Human Flourishing in the Medical Profession
Lily Abadal, PhD, University of South Florida; Rafael Flores, PhD (c) and William Kuehnle, PhD (c), The Ohio State University
Though much of the work in clinical ethics focuses specifically on the patient and their biomedical, psychological, and spiritual needs, we turn our attention to the medical professionals themselves and their wellbeing. More specifically, we explore how to best care for the souls of medical professionals and question what structures best protect the excellent practice of medicine. For instance, how might doctors, nurses, and other health care workers flourish as human beings in their practice of medicine? How is their ability to do so sometimes thwarted? What is the role of healthcare institutions in promoting or hindering this? Our panel seeks to answer these questions and will examine this notion of human flourishing in the medical profession using an Thomistic-Aristotelian framework of virtue ethics as articulated by Edmund Pellegrino, Nicanor Pier Giorgio Austriaco, Therese Lysaught, Alasdiar MacIntyre, Christopher Tollefsen, and Farr Curlin.
This is a particularly poignant and timely theme given the nationwide “burnout” of nurses and other health care workers. Though many cite increased hours and stagnant pay as the cause, we contend that there are deeper spiritual, existential, and psychological wounds at play here, ones that inhibit human flourishing in the profession. Moreover, these wounds have been eclipsed in healthcare institutions due to the increasingly myopic focus on technical effectiveness, scale, and innovation. As it has been so well articulated in this year’s description of the Medicine & Religion Conference theme, “most of contemporary medicine is animated by pragmatic questions and framed by technological solutions: what are our technological, clinical, medical abilities?” Though these pragmatic questions are important, they are not the only questions. Perhaps they are not even the most important ones either. Only by returning to the most fundamental questions about medicine can hospitals best understand how to best support and retain excellent medical professionals and acknowledge the humanity of the workers that provide care in the process. These fundamental questions include: What is the purpose of medicine? What is health? What protects the patient/physician relationship? These questions are best answered using the resources of the virtue ethics tradition. Thus, we contend serious exploration into the theme of our panel is warranted and essential for understanding impediments to human flourishing in the profession and ways to reimagine new paths forward.
This panel will include three contributors. Our first panelist explores the notion of Chronic Moral Injury (CH-MI) (Abadal & Potts, 2022) and how it occurs in the context of healthcare institutions. Generally speaking, “CH-MI occurs when institutions betray the internal and common goods they must strive to promote and therefore marginalize the very practices they aim to sustain” (Abadal & Potts, 2022). She situates this phenomenon (CH-MR) within the context of what Tollefsen & Carr (2021) call “The Provider of Services Model” (PSM) of healthcare. Ultimately, she contends that CH-MR results among healthcare professionals when the telos of medicine is forgotten by Weberian administrators who allow consumers to determine the standards of excellence in the profession. Preventing CH-MR, and the burnout that results from it, will require a radical shift in healthcare–a shift to “The Way of Medicine.”
Additionally, our second panelist asks how differing conceptions of the healthcare profession contribute or distract the flourishing of medical practitioners. In recent academic literature, some bioethicists have asserted that a modern reinterpretation of the Hippocratic Oath might serve as a suitable conceptual and ethical framework for understanding the medical profession (Cruess & Cruess, 2014). These arguments contend that an adaptation of the Hippocratic Oath fit for the twenty-first century would demonstrate that medical professionals are identified and bound by a social contract, one that enumerates both the duties demanded of medical professionals and the form and proportion of the compensation offered in return. But this social contract framework for conceptualizing the medical profession is deficient conceptually and ethically, despite its institutional utility. In place of a social contract conception of the medical profession, this panelist argues that a virtue-based approach to understanding the identity and ethical boundaries of the medical profession reorients medicine around human flourishing, not only for the sake of patients but especially for the sake of physicians and practitioners.
Finally, our third panelist will seek to offer a reflection on how the recent COVID-19 vaccine mandates and the pushback within Catholic healthcare serves as a case study on moral injury caused by biopolitics driving perspective in Catholic ethics. He will unpack how the conscience-claims made by many Catholics - and supported by some notable Catholic organizations, bishops, theologians, etc - relied upon the primacy of conscience to claim that mandating a vaccine was contrary to their religious values, and as such receiving said vaccine would cause moral injury. From this point the panelist will claim that this was done without the practice of reflective equilibrium between Catholic ethical principles such as the common good and thus reveals that the moral injury experienced due to vaccine mandates by Catholic healthcare workers was a moral self-injury due to a lack of said reflective equilibrium. This in turn will lead to reflection on how Catholic healthcare needs to form its Catholic participants in a holistic understanding of Catholic bioethical principles so as to prevent unneeded experiences of moral injury, and cultivate human flourishing within its walls.
