Pathways to Moral Courage,” American Nurse Today 7, no. 5 (2012): 24-29; J. S. Murray, “Moral Courage in Healthcare,” Online Journal in Nursing 15, no. 3 (2010). 3. Lachman et al., “Doing the Right Thing,” 25. 4. J. O. Urmson, “Saints and Heroes,” in Essays on Moral Philosophy, ed. A. I. Melden (Seattle: University of Washington Press, 1958), 198-216, at 206. 5. I. Kant, Groundwork of the Metaphysics of Morals, trans. H. J. Paton (New York: Harper and Row, 1964). 6. This is not to suggest that utilitarians view the personal welfare of health professionals to be irrelevant. It is, rather, always subject to being overridden by countervailing social benefits. 7. Philosophers of both utilitarian and Kantian persuasions would most likely respond that their preferred moral theory is capable of accounting for supererogatory action with a bit of theoretical tweaking. We have found such attempts to be unconvincing, but this is not the place to argue our case. 8. Aristotle, Nicomachean Ethics, 1115b25. 9. For a robust defense of Aristotelian courage as an instance of practical reason, see D. Walton, Courage: A Philosophical Investigation (Berkeley: University of California Press, 1986), 59.
10. Aristotle focused on the threat of death in battle; see Nicomachean Ethics, 1115a25. 11. Time Magazine, “Person of the Year 2014: Ebola Healthcare Workers,” at http://www.time.com/ time-person-of-the-year-ebola-fighters. 12. American Nurses Association, “Justice Is Served: Texas Physician Pleads Guilty: ANA Gratified by Convictions in ‘Winkler County’ Nurses Whistleblower Case” (press release), November 8, 2011, http://nursingworld.org/FunctionalMenuCategories/ MediaResources/PressReleases/2011-PR/ Justice-is-Served-Texas-Physician-PleadsGuilty.pdf. 13. Aristotle, Nicomachean Ethics, 1115b20. 14. Ibid., 1106a5. 15. Some contemporary virtue theorists have discerned a tension or perhaps even a contradiction between Aristotle’s definition of virtue as a mean between extremes and the possibility of supererogatory action. How is it, they ask, that virtue is always a mean, while supererogation goes well beyond the mean in pursuing a good objective? Although the tide of contemporary scholarship seems to run against our position on the ultimate compatibility of supererogation and the doctrine of the mean, we are content to let this controversy play out in the virtue ethics literature while clinging, albeit tenuously, to the traditional view.
6.
16. Aristotle, Nicomachean Ethics, Book
17. Ibid., III.6. 18. L. Tessman, Burdened Virtues: Virtue Ethics for Liberatory Struggles (New York: Rowman & Littlefield, 2005), 125. 19. M. U. Walker, “Moral Luck and the Virtues of Impure Agency,” in Moral Contexts, M. U. Walker (New York: Rowman & Littlefield, 2003), 21-34, at 26. 20. Philosopher Amélie Oksenberg Rorty offers a particularly cogent discussion of the seductive attractions of “heroic” blindness, misread as virtue; A. O. Rorty, “The Two Faces of Courage,” Philosophy 61 (1986): 151-71. 21. Lachman et al., “Doing the Right Thing”; Murray, “Moral Courage in Healthcare.” 22. E. J. Gordon and A. B. Hamric, “The Courage to Stand Up: The Cultural Politics of Nurses’ Access to Ethics Consultation,” Journal of Clinical Ethics 17 (2006): 231-54. 23. E. G. Epstein and A. B. Hamric, “Moral Distress, Moral Residue, and the Crescendo Effect,” Journal of Clinical Ethics 20 (2009): 330-42. 24. Ibid. 25. Tessman, Burdened Virtues, 127. 26. Rorty, “The Two Faces of Courage,” 154. 27. Murray, “Moral Courage in Healthcare.”
