Virtue ethics Health Dictionary

Virtue Ethics: From 1 Different Sources


theories that emphasize the ethical importance of the virtues (e.g., honesty or courage), true happiness, and practical wisdom (compare consequentialism; deontology). In medical ethics, the traits of a ‘good doctor’ provide the moral compass by which to assess professional practice.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Ethics

Within most cultures, care of the sick is seen as entailing special duties, codi?ed as a set of moral standards governing professional practice. Although these duties have been stated and interpreted in di?ering ways, a common factor is the awareness of an imbalance of power between doctor and patient and an acknowledgement of the vulnerability of the sick person. A function of medical ethics is to counteract this inevitable power imbalance by encouraging doctors to act in the best interests of their patients, refrain from taking advantage of those in their care, and use their skills in a manner which preserves the honour of their profession. It has always been accepted, however, that doctors cannot use their knowledge indiscriminately to ful?l patients’ wishes. The deliberate ending of life, for example, even at a patient’s request, has usually been seen as alien to the shared values inherent in medical ethics. It is, however, symptomatic of changing concepts of ethics and of the growing power of patient choice that legal challenges have been mounted in several countries to the prohibition of EUTHANASIA. Thus ethics can be seen as regulating individual doctor-patient relationships, integrating doctors within a moral community of their professional peers and re?ecting societal demands for change.

Medical ethics are embedded in cultural values which evolve. Acceptance of abortion within well-de?ned legal parameters in some jurisdictions is an example of how society in?uences the way in which perceptions about ethical obligations change. Because they are often linked to the moral views predominating in society, medical ethics cannot be seen as embodying uniform standards independent of cultural context. Some countries which permit capital punishment or female genital mutilation (FGM – see CIRCUMCISION), for example, expect doctors to carry out such procedures. Some doctors would argue that their ethical obligation to minimise pain and suffering obliges them to comply, whereas others would deem their ethical obligations to be the complete opposite. The medical community attempts to address such variations by establish-ing globally applicable ethical principles through debate within bodies such as the World Medical Association (WMA) or World Psychiatric Association (WPA). Norm-setting bodies increasingly re?ect accepted concepts of human rights and patient rights within professional ethical codes.

Practical changes within society may affect the perceived balance of power within the doctor-patient relationship, and therefore have an impact on ethics. In developed societies, for example, patients are increasingly well informed about treatment options: media such as the Internet provide them with access to specialised knowledge. Social measures such as a well-established complaints system, procedures for legal redress, and guarantees of rights such as those set out in the NHS’s Patient’s Charter appear to reduce the perceived imbalance in the relationship. Law as well as ethics emphasises the importance of informed patient consent and the often legally binding nature of informed patient refusal of treatment. Ethics re?ect the changing relationship by emphasising skills such as e?ective communication and generation of mutual trust within a doctor-patient partnership.

A widely known modern code is the WMA’s International Code of Medical Ethics which seeks to provide a modern restatement of the Hippocratic principles.

Traditionally, ethical codes have sought to establish absolutist positions. The WMA code, for example, imposes an apparently absolute duty of con?dentiality which extends beyond the patient’s death. Increasingly, however, ethics are perceived as a tool for making morally appropriate decisions in a sphere where there is rarely one ‘right’ answer. Many factors – such as current emphasis on autonomy and the individual values of patients; awareness of social and cultural diversity; and the phenomenal advance of new technology which has blurred some moral distinctions about what constitutes a ‘person’ – have contributed to the perception that ethical dilemmas have to be resolved on a case-by-case basis.

An approach adopted by American ethicists has been moral analysis of cases using four fundamental principles: autonomy, bene?cence, non-male?cence and justice. The ‘four principles’ provide a useful framework within which ethical dilemmas can be teased out, but they are criticised for their apparent simplicity in the face of complex problems and for the fact that the moral imperatives implicit in each principle often con?ict with some or all of the other three. As with any other approach to problem-solving, the ‘four principles’ require interpretation. Enduring ethical precepts such as the obligation to bene?t patients and avoid harm (bene?cence and non-male?cence) may be differently interpreted in cases where prolongation of life is contrary to a patient’s wishes or where sentience has been irrevocably lost. In such cases, treatment may be seen as constituting a ‘harm’ rather than a ‘bene?t’.

