Moral Virtues in the Doctor-Patient Relationship
By Liza C. Manalo, MD, MSc.
• Profession, in its etymological root, means
to declare aloud, to proclaim something
• Thereby, professionals make a profession
of the specific kind of activity and conduct
to which they commit themselves and to
which they can be expected to conform.
• The essence of a profession then is this
act of profession-of
promise, commitment, and dedication to
• Clearly, a profession is much more than a
job, it is an identity.
• To be a professional is to assume and
maintain a life-long role of dedication to the
welfare of others-a role which confers dignity,
status, and power.
• Inherent in professionalism is a commitment to
• Destructive to professionalism is
expectation of personal gain and neglect of
the self-discipline and learning required to
• The first written use of the word profession in
relation to medicine was in 47 AD.
• In a book of prescriptions written by
Scribonius, who was physician to the court of
the Roman Emperor Claudius, he defined the
word profession as a commitment to
compassion or clemency in the relief of
• Scribonius also spoke about the Hippocratic
profession and the bans on abortion and
euthanasia and the requirement to always act
to help the sick by whatever means are
• Scribonius presented a humanistic
interpretation of the profession of medicine and
linked it to the humanistic virtues of
benevolence, compassion, mercy, and
competence in the use of medications.
• Thus, we can learn from Scribonius the history
of the word profession has been l inked to these
virtues from its very first usage.
• A virtue is an habitual and firm
disposition to do the good.
• It allows the person not only to perform
good acts, but to give the best of
• The virtuous person tends toward the
good with all his sensory and spiritual
powers; he pursues the good and
chooses it in concrete actions.
THE HUMAN VIRTUES
• Firm attitudes, stable dispositions, habitual
perfections of intellect and will that govern our
actions, order our passions, and guide our
conduct according to reason and belief (faith).
• They make possible ease, self-mastery, and joy
in leading a morally good life.
»The virtuous man is he who freely practices
The Cardinal Virtues
• Four virtues play a pivotal role and
accordingly are called "cardinal"; all the
others are grouped around them.
1. Prudence (practical wisdom)
3. Fortitude (courage)
4. Temperance (self-control)
Prudence (Practical Wisdom)
• The virtue that disposes practical reason to
discern our true good in every circumstance
and to choose the right means of achieving it.
• “Right reason in action“ – St. Thomas Aquinas
• Central virtue of medicine: It is the habitual
disposition to make right choices in complex
• The moral virtue that consists in the constant
and firm will to give their due to God and
• Justice toward men disposes one to respect the
rights of each and to establish in human
relationships the harmony that promotes equity
with regard to persons and to the common
• The moral virtue that ensures firmness in
difficulties and constancy in the pursuit of
• Enables one to conquer fear, even fear of
death, and to face trials and persecutions.
• The moral virtue that moderates the
attraction of pleasures and provides
balance in the use of material goods.
• It ensures the will's mastery over instincts
and keeps desires within the limits of what
Some of the virtues entailed by professional
commitment and the outcomes which actualize
that commitment are:
1. Fidelity to trust
3. Intellectual honesty
FIDELITY TO TRUST
• First, a physician has invited trust.
• If a patient accepts a physician, then the
patient cannot avoid trusting the physician
and it is essential if helping and healing
are to occur.
• Second, the prime concept of medical
ethics since the time of Hippocrates has
been acting for the good of the patient
and, of course, primum non
nocere, first do no harm:
• Third, medicine is a powerful instrument of both
good and harm, depending upon how medical
knowledge and skill are used.
• Knowing when one does not know and having
the humility and ability to admit it and to obtain
assistance are virtues critical to avoiding harm
and demand intellectual honesty.
• Fourth, a physician may expose himself/
herself to possible physical harm in
• It takes courage to be a patient advocate
in our commercialized and industrialized
system of care.
• Fifth, for any situation or clinical decision, a
physician must assume the predicament of the
patient in order to feel something of the
patient's plight if his scientific judgments are to
be morally defensible and suited to the life of
• Finally, a patient is owed the knowledge
necessary for making informed choices.
• A patient must be able to assess a
doctor's competence and truthfulness to
undertake the proposed course of action.
The opposite vices to these virtues are :
1. Fidelity to trust
3. Intellectual honesty
2. Malevolence, ill will
5. Indifference, Merciless
6. Untruthfulness, Lying
• De Rosa, G. Paul (2006), Professionalism
and Virtues in Clinical Orthopedics and
Related Research, Number 449, pp. 28-
33, Lippincot Williams& Wilkins.
• Pawlikowski J. Ethical principles and moral
virtues in the doctor-patient relationship.