Another Voice Practitioner Courage and Ethical Health Care Environments by justin oakley
I
n “Must We Be Courageous?,”1 Ann Hamric, John Arras, and Margaret Mohrmann highlight how contemporary accounts of the virtue of courage in health care often gloss over deeper problems in the underlying health care systems themselves. They express particular concerns about the appropriateness and personal costs of exhortations to health professionals to take courageous action in circumstances where this is “required only because of unethical institutional structures” (p. 39). For instance, inadequate whistleblowing protection procedures leave clinicians exposed to unnecessary risks
Justin Oakley, “Practitioner Courage and Ethical Health Care Environments,” Hastings Center Report 45, no. 3 (2015): 40-42. DOI: 10.1002/ hast.454
40 HASTI N G S C E N T E R R E P ORT
when reporting patient harms caused by clinician negligence or when speaking out against workplace bullying. The shortcomings of such procedures are unfair to individual practitioners when the onus is left on them to see that patients and colleagues are adequately protected. The failings of such systems are also unfair to the community, since relying in such ways on the extraordinary personal qualities of rare individuals risks distracting regulators’ attention from the underlying systemic issues. Hamric, Arras, and Mohrmann also bring out well how relevant background factors implicated in such harms can be overlooked by other approaches, such as utilitarianism, which tends to advise clinicians to respond well to present harms without necessarily investigating what caused a situation to become so dire in the first place. May-June 2015
These are valuable points, which are not adequately recognized in discussions of courage as a professional virtue in health care practice. I wish to extend, and qualify somewhat, these points here. The history of health care whistleblowing is indeed littered with cases where too much was left to too few. For example, the sorts of institutional incentives established to reward Australian hospitals for reducing the duration of patient admissions also created obstacles to legitimate whistleblowing, and unnecessarily high levels of courage and determination were necessary to overcome these obstacles. Intensive care nurse Toni Hoffman discovered this in her efforts to expose the dangerous practices of surgeon Jayant Patel at Bundaberg Base Hospital in Queensland, in 2005.2 It is unreasonable for patient safety to depend on the exercise of such outstanding levels of courage from individual practitioners. While their specialized knowledge and access to otherwise restricted areas provide professionals with greater opportunities to detect unethical organizational practices, thus making them the “eyes and ears of the community,” reliance on whistleblowing is nevertheless a poor, last-resort, form of accountability. Parallel concerns about individuals being expected to shoulder unjustifiably high moral burdens due to others’ neglect of their obligations also arise in discussions of Bernard Williams’s famous argument that utilitarianism violates personal integrity.3 Elizabeth Ashford points out that it would seem unjust if a very stringent duty of general beneficence required some people to give up deeply valued personal commitments in order to make amends for the moral complacency of others, if others were contributing nothing at all to such assistance efforts.4 These calls by Hamric et al. for more judicious appeals to health professionals to exercise courage in health care practice should clearly be heeded by the profession. A sole reliance on practitioner courage for exposing unethical workplace practices would clearly be misguided. Nevertheless, there is still (as the authors acknowledge) a legitimate place for encouraging health professionals to develop and act on courage in various contexts in clinical practice. For example, health professionals need to develop and show courage in facing the risks posed by serious infectious diseases and in being willing to cease interventions when this would be appropriate. Arguably, “excessive valorization of courage”5 also occurs when, out of misplaced bravado, individual practitioners rashly disregard grave personal risks in an emerging serious epidemic by attempting to treat newly infected patients without taking sufficient precautions for their own safety and when such practitioners urge their colleagues to do likewise.6 Aristotle explained how courage can be understood as a mean between the twin vices of cowardice and rashness, and so beyond a certain point, taking such risks might overflow beyond courage into rashness.7 May-June 2015
