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Respect for patient autonomy as a medical virtue*

  • Thomas Cook (a1), Constantine D. Mavroudis (a2), Jeffrey P. Jacobs (a3) (a4) and Constantine Mavroudis (a3) (a4)

Respect for patient autonomy is an important and indispensable principle in the ethical practice of clinical medicine. Legal tenets recognise the centrality of this principle and the inherent right of patients of sound mind – properly informed – to make their own personal medical decisions. In the course of everyday medical practice, however, challenging cases may result in ethical dilemmas for the patient, the physician, and society. Resolution of these dilemmas requires a thorough understanding of the underlying principles that allow the clinician to make informed decisions and to offer considered therapeutic options to the patient. We argue in this paper that there is also need for a transition of moral competency from understanding principles to attaining virtue in the classic Aristotelian tradition. Achieving moral virtue is based on a lifetime of learning, practising, and watching how others, who have achieved virtue, act and perform their duties. We further claim that learning moral virtue in medical practice is best realised by incorporating the lessons learnt during daily rounds where frank discussions and considered resolutions can occur under the leadership of senior practitioners who have achieved a semblance of moral excellence.

Corresponding author
Correspondence to: Dr C. Mavroudis, MD, Johns Hopkins Children’s Heart Surgery, Florida Hospital for Children, 2501 N. Orange Avenue, Suite 540, Orlando, FL 32804, United States of America. Tel: 407 303 3697; Fax: 407 303 3634; E-mail:
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Presented at the Johns Hopkins All Children’s Heart Institute 15th Annual International Symposium on Congenital Heart Disease, Saint Petersburg, Florida, United States of America, Friday 6 February, 2015 to Monday 9 February, 2015.

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1.Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics, 6th edn. Oxford University Press Inc, New York, 2009.
2.Berg, JW, Applebaum, PS, Lidz, CW, Parker, LS (eds). Informed Consent: Legal Theory and Clinical Practice, 2nd edn. Oxford University Press Inc, New York, 2001.
3.Plato. Meno. In: Hamilton E, Cairns H (eds). The Collected Dialogues (translated by WKC Guthrie), Bollingen Series LXXI. Princeton University Press, Princeton, New Jersey, 1989.
4.Plato Republic. In: Hamilton E, Cairns H (eds). The Collected Dialogues (translated by P Shorey), Bollingen Series LXXI. Princeton University Press, Princeton, New Jersey, 1989.
5.Aristotle. The Nicomachean Ethics Book III (translated by Sir D Ross). Oxford University Press, London, 1954.
6.MacIntyre, A. After Virtue: A Study in Moral Theory, 3rd edn. University of Notre Dame Press, Notre Dame, Indiana, 2007.
7.MacIntyre, A. Whose Justice? Which Rationality?. University of Notre Dame, Notre Dame, Indiana, 1988.
8.Nozick, R. The Nature of Rationality. Princeton University Press, Princeton, New Jersey, 1993.
9.Kant, I. Grounding for the Metaphysics of Morals, 3rd edn. (translated by JW Ellington [1785]). Hackett Publishing Co, Cambridge, Massachusetts, 1993.
10.Mill, JS. Utilitarianism. Parker, Son, & Bourn West Strand, London, 1863, Retrieved July 1, 2015, from
11.Mill, JS. On Liberty, 2nd edn. Parker, Son, & Bourn West Strand, London, 1859.
12.Anscombe, GEM. Modern moral philosophy. Philosophy 1958; 33: 116.
13.Smart, JJC, Williams, B. Utilitarianism: For and Against. Cambridge University Press, New York, 1973.
14.Nagel, T. Mortal Questions. Cambridge University Press, New York, 1979.
15.Taylor, C. Sources of the Self: The Making of the Modern Identity. Harvard University Press, Cambridge, Massachusetts, 1989.
16.Lyons, D. Forms and Limits of Utilitarianism. Clarendon Press, Oxford, 1965.
17.Van Stavern, I. Beyond utilitarianism and deontology: ethics in economics. Rev Polit Econ 2007; 19: 2135.
18.Birden, H, Glass, N, Wilson, I, Harrison, M, Usherwood, T, Nass, D. Defining professionalism in medical education: a systematic review. Med Teach 2014; 36: 4761.
19.Mavroudis, C. Presidential address, the Southern Thoracic Surgical Association: a partnership in courage. Ann Thorac Surg 2003; 75: 13661371.
20.Aristotle. The metaphysics. In Barnes, J (ed.). The Complete Works of Aristotle: The Revised Oxford Translation. Princeton University Press, Princeton, New Jersey, 1984.
21.Chamberlain, JE, Nisker, JA. Residents’ attitudes to training in ethics in Canadian obstetrics and gynecology programs. Obstet Gynecol 1995; 85: 783786.
22.Parker, L, Watts, L, Scicluna, H. Clinical ethics ward rounds: building on the core curriculum. J Med Ethics 2012; 38: 501505.
23.Wen, LS, Baca, JT, O’Malley, P, Bhatia, K, Peak, D, Takayesu, JK. Implementation of small-group reflection rounds at an emergency medicine residency program. CJEM 2013; 15: 175177.
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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
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