Abstract
I utilize, in this chapter, the ontological virtue of caring to explicate specifically the notion of virtuous physician. Briefly, caring is a fundamental disposition in which one exhibits profound compassion or empathy for the suffering of another in order to relief that suffering. I next examine two ontic virtues derived from caring, care and competence, which are important in medical practice. The discussion then turns to the ontological vice of the unvirtuous physician—uncaring—and the two ontic vices derived from it—carelessness and incompetence.
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Interestingly, the majority of these professionals are nurses, even though some nurses question caring or care as the basis for nursing practice or ethics (Warelow, 1996). Pamela Salsberry (1992), for example, argues that virtue theories based on caring do not provide an adequate replacement for duty-based theories of nursing practice.
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Traditionally, the ontological refers to fundamental or basic existence, i.e. what is prior to or makes existence actual, while the ontic refers to actual existence or something’s facticity. Thus, caring as an ontological virtue is prior to or makes possible the existence of other virtues like care and competence, which are instantiations of caring. Although the use of caring and care might appear strained at times in subsequent discussion, still the distinction is important in terms of explicating precisely the philosophical foundation of the notion of virtuous physician and the specific roles the ontological virtue of caring and the ontic virtue of care play in that notion.
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Mayeroff’s notion of caring operates differently depending on context. For example, in terms of parenting caring involves an intimacy and affection not found in professional relationships such as the patient-physician relationship.
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Mayeroff adds that one can take care of not only persons but also things, such as ideas or physical objects.
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Roach also identifies other C-attributes, such as comportment and communication, in caring.
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The distinction between co-feeling and empathy is Gilligan’s, in which she takes empathy to be identification with another’s feelings in contrast to co-feeling which maintains the autonomy or integrity of the caring agent, as well as the person cared for. Michael Slote (2007), among others, criticizes this distinction claiming that empathy, based on current psychological research, is a multifaceted notion and that co-feeling is simply one species of empathy.
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Interestingly, Held considers Slote a prime exponent of care ethics as a species of virtue ethics.
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Personally, I envision care ethics as a species of virtue ethics since care is a central virtue to the larger enterprise of virtue ethics.
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Trust here refers to more than simple reliance upon a physician’s skill, but more importantly, it represents an attitude of deeply felt faith in the physician as a caring and competent person who can meet a patient’s overall medical needs.
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In general, the unvirtuous person vis-à-vis the virtuous person simply lacks virtues, i.e. non-virtuous, and may not exhibit a vice, while the vicious person vis-à-vis the virtuous person not only lacks virtue but exhibits vice.
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Interestingly, however, Mark Quirk and co-workers find that whether the healthcare provider was caring or uncaring depended largely upon the patient’s perception (Quirk et al., 2008). For instance, a clinician’s inquiry whether patients has someone they could discuss a cancer diagnosis was viewed as uncaring by some patients. Whether a healthcare worker is caring or uncaring is, they conclude, “in the eye of the beholder” (Quirk et al., 2008, p. 364). However, this conclusion does not exclude the reality that uncaring healthcare providers often do cause substantial physical and mental harm.
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I would like to thank Rachel Sherhart for drawing my attention to this clinical case.
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A fourth possible form of carelessness1 exists. The healthcare provider is competent both technically and ethically. In this case, the provider meets both the patient’s physical and existential needs but at some point he or she is unable to sustain that competence in order to meet those needs.
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A rare form is the healthcare provider who cares about the patient but is incompetent both technically and ethically to care for the patient. Such a provider, if such a person could be called that, may be the result of a terribly faulty education. Of course, the goal is a healthcare provider who cares about the patient’s physical and existential needs so that he or she is fully competent both technically and ethically to care for those needs.
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Robert Veatch (1985) also contends that virtues are not required for medical practice, under certain—if not most—circumstances. He claims that technical expertise is what is required, especially with respect to what he calls “stranger medicine,” i.e. medicine practiced among strangers. Daniel Putman (1988), in critiquing Veatch, argues that even for stranger medicine virtues are necessary for consistent medical practice—particularly when practice challenges a physician’s self-interests.
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Curzer cites with approval Veatch’s claim that contemporary medicine is “stranger medicine,” since patients and physicians are generally strangers to one another.
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Marcum, J.A. (2012). On Caring and Uncaring. In: The Virtuous Physician. Philosophy and Medicine(), vol 114. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2706-9_4
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