The importance accorded to ethics in daily practice has undergone considerable development in the latter half of the 20th century. From being seen mainly as a set of values passed on from experienced practitioners to their students at the bedside, medical ethics have increasingly become the domain of lawyers, academic philosophers and professional ethicists, although the role of experienced practitioners is still considered central. In the UK, law and medical ethics increasingly interact. Judges resolve cases on the basis of established medical ethical guidance, and new ethical guidance draws in turn on common-law judgements in individual cases. The rapid increase in specialised journals, conferences and postgraduate courses focused on ethics is testimony to the ever-increasing emphasis accorded to this area of study. Multidisciplinary practice has stimulated the growth of the new discipline of ‘health-care ethics’ which seeks to provide uniformity across long-established professional boundaries. The trend is to set common standards for a range of health professionals and others who may have a duty of care, such as hospital chaplains and ancillary workers. Since a primary function of ethics is to ?nd reasonable answers in situations where di?erent interests or priorities con?ict, managers and health-care purchasers are increasingly seen as potential partners in the e?ort to establish a common approach. Widely accepted ethical values are increasingly applied to the previously unacknowledged dilemmas of rationing scarce resources.

In modern debate about ethics, two important trends can be identi?ed. As a result of the increasingly high pro?le accorded to applied ethics, there is a trend for professions not previously subject to widely agreed standards of behaviour to adopt codes of ethical practice. Business ethics or the ethics of management are comparatively new. At the same time, there is some debate about whether professionals, such as doctors, traditionally subject to special ethical duties, should be seen as simply doing a job for payment like any other worker. As some doctors perceive their power and prestige eroded by health-care managers deciding on how and when to ration care and pressure for patients to exercise autonomy about treatment decisions, it is sometimes argued that realistic limits must be set on medical obligations. A logical implication of patient choice and rejection of medical paternalism would appear to be a concomitant reduction in the freedom of doctors to carry out their own ethical obligations. The concept of conscientious objection, incorporated to some extent in law (e.g. in relation to abortion) ensures that doctors are not obliged to act contrary to their own personal or professional values.... ethics

Ethics Committee

A committee that can have a number of roles in relation to ethics. For example, it may develop policy relative to the use and limitation of treatment; serve as a resource for individuals and their families regarding options for terminal illness; or assess research projects with respect to the appropriate application of ethical principles.... ethics committee

Ethics (of Care)

The basic evaluative principles which (should) guide “good” care. Principles typically refer to respect for, and the dignity of, human beings. Basic dimensions are “autonomy” (respect for self determination), “well-being” (respect for happiness, health and mental integrity) and “social justice” (justifiable distribution of scarce goods and services). More specifically, ethics of care refer to ethical standards developed for the care professions which are designed to implement ethical principles in the practice of care provision.... ethics (of care)

Ethics Committees

(In the USA, Institutional Review Boards.) Various types of ethics committee operate in the UK, ful?lling four main functions: the monitoring of research; debate of di?cult patient cases; establishing norms of practice; and publishing ethical guidance.

The most common – Local Research Ethics Committees (LRECs) – have provided a monitoring system of research on humans since the late 1960s. Established by NHS health authorities, LRECs were primarily perceived as exercising authority over research carried out on NHS patients or on NHS premises or using NHS records. Their power and signi?cance, however, developed considerably in the 1980s and 90s when national and international guidance made approval by an ‘appropriately constituted’ ethics committee obligatory for any research project involving humans or human tissue. The work of LRECs is supplemented by so-called ‘independent’ ethics committees usually set up by pharmaceutical companies, and since 1997 by multicentre research ethics committees (MRECs). An MREC is responsible for considering all health-related research which will be conducted within ?ve or more locations. LRECs have become indispensable to the conduct of research, and are doubtless partly responsible for the lack of demand in the UK for legislation governing research. A plethora of guidelines is available, and LRECs which fail to comply with recognised standards could incur legal liability. They are increasingly governed by international standards of practice. In 1997, guidelines produced by the International Committee on Harmonisation of Good Clinical Practice (ICH-GCP) were introduced into the UK. These provide a uni?ed standard for research conducted in the European Union, Japan and United States to ensure the mutual acceptance of clinical data by the regulatory authorities in these countries.

Other categories of ethics committee include Ethics Advisory Committees, which debate dif?cult patient cases. Most are attached to specialised health facilities such as fertility clinics or children’s care facilities. The 1990s have seen a greatly increased interest in professional ethics and the establishment of many new ethics committees, including some like that of the National Council for Hospice and Specialist Palliative Care Services which cross professional boundaries. Guidance on professional and ethical standards is produced by these new bodies and by the well-established ethics committees of regulatory or representative bodies, such as the medical and nursing Royal Colleges, the General Medical Council, United Kingdom Central Council for Nursing, Midwifery and Health Visiting, British Medical Association (see APPENDIX 8: PROFESSIONAL ORGANISATIONS) and bodies representing paramedics and professions supplementary to medicine. Their guidance ranges from general codes of practice to detailed analysis of single topics such as EUTHANASIA or surrogacy.

