Virtuous Care Research Articles

Bodily contrast experiences in cultivating character for care.

Since 2008, in Flanders, we organize immersion sessions in a simulated context with the aim of stimulating student nurses and health professionals to learn virtuous caring. In this contribution, we first outline the purpose of this experiential learning: the cultivation of moral character. We come to the core of what we mean by moral character for care. We refer to Joan Tronto and Stan van Hooft to claim that caring is central to all aspects of nursing practice and is the basis of its moral quality. We also stipulate that caring involves the integration of action with emotions, motivations, and knowledge. Second, we briefly explain how the immersion sessions in the care ethics lab take place and, in particular, reflect on what it yields in terms of experiences for the participants who take on the role of simulant patients in this experiential learning process. We focus on the significant role contrast experiences play in these experiences. Especially the negative contrast experiences do not wear off easily; care professionals remember even long after the immersion session and continue to carry them with them as a "corporeal built-in alarm." Third, we discuss the role of contrast experiences in cultivating moral character for care. In particular, we explore the role of the body in the kind of knowing it cultivates and, by extension, its role in cultivating virtuous caring. By referring to specific philosophical ideas of Gabriël Marcel, Hans Jonas and Emmanuel Levinas, we try to understand how contrast experiences bring about an integration of virtuous action into knowledge, motivation, and emotion. We conclude that we need more space for contrast experiences in cultivating moral character. More attention should be paid to the role of the body in this learning process.

Are we virtuously caring or just anxious?

According to Grossmann, the high levels of cooperation seen in humans are the result of a "virtuous caring cycle" on which the increased care that more fearful children receive brings increased cooperative tendencies in those children. But this proposal overlooks an equally well supported alternative on which children's anxiety - not a virtuous caring cycle - explains the cooperative tendencies of humans.

Current management of cancer pain in Italy: Expert opinion paper.

IntroductionChronic pain and breakthrough cancer pain (BTcP) have a high prevalence in all cancer types and cancer stages, combined with a significant physical, psychological, and economic burden. Despite efforts to improve appropriate management of cancer pain, a poor assessment and guilty undertreatment are still reported in many countries. The purpose of this expert opinion paper is to contribute to reduce and clarify these issues with a multidisciplinary perspective in order to share virtuous paths of care.MethodsCommon questions about cancer pain assessment and treatment were submitted to a multidisciplinary pool of Italian clinicians and the results were subsequently discussed and compared with the findings of the published literature.ConclusionDespite a dedicated law in Italy and effective treatments available, a low percentage of specialists assess pain and BTcP, defining the intensity with validated tools. Moreover, in accordance with the findings of the literature in many countries, the undertreatment of cancer pain is still prevalent. A multidisciplinary approach, more training programs for clinicians, personalised therapy drug formulations, and virtuous care pathways will be essential to improve cancer pain management.

Principled decisions and virtuous care: an ethical assessment of the SIAARTI Guidelines for allocating intensive care resources.

This article sets forth ethical principles for responding to extraordinary circumstances in which the demand for medical care threatens to overwhelm available resources, as in the COVID-19 pandemic. In light of these principles, the author then assesses the ethics of the SIAARTI guidelines for rationing ICU beds and ventilators under such circumstances.

Doctorhood in Radiology: What Makes a Radiologist a Physician?

Because image interpretation occurs out of public view, the lay public does not always know what a radiologist is, or that a radiologist is even a physician. Despite the reality that many radiologists have little to no patient contact, all have considerable impact on patient care. As viewed through the lens of patient impact and in the context of the social contract that physicians enter, radiologists lay equal claim to the title "doctor" as any other physician. With titles come responsibilities: as physicians, radiologists are obligated through the social contract to provide humanistic and virtuous care, irrespective of time spent in close proximity with patients. This paper touches on ways in which radiologists can honor the social contract, providing care through a commitment to empathy, compassion, generosity, honesty and collaboration with nonradiologist colleagues. This invitation for introspection assumes special meaning for a profession that is undergoing an identity change at the behest of AI, serving as a reminder that radiologists ought to pay as much heed to maintaining virtuous physician character as they do to the fine points of image interpretation.

