Virtue Ethics

January 10, 2024

Information

November 15, 2023

Bryanna Moore, PhD, HEC-C

Assistant Professor,

Department of Bioethics and Health Humanities,

School of Public and Population Health

University of Texas Medical Branch, Galveston, TX

ID11169

To CiteDCA Citation Guide

00:00All right, welcome. My name is Mark Mercurio,
00:03and this is the Program for Biomedical
00:05Ethics at Yale School of Medicine
00:07Evening Ethics Seminar series.
00:10And I'm very pleased tonight to welcome
00:13Brianna Moore from the University of
00:15Texas Medical Branch at Galveston.
00:17Professor Moore is an
00:20associate assistant professor.
00:21Excuse me, In the Department of Bioethics.
00:24What's that? You can give me a promotion up.
00:26We can right here. Show of hands.
00:27Wait. Wait till the end of the talk.
00:29Wait, not, not so fast.
00:30The end of the talk.
00:31We'll decide about the
00:32associate professor thing.
00:35Professor Moore is here for a
00:41couple of specific reasons,
00:43but she has a pH.
00:44D from Monash in Melbourne, Australia.
00:46She did fellowships at Children's
00:49Mercy as well as at Baylor.
00:51She is the chairman of the
00:53American Society of Bioethics,
00:54the pediatric ethics affinity group,
00:57and she has particular expertise
00:59in pediatric ethics, but also
01:00particular expertise and virtue ethics.
01:02And this is something,
01:03as a couple of the medical students
01:04have heard me say as we do that when we
01:07when we teach and talk about medical
01:08ethics in a more didactic fashion,
01:11this is something that I don't think
01:13gets as much attention as it should.
01:14And there's only so many hours in
01:15the curriculum, we recognize that.
01:17But these evening seminars are a chance
01:19for us to do a little bit better,
01:21by all of us, by the students,
01:22certainly,
01:22but by everyone else who comes to join us.
01:24So for that reason and knowing that
01:26Brianna had an expertise in this,
01:28as well as knowing that she's
01:29already a member of the family,
01:31essentially because of her work with
01:33Laurie's program this past summer
01:35across campus and other things,
01:37I'm very,
01:38very pleased to welcome Professor
01:39Brianna Moore to talk to us
01:41tonight about virtue ethics.
01:43This will work the way it usually works,
01:44which is to say we'll have
01:46a talk for about 45 minutes,
01:48plus or minus,
01:49then we'll have an audience conversation.
01:51So I'll moderate folks who are on Zoom
01:53can send in questions via the Q&amp;A portion,
01:56the Q&amp;A function on Zoom and we'll
01:57try to get to some of those questions
01:59as well as the questions in the room.
02:00And we'll go until 6:30 and then at 6:30,
02:03we will call it a night.
02:04So thank you so much for coming.
02:05And especially thank you for coming up.
02:07Brianna,
02:10no vote yet. No vote yet
02:12about these. Thanks. Yeah.
02:13And the pressure just really has risen.
02:17Can everyone hear me OK? Yes. Great.
02:21Doctor Mccario, thank you so much
02:22for the invitation to come up.
02:24And thank you to Karen as well for all of
02:25your help with the with the arrangements.
02:27Yeah. These things take a lot
02:29of time and energy to arrange.
02:31I appreciate it. OK.
02:33So quickly, this is a comic by
02:35one of my favorite comic artists.
02:37If you had a little giggle at this,
02:39Jake likes onions, it's fantastic.
02:43On my question here,
02:44I said we don't.
02:45It was really exciting to me to
02:47come back and get a chance to talk
02:48about virtue ethics because we
02:49don't really talk about it as much.
02:51I think having grown up and kind
02:53of trained in Australia,
02:56we talk about it a little bit more there.
02:58I think culturally we talk
02:59about it less in the US,
03:01which is just an interesting place to start.
03:05I'm a humanity scholar.
03:06No one wants to give us any
03:07money or glory or riches.
03:08So no, never. Any conflicts.
03:10I hope to one day have
03:11a conflict to disclose.
03:14These are our learning objectives for today.
03:19That third one's a little fuzzy.
03:20I kind of had a case carefully
03:22written up and I thought we'd
03:23systematically apply virtue ethics.
03:25And then I was sitting there last night.
03:26I thought, I hate that.
03:27I don't want to do that.
03:31And a virtual ethicist
03:32wouldn't approach it that way.
03:33So I thought, no.
03:34So I'm just going to give you
03:35some stories a little bit later.
03:37That's our application.
03:39So I'm going to start with
03:40a question for you.
03:41And when you want to think about someone,
03:45it can be anyone in your life.
03:46It can be someone in a professional
03:48setting who you look up to and
03:51I if anyone's feeling brave,
03:53brave enough to share,
03:54who is it and why do you look up to them?
03:56Who is someone that that that you respect,
03:58that you that you admire in your life?
04:01It can be for any reason.
04:02What is it about them
04:04that so impresses you?
04:05Diane
04:10Hoffman at the University of Maryland.
04:12She is a genius but is always put
04:18together incredibly hospitable. And.
04:24OK, so we had someone,
04:25a mentor or colleague who was both and,
04:31yeah, kind hospitable, always put together.
04:34Just generous, generosity of spirit.
04:35Kind of. Yeah. OK, good. Yeah.
04:39Anyone else want to share? Who is it?
04:42And what do you admire about them?
04:43Yeah. Marty Samuels is a
04:46neurologist recently passed away.
04:48He's famous for going to major
04:52national lectures and giving talks
04:54about mistakes he made lessons you've
04:56drew from the mistakes he made. Yep.
04:58So in case anyone online couldn't hear that,
05:00we had a wonderful example just then
05:02of someone who owns their mistakes,
05:03who was comfortable talking about them.
05:05We might call that something
05:06like humility and honesty. Yep.
05:08Yep. Anyone else want to share?
05:09We'll do one more.
05:15I I think Jackie is just
05:17sitting right next to him.
05:18I I noticed that I was a A
05:20fellow and I've always seen him
05:23with somebody who has devoted
05:24his life to medical education
05:27and medical care. And
05:29this is true.
05:30Yep. Yep. So again, a beautiful example
05:32and a nice one from in the room.
05:35Also, just feeling like there's
05:36someone in your life that you look
05:38up to who's devoted to what they do,
05:40who shows up for people,
05:41who shows up every day. Yeah, began.
05:44I heard, like, generosity,
05:45dedication and integrity. Yeah, good.
05:49So you can all see where I'm going with this.
05:50It wasn't kind of a big giveaway.
05:51Right? But you've naturally started
05:53framing things in terms of like,
05:54qualities that people have that,
05:56you know, don't just make them like,
05:57oh, they're an OK person to hang with,
05:59but like really kind of move us to have,
06:01like, respect and admiration for people
06:03like these exemplars in our lives who
06:05we sort of look up to and and try,
06:06I think a lot of the time to sort
06:10of take a little bit from and carry
06:11it forward in our own practice.
06:12So there's my unsubtle Segway
06:15into the virtue ethics.
06:18Has anyone in the room ever taken a
06:20philosophy class or an intro to ethics class?
06:21And we're getting lots of nods.
06:22I'm guessing that's.
06:23Yeah.
06:23Most of you have.
06:24So you've probably heard about
06:26consequentialism and the the ontology,
06:27the ontological ethics,
06:30the three main branches of sort
06:32of normative ethics.
06:33The branch of ethics that's
06:35interested in what we should do,
06:40are typically held support
06:41to be like consequentialism.
06:42Ontology, and then virtue ethics is
06:44kind of the the murky third branch.
06:47So as you all know,
06:47consequentialism holds that an action
06:50is right if and only if it produces
06:54the best possible consequences.
06:55So utilitarianism is the most well
06:58known form of consequentialism.
06:59So maximize the greatest good
07:01for the greatest number.
07:02Basically, the the consequences,
07:03the outcomes of our actions
07:05are really important,
07:06perhaps the most decisive
07:08moral or ethical factor.
07:10It's sort of contrasted
07:12with deontological ethics,
07:13which holds that an action is right if and
07:17only if it adheres with the relevant rules,
07:20obligations,
07:20or duties that someone has.
07:22And it differs from consequentialism
07:26in that it says that sometimes
07:29there are just going to be things
07:30that we absolutely can't do,
07:31regardless of how good the
07:33consequences of that thing are.
07:36Some things are just absolutely
07:38prohibited or or obligatory,
07:39right?
07:40And then there's virtue ethics,
07:42sort of the weird cousin that people
07:45don't really like to look at.
07:47And I'm looking at my my buddy James,
07:50who I Yes.
07:52And because in 2015 I have this very
07:56distinctive memory of sitting in
07:58a lecture theater as a student in
08:01Yale Summer Institute and bioethics
08:02program and listening to Shell,
08:03the wonderful Shelley Kagan give
08:04a lecture on normative ethics.
08:06And he didn't once James is laughing,
08:08now mentioned character or
08:10dispositions or kind of motives.
08:12And I remember, like me,
08:13a little grad student at the time,
08:15popping my hand up and saying
08:16not once mentioned virtue ethics
08:18and him saying it's not ethics.
08:21And then James found me afterwards
08:22and he was like,
08:23shout out to virtue ethics and then
08:25we decided we'd be best friends.
08:26But this was back in 2015.
08:28So not everyone thinks of virtue
08:29ethics as a kind of normative
08:31ethics because it does have a
08:33little bit of a different project.
08:35It's not sort of a systematic moral
08:38theory that's trying to explain right
08:40action in the same way that these
08:43other branches of normative ethics are.
08:47What is it trying to do?
08:49So it's starting point.
08:50And what I mean by that is sort of
08:54the the the framework through which
08:56it looks at like ethical questions
08:59and sort of just orients itself
09:02to ethical problems and conflicts,
09:04is to start first with character
09:07as central to morality.
09:08It's sort of the guiding thing.
09:10So instead of focusing on right action,
09:12we should think about what kind
09:13of people we want to be,
09:14what kind of character we want to cultivate.
09:17And maybe right action comes from that,
09:18but it just sort of has a different
09:21starting point than something like
09:24consequentialism or deontological ethics.
09:27As I said it,
09:28the slogan is typically that its
09:29focus is more in being than doing.
09:31That's a little simplified,
09:32but it can be a helpful way of
09:34sort of remembering it.
09:35And most people attribute virtue
09:36ethics back to Aristotle and
09:38kind of the ancient Greeks.
09:39And you can Machan ethics is sort
09:41of typically thought of as like the
09:43main text on virtue ethics, but
09:47sort of ancient Eastern Chinese philosophy.
09:49Also, Confucius famously did
09:51talk about virtues as well,
09:53particularly familial virtues and
09:54sort of what it meant to be a
09:57virtuous actor within your family.
09:58But Aristotle is really kind of the main
10:03sort of white male philosopher associated
10:07with this particular branch of ethics.
10:09And I'm not going to say them in
10:11Greek because I don't know how to.
10:12But he had three guiding concepts.