Hamric et al. rightly emphasize that “we need to build settings where courage is rarely needed to do the right thing and practice ethically” (p. 39). Of course, even the best-designed health care systems can have unintended consequences, and practitioners who personally benefit from such systems may be reluctant to point out the systems’ flaws. It therefore seems that there will always be some need for courage on the part of health professionals who are in a position to expose systemic failures and corrupt behavior. The goal of creating better institutional structures might require courage. I share the authors’ concerns about health professionals’ being “routinely required to exhibit courage to survive their practice in an institution” (p. 39). Indeed, we might consider the frequency of calls for courage in these circumstances as some sort of moral “litmus test” of the moral health of an organization, insofar as a frequent need for such practitioner courage points to underlying moral failings in the health care system itself. Williams once made an analogous point about the broader significance of feelings of alienation among certain groups of criminal defense lawyers: “Let us make it a condition of applying the two-tier structure to our topic that the alienation problem should not arise. If there is to be a second-order justification of professional dispositions, then the consciousness appropriate to those dispositions should be able to co-exist coherently with the consciousness of their justification, not just in one society, but in one head.”8 Williams was arguing, in other words, that if an adversarial system of criminal law leads to widespread feelings of alienation by practitioners from the activities of their professional selves—for example, due to the tactics such a system encourages practitioners to adopt in advocating for their clients—then the system needs changing. The alienation would be too high a moral cost to pay for it. The authors also speculate that, when courage is excessively or inappropriately valorized, “[o]ppressive conditions—unresponsive systems, bullying clinicians, job insecurity, and the like—may be tolerated not only as unalterable but even as acceptable because they nurture desirable practices of courage.”9 Conceivably, such perverse consequences would result from strongly emphasizing the importance of practitioner courage in health care. However, we can recognize courage as a crucial remedial virtue in health care without being committed to creating or tolerating the conditions needed for its exercise. Consider an analogy with compassion, as a valuable attribute—and, some would say, virtue—in health care professionals. We can appreciate the value of compassionate health care practitioners and valorize compassion without thinking that distressing circumstances ought to be created or maintained for the sake of nurturing compassion. Otherwise, we lose sight of how these practitioner traits are valuable and count as virtues, not in being ends in themselves, but ultimately because they help doctors H AS TI N GS C EN TE R RE P O RT
41
serve patient health—a central goal of medicine—which unrelieved suffering and oppressive workplace conditions clearly do not serve: as Hamric et al. point out, “[E]thical work environments are good for patients and providers alike” (p. 39). Indeed, recognizing that courage is required only when other prevention efforts have failed is part of developing the sort of nuanced understanding of courage that Hamric et al. are seeking. In any case, I agree that “[f ]ocusing on the moral virtues of individual providers is only one part of creating more ethical practice environments” (p. 39). A key lesson of the recent situationist critique of virtue ethics is that both character and situation are important for understanding why people act rightly and wrongly. Indeed, as Nancy Snow argues in her account of virtue as “social intelligence,” “Identifying problematic situational pressures can then point the way to the kind of character formation that would be helpful in combating them.”10 Because governments commonly accept a commitment to help physicians maintain the therapeutic orientation of physician-patient relationships, and because physicians’ medical virtues (or vices) are revealed in the nature of the professional relationships they develop and maintain with their patients, governments have an obligation to maintain physicians’ medical virtues. One way in which governments can meet this obligation is by helping to create institutional and regulatory environments that support practitioners’ efforts to maintain the sorts of professional relationships with patients and clients—and thus the relevant professional virtues—that they agreed to have when they joined the profession. For example, governments could more strictly regulate pharmaceutical direct-to-consumer advertising and could take steps
