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Respect for patient autonomy as a medical virtue*

Published online by Cambridge University Press:  16 December 2015

Thomas Cook ,
Constantine D. Mavroudis ,
Jeffrey P. Jacobs  and
Constantine Mavroudis
Thomas Cook
Affiliation:
Department of Philosophy, Rollins College, Winter Park, Florida, United States of America
Constantine D. Mavroudis
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
Jeffrey P. Jacobs
Affiliation:
Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America Department of Surgery, Division of Cardiovascular Surgery, Johns Hopkins All Children’s Heart Institute, All Children’s Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida, United States of America
Constantine Mavroudis*
Affiliation:
Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America Department of Surgery, Division of Cardiovascular Surgery, Johns Hopkins All Children’s Heart Institute, All Children’s Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida, United States of America
*
Correspondence to: Dr C. Mavroudis, MD, Johns Hopkins Children’s Heart Surgery, Florida Hospital for Children, 2501 N. Orange Avenue, Suite 540, Orlando, FL 32804, United States of America. Tel: 407 303 3697; Fax: 407 303 3634; E-mail: constantine.mavroudis.md@flhosp.org
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Abstract

Respect for patient autonomy is an important and indispensable principle in the ethical practice of clinical medicine. Legal tenets recognise the centrality of this principle and the inherent right of patients of sound mind – properly informed – to make their own personal medical decisions. In the course of everyday medical practice, however, challenging cases may result in ethical dilemmas for the patient, the physician, and society. Resolution of these dilemmas requires a thorough understanding of the underlying principles that allow the clinician to make informed decisions and to offer considered therapeutic options to the patient. We argue in this paper that there is also need for a transition of moral competency from understanding principles to attaining virtue in the classic Aristotelian tradition. Achieving moral virtue is based on a lifetime of learning, practising, and watching how others, who have achieved virtue, act and perform their duties. We further claim that learning moral virtue in medical practice is best realised by incorporating the lessons learnt during daily rounds where frank discussions and considered resolutions can occur under the leadership of senior practitioners who have achieved a semblance of moral excellence.

Keywords

Medical ethicspatient rightsphysician trainingutilitariandeontologicalvirtue ethics
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 8: HeartWeek 2015 , December 2015 , pp. 1615 - 1620
Copyright
© Cambridge University Press 2015 

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Footnotes

*

Presented at the Johns Hopkins All Children’s Heart Institute 15th Annual International Symposium on Congenital Heart Disease, Saint Petersburg, Florida, United States of America, Friday 6 February, 2015 to Monday 9 February, 2015.

References

1.Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics, 6th edn. Oxford University Press Inc, New York, 2009.Google Scholar
2.Berg, JW, Applebaum, PS, Lidz, CW, Parker, LS (eds). Informed Consent: Legal Theory and Clinical Practice, 2nd edn. Oxford University Press Inc, New York, 2001.CrossRefGoogle Scholar
3.Plato. Meno. In: Hamilton E, Cairns H (eds). The Collected Dialogues (translated by WKC Guthrie), Bollingen Series LXXI. Princeton University Press, Princeton, New Jersey, 1989.Google Scholar
4.Plato Republic. In: Hamilton E, Cairns H (eds). The Collected Dialogues (translated by P Shorey), Bollingen Series LXXI. Princeton University Press, Princeton, New Jersey, 1989.Google Scholar
5.Aristotle. The Nicomachean Ethics Book III (translated by Sir D Ross). Oxford University Press, London, 1954.Google Scholar
6.MacIntyre, A. After Virtue: A Study in Moral Theory, 3rd edn. University of Notre Dame Press, Notre Dame, Indiana, 2007.Google Scholar
7.MacIntyre, A. Whose Justice? Which Rationality?. University of Notre Dame, Notre Dame, Indiana, 1988.Google Scholar
8.Nozick, R. The Nature of Rationality. Princeton University Press, Princeton, New Jersey, 1993.CrossRefGoogle Scholar
9.Kant, I. Grounding for the Metaphysics of Morals, 3rd edn. (translated by JW Ellington [1785]). Hackett Publishing Co, Cambridge, Massachusetts, 1993.Google Scholar
10.Mill, JS. Utilitarianism. Parker, Son, & Bourn West Strand, London, 1863, Retrieved July 1, 2015, from https://archive.org/details/a592840000milluoftGoogle Scholar
11.Mill, JS. On Liberty, 2nd edn. Parker, Son, & Bourn West Strand, London, 1859.Google Scholar
12.Anscombe, GEM. Modern moral philosophy. Philosophy 1958; 33: 1–16.CrossRefGoogle Scholar
13.Smart, JJC, Williams, B. Utilitarianism: For and Against. Cambridge University Press, New York, 1973.CrossRefGoogle Scholar
14.Nagel, T. Mortal Questions. Cambridge University Press, New York, 1979.Google Scholar
15.Taylor, C. Sources of the Self: The Making of the Modern Identity. Harvard University Press, Cambridge, Massachusetts, 1989.Google Scholar
16.Lyons, D. Forms and Limits of Utilitarianism. Clarendon Press, Oxford, 1965.CrossRefGoogle Scholar
17.Van Stavern, I. Beyond utilitarianism and deontology: ethics in economics. Rev Polit Econ 2007; 19: 21–35.CrossRefGoogle Scholar
18.Birden, H, Glass, N, Wilson, I, Harrison, M, Usherwood, T, Nass, D. Defining professionalism in medical education: a systematic review. Med Teach 2014; 36: 47–61.CrossRefGoogle ScholarPubMed
19.Mavroudis, C. Presidential address, the Southern Thoracic Surgical Association: a partnership in courage. Ann Thorac Surg 2003; 75: 1366–1371.CrossRefGoogle Scholar
20.Aristotle. The metaphysics. In Barnes, J (ed.). The Complete Works of Aristotle: The Revised Oxford Translation. Princeton University Press, Princeton, New Jersey, 1984.Google Scholar
21.Chamberlain, JE, Nisker, JA. Residents’ attitudes to training in ethics in Canadian obstetrics and gynecology programs. Obstet Gynecol 1995; 85: 783–786.CrossRefGoogle ScholarPubMed
22.Parker, L, Watts, L, Scicluna, H. Clinical ethics ward rounds: building on the core curriculum. J Med Ethics 2012; 38: 501–505.CrossRefGoogle ScholarPubMed
23.Wen, LS, Baca, JT, O’Malley, P, Bhatia, K, Peak, D, Takayesu, JK. Implementation of small-group reflection rounds at an emergency medicine residency program. CJEM 2013; 15: 175–177.CrossRefGoogle ScholarPubMed