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Autonomy and the Principles of Medical Practice

  • J. Thomas CookEmail author
  • Constantine Mavroudis
  • Constantine D. Mavroudis
Chapter
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Abstract

Respect for patient autonomy is an important and indispensable principle in the ethical practice of clinical medicine. Legal tenets recognize 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 chapter 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, practicing, 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 realized by incorporating the lessons in 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 ethics Patient rights Physician training Utilitarian Deontological Virtue ethics 

References

  1. 1.
    Berg JW, Appelbaum PS, Lidz CW, Parker LS. Informed consent: legal theory and clinical practice. 2nd ed. New York: Oxford University Press; 2001.Google Scholar
  2. 2.
    Cook T, Mavroudis CD, Jacobs JP, Mavroudis C. Respect for autonomy as a virtue in clinical medicine. Cardiol Young. 2015;25:1615–20.CrossRefGoogle Scholar
  3. 3.
    Plato. Meno, translated by W.K.C. Guthrie. In: Hamilton E, Cairns H, editors. The collected dialogues, Bollingen series LXXI. Princeton: Princeton University Press; 1989.Google Scholar
  4. 4.
    Plato. Republic, translated by Paul Shorey. In: Hamilton E, Cairns H, editors. The collected dialogues, Bollingen series LXXI. Princeton: Princeton University Press; 1989.Google Scholar
  5. 5.
    Aristotle: the Nicomachean ethics, Book III (Translated by Sir David Ross). London: Oxford University Press; 1954.Google Scholar
  6. 6.
    MacIntyre A. After virtue: a study in moral theory. 3rd ed. Notre Dame: University of Notre Dame Press; 2007.Google Scholar
  7. 7.
    MacIntyre A. Whose justice? Which rationality? Notre Dame: University of Notre Dame; 1988.Google Scholar
  8. 8.
    Nozick R. The nature of rationality. Princeton: Princeton University Press; 1993.Google Scholar
  9. 9.
    Kant I. Grounding for the metaphysics of morals [1785] (translated by James Wesley Ellington). Indianapolis: Hackett Pub Co.; 1993.Google Scholar
  10. 10.
    Mill JS. Utilitarianism. 1st ed. London: Parker, Son & Bourn, West Strand; 1863.Google Scholar
  11. 11.
    Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th ed. New York: Oxford University Press; 2009.Google Scholar
  12. 12.
    Mill JS. On liberty. 2nd ed. London: Parker, Son, & Bourn West Strand; 1859.Google Scholar
  13. 13.
    Anscombe GEM. Modern moral philosophy. Philosophy. 1958;33:1–16.CrossRefGoogle Scholar
  14. 14.
    Smart JJC, Williams B. Utilitarianism: for and against. New York: Cambridge University Press; 1973.CrossRefGoogle Scholar
  15. 15.
    Nagel T. Mortal questions. New York: Cambridge University Press; 1979.Google Scholar
  16. 16.
    Taylor C. Sources of the self: the making of the modern identity. Cambridge: Harvard University Press; 1989.Google Scholar
  17. 17.
    Lyons D. Forms and limits of utilitarianism. Oxford: Clarendon Press; 1965.CrossRefGoogle Scholar
  18. 18.
    Van Stavern I. Beyond utilitarianism and deontology: ethics in economics. Rev Political Econ. 2007;19:21–35.CrossRefGoogle Scholar
  19. 19.
    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 Scholar
  20. 20.
    Mavroudis C. Presidential address: a partnership in courage. Ann Thorac Surg. 2003;75(5):1366–71.CrossRefGoogle Scholar
  21. 21.
    Aristotle. The metaphysics. In: Barnes J, editor. The complete works of Aristotle: the revised oxford translation. Princeton: Princeton University Press; 1984.Google Scholar
  22. 22.
    Chamberlain JE, Nisker JA. Residents’ attitudes to training in ethics in Canadian obstetrics and gynecology programs. Obstet Gynecol. 1995;85:783–6.CrossRefGoogle Scholar
  23. 23.
    Parker L, Watts L, Scicluna H. Clinical ethics ward rounds: building on the core curriculum. J Med Ethics. 2012;38:501–5.CrossRefGoogle Scholar
  24. 24.
    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;15:175–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • J. Thomas Cook
    • 1
    Email author
  • Constantine Mavroudis
    • 2
    • 3
  • Constantine D. Mavroudis
    • 4
  1. 1.Department of PhilosophyRollins CollegeWinter ParkUSA
  2. 2.Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Division of Cardiovascular SurgeryJohns Hopkins All Children’s HospitalSt. PetersburgUSA
  4. 4.Department of SurgeryUniversity of Pennsylvania School of MedicinePhiladelphiaUSA

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