10:15They were sort of excellence,
10:18human flourishing and practical
10:19wisdom that he used to sort of
10:22Orient his idea of the virtues,
10:24what counted as a virtue,
10:25what didn't,
10:26how it was virtuous and human flourishing.
10:28Really kind of is I think the main one
10:32for us to potentially talk about this
10:34idea that morally valuable traits were
10:36the ones that helped you live a good life,
10:38that helped you live a good
10:40human flourishing life.
10:40There are all kinds of
10:41problems associated with that.
10:42We can dig into them a little bit,
10:44and the idea is that the virtue,
10:46sort of,
10:46for Aristotle at least,
10:47work together in a big web.
10:49So you can't just kind of think
10:50about 1 virtue in isolation.
10:52It's all sort of cultivating a
10:55range of virtues and sensitivity
10:57to the different situations you're
10:59in and sort of how to exercise
11:02different virtues and balance
11:03them in this nice kind of web.
11:06And that was what he thought
11:07of as practical wisdom,
11:07this idea that you would sort of
11:09know how to balance and weigh
11:10and act virtuously in different
11:12situations by practicing and
11:13getting it wrong sometimes right.
11:14And the idea was to live a good life,
11:16you have to really kind of strive to
11:18cultivate habitually virtuous qualities.
11:28There's a nice little quote
11:29here from Rosalind Hurst House.
11:30She says excellences of character,
11:35qualities that help us to notice,
11:36expect, value, feel, desire,
11:38choose, act and react in
11:41certain characteristic ways,
11:43and that phonesis.
11:44In short, practical wisdom is needed
11:46to apply duty's rules or principles
11:48in in in a morally sensitive way.
11:51There are also non Aristotelian branches
11:54of virtue ethics famously attributed to
12:00Soccer Christine Swanton.
12:04They're not committed to any kind
12:06of idea of human flourishing in
12:07the same way that Zionists or
12:10Aristotelian virtue ethicists are.
12:11They talk much more just
12:13generally about moral exemplars,
12:15target based virtues.
12:20They just kind of have a bit
12:22of a broader lens on things.
12:24They're not trying to explain the
12:26the value of of virtues in relation
12:29to some other like thing that
12:32it's value that virtues, values,
12:34derivative of like human flourishing.
12:35It's just sort of how are they valuable in
12:38other situations or roles that you're in.
12:41And they just talk much more
12:43broadly non Aristotelian virtue
12:44ethicists about dispositions,
12:46motives and motions and sort
12:48of how they shape the virtues.
12:51There's also kind of virtue theory.
12:53So there's a lot of kind of overlap
12:55now and people are talking about
12:56Kantian virtue ethics and sort of
12:58consequentialist virtue ethics.
13:00And Sidwick like they're kind of like
13:02all these lines between these different
13:04branches of normative ethics are very
13:06blurry to begin with but are kind
13:07of getting blurrier and people are
13:09sort of just want to just like what
13:10people call virtue theory going on now.
13:12So sort of everything else that's out there.
13:14Again, not interested necessarily in
13:16how the virtues relate to a good life or
13:19developing kind of a robust account of that,
13:21but just thinking more generally in
13:23psychological terms about virtues and biases,
13:25social theory,
13:26moral psychology,
13:27stuff like that.
13:29This is a very quick and shallow overview
13:31of a lot of complex stuff that's going on,
13:33but it's all to kind of help you
13:35understand where did this come
13:36from and how do we kind of get
13:38to thinking about virtues in in
13:40healthcare and medical practice?
13:44If you've ever taken any classes on
13:45virtue, I think you've probably seen
13:47something like this kind of list.
13:51It's just kind of a way of for us
13:52to kind of map out the virtues.
13:53Aristotle in particular was really
13:55interested in this idea of the golden
13:56me that you couldn't just say,
13:57be honest, you had to really kind of
14:00balance or think about honesty through
14:02like the situation that you were in.
14:03And like, man, I could,
14:04I could really kind of be almost
14:06too honest here and and be kind
14:08of rude and callous, right?
14:09Or I could not have enough
14:11honesty and just be like,
14:13definitely withholding of
14:14relevant information. Right.
14:15So it was all about kind of balancing
14:16and hitting the target of the virtue,
14:17showing the right amount of the
14:18right thing to the right person in
14:20the right way in the right place,
14:21in the right time. Right.
14:22That was practically listen for him.
14:25So yeah,
14:25you'll often see a list like
14:26this where it's like,
14:27here's the target of the virtue and
14:29then kind of thinking about excess
14:31or deficiency of that quality and
14:33where that would kind of lead us.
14:34I don't know that all virtues
14:36fit into something like this.
14:38So we might justice as one, you know,
14:40being a just person we typically
14:42think of as being a being a virtue.
14:43You can't really have too much justice,
14:45right?
14:45This doesn't kind of fit,
14:46I think necessarily into its
14:47deficiency or excess model,
14:48but it can be a helpful way of kind
14:50of thinking about different virtues
14:53and their corresponding biases.
14:54So we don't talk about virtue a lot.
14:56We don't talk about bias very
14:58much as well in in healthcare
14:59and healthcare ethics.
15:03Why virtue ethics?
15:07These are some reasons why I find
15:09it attractive as a way of kind of
15:12framing and thinking about moral
15:13problems or ethical problems.
15:15I think this idea of kind of
15:17just focusing on developing.
15:20I just think like sometimes, you know,
15:23I work as a clinical ethicist, right?
15:24There's so many things in the hospital,
15:26in our healthcare system
15:26that are out of our control.
15:28Often I'm like, what do I control?
15:29I control me, right?
15:30And kind of really focusing on who do I
15:33want to be when I walk into the room.
15:36How do I want to carry myself
15:37what I want to care about.
15:38So for me, I think just focusing on
15:41cultivating certain kinds of habits,
15:42good habits and sensitivity to a
15:44range of of situations, that feels,
15:46I think sometimes a little more
15:47achievable for me at least.
15:48So This is why I like it as a theory,
15:52role ethics and role modelling.
15:53As I say here,
15:54it's just a really common way
15:55for us to think about doing good.
15:56So again,
15:56we kind of look at people in our lives.
15:58How are they doing it?
15:58What do I like about that?
15:59What do I not what seems like a good
16:01kind of admirable way of doing something.
16:04It's just a common way for us
16:05to think about this.
16:08I think this is just a good
16:09broad whether we like it or not.
16:11Virtue, ethics, virtue,
16:11language is just part of
16:13the moral landscape, right?
16:14It's part of our you know,
16:15assumptions when we interact
16:17with other people in the world.
16:19And this is all to say, not to say at all,
16:22that consequences and and duties
16:24or or rules do not matter.
16:26So, and very much a pluralist.
16:29I'm not arguing that virtue
16:30ethics is the one right way of
16:32thinking about ethical conflicts,
16:33particularly in patient care at all,
16:35but just encourage you to think it is
16:37another tool to have in your toolbox,
16:39right?
16:39To kind of whip out and think things through,
16:41Which of course ********
16:43philosophers won't like very
16:44much because they're much more,
16:46I think, kind of
16:49sensitive to some of the the theoretical
16:52conflicts and the meta ethical
16:53conflicts between these theories.
16:55I think when we work in healthcare,
16:56we get comfortable with that messiness
16:57and we're quite comfortable kind
16:59of just drawing upon different
17:00things that feel good in the moment,
17:01Right. Big fan of that.
17:05OK, so these are these are the I I don't
17:08think they're devastating critiques,
17:09but these are the critiques of virtue ethics
17:10that are commonly levelled against it.
17:11There's probably some more.
17:14Most people, particularly those of us
17:16who work in very practical settings
17:17and have sort of practical ethical
17:18issues that we have to navigate,
17:20think, you can't just say, be honest,
17:21that's not action guiding at all.
17:23Be a good person.
17:24Like, I want you to tell me what
17:26to do in concrete terms, right.
17:28So this is kind of one big critique
17:31that's levelled against virtue ethics.
17:33Virtue ethicists have tried
17:34to respond to this by saying,
17:36well something a maxim like do the most good,
17:42that's like create the best consequence,
17:44that's also you've got to get much
17:45more concrete and specific, right.
17:46So that's just to say that other nominee
17:48theories also struggle with being
17:50action guiding when it gets messy and
17:52kind of you have to really dig into
17:53into the into the specifics of this the
17:55case or the situation that you're in.
17:57And virtue of the system,
17:59well actually like it is quite action guiding
18:02to think about something like tell the truth,
18:05right.
18:05Like,
18:05like a lot of virtues do translate
18:08pretty directly into action guidance,
18:10you know, be brave.
18:11Obviously we have to think through what
18:12that means in a particular situation.
18:13But virtue ethics has kind of
18:15said they're actually not that
18:16much less action guiding than any
18:17other branch of normative ethics.
18:19Roslyn Hursthouse talks about the rules,
18:22virtue rules,
18:23and how they can produce a
18:25theory of right action.
18:26Again,
18:26it's tricky because I think virtue
18:28ethics is just sort of thinking if
18:29you're focusing on right action,
18:30you're maybe not looking at things
18:31in the way that we want you to,
18:33but they sort of tried to respond to
18:36that by creating kind of the rules,
18:38mapping out virtues and sort
18:40of reframing them in terms of
18:42more concrete action guidance.
18:46The next critique is just saying,
18:48like the right thing to do is
18:50what a virtuous agent would do.
18:51That's just kind of circular,
18:52right? Like, haha,
18:53we've got you now virtual emphasis.
18:55It's too circular, right?
18:58I think it's kind of a problem that
19:00virtue ethicists created for themselves by
19:01trying to come up with a theory of right
19:03action and then linking it back to virtue,
19:04And they did kind of get into this loop.
19:06So there's some sort of attempts to get
19:08out of that in the theoretical debates.
19:10Again, I think virtue ethicists kind of
19:12say like it's not necessarily and less
19:14circular than saying the white thing to
19:16do is to maximize the best consequence.
19:17Like, there's sort of a circularity,
19:19I think, in a lot about ethical theories,
19:21big meta ethical debate behind that going on
19:24that I don't feel qualified to weigh in on.
19:26And I think that's kind of
19:27not our focus for today.
19:28But this is another sort of charge
19:31that's levelled against virtue ethics.
19:33What about conflicting virtues?
19:34What do we do when kind of being honest and
19:38being compassionate come into conflict,
19:40right?
19:40What are we going to do if we kind
19:42of have to balance these things?
19:44The same goes for kind of different
19:46different outcomes,
19:46different consequences that we have to weigh,
19:48right?
19:49Or different duties sometimes
19:51come into conflict.
19:52So I think virtue ethicists would
19:53bite that bullet and say, Yep,
19:54sometimes you have to make trade-offs,
19:56right?
19:56You have to do that complex ethical
19:58work of weighing and balancing
19:59different relevant virtues or
20:01or ethical considerations.
20:02Again,
20:03that's not a problem that's unique
20:05to virtue ethics. Pretenders.
20:07What are we going to do with
20:08moral pretenders?
20:09These kind of fakes,
20:10these phonies out there who sort
20:11of look like they're being virtuous
20:12but actually are quite terrible
20:14people on the inside,
20:15how do we know anyone's ever
20:17actually really acting virtuously,
20:18right?