LRECs are now supervised by a central body

– COREC (www.corec.gov.org.uk).... ethics committees

Virtue

(Latin) Having moral excellence, chastity, and goodness Virtu, Vyrtue, Vyrtu, Vertue, Vertu... virtue

Code Of Ethics

The following rules are amplified in the official Code of Ethics observed by members of the National Institute of Medical Herbalists. Summarised as follows:–

Rule 1. Members shall at all times conduct themselves in an honourable manner in their relations with their patients, the public, and with other members of the Institute.

The relationship between a medical herbalist and his or her patient is that of a professional with a client. The patient puts complete trust in the practitioner’s integrity and it is the duty of members not to abuse this trust in any way. Proper moral conduct must always be paramount in member’s relationships with patients. Members must act with consideration concerning fees and justification for treatment.

Rule 2. No member may advertise or allow his or her name to be advertised in any way, except in the form laid down by the Council of the Institute.

Any form of commercialism in the conduct of a herbal practice is unseemly and undesirable. Particular considerations govern commencement of practice, partnerships, assistantships, door plates, signs, letter headings, broadcasts, etc.

Rule 3. Members shall comply at all times with the requirements of the Code of Practice.

Rule 4. Members shall not give formal courses of instructions in the practice of herbal medicine without the approval of the Council of the Institute.

Rule 5. It is required that members apply the Code of Practice to all their professional activities.

Rule 6. Infringement of the Ethical Code renders members liable to disciplinary action with subsequent loss of privileges and benefits of the Institute. ... code of ethics

Clinical Ethics

consideration of the moral issues attendant upon, and questions arising from, clinical practice, as distinct from research. In North America, it is common for hospitals to employ a clinical ethicist or provide a formal clinical ethics consultation service. In the UK, clinical *ethics committees are increasingly common in the NHS.... clinical ethics

Feminist Ethics

an approach that is critical of the prevailing focus and methods of *medical ethics. In particular, it is argued that contemporary bioethics has replicated oppressive social structures, privilege, and power relationships at the expense of the marginalized. Moral problems are seen as determined from the social context in which they arise and narrative, care, and *empowerment are usually integral to feminist analyses of ethical dilemmas.... feminist ethics

Global Ethics

an approach to moral problems acknowledging that ethical analysis is frequently culture-specific and geographically limited. The international and worldwide experience of health care is the subject of study and there is commonly close attention to inequities in health and health-care provision, with frequent emphasis on *human rights, *justice, and *equality.... global ethics

Kantian Ethics

approaches to moral questions based on the thought of the German philosopher Immanuel Kant (1724–1804). These seek to discover what is morally right by asking what basic rules all rational people (see autonomy) could adopt for themselves and then act on as an *imperative matter of *duty, regardless of their personal desires or of the possible consequences (see deontology; consequentialism). The Kantian tradition has been influential in medical ethics, especially in its insistence that every human life must be treated as an end in itself and not simply as a means.... kantian ethics

Medical Ethics

the standards of conduct required of medical professionals and also the academic study of ethical issues arising from the practice of medicine. From the *Hippocratic oath onwards, standards are designed to reassure that professionals subscribing to them will act in the *best interests of, and will avoid harming, their patients. Today they lay greater emphasis on patient *autonomy, while the contemporary study of medical ethics is concerned with a great variety of complex societal and social issues related to medical practice and research. Medical ethics is now taught in all medical schools in the UK as an essential part of a professional training, and the wider field of *bioethics is becoming a recognized academic specialty. See also clinical ethics; feminist ethics; public health ethics; publication ethics; virtue ethics.

Guidance on good medical practice from the website of the General Medical Council... medical ethics

Narrative Ethics

an approach to ethical problems and practice that involves listening to and interpreting people’s stories rather than applying principles or rules to particular situations. This context-specific empathetic approach to patient and professional life stories is often contrasted with the universalizing rationalist approach of *Kantian ethics. Narrative ethics has an obvious relevance to the doctor–patient relationship and mirrors the clinical context in which moral choices are made.... narrative ethics

Publication Ethics

the standards expected from those who write, publish, and disseminate research. The International Committee on Publication Ethics (COPE), comprising the editors and publishers of most major academic biomedical journals, consults and advises on aspects of publication ethics, such as research misconduct, plagiarism, so-called gift authorship, determination of contribution to research, and peer review processes.

A detailed guide to publication ethics from COPE... publication ethics

Public Health Ethics

the ethics of population (as opposed to individual) health, including issues related to epidemiology, disease prevention, health promotion, *justice, and *equality. Public health ethics is commonly concerned with the tensions between individual *autonomy and *communitarianism and/or *utilitarianism.... public health ethics

Research Ethics Committee

see ethics committee.... research ethics committee



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