To practice medicine and ethics, physicians need wisdom and integrity to integrate scientific knowledge, patient preferences, their own moral commitments, and society's expectations. This work of integration requires a physician to pursue certain goals of care, determine moral priorities, and understand that conscience or integrity require harmony among a person's beliefs, values, reasoning, actions, and identity. But the moral and religious pluralism of contemporary society makes this integration challenging and uncertain. How physicians treat patients will depend on the particular beliefs (...) and values they and other health professionals bring to each instance of shared decision making. This book offers a framework for practical wisdom in medicine that addresses the need for integrity in the life of each health professional. In doing so, it acknowledges the challenge of moral pluralism and the need for moral dialogue and humility as professionals fulfil their obligations to patients, themselves, and society. (shrink)

Backround Education in ethics and professionalism should reflect the realities medical students encounter in the hospital and clinic. Method We performed content analyses on Case Observation and Assessments (COAs) written by third-year medical students about ethical and professional issues encountered during their internal medicine and paediatrics clinical clerkships. Results A cohort of 141 third-year medical students wrote 272 COAs. Content analyses identified 35 subcategories of ethical and professional issues within 7 major domains: decisions regarding treatment (31.4%), communication (21.4%), professional duties (...) (18.4%), justice (9.8%), student-specific issues (5.4%), quality of care (3.8%), and miscellaneous (9.8%). Conclusions Students encountered a wide variety of ethical and professional issues that can be used to guide pre-clinical and clinical education. Comparison of our findings with results from similar studies suggests that the wording of an assignment (specifying “ethical” issues, “professional” issues, or both) may influence the kinds of issues students identify in their experience-based clinical narratives. (shrink)

Christopher Meyers attempts a utilitarian defense of the deception of patients when the purported harms of truthful disclosure outweigh its benefits. He suggests that honesty i...

When health professionals experience moral distress during routine clinical practice, they are challenged to maintain integrity through conscientious practice guided by ethical principles and virtues that promote the dignity of all human beings who need care. Their integrity also needs preservation during a crisis like the COVID-19 pandemic, especially when faced with triage protocols that allocate scarce resources. Although a crisis may change our ability to provide life-saving treatment to all who need it, a crisis should not change the ethical (...) values that should always be guiding clinical care. Enduring ethical commitments should encourage clinicians to base treatment decisions on the medical needs of individual patients. This approach contrasts with utilitarian attempts to maximize selected aggregate outcomes by using scoring systems that use short-term and possibly long-term prognostic estimates to discriminate between patients and thereby treat them unequally in terms of their eligibility for life-sustaining treatment. During times of crisis and calm, moral communication allows clinicians to exercise moral agency and advocate for their individual patients, thereby demonstrating conscientious practice and resisting influences that may contribute to compartmentalization, moral injury, and burnout. (shrink)

Decision-making in health care is often challenging and therefore requires practical wisdom. The domains of such wisdom involve goals, perception, ethics, deliberation, and motivation. For Christian patients, there is a need for practical wisdom founded on Christian commitments that shape and guide these domains according to a Christian understanding of life, health, technology, illness, suffering, and death. In this essay, I outline a Christian approach to practical wisdom in health care by infusing Christian beliefs and values into a general framework (...) for practical wisdom in medicine I have described previously. I organize this approach by referring to Christian purpose, vision, ethics, piety, and practice. The result is a framework that intends to integrate faith and reason so that what we believe as Christians forms how we think about health and guides what we choose or decline when considering the possibilities that come before us in health care. (shrink)

Given the moral pluralism that characterizes Western democratic societies and their health professions, it should be expected that there will be ethical differences among citizens and health professionals, due to contrasts between the foundational beliefs and values on which their ethical convictions rest. It should also be expected that some of these differences will have practical implications for the way professionals are willing to practice, and the way patients are willing to receive, health care. These practical implications include our responses (...) to ethically controversial practices and the ways in which we maintain or compromise our individual integrity, that quality of the moral life that refers to... (shrink)

The article by Doernberg and Truog (2023) suggests that five different medical spheres have five distinctive sets of moral norms based on the ends of those spheres, implying that different roles in...