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Measuring ‘virtue’ in medicine

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Abstract

Virtue-approaches to medical ethics are becoming ever more influential. Virtue theorists advocate redefining right or good action in medicine in terms of the character of the doctor performing the action (rather than adherence to rules or principles). In medical education, too, calls are growing to reconceive medical education as a form of character formation (rather than instruction in rules or principles). Empirical studies of doctors’ ethics from a virtue-perspective, however, are few and far between. In this respect, theoretical and empirical study of medical ethics are out of alignment. In this paper, we survey the empirical study of medical ethics and find that most studies of doctors’ ethics are rules- or principles-based and not virtue-based. We outline the challenges that exist for studying medical ethics empirically from a virtue-based perspective and canvas the runners and riders in the effort to find virtue-based assessments of medical ethics.

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Notes

  1. Eckles et al. (2005) call this the ‘virtue/skill dichotomy’.

  2. See Mattick and Bligh (2006).

  3. Some virtue ethicists may hold that virtue is not the sort of thing that one can test for using a psychometric test, but that whether another person is virtuous is a matter of judgement. This is an interesting matter that cannot be taken up fully here. Suffice it to say that, were it true that virtue is not susceptible to empirical testing, this would leave virtue approaches at a permanent disadvantage vis-à-vis rules-/principles-based approaches, as such approaches are thought to be amenable to testing. This may not trouble all virtue ethicists; however it behoves virtue ethicists not to give up on the possibility of empirical testing of virtue too readily.

  4. In this paper, we often write of rules- or principles-based approaches to ethics and cognitive approaches to moral psychology in the same breath. The one naturally invites the other.

  5. …and professional education more broadly, in the case of the papers by Bebeau.

  6. Some of the problems involved in measuring professionalism or ethical awareness/behaviour are already set out in Eccles, 2005.

  7. For Haidt, people have different moral orientations or priorities that reflect whether they see a moral problem as one concerning (1) care/harm, (2) fairness/cheating, (3) loyalty/betrayal, (4) authority/suberversion, (5) sanctity/degradation or (6) liberty/oppression. See Haidt (2012).

  8. See Fowers (2005, 2014) and Kristjánsson (2015), for discussion of the psychology of virtue. In a similar vein, Kinghorn (2010) explains a number of these problems from a specifically medical perspective.

  9. Indeed, Aristotle himself cautioned that the study of virtue can be no more exact than its subject matter (i.e. virtue itself) allows for (NE, 1094b and 1095a).

  10. See “Discussion” section, below, for more on Jayawickreme et al.’s study.

  11. See Curren and Kotzee (2014) for a discussion of the prospects for measuring virtue in moral psychology.

  12. See Haslam et al. (2004) and Macdonald et al. (2008).

  13. Notably, efforts have recently been made to understand empathy from a brain-based perspective. Decety et al. (2010) performed a study using electrophysiological methods (Event Related Potential or ERP methods) to study physiological reactions to perceiving pain in another. When comparing doctors to a control group, Decety et al. found that doctors’ physiological response to watching a person’s skin pierced by a needle was dampened. What this physiological response alone indicates about the character trait empathy in doctors is debateable; however methods beyond self-reporting are increasingly becoming available.

  14. For more on the use of ESM in this area, see Fowers and Lefevor (2013). For one study using ESM in medicine (although not to study character specifically), see Ahmad et al. (2012).

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Authors and Affiliations

  1. School of Education, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

    Ben Kotzee

  2. Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK

    Agnieszka Ignatowicz

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  1. Ben Kotzee
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Correspondence to Ben Kotzee.

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Kotzee, B., Ignatowicz, A. Measuring ‘virtue’ in medicine. Med Health Care and Philos 19, 149–161 (2016). https://doi.org/10.1007/s11019-015-9653-6

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