Moral Side of Medicine
Contemporary opinions on engaging in these conversations, revealed with little more than a perfunctory online search, are myriad. However, one may look to the history of medical ethics, which has produced well-known touchstones such as the Hammurabi Code, the Hippocratic Oath and Thomas Percival’ s Medical Ethics, for possible answers. Thomas Percival’ s book, notably, served as“ a paradigmatic source for the first, and subsequent, Code of the American Medical Association.” 3 Our modern AMA Code of Ethics does acknowledge the imbalance of power in a physician-patient relationship and the need to approach any political conversation with caution when the physician wishes to express his or her political views to a patient. 4 The quandary presented herein, notably, has the roles reversed. An answer, however, can be found in the ethical constructs behind Percival’ s Medical Ethics, which relied heavily on the concept of virtue ethics. This ethical theory is“ based solely on the principles of beneficence and non-maleficence, along with the virtues of physicians who applied these principles.” 5 While it doesn’ t necessarily ignore rules or consequences, virtues are the fundamental focus of the theory. 6 Virtue ethics puts moral character at the center and, simply put, asks,“ What would an honest, compassionate and wise doctor do?”
Self-inquiry of virtuous ethics may well be the escape route when confronted with controversial or political conversations that back a physician, however well intent on engaging in relationship building with a patient, into a corner. Virtue ethics at one’ s side, physicians are not above engaging but, instead, are just good enough to engage in these conversations with patients. Dr. Barton, for his part, did not enforce a particular ethical or moral code on those listening to his remarks in that 1964 freshman orientation. He challenged his listeners, instead, to contemplate moral and ethical questions throughout their future careers. A“ virtuous” physician, an educated voice in the exam room, would do the same, providing the patient an opportunity for perspective and reflection. Whereas, on the contrary, confrontation and protracted discourse distract and diverge from the ultimate goals of a patient interaction.
Often met with some regard, in the experience of this author, presenting a patient, when mired in controversial or political talk, with an idea about which to give consideration can quickly change the tone of a room. Strategies abound and can include simply presenting a counterpoint or gently acknowledging a stated contradiction. Patient statements with factual errors may allow a physician to inquire about quality and quantity of sources of information and an opportunity to present new sources of quality information. Difficult individual decisions, informed by the political, can be reframed in the context of public health, emphasizing the effect of individual decisions, in aggregate, on the population as a whole. Once an emotionally charged thread of conversation is starved of the confrontation of dissension or unanimity, the physician has the available option to, if appropriate, move on.
Regardless of the motivation for straying into controversial territory during their time in the exam room, which may or may not be evident, patients present for counsel( whether it is ultimately accepted or not). Silence from a physician can be easily misinterpreted as indifference or dismissiveness. Acknowledging the issue at hand, and encouraging further deliberation and perspective, is laudable both for encouraging thought and for behavior that is“ honest, compassionate and wise.”
The concept of virtue ethics likely feels familiar to most physicians, but is particularly at home in the primary care setting given the undue variety of queries that can arise during patient visits. While a comfort with virtue ethics may be a result of upbringing, personal conviction or medical training( or all three), it is not the exclusive ethical theory at play in any exam room. Nevertheless, the virtue ethics construct forces physicians to ask themselves the question we ought to ask at every decision, if only the luxury of time be omnipresent in practice to allow such dwellings. Dr. Barton, concluding his 1964 address, noted that the varying moral and ethical approaches over time seemed to borrow from one another, and he conjectured that they often ended up saying somewhat the same thing. He further noted,“ In essence, the present-day philosophers, religionists and scientists are talking about three broad concepts: freedom, truth and love.” As we engage with our patients in the present day, oh how much, and how little, has changed.
References
1
Barton, RT. SOURCES OF MEDICAL MORALS. JAMA. 1965 Jul 12; 193:133- 8. doi: 10.1001 / jama. 1965.
2
Jonathan F Will A brief historical and theoretical perspective on patient autonomy and medical decision making: Part II: The autonomy model. Chest. 2011 Jun; 139( 6): 1491-1497.
3
Pellegrino ED. Percival’ s Medical Ethics: The Moral Philosophy of an 18th-Century English Gentleman. Arch Intern Med. 1986; 146( 11): 2265 – 2269.
4
American Medical Association.( n. d.). Political communications( Opinion 2.3.4). AMA Code of Medical Ethics. code-medical-ethics. ama-assn. org / ethics-opinions / political-communications.
5
John M Luce +, Douglas B White # A History of Ethics and Law in the Intensive Care Unit. Crit Care Clin. 2009 Jan; 25( 1): 221 – x.
6
Hursthouse, Rosalind and Glen Pettigrove,“ Virtue Ethics”, The Stanford Encyclopedia of Philosophy( Summer 2026 Edition), Edward N. Zalta & Uri Nodelman( eds.),
URL = plato. stanford. edu / archives / sum2026 / entries / ethics-virtue /.
Dr. Kolter is an internist with Baptist Health.
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