20:21That's true.
20:21We never really know kind of what's
20:22going on inside someone's head, right?
20:24Or what's motivating them.
20:25I think that's certainly a problem.
20:27We could have someone who's doing
20:28great people, good in the world,
20:30But ******** utilitarian,
20:30he was just a bit of a rotten
20:32human on the inside, right?
20:33That's true again,
20:34just true generally.
20:35I think.
20:37I think there's a really interesting
20:38psychological point in there about
20:39if you're going through the motions,
20:41do you start to identify with them
20:42and sort of feel different ways about
20:44different things that you're doing?
20:46I think it's a bullet that Birch
20:48worth is just kind of kind of bite.
20:50And there's some really interesting
20:51work in kind of social and moral
20:52psychology coming out about kind
20:53of do we actually have virtues?
20:55What do they look like?
20:55How do they manifest in different
20:58people in different situations as well?
21:00Again, I'm going to go too far into that.
21:01But I don't think,
21:02again,
21:02this is a unique problem
21:04for virtue ethicists.
21:08Yeah, I don't know.
21:09We never really know what's going
21:10on in someone else's head, right?
21:12Just like this idea, that virtue,
21:14it's just so demanding,
21:15trying to be good all the time.
21:17Like, who has time for that?
21:18It's training.
21:21Well, maybe it should be.
21:24And I think virtual
21:25ethicists are certainly
21:28aware of this critique and very quick to
21:34acknowledge that yes, it takes practice.
21:35You're going to get it wrong sometimes,
21:37and there's a lot of people do.
21:40So I'm thinking about, you know,
21:42Jack, Jack, I'm sure you've
21:44done things where you're like,
21:45we would not say you weren't virtuous,
21:46but you're like, I made some mistakes, right?
21:48That doesn't not make you a virtuous.
21:49No mistakes, OK, you know what I mean?
21:53They would say like this times 2 where
21:56it's like we're not going to call someone
21:59a vicious person overall because they
22:02perhaps made a mistake or didn't get it,
22:03you know, didn't get it right.
22:04In that particular situation,
22:06it's about practice.
22:06It's about cultivation.
22:08It's about this accumulation
22:09of habits and dispositions.
22:15See, I think virtuous.
22:16There's another bullet that
22:17they would bite and say, yeah,
22:18it is demanding, It's hard.
22:19It may not be perfect.
22:20Aristol had sort of a framework
22:22where he talked about things like
22:23sort of almost like impotent virtue,
22:25where it's like you kind of know
22:26what the right thing to do is.
22:27But you have this weakness of will.
22:28You can't always kind of get there.
22:30And again, kind of just practicing
22:32allowing yourself to get it wrong sometimes
22:34and sort of working on building that up,
22:36building habits that help you to get
22:38there if it comes up again in the future.
22:40And then the situation isn't,
22:42which is a little bit more
22:44of a contemporary critique.
22:45The Situationists are folks who ran
22:47some experiments in social psychology
22:49that they thought demonstrated
22:50that there's no such thing as
22:52sort of a stable character trait.
22:54They sort of came up with some
22:56experiments that they felt showed
22:58people don't have virtues right
23:00by manipulating situations.
23:03That goes out the window real quick.
23:05Situations have a tremendous amount
23:07of influence on how we behave.
23:09And someone who you know beforehand was like,
23:10I'm a really honest person would
23:11straight up lie if we just fixed
23:13the situation in a certain way.
23:14And they thought that when there's
23:16no such thing as virtues right,
23:18The methods and the design of their
23:20studies have been heavily critiqued.
23:22And virtue ethicists also, I think,
23:24took very admirably a lot of,
23:26a lot of what they did find on board
23:28and have been doing a better job of
23:30partnering with empirical researchers,
23:32with social scientists and have
23:33sort of come up with a lot of their
23:36own experiments as a response to
23:37the situation of studies that.
23:39Sure, actually, yeah,
23:40by nudging situations we can
23:41cultivate virtue or make people more
23:43inclined to move in certain ways.
23:45And actually that's kind of
23:46grist to our mill, right?
23:46Like we have to think about the
23:48virtues in an environmental
23:48way and how we sort of
23:52how we kind of the architects of the
23:54spaces that we're in and how to kind
23:56of promote and encourage those kinds
23:58of qualities and their development.
24:00So they've just, again, kind of taken
24:01that on board and responded to it,
24:03moving through these really,
24:04really quickly again.
24:05But these are sort of some
24:06of the main critiques.
24:07I think there's teeth to a lot of them.
24:09I think virtue ethicists have done a
24:10good job of trying to respond to them.
24:12And again, if you're sitting here
24:13listening to this and you're like virtue
24:15ethics is just not for me, that's OK.
24:17Take take it or leave it.
24:19There's some really cool work
24:20just really quickly going on,
24:21some sort of overlap between virtue
24:23ethics and all of these areas,
24:25Care ethics, feminist ethics,
24:27African and indigenous bioethics who
24:30talk a lot about relationships to sort
24:32of land and and sort of practices.
24:34And this is not to say any of these
24:36things are derivative of virtual ethics.
24:37They're not their ethical theories
24:39and really important areas of
24:40study in their own right,
24:42but just that there's some really
24:43cool and interesting synergies here.
24:45Philosophy of emotions,
24:46lots of really cool overlap there.
24:47As I said,
24:48moral and social social psychology.
24:50Lots of cool collaboration and partnership
24:52going on between virtue ethicists,
24:54virtue theorists and folks
24:56working in those areas.
24:58And then professional and
24:59institutional ethics too.
25:00There's sort of some debates going
25:02on about at the moment around whether
25:04or not organizations have sort of
25:06a collective psyche and whether it
25:09makes sense to talk about things
25:11like institutional virtues and vices.
25:13We're not going to wade into that that area,
25:15but it's up there in case you're interested.
25:18OK,
25:18virtual ethics and healthcare.
25:23Has anyone in here ever read
25:25their professional code?
25:26We've got it. OK good couple.
25:28Couple. James has gone like, yeah.
25:33Has anyone here, did anyone here
25:35take the Hippocratic Oath? Yes. OK.
25:38So we just asked that references
25:41to certain kinds of virtues is
25:43really common in professional oaths,
25:45professional codes of ethics.
25:47Throughout history,
25:47it's always sort of been embedded in there,
25:49this sort of virtue language
25:51and virtue framing.
25:52Also being a good doctor
25:53or being a good nurse,
25:54being a good ethicist,
25:55being a good speech pathologist.
25:57These are all sort of I think,
25:58common ways that we think about how
26:00we're approaching our roles and why
26:01we're doing the work that we're doing.
26:03Frequently cited virtue sort of cutting
26:06across all fields of healthcare,
26:08all disciplines, all kind of trainings
26:10include things like compassion,
26:12empathy, benevolence, competence,
26:15trustworthiness, humility, patience,
26:18all of these things.
26:22Sorry, this is probably not super
26:24easy to read, but this is a little
26:26bit from the American Medical
26:27Association's Code of Ethics.
26:29So I did bold them,
26:31but you can't really see it.
26:32But talks about physicians being
26:34dedicated to providing competent medical
26:37care with compassion and respect,
26:39being honest, respect for the law,
26:43avoiding things that are contrary to
26:45the best interests of the patient.
26:47It's as a physician to support shall support
26:49access to medical care for all people.
26:51We might frame that as something like,
26:53you know, them being committed
26:54to justice or fairness or equity.
26:56So again, you can kind of see there's
26:59some virtue terms embedded in here.
27:01The nursing association
27:02code of ethics is wonderful.
27:03So again, sorry,
27:04it's a little bit hard to read.
27:06But again, compassion,
27:08respect the inherent dignity,
27:10work and unique attributes of every person.
27:12So being very person,
27:14patient oriented and sensitive,
27:16being accountable,
27:17being responsible,
27:20being collaborative, there's all kinds
27:23of virtue terms embedded in here,
27:26conferences certainly in there as
27:29well-being advocate, working to
27:31promote health and safety all in there.
27:34And these are just examples of sort of
27:37how it crops up in our professional
27:39language and framing of our roles.
27:41So I was talking to Doctor Mercurio before
27:44we started and I asked what would you
27:46want me to talk about virtual ethics today?
27:48And you said, well,
27:49we talk a lot about principles and rights.
27:52These are sort of a lot of other
27:53concepts and sort of frameworks
27:55that we use in healthcare ethics.
27:57You know, we talk about respect for autonomy,
27:59we talk about an efficence,
28:01normal epicence justice,
28:02we talk about right to bodily integrity,
28:05right to access to healthcare,
28:06things like this.
28:07These are all really, really important.
28:08But as I said earlier,
28:10we're often pluralists.
28:11It's messy.
28:12We draw on lots of different things
28:14to help us think through really,
28:16really concrete,
28:16really real practical problems
28:20in healthcare. We often disagree.
28:23I think that's probably true
28:24of a lot of other areas.
28:25Our disagreements probably have a certain
28:26kind of flavour to them and certain sort
28:29of sort of effect on certain groups.
28:30There's often uncertainty in our practice.
28:32I think that's becoming more and more true
28:36with technological advancements and kind
28:38of the political climate that we're in.
28:40As I said, Healthcare is usually
28:42pluralistic and we often adopt
28:44A process oriented approach.
28:45We don't have to agree on values or outcomes,
28:47but we can agree on sort of how we
28:49get there and what sorts of processes
28:51we employ to resolve conflicts.
28:53So that's just to say we reason a lot on a
28:56case by case basis and we principles, rules,
29:00rights and virtues I think are all very,
29:04very important and it's messy
29:09applications. So I was sort of
29:13sitting back thinking like what's
29:15what do I want you to to sort of
29:16take away from today lots of things.
29:18But I think virtual ethics really is
29:20interested in not just in in what
29:21we do or what we end up doing or
29:23producing or the effect of things,
29:25but how we do it, how do we get there.
29:27As I said, for me,
29:28I always think about how how,
29:30what am I carrying into the room today?
29:32How do I want to approach a relationship
29:35or a conflict or a conversation?
29:38How, how am I going to do that?
29:40That's just very, very important for
29:42us to think about ethically as well.
29:44So as I said,
29:45I was going to do a case and then I go,
29:47no, just kidding,
29:47I'm going to give you some stories instead.
29:49Mark,
29:53I'm going to put you on the spot for
29:55a second. What's sort of a common
29:57conflict that comes up in the NICU?
30:01A common conflict that comes up
30:03with the Nick Do is a child, Sorry.
30:07A child who is terribly sick and
30:10ventilator dependent and has reached
30:12the point where many members of the
30:14staff are concerned that the prognosis
30:16is very poor and ongoing care is
30:18more cool than kind. And the
30:21conflict between the potential
30:23between the staff and the parents,
30:24where the parents want to continue
30:26all efforts and the staff feels
30:28what's going on with the.
30:30So just for the folks online,
30:31in case they couldn't hear that just
30:33classic kind of conflict between
30:35clinicians and parents about the
30:37appropriateness of continuing with
30:39sort of invasive life prolonging
30:40interventions for a very, very,
30:42very sick baby in the neck. You.
