This article engages with Atkinson's (2011) recent criticisms of concepts of collective habitus, such as 'institutional' and 'familial' habitus, in order to defend their
When teaching ethics to medical students it is commonplace to distinguish between 'ethics', 'law' and 'professional guidelines'. We encourage them to think about the difference between what one ought to (not) do and what one is mandated (not) to do. There is, of course, a relationship between guidelines, law and ethics, and we might call it jurisprudence. Nevertheless they are distinct. In contrast it is less common to find similar attention being paid to the differences between 'ethics' and 'governance'. Certainly medical students are encouraged to think about ethics independently and not to simply rely on the quasi-legal guidelines set by the profession. However, at least in a manner comparable to that drawn between law and ethics, or even guidelines and ethics, we do not find any emphasis on the difference between them. This may well be because although at first blush we might consider ethics and governance to be distinct, further reflection reveals this not to be the case. It is unavoidable that, more or less explicitly, ethics involves governance.
BackgroundMaking particular use of Shale’s analysis, this paper discusses the notion of leadership in the context of palliative medicine. Whilst offering a critical perspective, I build on the philosophy of palliative care offered by Randall and Downie and suggest that the normative structure of this medical speciality has certain distinctive features, particularly when compared to that of medicine more generally. I discuss this in terms of palliative medicine’s distinctive morality or ethos, albeit one that should still be seen in terms of medical morality or the ethos of medicine.Main textI argue that, in the context of multi-disciplinary teamwork, the particular ethos of palliative medicine means that healthcare professionals who work within this speciality are presented with distinct opportunities for leadership and the dissemination of the moral and ethical norms that guide their practice. I expand on the nature of this opportunity by further engaging with Shale’s work on leadership in medicine, and by more fully articulating the notion of moral ethos in medicine and its relation to the more formal notion of medical ethics. Finally, and with reference to the idea of medical education as both on going and as an apprenticeship, I suggest that moral and ethical leadership in palliative medicine may have an inherently educational quality and a distinctively pedagogical dimension.ConclusionsThe nature of palliative medicine is such that it often involves caring for patients who are still receiving treatment from other specialists. Whilst this can create tension, it also provides an opportunity for palliative care professionals to disseminate the philosophy that underpins their practice, and to offer leadership with regard to the moral and ethical challenges that arise in the context of End of Life Care.
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