Medicine always needs good people, but never more so than during a pandemic.
During a recent “Ethics Talk” videocast from the AMA Journal of Ethics® (@JournalofEthics), the journal’s editor-in-chief, Audiey Kao, MD, PhD, revisited a video interview he conducted with the late Edmund Pellegrino, MD, then-professor emeritus of medicine and medical ethics at Georgetown University and widely considered to be one of the founders of American bioethics. The 2003 interview provides enduring reminders of what makes a good physician in times of crisis.
The primacy of virtues
“The question is often asked, ‘What’s the most important thing in the ethics of medicine?’ And I always say it's the character of the physician,” Dr. Pellegrino said. “The kind of person the physician ought to be—that’s what virtue ethics concerns itself with.”
Virtue ethics emphasizes the centrality of moral character, in contrast with the other normative ethics of deontology, which specifies duties or rules, and consequentialism, which focuses on the outcomes of actions. Principlism—which encompasses the familiar four key ethical principles of autonomy, beneficence, nonmaleficence and justice—is an applied ethics approach.
“The virtues I've been talking about—namely, fidelity to trust, compassion, intellectual honesty, courage, benevolence, for example—are necessary because without those personal characteristics, the physician cannot truly heal, cannot make whole again,” Dr. Pellegrino said.
Read the AMA Principles of Medical Ethics.
Prepare for pushback
By the time of his 2013 death, Dr. Pellegrino had written or co-written more than 600 articles and 23 books on medical science, philosophy and ethics, and helped pioneer the teaching of humanities in medical school. He also served as chair of the President's Council on Bioethics under President George W. Bush. Watch this AMA video about Dr. Pellegrino, whose career was marked with distinction.
Dr. Pellegrino was particularly critical of the commercial nature of medicine in the U.S., noting that health care is seen as a commodity, which presents challenges to the physician’s character.
“I've been challenged by physicians who say, ‘Dr. Pellegrino, you’re a fool … an idealistic fool. You know it's a business. Why don't you call it such and stop all of this blather about ethics and virtue?’” he said. “A significant number of physicians feel that way. I'm happy to say a large number do not and still want to do the right thing. They are the hope for the future.”
Read the AMA Declaration of Professional Responsibility.
Advice for next generation
Young people contemplating a career in medicine should be aware that physicians are not defined by their credentials, but also by their commitments, Dr. Pellegrino noted.
“We enter the profession of medicine not when we get the degree of medicine—that’s only a certificate of exposure to an education,” he said. “We enter the profession when we take an oath, and we say, ‘I declare to everyone here that I am committed to the ideals of medicine.’”
Before embarking on their medical education, aspiring physicians should ask themselves some diagnostic questions, Dr. Pellegrino advised.
“For the young person contemplating medicine today, they should step back and ask themselves what kind of life they want to lead in a general way,” he said. “More important than that, ask themselves: do they want to do something which is more challenging than they can ever meet fully in their whole lives—something which will lead them to a body of information which is bigger than they can encompass, which will bring them into duties and obligations which are larger than most people in this world face?”
This includes needing to understand that as a physician you can do much good, but also enormous harm, he added.
“If they can say yes to those things, they want to think about medicine.”
This “Ethics Talk” videocast is CME activity designated for 0.25 AMA PRA Category 1 Credit™. Check out previous episodes of the “Ethics Talk” podcast or subscribe to the series in iTunes or other services.