From these three perspectives, we anticipate the emergence of a synergy that points toward human flourishing as the end of the medical profession. When the aims of medicine are reduced to outcomes determined by strictly empirical metrics, both the patient and physician suffer. So, our panel will offer an alternative vision of the medical profession, a vision that identifies human flourishing as the aim of medical practices. With this in view, the consequences of chronic moral injury on medical practitioners will become clear, the ambiguity over the identity and social role of physicians will resolve by rejecting social contract models, and the necessity of forming physicians and their consciences according to holistic visions of human life will be made explicit. At a time of increasing suspicion of physicians and a crisis of medical credibility, our panelists will present a model of dialogue about medicine that we hope will inspire a turn toward the concept of human flourishing.
This is a particularly poignant and timely theme given the nationwide “burnout” of nurses and other health care workers. Though many cite increased hours and stagnant pay as the cause, we contend that there are deeper spiritual, existential, and psychological wounds at play here, ones that inhibit human flourishing in the profession. Moreover, these wounds have been eclipsed in healthcare institutions due to the increasingly myopic focus on technical effectiveness, scale, and innovation. As it has been so well articulated in this year’s description of the Medicine & Religion Conference theme, “most of contemporary medicine is animated by pragmatic questions and framed by technological solutions: what are our technological, clinical, medical abilities?” Though these pragmatic questions are important, they are not the only questions. Perhaps they are not even the most important ones either. Only by returning to the most fundamental questions about medicine can hospitals best understand how to best support and retain excellent medical professionals and acknowledge the humanity of the workers that provide care in the process. These fundamental questions include: What is the purpose of medicine? What is health? What protects the patient/physician relationship? These questions are best answered using the resources of the virtue ethics tradition. Thus, we contend serious exploration into the theme of our panel is warranted and essential for understanding impediments to human flourishing in the profession and ways to reimagine new paths forward.
This panel will include three contributors. Our first panelist explores the notion of Chronic Moral Injury (CH-MI) (Abadal & Potts, 2022) and how it occurs in the context of healthcare institutions. Generally speaking, “CH-MI occurs when institutions betray the internal and common goods they must strive to promote and therefore marginalize the very practices they aim to sustain” (Abadal & Potts, 2022). She situates this phenomenon (CH-MR) within the context of what Tollefsen & Carr (2021) call “The Provider of Services Model” (PSM) of healthcare. Ultimately, she contends that CH-MR results among healthcare professionals when the telos of medicine is forgotten by Weberian administrators who allow consumers to determine the standards of excellence in the profession. Preventing CH-MR, and the burnout that results from it, will require a radical shift in healthcare–a shift to “The Way of Medicine.”
Additionally, our second panelist asks how differing conceptions of the healthcare profession contribute or distract the flourishing of medical practitioners. In recent academic literature, some bioethicists have asserted that a modern reinterpretation of the Hippocratic Oath might serve as a suitable conceptual and ethical framework for understanding the medical profession (Cruess & Cruess, 2014). These arguments contend that an adaptation of the Hippocratic Oath fit for the twenty-first century would demonstrate that medical professionals are identified and bound by a social contract, one that enumerates both the duties demanded of medical professionals and the form and proportion of the compensation offered in return. But this social contract framework for conceptualizing the medical profession is deficient conceptually and ethically, despite its institutional utility. In place of a social contract conception of the medical profession, this panelist argues that a virtue-based approach to understanding the identity and ethical boundaries of the medical profession reorients medicine around human flourishing, not only for the sake of patients but especially for the sake of physicians and practitioners.
Finally, our third panelist will seek to offer a reflection on how the recent COVID-19 vaccine mandates and the pushback within Catholic healthcare serves as a case study on moral injury caused by biopolitics driving perspective in Catholic ethics. He will unpack how the conscience-claims made by many Catholics - and supported by some notable Catholic organizations, bishops, theologians, etc - relied upon the primacy of conscience to claim that mandating a vaccine was contrary to their religious values, and as such receiving said vaccine would cause moral injury. From this point the panelist will claim that this was done without the practice of reflective equilibrium between Catholic ethical principles such as the common good and thus reveals that the moral injury experienced due to vaccine mandates by Catholic healthcare workers was a moral self-injury due to a lack of said reflective equilibrium. This in turn will lead to reflection on how Catholic healthcare needs to form its Catholic participants in a holistic understanding of Catholic bioethical principles so as to prevent unneeded experiences of moral injury, and cultivate human flourishing within its walls.
From these three perspectives, we anticipate the emergence of a synergy that points toward human flourishing as the end of the medical profession. When the aims of medicine are reduced to outcomes determined by strictly empirical metrics, both the patient and physician suffer. So, our panel will offer an alternative vision of the medical profession, a vision that identifies human flourishing as the aim of medical practices. With this in view, the consequences of chronic moral injury on medical practitioners will become clear, the ambiguity over the identity and social role of physicians will resolve by rejecting social contract models, and the necessity of forming physicians and their consciences according to holistic visions of human life will be made explicit. At a time of increasing suspicion of physicians and a crisis of medical credibility, our panelists will present a model of dialogue about medicine that we hope will inspire a turn toward the concept of human flourishing.