Altruism and its challenges in medical education
Altruism offers one possible way by which medical professionals may
attend to this arrival and the myriad needs and vulnerabilities that
accompany someone arriving at an inhospitable time of night. It has been
described as “the cornerstone of the Hippocratic oath and other
professional codes of conduct”,5 underlying
organizational charters,22 doctrines of humanistic
healthcare,4 and influential competency-based medical
education frameworks.8,9 Altruism has a long history
in Western thought,23,24 yet as a concept in medical
education and practice it “remains “intangible and opaque” to
scholars5 and medical students25alike.
Various scholars have attempted to address this lack of conceptual
clarity around the teaching, learning, and practice of altruism.
Altruism has been defined both as the selfless intention informing a
person’s actions, or the observable actions themselves. For example,
Myers defines it as “a motive to increase another’s welfare
without conscious regard for one’s self interests,”26while McGaghie et al 2002 call for behaviour-based models that can be
aligned with standardized measurement tools.5 With the
goal of better balancing the needs of others and the needs of physicians
in the contexts of 21st century practice, Burke and
Kobus 2012 suggest altruism give way to the development of “empathy and
pro-social behaviours” in individuals and an “integration of
humanistic curricula into medical education”.6 In
light of its emphasis on “utter self sacrifice”, others have cast
altruism aside entirely in favour of virtue ethics and the cultivation
of phronesis .23
We also see traces of altruism in biomedical ethics familiar to those in
active medical practice. The principle of beneficence suggests that
physicians act with the intent of not just doing the bare minimum for
patients, but providing high quality care with respect to empathy,
kindness, and maximizing utility insofar as this value does not come
into conflict with non-maleficence, justice, and
autonomy.27 However, the principlist framework –
while exceptionally useful as a practical tool for adjudicating
competing claims, desires, and interests in the provision of healthcare
– is less equipped to account for an overall orientation to medical
care and practice. Taken together, altruism remains a fraught concept
for an individual physician to put meaningfully into practice. On the
one hand, it has been reduced to something that can be reliably measured
through behaviour, while on the other hand, it remains an ethos of
practice and orientation to the needs of others that is expansive yet
lacks direction.