbon nanotubes (CNTs) are presented as feasible carriers for carboplatin, a therapeutic agent for cancer treatment. The drug was introduced into CNTs to demonstrate that they are suited as nanocontainers and nanocarriers and can release the drug to initialize its medical virtue. The filling was accomplished by a wet-chemical approach after the CNTs were opened. The effect on cell proliferation and cytotoxicity of the carboplatin-filled CNT was investigated by using a viability assays. Using different analysis methods such as electron energy loss spectroscopy and x-ray photoelectron spectroscopy the structure of carboplatin incorporated into the CNTs was found to be retained. In vitro studies showed that carboplatin-filled CNTs inhibited growth of bladder cancer cells whereas unfilled, opened CNTs barely affected cancer cell growth. A reversible filling-emptying process could be performed successfully within this work. This highlights the potential of CNTs for applications in the field of drug delivery.

Treatise on correcting mistakes by Xuanyuan and Qibo, A book of self-treatment by a doctor

Treatise on Correcting Mistakes by Xuanyuan and Qibo (Xuan Qi Jiuzheng Lun), written by doctor Xiao Jing from the last years of Ming Dynasty to early years of Qing Dynasty, is a rare work dealing with doctor's shortcomings. This book includes two sections. Although the styles of these two sections are different, the contents of them are related. In the first part of the book the author implicitly criticizes doctors showing contempt for medical classics, and defends purity and honor of medical classics. While in the second part of the book he expands the view of the Confucianists, points out the lack of medical virtue in that period without mincing words, and advocates that medical practitioners should take Confucian doctors as the model. Thus the value and manner of traditional Confucian doctors are defended.

THE MOSQUITO AND YELLOW FEVER.

The evidence adduced by Drs. Reed, Carroll, and Agramonte that the mosquito is the carrier of the infection of yellow fever, has called out other evidence or suggestions. The freedom of the Southern piney woods region from yellow fever has been noticed before. It is said that the disease never spreads there, and the fact was generally attributed to some peculiar influence of the pines. Now it is claimed that the absence of the mosquitoes in the pine woods may account for the freedom from the disease, previously credited to some medical virtue of the trees. Another thing noticed in the South as corroborative of the mosquito theory, is that, while the yellow-fever infection seems sometimes to survive a cold winter, it disappears after a slight frost, which also makes an end of the mosquito. These are not yet scientifically demonstrated facts, but they may be worth looking into and