Cultivating Physician Character in Diagnostic Radiology Through Virtuous Caring and Collaborative Professionalism

In the contemporary environment of patient- and value-centered care, it is no longer sufficient to limit the definition of an "excellent radiologist" to someone who is skilled at image interpretation. Since diagnostic radiologists are physicians, they are held to a certain character standard expected of a physician, whose primary objective is to serve the best interest of patients. An "excellent radiologist," then, is better defined as one who is both skilled at interpreting medical imaging and embodies the attributes of physician character. The concept of physician character can be understood as the interplay between the practice of the care-related virtues, such as empathy, compassion, and kindness, and cooperative efforts with nonradiologist health care team members, termed collaborative professionalism. The very nature of the work of diagnostic radiology, aided by advances in technology, increasingly isolates the radiologist from both patients and other care providers, making it difficult to find opportunities for virtuous care and collaborative professionalism. Using the moral intuitionist model of character development as a conceptual framework, we first delineate the challenges that diagnostic radiologists face in demonstrating virtuous caring and collaborative professionalism. Then, we explore strategies that diagnostic radiologists can employ to overcome these barriers, thereby cultivating their own physician character and setting an example for other radiologists, medical students, and trainees. Finally, we will examine some of the limitations of applying this theoretical model to the real world.

Project on the Good Physician: A Proposal for a Moral Intuitionist Model of Virtuous Caring

ABSTRACTTheory: In the Project on the Good Physician, the authors endeavor to advance medical character education by proposing and testing a moral intuitionist model of virtuous caring that may be applicable to physician training. This model proposes that the moral intuition to care/harm motivates students to extend care to those in need. Hypotheses: Hypothesis 1: Medical students will report stronger preferences for the intuition to Care/harm over other moral intuitions in clinical decision making. Hypothesis 2: Care/harm will have the strongest correlation with Generosity than the other moral intuitions. Hypothesis 3: There will be positive associations between Care/harm and the caring virtues (Mindfulness, Empathic Compassion, and Generosity). Hypotheses 4–5: The virtue of Empathic Compassion (or Mindfulness) will moderate the relationship between Care/harm and Generosity. Hypotheses 6–7: Neuroticism (or Burnout) will negatively moderate the association between Care/harm and Generosity (or between Empathic Compassion and Generosity). Method: The authors used data from a 2011 nationally representative sample of U.S. medical students (N = 500) to test the relationship between the moral intuition to Care/harm and physician caring virtues. Moral intuitions were assessed using the Moral Foundations Questionnaire, whereas physician virtues were measured using scales adapted from validated constructs. Results: The authors found that students reported stronger preferences for the intuition to Care/harm over the four other moral intuitions. Each moral foundation was weakly but significantly correlated with Generosity, yet Care/harm had the strongest correlation among them. Neuroticism and Burnout did not weaken the link between Care/harm and the virtues. Conclusions: Data from the descriptive-correlational study reported here offer preliminary support for the construct validity of an educational model that targets the moral intuitions. The article concludes with a discussion of the implications of a moral intuitionist approach for medical character education and offers three hypotheses for future empirical research.

Relevance of the rationalist-intuitionist debate for ethics and professionalism in medical education.

Despite widespread pedagogical efforts to modify discrete behaviors in developing physicians, the professionalism movement has generally shied away from essential questions such as what virtues characterize the good physician, and how are those virtues formed? Although there is widespread adoption of medical ethics curricula, there is still no consensus about the primary goals of ethics education. Two prevailing perspectives dominate the literature, constituting what is sometimes referred to as the "virtue/skill dichotomy". The first perspective argues that teaching ethics is a means of providing physicians with a skill set for analyzing and resolving ethical dilemmas. The second perspective suggests that teaching ethics is a means of creating virtuous physicians. The authors argue that this debate about medical ethics education mirrors the Rationalist-Intuitionist debate in contemporary moral psychology. In the following essay, the authors sketch the relevance of the Rationalist-Intuitionist debate to medical ethics and professionalism. They then outline a moral intuitionist model of virtuous caring that derives from but also extends the "social intuitionist model" of moral action and virtue. This moral intuitionist model suggests several practical implications specifically for medical character education but also for health science education in general. This approach proposes that character development is best accomplished by tuning-up (activating) moral intuitions, amplifying (intensifying) moral emotions related to intuitions, and strengthening (expanding) intuition-expressive, emotion-related moral virtues, more than by "learning" explicit ethical rules or principles.

Health as spiritual and virtuous harmony with compassion and vital energy

Altruistic virtuous caring, possibly originated from religion and/or spirituality, is indispensable for holistic health through channeling vital energy with diet, exercise and meditation. This is a participant-observed medical anthropological research of a first generation Korean elderly immigrant health professional woman living in a four generational family. She had hypertension and was concerned about possible attack of stroke. Multi-religious, spiritual, and cosmological vital energy based on holistic Nature-oriented health beliefs and practices influenced by psychosocial, cultural and economic background, education, self- discipline and self-cultivation of individual, and group or family may create health. Self-care beliefs based on confidence in self-control of one's life style for oneself and others influence individual and group health practice. The holistic alternative health beliefs and practices were proved to be efficacious and beneficial by her self-evaluation, evaluation of significant others, biomedical professionals, and laboratory tests. That may have potential application for global health.