30:44Yes, that's sort of exactly the
30:45the kind of long case that I had
30:47written up that I thought we'd
30:49work through systematically.
30:50But I thought this is sort of typical.
30:51I think of a lot of disagreements
30:54and cases where there's a little
30:56bit of uncertainty in healthcare.
30:58And I was thinking,
31:00my colleague Ros and I ended up
31:02writing a paper about virtue ethics
31:04as it relates to the parental
31:07role in decisions for children,
31:09published that last year precisely because
31:11of these kinds of classic conflicts.
31:14Right. And we talked a lot about,
31:19sorry, this is my first story.
31:24We talked a lot about walking as
31:27the ethicists getting consulted
31:28in these kinds of cases after,
31:30you know, weeks to months of of
31:32clinicians meeting with the parents,
31:34sort of talking to them
31:35about the child's prognosis,
31:36making recommendations about
31:38discontinuing some things potentially.
31:41And as the ethicist, this is sort of
31:43funny thing that happens sometimes.
31:44You know, you'll get consulted on the case
31:46and you'll talk to say that the attending,
31:49the neonatologist who consulted you or
31:50the nurse practitioner that consulted you.
31:52And they'll say this,
31:53this family loves their kid,
31:55but they're just not getting where we're at.
31:58And we need your help kind of getting
32:00them to understand that there's this,
32:02this isn't going anywhere, right.
32:05It's just hurting the kid at this point,
32:06the baby at this point.
32:08And you're going kind of sometimes
32:10I'll feel kind of nervous just
32:12because of some of the things the team
32:15has said about the parents being,
32:17you know, kind of kind of hard headed
32:19and not really in denial,
32:20not really receiving information.
32:21And I'll leave a conversation
32:23with the parents thinking,
32:24wow,
32:24those what amazing parents they
32:27are just an amazing,
32:28overwhelming sense of just love
32:31and dedication to their kid.
32:32And so sort of coming out of these
32:35kinds of consults got me thinking about
32:37virtue ethics a lot because they think
32:39we don't necessarily need to agree
32:41on what the right thing to do is,
32:43and perhaps we will never agree on that.
32:46We don't necessarily have to know
32:50what the babies, what survival
32:53would look like, what their quality
32:55of life is going to look like,
32:57what their odds of kind of making
32:59it out of the NICU will be.
33:00We don't necessarily have to know
33:02that there's always going to be some
33:04element of uncertainty in a lot of
33:06the the situations that we're in.
33:08But what we can do,
33:09I think is sort of take a breath
33:12and and and recognize and sort
33:15of validate the really admirable
33:17qualities that both sort of the
33:19clinical team and parents bring
33:20to these kinds of disagreements.
33:22And so for me,
33:23kind of thinking about parental
33:24virtues and sometimes working
33:25with the team to reframe
33:29these kinds of conflicts to sort of
33:31say to my, to my clinical colleagues,
33:33like, hey, I did talk with the family
33:34and what I heard was that they're
33:36just trying to be good parents and
33:37that's really driving their decisions
33:38and why they feel like they cannot
33:41discontinue things at this point.
33:43Have you talked to them about what
33:44it means to be a good parent?
33:45Sort of framing things around the parental
33:48role and thinking that through has,
33:49at least for me and my practice,
33:51been a helpful way of sort of
33:53approaching these disagreements.
33:55And you don't have to kind of move one
33:57party to the other's point of view,
33:58but we can get a little bit closer
34:00to a shared middle I think.
34:01So that's one way.
34:02And again not I don't walk into
34:03the room thinking what would virtue
34:05ethics say about this disagreement.
34:07But kind of thinking often post talk
34:10about like what were the things I
34:11heard and how are they reflective of
34:13what people think it means to be a
34:15good parent or a good neonatologist
34:17or a good nurse in this case.
34:19And how can we recognize and validate
34:20those things so that we build
34:22a little bit more rapport.
34:23So that is certainly one kind of case
34:25where I think that this thinking about
34:28virtues and particularly role based virtues,
34:30what it means as I said to be a
34:32good parent and good Commission,
34:35good social work and good healthcare
34:36administrator or whoever is involved
34:37in the console thinking that through
34:39those different role based virtue
34:40lenses has been really helpful for me.
34:45Anyone in the room ever had
34:48sort of a conflict with a
34:50colleague about patient care?
34:51Yeah, we've got some nods.
34:53Yeah, not surprised. Yeah.
34:55So sometimes I think about this too.
34:57So you know we'll get again a kind of
34:59consult that we'll get sometimes is
35:03maybe a consult from a nurse or from
35:07a resident or sort of a specialist
35:09consultant who's like I don't know
35:10what we're doing to this patient,
35:12like everyone's pulling their
35:14care in different directions.
35:16We need you to come in
35:17and sort of help us sort,
35:17sort it through and get on
35:18the same page about things.
35:19So this is sort of another role
35:21based case where I really think
35:25that again we may not ever think
35:27or agree upon what the absolute
35:28best thing to do is for a patient.
35:30There may be uncertainty about outcomes.
35:32We may not know what's going to
35:33happen if we do X versus one we do Y.
35:35So again there might be sort of
35:38disagreement or uncertainty at
35:39the epistemic level about sort of
35:41predicted outcomes about what's
35:43important for this patient.
35:44But what we can do is sort of again,
35:46adopt that role based lens and recognize
35:51why there's a little bit of tension,
35:52right,
35:52why we're kind of pulling
35:54things in different directions.
35:55So again,
35:55sort of just piercing things out and
35:56everyone sort of wearing a different hat.
35:58And there's some different commitments,
36:00different,
36:00different virtues that people
36:02are sort of carrying in based
36:04on their role to that situation.
36:05I think it has helped me in these
36:08kinds of cases as well to sort of find
36:10some shared ground and just try and
36:12like take a breath and just be like,
36:14you don't have to like this person.
36:16But we can kind of respect that
36:17They're trying to be a good
36:18nurse or they're trying to be,
36:19you know, a good clinician,
36:20a good, a good cardiologist,
36:21a good,
36:22you know,
36:22whoever's in the room involved in
36:24in the conflict in the consult.
36:29One more story.
36:30How am I going for time? OK, perfect.
36:33So I was in Melbourne in September
36:38for a conference on pediatric
36:40bioethics with Lynn and the team
36:41at Royal Children's Hospital.
36:43And the theme of the conference was
36:45innovation. So we spent 2 1/2 days
36:47talking a lot about these amazing
36:50technological advances in healthcare.
36:52You know, cut like cutting edge
36:56surgical techniques, devices.
36:57We talked a lot about AI, machine learning,
37:01just kind of the brave new world,
37:02just kind of everything that's
37:04pulling healthcare in certain
37:05directions at the moment,
37:06where funding is going,
37:07what we're what we're interested in,
37:09what we seem to value overall within
37:12clinical practice and research.
37:14And it's really interesting.
37:15Things started to happen on the second day
37:19during the Q&amp;A for the sessions.
37:21People, much to my delight and surprise,
37:25really started drawing upon virtue
37:27terms to talk about their roles
37:29and their professional obligations.
37:30And it was just sort of this
37:32really interesting natural thing
37:33that sort of happened with a
37:35particular group that we had there.
37:36And I was talking to my colleague
37:38John Massey, and we all come.
37:39This is so interesting, like,
37:40why are we drawing upon virtue ethics
37:43so much in the context of this really
37:46broad philosophical and practical
37:47discussion about what is innovation and like,
37:49is it good, is it bad?
37:50People were really latching onto well,
37:52well my role is this,
37:54I feel like I have to do this and you
37:57know people I think were looking for
37:59something to grasp onto that felt
38:01a little more tangible just given
38:02how much uncertainty and how much
38:04we're kind of pushing boundaries
38:05around what's possible in healthcare.
38:08And we just found that really interesting.
38:10And So what I've been thinking about
38:15is why are we so drawn to it?
38:16When are we drawn to it?
38:17Who is drawn to this kind
38:19of virtue based framing?
38:20And and I think as I said,
38:23where it sort of feels like
38:25more solid ground and where it
38:27feels like it has more value
38:28is often when we're talking
38:30about roles and relationships
38:31that kind of interpersonal bit.
38:32What are the qualities I want to
38:34approach that interaction with
38:38and particularly when those roles
38:41and relationships potentially
38:43create different epistemic,
38:45normative or practical commitments?
38:48So again, recognizing we may not be
38:49on the same page about something,
38:51but what I can control is sort of
38:53how I approach this interaction.
38:55As I said, when there's disagreement,
38:56when there's uncertainty about things,
38:58I think that is a time when
39:00virtue ethics really,
39:01I think it always adds something.
39:02But the the less certain things are,
39:05the more prone we are to disagreement.
39:06I think that's really a time when
39:08it can help us because again,
39:10you have control over you, right?
39:11That's kind of the thing that you
39:13can control when you approach and
39:14by cultivating those in a personal
39:16sort of skills and virtues,
39:19I think I've seen it be very
39:21powerful in different settings.
39:22And it was really interesting at
39:24this conference how much people
39:25were drawn to it when we were sort
39:26of struggling with like what are we
39:28doing as healthcare practitioners
39:29and researchers at the moment doing
39:31all this cool stuff. But like, why?
39:33What is it we care about?
39:34How are we kind of thinking about
39:37the the professional roles that
39:39we have and who they're helping?
39:41I'm going to whiz through this.
39:45The other thing I just whizzed through
39:46was just some research that we're
39:48doing at the moment on responses to
39:49suffering and sort of carrying the
39:50work and moral and social psychology.
39:52What actually happens in our brains
39:54when we when we witness someone
39:55suffering with some of the virtue ethics
39:57theory on virtues like compassion,
39:59mercy, pity, things like that.
40:01So putting them in conversation,
40:02it's going to be really cool.
40:06We're at 5:45. I'm going to kind of
40:08wrap it up there with just these
40:10are sort of questions that I had
40:12for you all coming into tonight.
40:13I was really sort of thinking about
40:17as I said, where we're at.
40:18I know we've got some trainees in the room.
40:19How do you think about your role?
40:21What kinds of qualities do you think
40:24healthcare practitioners need to have
40:26this particular moment in history with
40:28sort of everything that's going on,
40:29all of these conversations
40:31questioning medical expertise,
40:33authority of clinicians,
40:36what sorts of traits feel really,
40:37really valuable to you?
40:39So it's even something you think about.
40:41How do you see,
40:42how do you all see virtue ethics applying
40:43to your personal or professional
40:44life if you think that they do?
40:46And what value do you think it has, if any?
40:50What bugs you about it?
40:51These are sort of some questions
40:53that I had coming into it that I
40:55would love to hear your thoughts on.
40:56I can leave that up.
41:01Here's my info. Please feel free to
41:02reach out if you have any questions.
41:03I work mostly in pediatric Biomedics as well.
41:05So if you have questions about
41:07decision making for kids,
41:08super happy to chat about that, about this,
41:10about pretty much anything else.
41:11So thank you all so much. Yeah,
41:18leave that out.
41:19That's great. Thank you.
41:20Thank you very much.
