The Role of the Virtues in Physicians’ Care of Dying Patients
Lydia Dugdale, MD, Yale School of Medicine
Care of a dying patient exacts a toll on all involved, including physicians. The doctor’s responsibilities as custodian of the deathbed might be characterized by multiple distinct yet competing roles: to instill hope despite the finitude of the human body, to speak honestly about the imminence of death, to persist in excellent care despite adverse circumstances, to ensure that the patient’s wishes are met, and to act with beneficent authority. Held together, these roles often contradict one another, generating unresolved tensions for physicians who care for patients as they experience bodily death.
Individuals and communities have for millennia relied upon discussion of the virtues to make sense of how they should live their lives. In this paper, I will draw from that discussion in order to think through how physicians might best care for the dying. For example, an account based on virtue ethics might re-interpret these competing roles as tensions between the virtues of hope, courage, patience, regard for persons, and beneficence (among others). How can one both speak with courage about the proximity of death and act with hope? How does one patiently care for the dying when all concerned favor an immediate and assisted death? How can a doctor maintain a high regard for the patient whose wishes at the end of life directly contradict the physician’s acts of beneficence? I will explore how virtue ethics might offer a framework for addressing such conflicts. In particular, I will consider the concept of practical wisdom (or prudence) and ask whether it might be useful or sufficient for reconciling such tensions among the virtues.
Care of a dying patient exacts a toll on all involved, including physicians. The doctor’s responsibilities as custodian of the deathbed might be characterized by multiple distinct yet competing roles: to instill hope despite the finitude of the human body, to speak honestly about the imminence of death, to persist in excellent care despite adverse circumstances, to ensure that the patient’s wishes are met, and to act with beneficent authority. Held together, these roles often contradict one another, generating unresolved tensions for physicians who care for patients as they experience bodily death.
Individuals and communities have for millennia relied upon discussion of the virtues to make sense of how they should live their lives. In this paper, I will draw from that discussion in order to think through how physicians might best care for the dying. For example, an account based on virtue ethics might re-interpret these competing roles as tensions between the virtues of hope, courage, patience, regard for persons, and beneficence (among others). How can one both speak with courage about the proximity of death and act with hope? How does one patiently care for the dying when all concerned favor an immediate and assisted death? How can a doctor maintain a high regard for the patient whose wishes at the end of life directly contradict the physician’s acts of beneficence? I will explore how virtue ethics might offer a framework for addressing such conflicts. In particular, I will consider the concept of practical wisdom (or prudence) and ask whether it might be useful or sufficient for reconciling such tensions among the virtues.