Courage in practice

A major attribute of virtue theory is that it provides a framework for the discussion of courage; an aspect of ethics which escape deontological and consequentialist frameworks. I was recently struck by this when I read two accounts of people's experience of illness:


Kieran Sweeney's moving paper in the BMJ on his journey as a patient with mesothelioma

Published 14 August 2009, BMJ 2009;339:b2862

http://www.bmj.com/cgi/content/abstract/339/aug14_1/b2862



and an article in the Guardian on the battle a young man had to obtain the care he needed for his rehabilitation from a head injury.

In different ways courage was the key issue in both stories. Firstly of course the courage of the patient, as each of them copes with a life changing (and in Keiran's case life-threatening) illness. But also the courage practitioners need - not to shy away from bad news or someone facing a fatal illness.

Less obvious but increasingly important is the courage the carers of needed to take risks. We live in a risk-averse society and the point of the Guardian article was to show how the NHS sometimes seems more concerned with playing safe and covering its back than promoting the well-being of patients. He faced lots of limitations on what he was allowed to do as he recovered, based on fear of what might go wrong. A physiotherapist had to step outside the bounds of this "we're not covered" world and accept that if the young man concerned was to get better, he had to take the risk of falling and getting much worse.

We do this all the time in life, but our ligitation obsessed society finds it hard to accept that it has to be this way in healthcare, too.

Courage, Aristotle tells us, lies in a mean between cowardice and foolhardiness. I'm not sure we are very good at maintaining that mean these days. But we cannot flourish to our full potential if we don't take risks and show courage.

Are there ways in which our social structures can be changed to encourage us to become a more courageous society?

INTRODUCTION

Welcome to my Blog.

I'm a British GP with a fascination for the ethical issues which come through our surgery day by day, and which go unnoticed in the news media. I've started this blog as a way to raise the profile,in the UK and elsewhere, of these issues which so often get overlooked in favour of sexier things like assisted suicide and embryo research. (in case you want to know I'm against the former and for the latter, but I won't spoil the purity of this as a primary care blog by discussing why)

Of course doing this raises a major (ethical) problem and paradox. The raw material of medical ethics is encounters with patients, but we can't discuss real patients because it would be unethical! Fortunately after twenty-five years in practice I have a muddy field of memories which include few specific cases but form what I believe is called faction - realistic but not real cases. So my current patients can be assured that they will not be starring in this blog; nor will anyone else's. All contributions will be carefully screened to make sure that they discuss general issues rather than particular individuals.

My particular fascination is with requests for medical reports (see paper earlier this year in the BMJ which I will link to when I work out how) and virtue ethics, and the notion of the flourishing patient and doctor.(another link to be inserted). I'm an Anglican and an Aristotelean, and have been known to vote Lib Dem, so you can imagine that I am pretty middle of the road in most things.

I'd like this blog to turn into a discussion, so please send your contributions to peterdtoon@gmail.com. as well as adding your comments


Alongside this blog experiment I am trying to organise a primary care ethics interest group as part of the Society of Academic Primary Care, so if you are interested in that please contact me.