41:21An announcement I need to make
41:23that Karen reminds me before we
41:25get any further for CMA, please.
41:29And it is this for the folks
41:32on Zoom should have this.
41:33But for the folks in the room to get
41:36your continuing education credit for
41:38this talk you it's the number is
41:44203-442-9435. A lot of folks that yell
41:46know this number. It's in your phone
41:50203-442-9435. And the code you text is
41:5740965 40965. And if you didn't get that
41:58if some way at the end of the talk you can
42:00come see me and I'll send you that again.
42:02Or you can ask Karen. She has that.
42:04This was wonderful. Thank you so much.
42:08I'm going to take the the
42:10the moderator's prerogative.
42:12I've got 1 mic here. I'm going to ask you.
42:15You've got one as well. Terrific.
42:16OK. So when we go around your talk,
42:19if you'd be so kind as to raise your hand
42:22and I'll indicate who's going to speak next,
42:24and Karen will bring him, like,
42:25wait till the mic gets to you
42:27so that everybody can hear you,
42:29including the folks who are online.
42:31I want to start by answering what
42:32do I think one of the most valuable
42:34traits or dispositions?
42:35Because I was thinking of things
42:36and it might not be one of this is
42:39particularly for my student pals who
42:40were in the room because, you know,
42:42everybody's going to talk about
42:43kindness and honesty and all that stuff.
42:45Yeah. Yeah.
42:46Yeah.
42:47So And I think those things
42:49are horribly important,
42:49but I have to say that as someone
42:52who works with physicians and
42:54for years supervised physicians,
42:55what I found to be the most
42:57valuable trait or the trait that
42:59was most dangerous when it was
43:01missing was reliability.
43:03And you would touch on trustworthiness
43:05and we'll call it the same thing.
43:07When I say to someone did
43:08you do X and they say yes,
43:10I did X and then I find out
43:12afterwards that they didn't.
43:13That's a huge problem in
43:15the practice of medicine.
43:16The reliability and trustworthiness
43:18is is that's a what's the word.
43:22I'm thinking of a deal breaker when
43:23that's not really really solid.
43:25So that's just my throw in for
43:26the for the students and the
43:28younger folks in the room.
43:29But past that,
43:30I actually want to turn it over
43:32to others who may have answers to
43:33Professor Moore's questions or
43:34other things they want to ask her.
43:36But let's start before we start
43:37asking her the really hard questions,
43:39let's try and answer some of her questions.
43:42Can you bring the mic?
43:43Do you have the mic?
43:45So can you bring it up to
43:47Mark to start us off?
43:52Are you comfortable?
43:53Do you want me to grab your chair?
43:54Are you good? You're welcome.
43:56I'm just sitting at the
43:58table. I'm good.
43:59Thank you for an excellent talk.
44:01So I'll, I'll start with the middle,
44:03the middle question. So.
44:04So I was a Co chair of the adult bioethics
44:08committee for several years
44:10and one thing that struck me
44:12is that I was used to wonder
44:14why did this case come to us.
44:17And and I I regret looking
44:19back that you know I I took
44:21sort of a principalist approach
44:23to most of the challenges that
44:25were brought to our our table. But
44:27I think that what I'm seeing now
44:31particularly this evening is where
44:33the the absence of virtue actually
44:36might have contributed to the
44:38problem coming up in the 1st place.
44:40So not that virtue was going
44:41to offer easy solutions,
44:44but that the lack of honesty
44:47or the lack of integrity
44:49or the lack of kindness
44:51is actually what caused a dissolution
44:54of the relationship between the
44:56patients and the and the physicians
44:58and the and the healthcare team. And.
45:01And so the lesson was, if you almost think
45:02about it in like a preventive way,
45:05right, if if we acted virtuously, maybe,
45:09maybe the dilemmas that come to us
45:12would never have happened in the first place.
45:15Yeah, I've got like a million things going
45:16through my head with a comment like that.
45:18I also think it's an interesting question.
45:20Why? Why this case like something I'm like
45:22that you could have got that case weeks
45:24ago and it wouldn't have come like it was.
45:25Interesting trends and questions I think
45:27in there about when that particular
45:29mechanism of the committee gets triggered.
45:32I feel sometimes a little bit wary.
45:35A lot wary about talking about
45:39vices or kind of thinking about my
45:41colleagues or myself being like man,
45:42I just I was unkind or like how do how do.
45:45What I'm asking is kind of how
45:47do we balance not being overly
45:49judgmental with people or you know,
45:50I would never say in a meeting,
45:51man that person was like I might
45:55think it but like how do we kind of.
45:58I wouldn't.
45:58I would hate for us to have sort
46:00of a virtue ethics lens on a virtue
46:02ethics hat on and kind of come out
46:04of something thinking like well,
46:06it's just about kind of pointing at
46:07people who whack really important
46:08qualities And like again that
46:10doesn't kind of resolve anything.
46:11But what I think your comment gets
46:13us to is the importance of creating
46:16environments and workplace cultures
46:17that help us to be kind or help us to
46:19have humility or earn our mistakes.
46:21Or if we didn't do something,
46:22just be like, I did not do that.
46:24I will do it next time or you know,
46:25how do we.
46:26I think there's a really important
46:27point in there about
46:30why someone wasn't able to to
46:32possess or kind of demonstrate
46:33those things in their interactions.
46:35And I think that's particularly
46:36important for us to think about
46:38what kind of ethical climate of
46:39institutions and healthcare practice
46:41and training at the moment as well.
46:42I don't get any sense.
46:43Sorry, I feel like I'm battling yell.
46:44But yeah, that's yeah, it's
46:46a lot of sense. You know,
46:47you know I think you're right.
46:48It's not. It's not that we
46:50would condemn somebody, but.
46:51But I think that a lot of patients
46:53feel really lost in a big
46:55healthcare institution like ours.
46:57And the teams change and you know,
47:01mistakes happen and they
47:03wonder who's in charge.
47:04And and so there are all sorts of
47:07of problems that lead to loss of
47:09trust that I I think that somehow if
47:12we inculcated this notion like what
47:14what does the patient really need
47:15from us before a problem arises might
47:17actually keep that from happening.
47:19Yeah. These little missed
47:20opportunities to show a little bit
47:22of kindness or spend some extra
47:23time or double check something
47:25to be really meticulous or.
47:26Yeah, absolutely.
47:27Thank you for that comment. Yeah,
47:30let's hear from James. Oh, Jack.
47:31Looks like Jack's geared up to say something.
47:33I've. I've got the mic.
47:36You have the talking stick, Dr. Hughes.
47:39Ordinarily I'd say never mind but since
47:41you were named as as one of the most.
47:44And by the way, by the way,
47:46I'll go ahead and say this because because
47:48God would strike me down if it wasn't
47:50true that that's what I was going to say.
47:53So Mark and I are of like mind on
47:55this though I can't for the life of me
47:57remember why I was going to say it.
47:58But but that's what I was going to
47:59say that not I'm talking about Jack
48:01being the person that you would admire.
48:02All right.
48:03So because of that talk to Hughes
48:04land the next question and then we're
48:06going to hear from James in the back.
48:07Go ahead, please.
48:10With regard to the to the virtues
48:12what I think,
48:13and this is building off what Mark said,
48:17I I think of
48:20I don't know how
48:21to define whether to define this
48:23as a virtue or as a skill or both.
48:25And that is the ability to communicate.
48:28Because I think so often that's
48:30the the problem that leads to the
48:33mistrust and the and the sense
48:36of of loss and bewilderment that
48:38results in the ethics consultation.
48:41So but I can. I can see it as a skill,
48:45but they it does require a virtue
48:48of patience and humility and and a
48:52willingness to listen in order to
48:54get to the place where you learn
48:56that skill and can apply that skill.
48:59So that's simply an addendum.
49:08Hear from James then. I'm hoping.
49:09Oh, thank you very much,
49:10because I I wanted to hear from
49:12some medical students after that.
49:13But we're working our way down
49:16to the medical students. We'll
49:16talk to a house officer now,
49:17and then eventually we'll get to you guys.
49:19Yeah, attendings and residents.
49:20And you guys will be next.
49:21Yeah, so Bry already outed me as
49:25somebody sympathetic to her 'cause here.
49:28So hopefully the room will understand that
49:30I am teeing her up for a knockout punch.
49:32Not being critical,
49:34a common critique I've often heard of.
49:37Specifically, the Aristotelian
49:40framing of virtue ethics is that
49:44it is a self defeating framework.
49:48Because if we think of virtue as this,
49:51you know, classic undergraduate golden
49:54mean between excess and deficiency,
49:57then shouldn't virtue itself also
50:00be something that it's possible
50:02to have too much of?
50:04And in my mind,
50:05I don't think that's the case.
50:07I don't think that it is possible
50:10to be too good.
50:13What would you say to people who
50:14would kind of levy that criticism?
50:16Would you just say, well,
50:17that's just Aristotle,
50:18he's an he's an idiot,
50:19he's been dead for 2000 years.
50:21What would you say?
50:23Yeah, I would. I would say I was thinking
50:25about this earlier like it's kind of
50:27like it's the self effacing in many ways.
50:30Like do you want people to
50:32be doing the right thing?
50:32Because it's the right thing to do right.
50:34Like we want a little bit
50:36more like if is it Susan Wolf,
50:39someone has a paper on moral Saints
50:41and how they just seem like the
50:42most like cringe people that we
50:44couldn't stand to be around. Right.
50:46This idea of just like too good,
50:48like take it down a notch kind of exemplar,
50:52right? Like there's it's good
50:54to be bad sometimes, right?
50:55Or kind of to have him put imperfections,
50:57don't quote me on that.
50:59But like to have imperfections or flaws,
51:01right?
51:01Like this is part of of of who we are
51:04and how to kind of like balance that.
51:06I think it's valid.
51:07I think if we were all kind of these
51:10virtuous robots that would be awful.
51:12I don't know where that that
51:14balance is exactly.
51:15I think it would be different for
51:16different people and different
51:18roles depending what we're doing.
51:19But yeah, I think.
51:20I think that's an important one.
51:21And I am not an Aristotelian by any means.
51:26And I also, I'm a philosopher by training.
51:28But it's been a long time since
51:29I've dug into kind of where the,
51:31like,
51:31the theoretical debates around this are at.
51:33So I don't actually know if
51:34there's any kind of good.
51:35I'm sure there are responses to that
51:38kind of worry from more contemporary
51:40virtue ethicists or virtue theorists.
51:41But yeah, I think it's an important,
51:44important one,
51:44right?
51:45Like imperfections and sometimes
51:46getting it wrong and just having some
51:49flaws is really important to the paper
51:51on moral Saints is really a fun one.
51:53Yeah.
51:53If you would recommend it,
51:55if
51:55you like. I won't name you when I quote
51:57this but I'm definitely storing this
51:59in a way it's good to be bad sometimes.
52:01I mean I'll just say a noted bioethicist
52:03and we can leave it at that if you'd rather.
52:05If you want credit, I'll give it to you
52:06and by the way you say you haven't been,
52:08you've been in the in the clinical arena
52:10for a while and and we've talked about this
52:12and we were talking about this in terms
52:14of our interests here etcetera that you
52:15actually run a clinical ethics fellowship.