to strengthen physicians’ virtue of medical beneficence where such advertising is allowed, so as to reduce levels of physician acquiescence to the clinically inappropriate medication requests often evidently prompted by such advertising and thereby help preserve therapeutic relationships between physicians and patients.11 Hamric, Arras, and Mohrmann have taken a valuable first step toward providing a better contextualized account of how courage should operate in different health care contexts. More work is needed.12 1. A. B. Hamric, J. D. Arras, and M. E. Mohrmann, “Must We Be Courageous?,” Hastings Center Report 45, no. 3 (2015): 33-40. 2. See H. Thomas, Sick to Death (Sydney, Australia: Allen and Unwin, 2007). 3. B. Williams, “Consequentialism and Integrity,” in Consequentialism and Its Critics, ed. Samuel Scheffler (Oxford: Oxford University Press, 1988), 20-50. 4. See E. Ashford, “Utilitarianism, Integrity, and Partiality,” Journal of Philosophy 97, no. 8 (2000): 421-39, at 438. 5. Hamric et al., “Must We Be Courageous?,” 39. 6. There are anecdotal reports of such behavior in the early stages of the severe acute respiratory syndrome (SARS) epidemic, in 2003. 7. Aristotle, Nicomachean Ethics, Book II, chapter 7. 8. B. Williams, “Professional Morality and its Dispositions,” in Making Sense of Humanity, B. Williams (Cambridge: Cambridge University Press, 1995), 192-202, at 195. 9. Hamric, Arras, and Mohrmann, “Must We Be Courageous?,” 39. 10. N. E. Snow, “How Ethical Theory Can Improve Practice: Lessons from Abu Ghraib,” Ethical Theory and Moral Practice 12, no. 5 (2009): 555-68, at 563. 11. See J. Oakley, “Virtue Ethics and Public Policy: Upholding Medical Virtue in Therapeutic Relationships as a Case Study,” Journal of Value Inquiry 49 (forthcoming, 2015). 12. For one account of role-differentiated virtues in health care practice, see J. Oakley and D. Cocking, Virtue Ethics and Professional Roles (Cambridge: Cambridge University Press, 2001).
Congratulations to the 2015 Winners of The Hastings Center Cunniff-Dixon Physician Awards The Hastings Center Cunniff-Dixon Physician Awards recognize established and early-career physicians who are advancing the art of medicine for patients near the end of life and for their families.
n Senior Physician, $25,000 award David Nathan Korones, MD • University of Rochester Medical Center n Mid-Career Physician, $25,000 award Bruce E. Condit, MD, FHM • Central Maine Medical Center n Early-Career Physicians, $15,000 awards Shaida Talebreza Brandon, MD, FAAHPM, HMDC • University of
Utah School of Medicine
Mary Kathleen Buss, MD, MPH • Beth Israel Deaconess Medical Center
Laura Iglesias Lino, MD • Baystate Medical Center
For more information, please visit www.thehastingscenter.org
42 HASTI N G S C E N T E R R E P ORT
May-June 2015
Copyright of Hastings Center Report is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
10. Aristotle focused on the threat of death in battle; see Nicomachean Ethics, 1115a25. 11. Time Magazine, “Person of the Year 2014: Ebola Healthcare Workers,” at http://www.time.com/ time-person-of-the-year-ebola-fighters. 12. American Nurses Association, “Justice Is Served: Texas Physician Pleads Guilty: ANA Gratified by Convictions in ‘Winkler County’ Nurses Whistleblower Case” (press release), November 8, 2011, http://nursingworld.org/FunctionalMenuCategories/ MediaResources/PressReleases/2011-PR/ Justice-is-Served-Texas-Physician-PleadsGuilty.pdf. 13. Aristotle, Nicomachean Ethics, 1115b20. 14. Ibid., 1106a5. 15. Some contemporary virtue theorists have discerned a tension or perhaps even a contradiction between Aristotle’s definition of virtue as a mean between extremes and the possibility of supererogatory action. How is it, they ask, that virtue is always a mean, while supererogation goes well beyond the mean in pursuing a good objective? Although the tide of contemporary scholarship seems to run against our position on the ultimate compatibility of supererogation and the doctrine of the mean, we are content to let this controversy play out in the virtue ethics literature while clinging, albeit tenuously, to the traditional view.
6.
