By Tom L. Beauchamp, James F. Childress
Principles of Biomedical Ethics, Oxford University Press, 2008
Part I, 2 - Moral Character
In Chapter 1, we concentrated on the analysis and justification of acts and policies. We featured the language of ethical principles, rules, obligations, and rights. In this chapter, we concentrate on the moral virtues and moral character. Whereas ethics grounded in principles emphasizes action, character ethics or virtue ethics emphasizes the agent who performs actions. We also extend our analysis to the domain of moral ideals. These categories complement the analysis in the previous chapter without undermining principles and rules.
Often, what counts most in the moral life is not consistent adherence to principles and rules, but reliable character, good moral sense, and emotional responsiveness. Even specified principles and rules do not convey what occurs when parents lovingly play with nature their children or when physicians and nurses exhibit compassion, patience, and responsiveness in encounters with patients and families. Our feelings and concerns for others leads us to actions that cannot be reduced to instances of rule-following, and we all recognize that morality would be a cold and uninspiring practice without various emotional responses and heart-felt ideals that reach beyond principles and rules.
Some philosophers have criticized a heavy emphasis on the virtues. They see the virtues as lacking order and as difficult to unify in a systematic fashion. Though we accept the view that principles and virtues are very different in nature and are taught very differently, we believe that we can bring some order to standards of virtue. Some forms of order emerge directly from the connection between moral virtues and moral principles and rules. In addition, the goals and structure of medicine, health care, and research themselves give some order to the virtues in biomedical ethics.
We begin by analyzing the concept of virtue and considering the special status of the virtues. We then examine virtues in professional roles and explicate five focal virtues that are of particular importance in medicine, health care, and research.
The Concept of Virtue
A virtue is a trait of character that is socially valuable, and a moral virtue is a morally valuable trait of character. It is not sufficient that social groups approve a trait and regard it as moral for it to be morally virtuous. A claim or perception of moral virtue must have the support of moral reasons. Communities sometimes disvalue persons who act virtuously or admire persons for their meanness and churlishness. Moral virtue, then, is more than whatever is socially approved.
Some define “moral virtue” as a disposition to act or a habit of acting in accordance with moral principles, obligations, or ideals. For example, they might understand the moral virtue of nonmalevolence as the trait a person has of abstaining from causing harm to others when it would be wrong to harm them. However, this definition unjustifiably derives virtues wholly from principles and fails to capture the importance of motives in the virtuous person’s actions. We care morally about people’s motives, and we care especially about their characteristic motives, that is, the motives deeply embedded in their character. Persons who are motivated in this manner by sympathy and personal affection, for example, meet our approval, whereas others who act the same way, but from motives of personal ambition might not.
Imagine a person who discharges a moral obligation because it is an obligation, but who intensely dislikes being placed in a position in which the interests of others override his or her own interests. This person does not feel friendly toward or cherish others, and he or she respects their wishes only because obligation requires it. This person can nonetheless perform a morally right action and have a disposition to perform that action. But if the motive is improper, a critical moral ingredient is missing; and if a person characteristically lacks this motivational structure, a necessary condition of virtuous character is absent. The act may be right and the actor blameless, but neither the person nor the act is virtuous. In short, people may be disposed to do what is right, intend to do it, and do it, while also yearning to avoid doing it. Persons who characteristically perform morally right actions from such a motivational structure are not morally virtuous even if they always perform the morally right action.
Aristotle drew an important (although underdeveloped) distinction between right action and proper motive, which he also analyzed in terms of the distinction between external performance and internal state. An action can be right without being virtuous, he maintained, but an action can be virtuous only if performed from the right state of mind. Both right action and right motive are present in a virtuous action: “The agent must … be in the right state when he does [the actions]. First, he must know [that he is doing virtuous actions]; second, he must decide on them, and decide on them for themselves; and third, he must also do them from a firm and unchanging state,” including the right state of emotion and desire. “The just and temperate person is the one who [merely] does these actions, but the one who also does them in the way in which just or temperate people do them.”
We can conclude our analysis of the nature of virtue by incorporating Aristotle’s observations. In addition to being properly motivated, a virtuous person will experience appropriate feelings, such as sympathy and regret – even when the feelings are not motives and no action can result from the feelings. However, some virtues have no clear link to either motives or feelings. Moral discernment and moral integrity – two virtues treated later in this chapter – are examples. Here psychological properties other that feelings are paramount. We will integrate these virtues into our analysis later in the chapter.
The Special Status of the Virtues
Some writers in character ethics maintain that the language of obligation is derivative from what they view as the more basic language of virtue. They think that a person disposed by character to have good motives and desires provides the basic model of the moral person and that this model of action-from-obligation, because right motives and character tell us more about moral worth than do right actions performed under the prod of obligation.
This position is attractive, because we are often more concerned about the character and motives of persons than about the conformity of their acts to rules. When a friend performs an act of “friendship”, we expect it not to be motivated entirely from a sense of obligation to us, but because the person has a desire to be friendly, feels friendly, wants to keep friends in good cheer, and values friendship. The friend who acts only from obligation lacks the virtue of friendliness, and, absent this virtue, the relationship lacks moral merit.
Some writers in biomedical ethics also argue that attempt in obligation-oriented theories to replace the virtuous judgments of health care professionals with rules, codes, procedures will not produce better decisions and actions. Rather than using institutional rules and government regulations to protect subjects in research, they claim that the most reliable protection is the presence of an “informal, conscientious, compassionate, responsible researcher.” From this perspective, character is more important than conformity to rules, and virtues should be inculcated and cultivated over time through educational interactions, role models, and the like.
This conclusion provides a significant reason fro incorporating the virtues into biomedical ethics and into medical and nursing education, but it needs elaboration. 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.
A person’s character informs our judgment of the person and our assessment of his or her actions. If a virtuous person makes a mistake in judgment, thereby performing a morally wrong act, he or she would be less blameworthy than an habitual offender who performed the same act. In his chronicle of life under the Nazi SS in the Jewish ghetto in
, Thomas Keneally describes a physician faced with a grave dilemma: either inject cyanide into four immobile patients or abandon them to the SS, who were at that moment emptying the ghetto and had already demonstrated that they would brutally kill all captives and patients. This physician, Keneally reports, “suffered painfully from a set of ethics as intimate to him as the organs of his own body.” Here is a person of the highest moral character and virtue, motivated to act rightly and even heroically, yet who at first had no idea what was the morally right action. Ultimately, with uncertainty and reluctance, the physician elected active euthanasia (using 40 drops of hydrocyanic acid) without the consent or knowledge of the four doomed patients – an act almost universally denounced by canons of professional medical ethics. Even if one thinks that the physician’s act was wrong and blameworthy – a judgment we reject – no one could reasonably make a judgment of blame or demerit directed at the physician’s motives or character. Having already risked death by choosing to remain at his patient’s beds in the hospital rather than take a prepared escape route, this physician is a moral hero who over time displayed an extraordinary moral character. Cracow, Poland
Judgments of agent’s praiseworthiness and blameworthiness are significantly tied to agent’s motives, which serve as sign of their character. However, in contrast to radical forms of character ethics, we do not hold that the merit in an action resides in motive or character alone. The action must be appropriately gauged to bring about the desired results and must conform with relevant principles and rules. For example, the physician or nurse who is appropriately motivated to help a patient but who acts incompetently in seeking the desired result does not act in a praiseworthy manner.