Virtue Ethics

Transcript

• 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&A portion,
• 01:56the Q&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&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.