© The Author(s) 2015
Mohammed Ali Al-Bar and Hassan Chamsi-PashaContemporary Bioethics10.1007/978-3-319-18428-9_44. Virtue Ethics and Moral Character Related to Medical Profession
(1)
Medical Ethics Center, International Medical Center, Jeddah, Saudi Arabia
(2)
Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
Although moral values are universal, their application varies in different cultures. In this study we are inclined to choose the following:
(1)
Moral values are the result of habitual adherence to them. They become second nature as a consequence of habitually doing what one considers is right. This is what Aristotle maintained in his famous Nicomachian Ethics [1]. According to him all moral values and characters can be changed. Some Muslim writers on ethics accept such view (with some alterations). Tahanooni in his Kashaf Istilahat alFanoon wa alOloom “the lexicon of the terminologies of Arts and Sciences” says that morality “Khulq” is a habituation and nature, which is affected and directed by religion [2].
(2)
Others say morality is innate and emanates from within the self, and cannot be changed (except with great effort) (al-Jurjani [3], Miskawayh (Tahzib Al-aKhalaq).
(3)
Galen [4] combined the innate nature and temperaments, e.g., sanguineous temperament, which usually appears at young age and youth, but those of sanguineous temperament continue until their old age. All dictators, conquerors, and despots from Nimrod, Pharoes till Hitler, and Stalin have had this bloody temperament. Others have bilious temperament, some have melancholy, and at old age usually the temperament is phlegmatic. The theory of humors, which he proclaimed, controls the temperament and affects the character. These humors are four: the blood, the bile from the gall bladder, the black bile from the spleen, and the phlegm from the brain and lungs. The theory is obsolete, and instead of these four humors, the new sciences replace them with hormones, genes, and myriads of smaller factors from within the body and from outside the body, i.e., environment, which displays the effect of nature and nurture on our characters and morality.
(4)
Al-Mawardi [5] divided the origin of morality into two main branches:
(a)
The innate ones, which are part of our nature, which may be good or bad, and is controlled by instincts and humors (of Galen)
(b)
The voluntary character, which emanates from the training and using our faculties. It is of course influenced by one’s education and community.
It seems that he is combining both Aristotle and Galen, with a strong inclination to Islamic ethos developed by the Qur’an and Prophet Muhammad (PBUH). Other Muslim philosophers tried to combine Aristotle and Galen, e.g., alFarabi in his book “AlJama’ bain al Hakimain [6]” (Combining the two philosophers, i.e., Aristotle and Galen). Similarly, Miskawaih in his book Tahzib Al-akhalaq [7] defined morality as being innate, controlled by instincts and humors, but definitely can be changed by training, cultivation, and culture.
Tom Beauchamp and James Childress in their book “Principles of Biomedical Ethics [8] considered virtue as “a trait of character that is socially valuable; a moral virtue is a morally valuable trait of character … communities sometimes disvalue persons who act virtuously or admire persons for their meanness and churlishness.” This occurs when the innate good nature of human beings is changed by a system of life that extols power and wealth, which become the most important aspiration for the whole nation.
It happened in Pre-Islamic Arabia (Jahiliyyah). The poets of that epoch extolled the character of doing injustice to others, killing the men, enslaving the women, children and the weak, and appropriating their wealth (herds, money, jewelry, or land). The poet (Zuhair Ibn AbiSalma, a Jahyiliah) said:
Injustice is innate in all persons …
If you find one who refrains from injustice then he has a serious malady.
It seems that many in the present-day civilization have returned to this old PreIslamic morality, which Beauchamp and Childress deplored.
The Motive
Motive and intention play an important role in the formation of moral character. Hence, the act may appear virtuous, even when the intent and motive are bad. According to some ethicists, such acts are to be classified as immoral (Beauchamp and Childress).
In Islam, Prophet Muhammad (PBUH) taught that acts will in accord be with the intention of God. If the motive is good and the act is good, the person will be rewarded by God; however, if the act is good and the motive is bad, the person will be punished for it. There are many traditions to this effect. “Deeds and acts will be judged by the intention and motive” [9].
In another tradition the Prophet is reported to have said that the one who taught the Qur’an and religion would be dragged to Hell. He would exclaim and say: “O God I have taught people your book and your religion, for your sake.” God will say: “Nay you did it to be called a scholar (alim) and they did call you so.” The other example is of a wealthy person, who donated a lot of money to the poor and needy, but his intention was not for the sake of God, but to be called generous and benevolent by the people, and it was said.
The third tradition is about a person fought for the cause of religion against infidels, but his intention was to show off his bravery and courage, and not for the sake of God. Though he was slain in the war, and the people called him martyr, God ordered him to be dragged into Hellfire, because his intent and motive was people saying that he was brave and courageous [10].
These traditions show how important is the motive and intent in Islam in considering the deeds and acts of humans, which will only be judged by God according to their intent and motive.
On the other hand, a number of philosophers consider a person disposed by a good character with good motives to be more important than another person who acts only because of the strong sense of duty. The right motives and character tell us more about moral worth than do right actions performed under the prod of obligation [11]. The friend who acts only from obligation lacks the virtue of friendliness and the relation lacks moral merit [12].
The obligation-oriented theories which replaced the virtuous judgment of healthcare professionals with rules, codes, or procedures will not produce better decisions or actions. The most reliable protection of subjects in research is by an informed conscientious compassionate researcher [13]. From this perspective, character is more important than conformity to rules, and virtues should be inculcated and cultivated over time through educational interactions, role models, and the like [14]. Nevertheless, rules and regulations are very important to regulate research and health professionals, as only few will reach the high standards of innate benevolent character of the well-informed conscientious compassionate researcher or health provider. Many have to be controlled by rules, regulations, by-laws, and laws.
The person worthy of trust and praise is one who has ingrained motivation with a burning desire to perform the right action, and possessing a caring compassionate sympathetic generous character [8].
The action must also be appropriately done, according to the state of the art (of medicine), and conforming with the relevant principles and rules [8]. If the physician or nurse acts incompetently, he or she will not be praiseworthy, and has to improve himself/herself to the required standard.
Prophet Muhammad (PBUH) said: “Any person who practices medicine without due knowledge of medicine (or that specialty of medicine) is liable” [13].
He also said, “No person is wise without experience [14].” Islamic jurists for more than 1,200 years put the regulation that no one is allowed to practice medicine unless he is given a certificate from the Muhtasib (the controller of physicians) that he is competent. The practitioner has to get consent from those he is going to treat, or get the consent of the guardian if the patient is a child or mentally incompetent [15].
Roles and practices in medicine and nursing embody standard obligations and virtues. The important virtues in medicine and nursing are:
(1)
Compassion: showing active regard for the welfare of the patient. It involves both sympathy and empathy with deep mercy and actions of beneficence that attempt to alleviate the misfortunes and sufferings of others [8].
Physicians and nurses who express no emotions in their behavior toward their patients have a moral weakness. The compassion and emotions of the health provider should not cloud his judgment and his rational and effective response. If the patient is his own relative, he/she should abstain from medical management if his/her decision is going to be affected by the natural emotions.
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