16. Aristotle, Nicomachean Ethics, Book
17. Ibid., III.6. 18. L. Tessman, Burdened Virtues: Virtue Ethics for Liberatory Struggles (New York: Rowman & Littlefield, 2005), 125. 19. M. U. Walker, “Moral Luck and the Virtues of Impure Agency,” in Moral Contexts, M. U. Walker (New York: Rowman & Littlefield, 2003), 21-34, at 26. 20. Philosopher Amélie Oksenberg Rorty offers a particularly cogent discussion of the seductive attractions of “heroic” blindness, misread as virtue; A. O. Rorty, “The Two Faces of Courage,” Philosophy 61 (1986): 151-71. 21. Lachman et al., “Doing the Right Thing”; Murray, “Moral Courage in Healthcare.” 22. E. J. Gordon and A. B. Hamric, “The Courage to Stand Up: The Cultural Politics of Nurses’ Access to Ethics Consultation,” Journal of Clinical Ethics 17 (2006): 231-54. 23. E. G. Epstein and A. B. Hamric, “Moral Distress, Moral Residue, and the Crescendo Effect,” Journal of Clinical Ethics 20 (2009): 330-42. 24. Ibid. 25. Tessman, Burdened Virtues, 127. 26. Rorty, “The Two Faces of Courage,” 154. 27. Murray, “Moral Courage in Healthcare.”
Another Voice Practitioner Courage and Ethical Health Care Environments by justin oakley
I
n “Must We Be Courageous?,”1 Ann Hamric, John Arras, and Margaret Mohrmann highlight how contemporary accounts of the virtue of courage in health care often gloss over deeper problems in the underlying health care systems themselves. They express particular concerns about the appropriateness and personal costs of exhortations to health professionals to take courageous action in circumstances where this is “required only because of unethical institutional structures” (p. 39). For instance, inadequate whistleblowing protection procedures leave clinicians exposed to unnecessary risks
Justin Oakley, “Practitioner Courage and Ethical Health Care Environments,” Hastings Center Report 45, no. 3 (2015): 40-42. DOI: 10.1002/ hast.454
40 HASTI N G S C E N T E R R E P ORT
when reporting patient harms caused by clinician negligence or when speaking out against workplace bullying. The shortcomings of such procedures are unfair to individual practitioners when the onus is left on them to see that patients and colleagues are adequately protected. The failings of such systems are also unfair to the community, since relying in such ways on the extraordinary personal qualities of rare individuals risks distracting regulators’ attention from the underlying systemic issues. Hamric, Arras, and Mohrmann also bring out well how relevant background factors implicated in such harms can be overlooked by other approaches, such as utilitarianism, which tends to advise clinicians to respond well to present harms without necessarily investigating what caused a situation to become so dire in the first place. May-June 2015
These are valuable points, which are not adequately recognized in discussions of courage as a professional virtue in health care practice. I wish to extend, and qualify somewhat, these points here. The history of health care whistleblowing is indeed littered with cases where too much was left to too few. For example, the sorts of institutional incentives established to reward Australian hospitals for reducing the duration of patient admissions also created obstacles to legitimate whistleblowing, and unnecessarily high levels of courage and determination were necessary to overcome these obstacles. Intensive care nurse Toni Hoffman discovered this in her efforts to expose the dangerous practices of surgeon Jayant Patel at Bundaberg Base Hospital in Queensland, in 2005.2 It is unreasonable for patient safety to depend on the exercise of such outstanding levels of courage from individual practitioners. While their specialized knowledge and access to otherwise restricted areas provide professionals with greater opportunities to detect unethical organizational practices, thus making them the “eyes and ears of the community,” reliance on whistleblowing is nevertheless a poor, last-resort, form of accountability. Parallel concerns about individuals being expected to shoulder unjustifiably high moral burdens due to others’ neglect of their obligations also arise in discussions of Bernard Williams’s famous argument that utilitarianism violates personal integrity.3 Elizabeth Ashford points out that it would seem unjust if a very stringent duty of general beneficence required some people to give up deeply valued personal commitments in order to make amends for the moral complacency of others, if others were contributing nothing at all to such