Taking a moral holiday? Physicians’ practical identities at the margins of professional ethics

Abstract

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician’s lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts ‘at the margins of professionalism’ as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics overlaps with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard’s account offers a framework for interpreting different types of moral conflicts ‘at the margins of professionalism’ to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas.

Physicians’ duty to climate protection as an expression of their professional identity: a defence from Korsgaard’s neo-Kantian moral framework

“…Due to the specific character of our background theory, however, we see the need to restricting our analysis to one healthcare profession. As argued elsewhere 27 we feel that Korsgaard's theory is well suited for understanding the character of professional ethics in a distinct way, namely as a normative selfcommitment which is closely tied to the physician as a person with multiples practical identities. We argue there that Korsgaard's view, based on multiplicity of our practical identities, has strong explanatory power at 'the margins of professionalism' where professional duties coincide with duties from other life domains.…”

“…However, Korsgaard's theory leaves open what duties our commitment to an identity commits us to and the authority on what duties constitute an identity does not lie solely with the individual. This is especially true for the medical profession as we have argued elsewhere, 27 as being a medical professional is defined by intersubjective practices that include the medical profession as a community and society at large. Attributing responsibility to individuals for issues that need to be solved from a systemic perspective is a widespread flaw in ethical discourses and should not be repeated regarding physicians and climate change.…”

“…Normative affordances (ie, moral demands) that arise from within a situation, such as the obligation for a physician to take care of the help-seeking patient in front of them, can productively be understood through the lens of Korsgaard's moral theory on practical identities. 27 According to Korsgaard, our practical identities ground our reasons for action, as they provide 'a description under which one values oneself, a description under which one believes one's life to be worth living and one's actions to be worthwhile.' 28 In other words, our practical identities, as the expression of what we value in our lives and what we value, ground our choices and actions.…”

“…This specific duty of physicians shows first in the recent development that climate-related duties have increasingly become a topic in documents on medical professionalism and also in bioethical debates. The basis of these arguments are that physicians do not merely have a duty to the single patient immediately in front of them but also to the health of the public (see the next section and our previous work 27 for two different argumentative lines within Korsgaard's theory to defend this claim). One implication of this, as has been argued by Parker,23 is that regulatory bodies, such as the National Health Service (in the UK), need to take climate impact into their considerations.…”