52:17And also for the sake of I'm some of you
52:19folks know there's no doubt but for those
52:22who are less involved in pediatric ethics.
52:24So places like Melbourne this is
52:27this is one of the meccas for PDI,
52:29this the land of Lynn Gilliam and
52:31Trish Prentiss and so many others
52:33that's the place for pediatric ethics.
52:34And in the US,
52:36places like Children's Mercy and Baylor,
52:37I mean this, this,
52:38these are so you've not been
52:41involved in those heavy, deep,
52:43pure philosophical conversations lately.
52:45You have in fact been steeped
52:47in other areas that I think can
52:48be very helpful to this group.
52:50Now I've got something online,
52:51but before we get to that,
52:52I want to hear from Caitlin,
52:53perhaps one or two other medical students.
52:56OK, cool.
52:57So I actually wanted to
52:59address the third question.
53:01So in terms of value,
53:03when you were talking about virtue ethics,
53:05I actually found myself thinking
53:07a lot of my classmates and myself,
53:10just all the mistakes we make
53:14as we're learning.
53:16And I I find ourselves looking at each other,
53:19judging each other,
53:20even not by like what actually
53:23happened but the type of people we
53:25are and being like he really wanted
53:27to be honest with the patient,
53:29but maybe he said too much.
53:31So I feel like it's a really easy
53:33way to approach ethics that we're
53:36not necessarily taught.
53:37One thing I see that can potentially I
53:40think this tough is I find that as we
53:42spend more and more time in the hospital,
53:45the consequences of our accidents
53:47matter a lot more than our than what
53:50we are trying to do or like who
53:52we are trying to be as a person.
53:55So I feel like it can get conflated
53:58like what the right virtues are
54:00and what you should be doing.
54:04And as to answer the second part,
54:06the question what bothers me about.
54:11I think that when you were talking
54:14about the situationalist perspective,
54:15I thought that was really
54:17interesting because I thought to
54:19myself that for a situationalist,
54:21if you nudge a situation, any direction,
54:24that changes the situation.
54:26So my question became,
54:28is someone still virtuous as long
54:31as they have the same reaction
54:33to the same situation every time?
54:36Do they possess the same virtues every time?
54:39And my one worry with that in the
54:41hospital is I have encountered so
54:43little that it feels like I have to
54:46figure out what my reaction would
54:48be first to everything before I
54:50can become someone who's virtuous.
54:54Excellent points and comments.
54:54Do you want me to say a little
54:56bit? Absolutely. Whatever
54:57you're feeling saying, yeah, I
55:04yeah, I'm thinking about your comment about
55:05kind of your colleagues and just this,
55:07again, this judginess worry, I think.
55:11And I mean, again,
55:12it does like a big question about
55:13teachability in here, right?
55:15Like, can we, like, teach people
55:17to be empathetic or or honest?
55:20And like, what does that look like?
55:22You're not going to take an honesty class?
55:23Like that's kind of weird.
55:26But yeah, again, I think role modeling.
55:27So for me that was a big one,
55:29particularly as a clinical ethics fellow.
55:31Watching how my mentors did it,
55:32watching how attending other kind
55:35of clinicians in the space had had
55:38conversations or practice these things,
55:40really, really watching
55:41them and seeing it get done,
55:43being done badly a lot of the time.
55:45You know, I think we often learn a lot
55:47more from that and then sometimes we
55:48do when we see it done well, we just,
55:50oh man, that was that was good,
55:51was a good conversation kind of
55:52mop on to the next thing.
55:53So I think
55:56not that you asked me for advice, but again,
55:58you're doing that important work of kind of
56:00watching really closely and now thinking
56:02about like what was it that happened there,
56:04what kind of was done well,
56:06how could I've done things differently?
56:10And I think to your point, like getting it
56:12wrong a lot that's going to happen, right?
56:14And that is not necessarily a bad thing.
56:17It's kind of, again,
56:18how we approach getting it wrong and how
56:19we kind of talk with each other about it.
56:21I'll be honest about what went wrong.
56:23Do we have enough respect for
56:24each other to kind of be like,
56:25yeah, that was not great.
56:26And I can say that to you because we're
56:28in this together kind of thing. So yeah,
56:29I think this is all sounding very weird.
56:31But yes, I think you're thinking
56:32about all the right things.
56:36And then what bothers you about it?
56:37Yeah. So this idea that,
56:38like virtues, character traits
56:40should be fairly fixed, right?
56:41Like if you're an honest person,
56:42you should show that pretty consistently
56:45across different situations.
56:46But there's also this claim within
56:47burst reference that you have to be
56:49very sensitive to the particular
56:50situation that's in front of you.
56:52So how you're honest,
56:53like how much of it you sort of demonstrate
56:56how what what particular language you use,
56:58it depends on sort of your
56:59role in that particularity.
57:00It's going to come with experience.
57:02I think I'll tell you too,
57:05as a clinical ethicist,
57:06I walk out of conversation sometimes
57:07and I'm like I did not handle that well
57:08or like I there was a really different
57:10way I could have asked that question.
57:11And sometimes I'll go back and say, hey,
57:13if I have a few more minutes of your time,
57:16you know,
57:16you just realize like there's something
57:17really important I wanted to ask you about.
57:19So again,
57:19just like it's just it's practice,
57:20I think, and giving yourself
57:21permission to kind of get it wrong.
57:23Sometimes I think you're thinking
57:26about all the right things.
57:27And I appreciate your comment.
57:29If I could just add 1 little
57:31thing to to to add to that,
57:32which is to say it's not necessarily
57:35virtuous or a goal to look back when
57:37you're 60 years old and saying,
57:38man, I'm doing this exactly the
57:39same way I did it when I was 25.
57:41You know, it's all right that you're a
57:43work in progress throughout your career.
57:45It's not your mission to always
57:46do things the same way.
57:47It's your mission to do your best.
57:49And that may be different in
57:512024 than it was in 2023.
57:52That's all right.
57:53That's all right.
57:54This gentleman and this gentleman
57:55I've got a couple questions
57:56online I want to get to.
57:58Hi, thank you for talking to us today.
58:00I'm curious how you respond to the
58:02critique that virtual ethics is just
58:05a way of applying consequentialism
58:07and that like the reason we call
58:09some qualities virtues is because
58:11they have good consequences.
58:13And you talked about like the golden mean.
58:15And if not like consequences,
58:17how should we like?
58:18What are we drawing on to
58:19strike that balance? Yep,
58:21that's such an important question.
58:22Hang on to the mic for a SEC
58:23because I want to ask you,
58:23why does that feel important to you?
58:25Why you? Why you kind of asking?
58:29I guess I'm worried about people
58:31clinging to virtues when the consequences,
58:34if they think further about it,
58:36would actually be better if they
58:37didn't cling to the virtue.
58:38Yeah. Yeah. Super important question.
58:41And I think, I think a very valid one.
58:43And as I said, I'm not here to kind of
58:45virtue ethics is it ethically it's the one
58:47all and be all like end of it kind of thing.
58:49And I think I hope no one took me
58:51as saying consequences don't matter
58:53because they matter tremendously, right.
58:54And I was I think about this a lot in the
58:57context of pediatric bioethics where we
58:59we often experience disagreements between
59:02parents and clinicians and we always
59:04come back to what's the effect on the child.
59:05And I think that really is sometimes
59:07sort of an ethically decisive
59:10factor and it should be how we
59:13think of them as working together.
59:15So I think we have to think about both. And
59:23and I'm trying to kind of think
59:26about a situation in which,
59:27you know, feeling virtuous would
59:29come into conflict with what we
59:31felt was doing the right thing.
59:32Those are the kinds of
59:33situations you're interested in,
59:34it sounds like like kind of when
59:36they would come into conflict,
59:37we're like clinging on to the idea of
59:39being honest or compassionate would
59:40actually have nothing to do with kind
59:42of a good consequence for someone.
59:43Yeah. I
59:44mean, I, I, I guess the,
59:46like you talked about,
59:47like trying to balance these
59:48virtues, right? Like being too
59:49honest or not honest enough, like
59:50if if not just looking to the consequences,
59:52what what else should we be drawing upon?
59:54Right. OK. Sorry. That's.
59:55Yeah. Got your question now.
01:00:03Yeah, that's a good question.
01:00:04My answer is like, I don't know.
01:00:05I think, you know, when I'm kind
01:00:07of weighing and balancing again,
01:00:08it's rare for me to have a situation
01:00:10where I'm directly like being honest and
01:00:12being compassionate come into conflict.
01:00:13Like how will I choose between them. Like
01:00:16that's kind of not typically what happens.
01:00:17But certainly thinking about consequences
01:00:21is something that weighing and balancing.
01:00:23I don't know that. I don't know.
01:00:25I was kind of going back and kind of reading
01:00:27a little bit of the virtue ethics theory.
01:00:29I think it's fair that to say,
01:00:30like, sometimes it does sort of
01:00:32collapse into consequentialism.
01:00:33I think that's fine.
01:00:35Again, I'm not kind of a ******** moral
01:00:36theorist that's going to be like,
01:00:37oh, that's a catastrophe. Like,
01:00:40I think they probably feed into each other.
01:00:42Again, that's the same thing.
01:00:43I think if we were overly focused
01:00:45on consequences in them only,
01:00:46that could lead us to kind of a really
01:00:48bad place too. So it's all in there.
01:00:50That was a very unsatisfactory answer,
01:00:51but it's a very good question.
01:00:52Yeah.
01:00:53Thank you
01:00:59thing. I kind of struggle to grasp
01:01:01a little closer, if you would.
01:01:02The thing I kind of struggle
01:01:03to grasp with virtue,
01:01:04Essex is who decides what a virtue is?
01:01:07It's like, not like there's this omnival
01:01:08of being who like writes on every
01:01:10single virtue and it's set in stone.
01:01:12It seems like it's more
01:01:13like culturally defined.
01:01:14And I'm sure there's a bunch of overlap
01:01:17throughout time and through different
01:01:19cultures between what is a virtue.
01:01:21But in those times where there is no overlap,
01:01:23I could see that becoming an issue.
01:01:26So I guess my question is, how
01:01:28do you reconcile the variances in cultures
01:01:31and like, who defines what virtue is?
01:01:34Yeah, yeah, this kind of worry about
01:01:36cultural or moral relativism, right.
01:01:38Something that might might be,
01:01:40I'm thinking too even about different roles.
01:01:42So like the criminal good,
01:01:43the virtuous criminal
01:01:44defense lawyer might indeed,
01:01:46perhaps shall we say,
01:01:47lie for their clients sometimes.
01:01:49And that is a virtue professionally for them.
01:01:51So even between roles,
01:01:52I think there's sometimes conflicting
01:01:54ideas of what a virtue is,
01:01:55and then across cultures potentially as well.
01:01:57This is a really good and important question,
01:02:00but I certainly again also don't have a
01:02:03satisfactory answer to I think unlike any
01:02:05kind of concern about moral relativism.
01:02:07I think we always, like you said,
01:02:09look for common ground.