assistance efforts.4 These calls by Hamric et al. for more judicious appeals to health professionals to exercise courage in health care practice should clearly be heeded by the profession. A sole reliance on practitioner courage for exposing unethical workplace practices would clearly be misguided. Nevertheless, there is still (as the authors acknowledge) a legitimate place for encouraging health professionals to develop and act on courage in various contexts in clinical practice. For example, health professionals need to develop and show courage in facing the risks posed by serious infectious diseases and in being willing to cease interventions when this would be appropriate. Arguably, “excessive valorization of courage”5 also occurs when, out of misplaced bravado, individual practitioners rashly disregard grave personal risks in an emerging serious epidemic by attempting to treat newly infected patients without taking sufficient precautions for their own safety and when such practitioners urge their colleagues to do likewise.6 Aristotle explained how courage can be understood as a mean between the twin vices of cowardice and rashness, and so beyond a certain point, taking such risks might overflow beyond courage into rashness.7 May-June 2015
Hamric et al. rightly emphasize that “we need to build settings where courage is rarely needed to do the right thing and practice ethically” (p. 39). Of course, even the best-designed health care systems can have unintended consequences, and practitioners who personally benefit from such systems may be reluctant to point out the systems’ flaws. It therefore seems that there will always be some need for courage on the part of health professionals who are in a position to expose systemic failures and corrupt behavior. The goal of creating better institutional structures might require courage. I share the authors’ concerns about health professionals’ being “routinely required to exhibit courage to survive their practice in an institution” (p. 39). Indeed, we might consider the frequency of calls for courage in these circumstances as some sort of moral “litmus test” of the moral health of an organization, insofar as a frequent need for such practitioner courage points to underlying moral failings in the health care system itself. Williams once made an analogous point about the broader significance of feelings of alienation among certain groups of criminal defense lawyers: “Let us make it a condition of applying the two-tier structure to our topic that the alienation problem should not arise. If there is to be a second-order justification of professional dispositions, then the consciousness appropriate to those dispositions should be able to co-exist coherently with the consciousness of their justification, not just in one society, but in one head.”8 Williams was arguing, in other words, that if an adversarial system of criminal law leads to widespread feelings of alienation by practitioners from the activities of their professional selves—for example, due to the tactics such a system encourages practitioners to adopt in advocating for their clients—then the system needs changing. The alienation would be too high a moral cost to pay for it. The authors also speculate that, when courage is excessively or inappropriately valorized, “[o]ppressive conditions—unresponsive systems, bullying clinicians, job insecurity, and the like—may be tolerated not only as unalterable but even as acceptable because they nurture desirable practices of courage.”9 Conceivably, such perverse consequences would result from strongly emphasizing the importance of practitioner courage in health care. However, we can recognize courage as a crucial remedial virtue in health care without being committed to creating or tolerating the conditions needed for its exercise. Consider an analogy with compassion, as a valuable attribute—and, some would say, virtue—in health care professionals. We can appreciate the value of compassionate health care practitioners and valorize compassion without thinking that distressing circumstances ought to be created or maintained for the sake of nurturing compassion. Otherwise, we lose sight of how these practitioner traits are valuable and count as virtues, not in being ends in themselves, but ultimately because they help doctors H AS TI N GS C EN TE R RE P O RT
41
