Lecture 3

Virtues, Rules, and Professional Codes of Conduct

Necessity of Virtue

“A morally good person with the right configuration of desires and motives is more likely than others to understand what should be done, more likely to perform attentively the acts required, and even more likely to form and act on moral ideals.

“A person we trust is one who has an ingrained motivation and desire to perform right actions. Thus, the person we will recommend, admire, praise, and hold up as a moral model is the person disposed by character to be generous, caring, compassionate, sympathetic, fair, and the like.”Beauchamp and Childress, Principles of Biomedical Ethics, 5th ed., p.29.

Three kinds of failures of surgical residents

1. Technical • The resident discharges role

responsibilities conscientiously, but his or her technical training or information falls short of what the task requires

• Every surgical resident can be expected to make this sort of mistake occasionally

2. Judgmental

• A conscientious resident develops and follows an incorrect strategy

• Such a mistake is also to be expected

3. Normative

• The resident violates a norm of conduct, particularly by failing to discharge moral obligation conscientiously.

• Such an error is profoundly serious, especially when there is a pattern indicating a defect of moral character

Beauchamp and Childress, Principles of Biomedical Ethics, 5th ed., pp.30-31.

Honest error, mistake in good faith

vs.

Moral error; lack of conscientiousness

Insufficiency of virtues

• Virtues need direction as well, because a virtue alone can result in an condemnable action

• E.g., the virtue of courage can both save and destroy human lives

• The metaphor of compass

Virtue of Loyalty

• 50 years ago nurses are expected only to carry out the doctors’ orders

• Nowadays, nursing ethics do not regard this virtue as overriding

“Virtue Ethics”

• Good Character

• Good Habit

• Good Motive

• Ideal – Moral Saint, Moral Hero

Action Guides

• Legal Codes

• Moral Norms: principles and rules, duties and rights

• Directives: Professional Code of Conduct and others

• “Rules Ethics”

• To be vs. to do

• Fairy, “Prove yourself brave, truthful, and unselfish, and some day you will be a real boy”

• “You must learn to choose between right and wrong.”

• Pinocchio, “But how do I know?”

• Fairy, “Your conscience will tell you.”

有一次曹丕問其賓客：

「君父各有篤疾，有藥一丸，可救一人，當救君耶？父耶？」結果，「眾人紛紜，或父或君」

Moral Dilemma

“illegal” “immoral”

“professionally improper” (misconduct)

Illegal? Professionally improper? Immoral?

Ethics for health care professionals

Virtues rules (laws)

Moral rules in health care

(medical ethics)Prudent advices

Professional code of conduct

醫師專業守則 傳統中國醫德

外加規範 (moral rules) 內發美德 (moral virtues)

由外在監察的紀律守則（紀律處分）

透過制度，作外在強制，外在監管

發自內心的自然流露（良知的提醒及譴責）透過教育，增強自覺，自我督促，自律，自我修身

行為指引、準則、可表達為具體條文 / 條目/ 條例

可推行及監管，可客觀檢查有無遵守

習性、品挌、志向、立心、情操、動機、態度、感情、道德生命、理想人格、個人修養不是有或無二分，而是程度多寡，所以無單一客觀檢查方法

醫師專業守則 傳統中國醫德

醫師專業守則 傳統中國醫德外加規範 (moral rules) 內發美德 (moral virtue

s)針對人的惡念制惡、離惡、約束性、防止人失德（”專業上失當行為”）、規限及阻嚇人不作惡

消極離不仁範圍明確，有無二分

針對人的善心揚善、遷善、推動及激發人向善、培養人的善性、指導立德（培育美德 / 高尚品德），提供道德生命提升之方向積極近仁、成仁範圍廣闊，永無止境

醫師專業守則 傳統中國醫德

醫者患道德絕症私心、貪心、二心、粗心、野心、歹心、賊心、狼心、獸心不求痊癒，但求控制病情

醫者道德養生仁心、慈心、善心、惻隱之心、愛心、誠心增強抵抗力、免疫力，生命豐盛

醫師專業守則 傳統中國醫德

底線倫理（ minimalist ethics ），醫師操守的最低限度要求

止於至善（ maximalist ethics ），臻善臻美，醫師品德的極致表現

規範人不作庸醫（作醫之君子）

若作不到，是” 含靈巨賊”

鼓勵人努力作良醫、大醫（作醫之聖人）

若作不到，是醫之凡人

角色不同，各有局限；雙管齊下，相輔相成。任何一者皆不可偏廢，否則對人性（人的道德能力）或是估計太底，

或是估計太高。