01:02:10We look for how kind of things
01:02:12have evolved over time,
01:02:13sort of trends historically as
01:02:15we've moved away from certain
01:02:16things towards other things.
01:02:21I'm trying to decide like how
01:02:22worried I feel about that.
01:02:27I think it would be,
01:02:31like you said, very problematic for
01:02:32someone to be like this is the definitive
01:02:34list of virtues, and everyone now
01:02:36needs to work towards having them.
01:02:37It would be so weird and terrible, right?
01:02:40And also, who would that person be like?
01:02:41There's a huge issue there about, like,
01:02:43you know, what if they themselves were
01:02:45not particularly virtuous, right?
01:02:46There's no idea.
01:02:47This is a big meta ethical
01:02:49point about what grounds them,
01:02:50what makes them virtues.
01:02:53I don't know how successful they've been,
01:02:54but virtue ethicists have sort of
01:02:56tried to identify what counts as
01:02:57a virtue relative to a role or a
01:03:00relationship or some sort of concrete,
01:03:02like particular the situation
01:03:03that you're in
01:03:07recognizing. Again, though,
01:03:07if you're in a different situation,
01:03:09in a different place,
01:03:09it might not be a virtue.
01:03:10So that's sort of how they've
01:03:12tried to get out of that.
01:03:14James, you were nodding vigorously.
01:03:15Did you want to add anything to that?
01:03:18No. OK Yeah, it's a good question.
01:03:20I think it's a big meta ethical debate about
01:03:23what ground something that makes it a virtue.
01:03:25My, as I said,
01:03:26was trained in philosophy,
01:03:27but now I'm just very practical.
01:03:28I'm like, well,
01:03:29it depends on the situation we're in,
01:03:30right?
01:03:32And part of that is recognizing
01:03:34the social and cultural situation
01:03:35that we're in and kind of checking
01:03:37ourselves depending on that situation.
01:03:38Really good question.
01:03:39Let me let me ask you a couple of
01:03:41questions from the folks online.
01:03:42If I do it, it seems that virtue ethics
01:03:45can really inform shared decision making,
01:03:48especially when outcomes are unclear.
01:03:50Can you speak to how these two are connected
01:03:54virtue ethics and shared decision making?
01:03:57Yeah. Yeah. And again this
01:03:59question I love just because of
01:04:01the uncertainty point like I think
01:04:03consequential think about consequences.
01:04:05Outcomes are so compelling when
01:04:06we know what they are, right.
01:04:08That's that's when we can
01:04:09kind of really like, yeah,
01:04:10we this matters and we really
01:04:12need to do the most good or kind
01:04:14of optimize things for folks.
01:04:15Right Where I think as I said,
01:04:16virtue ethics really adds something
01:04:18as when we don't know and when we can
01:04:21focus on processes and relationships,
01:04:23how and communications,
01:04:24how we speak to each other, how we interact.
01:04:28And I haven't seen a lot of
01:04:32discussion of the relationship,
01:04:34perhaps none between virtue ethics
01:04:36and shared decision making in
01:04:38the literature within bioethics.
01:04:39I don't think it's something that
01:04:41we talk about instead of thinking
01:04:43about frameworks for something
01:04:44like shared decision making.
01:04:45I don't think I've seen any.
01:04:47So it's something that I would
01:04:48love to go away and think more
01:04:50about and potentially write about.
01:04:51Well,
01:04:51I'll say to my friend who wrote this
01:04:54question, and you know who you are,
01:04:57who's here at Yale and a very insightful
01:04:59member of the junior faculty,
01:05:01that there's a question that maybe we can
01:05:03explore maybe with our friend Brianna.
01:05:05Another question, please.
01:05:08This is from a colleague at NYU
01:05:09who says thank you for your talk.
01:05:11How have you seen ethics and value work
01:05:13practiced or given attention differently
01:05:16here in the US and in Australia?
01:05:21Yeah. So I said something earlier
01:05:22about this kind of the cultural
01:05:23differences around what we talk about,
01:05:24particularly in kind of medical
01:05:26education and professional ethics.
01:05:27I've, I've been thinking about this a lot.
01:05:30I'm like, I I when I when I moved to the
01:05:34when I moved to the US back in 2018,
01:05:36no one wanted to talk to
01:05:38me about patio ethics.
01:05:39I was like, this is weird, except James
01:05:45and there was a lot,
01:05:47I think a lot more chatter about it,
01:05:49probably because I was in a
01:05:50bit of a bubble in Australia.
01:05:52I was working with virtue ethicists,
01:05:53right? Like that was kind of
01:05:54what I was doing my PhD on.
01:05:55So I think I was just surrounded
01:05:57by like minded people.
01:06:00I think bioethicists,
01:06:00I think it's a bit of it is a is a
01:06:03kind of historical like who was working
01:06:05on what and where in a particular
01:06:06time and how that how philosophy
01:06:08departments and sort of law department
01:06:10like certain departments involved
01:06:12in connection with kind of health
01:06:14and medical ethics in Australia.
01:06:16I think some of those people were
01:06:18sort of in those debates historically
01:06:20throughout time in a way that
01:06:22perhaps they weren't here in the US
01:06:23This is just me speculating wildly.
01:06:25So I could be completely wrong about this,
01:06:27but I think it was just sort of
01:06:29who was where and working on what
01:06:31at a particular time.
01:06:35I was really, I was really shocked
01:06:39at this conference in September,
01:06:41how drawn to it at least people
01:06:43working in pediatric settings were.
01:06:45I was surprised by, as I said,
01:06:46how much sort of virtue chatter there was.
01:06:48So I don't know.
01:06:49I got me thinking about are we
01:06:51are we kind of returning to
01:06:52virtue ethics at the moment is it
01:06:54something that's going to come back?
01:06:56Sorry, I don't know.
01:06:58That was a that was a babbly answer but.
01:07:01But
01:07:01you think so. It it seems to me
01:07:03what you're saying is that perhaps
01:07:05those who pay attention to virtue
01:07:07ethics on a more academic or classic
01:07:09level are we're more involved in
01:07:11medical ethics in Australia than
01:07:13the United States as things evolve.
01:07:15So yeah, I think the bioethics community
01:07:17is smaller and there are just more
01:07:19philosophers working on virtue ethics
01:07:21connected to the bioethics community.
01:07:22And that means so that these
01:07:24things just get brought up in
01:07:26discussions there more readily,
01:07:27more just more familiar with it. I think
01:07:29more credit to the folks in
01:07:31Galveston who saw the wisdom of
01:07:32bringing you front and center in
01:07:34their conversations there. I have.
01:07:40Yes, Jen And then the gentleman back there,
01:07:47I'm wondering related to your second question
01:07:53and your prior mention of the
01:07:54article you published last year,
01:07:56we have a lot of clinicians
01:07:58who are also parents
01:08:00and then we have a lot of
01:08:02clinicians who need to do share
01:08:04decision making with parents.
01:08:05And so as someone who is neither
01:08:08a clinician nor a parent,
01:08:10I can't answer that question.
01:08:11But I was wondering if you'd be game to
01:08:14speak a little bit more on what, if any,
01:08:17virtues you found sort of uniquely
01:08:20fitting in the professional space or
01:08:23in the parental space that might help.
01:08:26Those of us facilitating ethics
01:08:28councils related to these kinds
01:08:31of disputes could again,
01:08:33look to the clinicians and appreciate
01:08:36what they're doing there and look
01:08:38to the parents and appreciate
01:08:39what they're doing in that space.
01:08:41But then also for the folks who
01:08:43do have and continue or anticipate
01:08:45wearing both hats as both clinician
01:08:47and parent to be able to think through.
01:08:50When I take my clinician hat off
01:08:52and put my parent hat on,
01:08:54this is part of the virtue set
01:08:57that I'm switching between.
01:08:59Or when I take off my parent hat
01:09:01and step into a clinical encounter,
01:09:04this is what I have to leave behind.
01:09:07And or are they entirely reconcilable
01:09:09so that you don't in fact need to
01:09:12take a hat off and sort of swap
01:09:14between distinct virtues in one
01:09:16space versus the other?
01:09:17Yeah, thanks for that question, Jen.
01:09:19Another great one for the,
01:09:21for the paper that we wrote,
01:09:21we wrote,
01:09:22we really read a lot about just
01:09:24the parental role.
01:09:25We were really focused on that and I
01:09:28can tell you a little bit about that.
01:09:30We were very careful in that paper
01:09:32not to try and present an account
01:09:34of like this is what a good parent
01:09:37is and these are the virtues that
01:09:38any good parent would possess.
01:09:39I would a not ever want to do
01:09:41that and BA don't think it would
01:09:43be super constructive
01:09:47what what we found and what is out
01:09:49there in the literature and Chris
01:09:51Fiedner and some some of his colleagues,
01:09:52they've published some fantastic
01:09:54studies and what they've found is
01:09:56different parents have different
01:09:57ideas about what good parenting is.
01:09:59But the construct of being a good
01:10:02parent and exercising whatever it is,
01:10:04qualities, whatever the content of
01:10:06that good parent belief is that is
01:10:08a very fixed construct that parents
01:10:10explicitly mention when you talk to
01:10:14them about their child being sick
01:10:16and and how they approach decisions
01:10:17and what happens in the hospital.
01:10:19So that construct of being a
01:10:21good parent is action guiding.
01:10:23Different parents kind of plug in
01:10:25different different values and
01:10:26beliefs and practices into that.
01:10:28There are some pretty consistent areas.
01:10:30I think this gets back to a really
01:10:31fantastic question we had earlier about
01:10:33kind of cultural relatives and right,
01:10:34we would never want to kind of say this
01:10:36is the only right way to be a good parent.
01:10:38It looks different in different
01:10:39places with different families.
01:10:40And that messiness I think is a good thing.
01:10:44What
01:10:47generally things like being
01:10:49accepting of your child,
01:10:51just love, being a loving parent,
01:10:53being committed, committed,
01:10:54making sacrifices.
01:10:55Things like this are kind of
01:10:58commonly sighted parental virtues.
01:10:59Being future oriented so sort of
01:11:02balancing short term and long
01:11:04term considerations about the
01:11:05child's interests and flourishing.
01:11:07When a child gets sick,
01:11:10good parent beliefs tend to kind of
01:11:12shift into sort of a handful of major
01:11:15themes or categories around being informed.
01:11:17So when a child's sick or in the hospital,
01:11:19one part of kind of good parent
01:11:21beliefs that's pretty consistent
01:11:22is the idea like as a good parent
01:11:23I have to know as much as possible
01:11:25that was at least in the participants
01:11:27in these studies pretty consistent
01:11:29so and that would lead to certain
01:11:31information season behaviors that I
01:11:33think clinicians sometimes get frustrated by.
01:11:35These parents have gone home and
01:11:36done all their own research, right?
01:11:37But for parents, it was like,
01:11:39if I'm not sitting up on my computer
01:11:40at 3:00 AM doing a deep dive into this
01:11:42and reading these papers on my orange line,
01:11:44I understand it.
01:11:44I'm not a good parent.
01:11:45I'm not doing everything possible
01:11:47to make myself informed and able to
01:11:49approach decisions, feeling empowered.