serve patient health—a central goal of medicine—which unrelieved suffering and oppressive workplace conditions clearly do not serve: as Hamric et al. point out, “[E]thical work environments are good for patients and providers alike” (p. 39). Indeed, recognizing that courage is required only when other prevention efforts have failed is part of developing the sort of nuanced understanding of courage that Hamric et al. are seeking. In any case, I agree that “[f ]ocusing on the moral virtues of individual providers is only one part of creating more ethical practice environments” (p. 39). A key lesson of the recent situationist critique of virtue ethics is that both character and situation are important for understanding why people act rightly and wrongly. Indeed, as Nancy Snow argues in her account of virtue as “social intelligence,” “Identifying problematic situational pressures can then point the way to the kind of character formation that would be helpful in combating them.”10 Because governments commonly accept a commitment to help physicians maintain the therapeutic orientation of physician-patient relationships, and because physicians’ medical virtues (or vices) are revealed in the nature of the professional relationships they develop and maintain with their patients, governments have an obligation to maintain physicians’ medical virtues. One way in which governments can meet this obligation is by helping to create institutional and regulatory environments that support practitioners’ efforts to maintain the sorts of professional relationships with patients and clients—and thus the relevant professional virtues—that they agreed to have when they joined the profession. For example, governments could more strictly regulate pharmaceutical direct-to-consumer advertising and could take steps
to strengthen physicians’ virtue of medical beneficence where such advertising is allowed, so as to reduce levels of physician acquiescence to the clinically inappropriate medication requests often evidently prompted by such advertising and thereby help preserve therapeutic relationships between physicians and patients.11 Hamric, Arras, and Mohrmann have taken a valuable first step toward providing a better contextualized account of how courage should operate in different health care contexts. More work is needed.12 1. A. B. Hamric, J. D. Arras, and M. E. Mohrmann, “Must We Be Courageous?,” Hastings Center Report 45, no. 3 (2015): 33-40. 2. See H. Thomas, Sick to Death (Sydney, Australia: Allen and Unwin, 2007). 3. B. Williams, “Consequentialism and Integrity,” in Consequentialism and Its Critics, ed. Samuel Scheffler (Oxford: Oxford University Press, 1988), 20-50. 4. See E. Ashford, “Utilitarianism, Integrity, and Partiality,” Journal of Philosophy 97, no. 8 (2000): 421-39, at 438. 5. Hamric et al., “Must We Be Courageous?,” 39. 6. There are anecdotal reports of such behavior in the early stages of the severe acute respiratory syndrome (SARS) epidemic, in 2003. 7. Aristotle, Nicomachean Ethics, Book II, chapter 7. 8. B. Williams, “Professional Morality and its Dispositions,” in Making Sense of Humanity, B. Williams (Cambridge: Cambridge University Press, 1995), 192-202, at 195. 9. Hamric, Arras, and Mohrmann, “Must We Be Courageous?,” 39. 10. N. E. Snow, “How Ethical Theory Can Improve Practice: Lessons from Abu Ghraib,” Ethical Theory and Moral Practice 12, no. 5 (2009): 555-68, at 563. 11. See J. Oakley, “Virtue Ethics and Public Policy: Upholding Medical Virtue in Therapeutic Relationships as a Case Study,” Journal of Value Inquiry 49 (forthcoming, 2015). 12. For one account of role-differentiated virtues in health care practice, see J. Oakley and D. Cocking, Virtue Ethics and Professional Roles (Cambridge: Cambridge University Press, 2001).
Congratulations to the 2015 Winners of The Hastings Center Cunniff-Dixon Physician Awards The Hastings Center Cunniff-Dixon Physician Awards recognize established and early-career physicians who are advancing the art of medicine for patients near the end of life and for their families.
n Senior Physician, $25,000 award David Nathan Korones, MD • University of Rochester Medical Center n Mid-Career Physician, $25,000 award Bruce E. Condit, MD, FHM • Central Maine Medical Center n Early-Career Physicians, $15,000 awards Shaida Talebreza Brandon, MD, FAAHPM, HMDC • University of
Utah School of Medicine
Mary Kathleen Buss, MD, MPH • Beth Israel Deaconess Medical Center
Laura Iglesias Lino, MD • Baystate Medical Center
For more information, please visit www.thehastingscenter.org
42 HASTI N G S C E N T E R R E P ORT
May-June 2015
Copyright of Hastings Center Report is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
