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.