01:11:50So that was,
01:11:51I think for us doing that reading,
01:11:52a really nice example of kind of
01:11:54clinician sees like this parent just
01:11:56going off and kind of reading much
01:11:58stuff they don't know about getting
01:11:59frustrated sometimes when parents like,
01:12:01well, I rent this.
01:12:02And for us,
01:12:03kind of looking at the literature
01:12:04and listening to parents,
01:12:04it was like
01:12:07I failed my kid if I'm not up and doing
01:12:09this and pushing myself to kind of
01:12:10find as much information as possible.
01:12:12So it was just a nice moment of what
01:12:14we think of as a tension when actually
01:12:15I think we have the same goal, right.
01:12:16We're just approaching you
01:12:18wearing different hats,
01:12:20being informed there was some consistency
01:12:25around the idea that a good parent
01:12:28still participates in care activities.
01:12:31There was there's discussion out there
01:12:32of a good parent being someone that kind
01:12:34of keeps the family unit together and
01:12:36functioning in some sort of normal way,
01:12:37whatever that looks like for that family.
01:12:39So this is just a few examples
01:12:41off the top of my head,
01:12:42but it was really interesting to
01:12:43look at the empirical literature
01:12:45on good parent constructs,
01:12:47where the points of overlap were,
01:12:48as I said,
01:12:49we weren't going to kind of present like,
01:12:51this is good parenting.
01:12:52I think good enough parenting is often
01:12:53like kind of or just getting by,
01:12:55right.
01:12:58That was kind of what we
01:12:58found about the parental law.
01:12:59I don't, I don't know about clinicians.
01:13:01It's not something I've kind of read
01:13:03recently about kind of how clinicians
01:13:04think about virtues and balancing them.
01:13:06And I think you've asked some important
01:13:08comment about what do we do when we're
01:13:10wearing multiple different hats and I
01:13:11don't know that we can ever take off.
01:13:13I think about the clinician, ethicist.
01:13:15I'm, you know, sometimes.
01:13:17Do you ever really stop being
01:13:18a physician even when you're
01:13:20kind of in your ethics role?
01:13:23No, I think. I think.
01:13:24I think if I understand where you're going,
01:13:26I think I'd go there with you,
01:13:28which is to say that that we are who we are.
01:13:29But I would say that I would say that as
01:13:34parents there may be more of an emphasis on
01:13:36virtues and as physicians there may be more.
01:13:39This is a gross generalization and more
01:13:41of an emphasis on rights and obligations.
01:13:43And, you know,
01:13:44and so I mean one of the smartest things,
01:13:46maybe the smartest thing I ever heard
01:13:48of an ethics council was a room full
01:13:50of physicians trying to figure out, you know,
01:13:53exactly what the right thing to do was.
01:13:54And we were weighing all
01:13:56these various principles.
01:13:56And then a friend of mine,
01:13:58a woman named Glennis,
01:14:00who was a chaplain, said,
01:14:01why don't we just not worry about
01:14:03that stuff and figure out what the
01:14:04most loving thing to do is and which,
01:14:06you know, hit some of us,
01:14:07including myself,
01:14:07like a ton of bricks.
01:14:09That is something one would hear
01:14:10more likely from a chaplain or from
01:14:12a parent than from a physician.
01:14:14But it is nevertheless insightful
01:14:15for all of us.
01:14:17We have this gentleman then, Jen upfront.
01:14:19Hi, thank you for the the talk.
01:14:22Amazing, super interesting.
01:14:24I'm wondering how you feel about
01:14:27like this characterization that
01:14:28sort of like I'm understanding.
01:14:30I wonder if we can think of like the virtue
01:14:34ethical approach differently from like
01:14:37the ontological or utilitarian approach,
01:14:40but more as a framework through
01:14:44which to do moral negotiations.
01:14:46So like I'm thinking a lot about like
01:14:51you you might have a certain set of
01:14:54virtues in your head and you aspire
01:14:56to have actions that reflect those.
01:14:59And that's like where the room for
01:15:01negotiation between a doctor and a parent.
01:15:03Or like that's where like the
01:15:05the parent is like, Oh no,
01:15:07I have this virtue and this is
01:15:09the action I should be taking.
01:15:11And I wonder in if there is room in
01:15:15there to reason to show the like the,
01:15:19the set of options that exist for
01:15:22the implementation of a certain
01:15:23virtue that taking perhaps a
01:15:25certain different action may not
01:15:27be not embodying that action,
01:15:29that virtue in that moment.
01:15:32Yeah, that's a wonderful,
01:15:34wonderful question again.
01:15:36And I think you're spot on.
01:15:37And I think as ethicists sometimes
01:15:40what our role to do is to normalize.
01:15:43I'm a little wary of this because
01:15:44I would never want to kind of
01:15:46think that was to convince or
01:15:47kind of shift someone to our
01:15:48idea of what being a good parent.
01:15:49But sometimes they'll say, like,
01:15:52you know, talking to parents will say,
01:15:53you know there's no wrong,
01:15:55there's no wrong decision.
01:15:57Regardless of what we do,
01:15:59we recognize you were a fantastic
01:16:01parent that loves your child to death.
01:16:03Like so we'll do some of that
01:16:06normalizing of different options through
01:16:08that lens of being a good parent.
01:16:10Like we'll kind of say like well,
01:16:11you know,
01:16:11we we had a similar case maybe and
01:16:13not quite exactly the same but in
01:16:15those parents we talked to them a
01:16:16lot and eventually decided that
01:16:18for them what was right and how
01:16:19they could show the most love for
01:16:21their child was to choose this.
01:16:22And it might be a little different
01:16:23from say the family in front of us,
01:16:24what they're considering.
01:16:25So we will,
01:16:26I think often try and use that approach
01:16:29of sort of thinking about that role,
01:16:31thinking about
01:16:34what it means for them for someone to be.
01:16:36I'm using a good parent example and
01:16:37then kind of trying to introduce
01:16:39some different options through that
01:16:41just to say like these are all OK,
01:16:43regardless of what you choose,
01:16:44you will not be any less
01:16:45of a parent in our eyes.
01:16:46And I think sometimes that
01:16:48can be really effective.
01:16:49I'm thinking about that question and
01:16:51conversation with a question about
01:16:53shared decision making now too,
01:16:54and sort of
01:16:57like almost like epistemic virtues too.
01:16:59And sort of how we approach negotiation
01:17:01or conversations like how to do that
01:17:03virtuously and thoughtfully and respectfully.
01:17:05I think that's all kind of linked as well.
01:17:07How to again, not bludgeon people with
01:17:09that kind of negotiation, but how to do
01:17:12it sort of carefully and with humility.
01:17:14That's a great question. Thank you.
01:17:18And the final question of the evening.
01:17:20Oh, no pressure. Make it good
01:17:22and then and then yeah, make it
01:17:24good. Respond to that and
01:17:25wrap up however you see fit.
01:17:27Better sing for my supper.
01:17:30Thank you for your really
01:17:31thought provoking talk.
01:17:32I I'm going to end with a thought provoking,
01:17:34hopefully a thought provoking question.
01:17:36Do you think that love,
01:17:37since Mark brought it up,
01:17:41is fully compatible with virtue ethics?
01:17:44This is why I'm asking.
01:17:45Because virtue ethics in some
01:17:47ways is very navel gazing, right?
01:17:49Was I honest? Was I, you know, reliable?
01:17:54Was I? It's very me, me, me.
01:17:57Whereas I'm not sure the
01:18:00world needs more me and I.
01:18:03And so, you know, we might need love.
01:18:06Is otherness right?
01:18:07Other centeredness and
01:18:08seeing the other person,
01:18:09recognizing the other person,
01:18:11uniting compassion with the other person.
01:18:14And do you see a disconnect between
01:18:16virtue and the self focus with
01:18:18the need for otherness, right.
01:18:20And unity. Yeah.
01:18:22That would be wonderful question to you.
01:18:24Thank you.
01:18:24I I don't,
01:18:29I don't think I do see them as incompatible.
01:18:30But maybe I've drunk the pool
01:18:32aid and I need to rethink this.
01:18:34But I think about the virtues as
01:18:37so socially embedded. And again,
01:18:40the reason why I think I I am always like,
01:18:42well, what do I control? It's me.
01:18:43That's kind of how I approach things.
01:18:47But that's always through the lens,
01:18:48like, who am I talking to?
01:18:49What is our relationship?
01:18:51How am I considering them?
01:18:53What can I know?
01:18:54What can I not know about about them,
01:18:56the other kind of bad things.
01:18:57So I think it's definitely a
01:18:59risk and one that I'm aware of,
01:19:01but I don't know.
01:19:04This may be a circular,
01:19:05but yeah,
01:19:05I think like part of being virtuous is
01:19:06thinking about other people and really
01:19:08centering that in in how you think about
01:19:10the virtues and your interactions.
01:19:11So I don't know if that gets us out of it,
01:19:14my body.
01:19:15Tyler Tate wrote a fantastic paper
01:19:17about love that got published in
01:19:19the Hastings Center either early
01:19:21this year or late last year.
01:19:23But he talks about the ethic of love
01:19:25within medicine and kind of talks
01:19:27about it through a virtue lens.
01:19:28So I can't answer,
01:19:29but maybe go read Tyler's paper and he
01:19:32will have a more satisfactory answer for you.
01:19:34But I think it's interesting and
01:19:35people kind of go a bit ick sometimes.
01:19:37When we talk about love in
01:19:39healthcare and decision making,
01:19:40I don't know, do people,
01:19:41we don't talk about love very much.
01:19:42And I think there's the sense
01:19:44that it's kind of weird like the
01:19:45idea of loving your patient but
01:19:49yeah.
01:19:52Yeah. Yeah. Or or compassion or just. Yeah.
01:19:55We're allowed to we're allowed to say
01:19:56compassion but we're not allowed to say yeah
01:19:57yeah. I think that's something
01:19:59really interesting now about
01:20:00but but parents parents will that's
01:20:02that that to to get to Jen's question
01:20:04I think to your point is that and my
01:20:06friend Glennis Chaplin Olshack when
01:20:08our point was that that's really
01:20:09where we should be focused on again.
01:20:11Seth brings in a whole, you know,
01:20:13which we just touched on briefly,
01:20:15the whole feminist ethics approach to things,
01:20:17as well as in the importance
01:20:20of relationships.
01:20:21Any final thoughts you have for us,
01:20:22my friend
01:20:23that's just got me thinking
01:20:24about the psychology of kind of
01:20:25how we approach things as well.
01:20:26I think that's all kind of in there.
01:20:28And I'm not just for an expert in
01:20:30psych methods, but I think yeah,
01:20:35yeah,
01:20:41yeah, I love that. Thank you.
01:20:46Well, we thank you very much.
01:20:49Yeah. Thank you all.
01:20:54Oh,
01:20:56the coveted, the coveted White cap.
01:20:58These are beautiful. All right.
01:20:59And some other yell swag for you.
01:21:02Outstanding. Thank you so
01:21:02much For excellent ease.
01:21:04Thank you so much. This was really good.