Abstract
The term ‘altruism’ is often used without definition, leading to contradictions in what we expect from medical students. In this reflection paper, we critique the concept of ‘altruism’ from the perspective of moral philosophy and social psychology and challenge its unquestioned usage within the medical education literature, especially that emerging from the USA. We will argue that ‘altruism’ is a social construction with a particular history, stemming from Kantian philosophy and perpetuated within newer disciplines such as social psychology. As it currently stands, ‘altruism’ seems to mean utter self-sacrifice—a position contradictory to recent recommendations by regulatory bodies in the UK, which suggest that graduates should look after the ‘self’ and achieve a work-life balance. In this article, we argue that it is undesirable to have ‘altruism’ as a learning outcome for medical students and we also argue that ‘altruism’ is not an observable behavior that can be measured. Instead, we suggest that medical educators should employ a more balanced term, borrowed from the social psychology literature i.e. pro-social behavior. We argue that whilst ‘pro-social behavior’ focuses on actions that benefit others, it does not do so at the expense of the self. In addition, it focuses on students’ observable behaviors rather than their inner motivations, so is measurable. We conclude our article by discussing the formation of physicians based upon a virtue ethics, where society and the profession are in dialogue about the telos of medicine and its virtues, and where the character of the young physician is formed within the crucible of that dialogue. Thus, central to this pro-social behavior is the concept of phronesis or prudence, including the balancing of self-interest such as self-care, and the interests of the other.
Similar content being viewed by others
References
American Board of Internal Medicine, American College of Physicians-American Society of Internal Medicine & European Federation of Internal Medicine (2002). Medical professionalism in the new millennium: a physician charter. Annals of Internal Medicine, 136, 243–6.
Aristotle (1986). Nicomachean Ethics, translated by W. D. Ross. In J. Barnes (Ed.), The complete works of Aristotle pp. 1729–1867. Princeton, NJ: Princeton University Press.
Comte, A. (1875). System of positive polity, volume 1. Translated by J.H. Bridges. (Originally published in 1851 under the title, Systèm de politique positive) New York: Burt Franklin.
Coulehan, J. (2005). Today’s professionalism: engaging the mind but not the heart. Academic Medicine, 80, 892–898.
Coulehan, J. & Williams, P. C. (2001). Vanquishing virtue. The impact of medical education. Academic Medicine, 76, 598–605.
Downie, R. S. (2002). Supererogation and altruism: a comment. Journal of Medical Ethics, 28, 75–76.
Editors (2000). Looking back on the millennium in medicine. New England Journal of Medicine, 342, 42–49.
Faulkner, L. R. & McCurdy, R. L. (2000). Teaching medical students social responsibility: the right thing to do. Academic Medicine, 75, 346–350.
Firth-Cozens, J. & Payne, R. (1999). Stress in health professionals: Psychological and organizational causes and interventions. London: Wiley.
Foundation Programme Committee of the Academy of Medical Royal Colleges, in cooperation with Modernising Medical Careers in the Department of Health (2005). Curriculum for the foundation years in postgraduate education and training. London: Crown.
General Medical Council (2003). Tomorrow’s doctors. Recommendations on undergraduate medical education. London: General Medical Council.
General Medical Council (2005). The new doctor. Recommendations on general clinical training. London: General Medical Council.
General Medical Council (2006). Good medical practice. London: General Medical Council.
Glannon, W. & Ross, L. F. (2002). Are doctors altruistic? Journal of Medical Ethics, 28, 68–69.
Goldacre, M. J., Lambert, T. W., & Davidson, J. M. (2001) Loss of British-trained doctors from the medical workforce in Great Britain. Medical Education, 35, 337–344.
Gordon, J. (2003). Fostering students’ personal and professional development in medicine: a new framework for PPD. Medical Education, 37, 341–349.
Hafferty, F. W. (2002). What medical students know about professionalism. Mount Sinai Journal of Medicine, 69, 385–397.
Hafferty, F. (2006). Measuring professionalism: a commentary. In D. T. Stern (Ed.), Measuring medical professionalism pp. 281–306. New York: Oxford University Press.
Hilton, S. R. & Slotnick, H. B. (2005). Proto-professionalism: how professionalisation occurs across the continuum of medical education. Medical Education, 39, 58–65.
Jones, R. (2002) Declining altruism in medicine. British Medical Journal, 324, 624–625.
Kant, I. (1996). The metaphysics of morals, translated and edited by M. Gregor. Cambridge: Cambridge University Press. Originally published in 1797 under the title of Metaphysik der Sitten.
Kant, I. (1997). Groundwork for the metaphysics of morals, translated and edited by M. Gregor. Cambridge: Cambridge University Press. Originally published in 1785 under the title, Grundlegung zur Metaphysik der Sitten.
Kaplan, J. (2005). The dressing station. A surgeon’s odyssey. London: Picador.
Kearney, R. A. (2005). Defining professionalism in anaesthesiology. Medical Education, 39, 769–776.
Klein, E. J., Jackson, J. C., Kratz, L., Marcuse, E. K., McPhillips, H. A., Shugerman, R. P., Watkins, S., & Stapleton, F. B. (2003). Teaching professionalism to residents. Academic Medicine, 78, 26–34.
McGaghie, W. C., Mytko, J. J., Brown W. N., & Cameron, J. R. (2002). Altruism and compassion in the health professions: a search for clarity and precision. Medical Teacher, 24, 374–378.
McLean, S. A. M. (2002). Commentary on Glannon and Ross, and McKay. Journal of Medical Ethics, 28, 74.
Medical School Objectives Writing Group (1999). Learning objectives for medical student education—guidelines for medical schools: Report I of the Medical School Objectives Project. Academic Medicine, 74, 13–18.
Myers, D. G. (1999). Social psychology (6th ed.). Boston: McGraw-Hill.
Oxford English Dictionary Online. http://dictionary.oed.com/entrance.dtl, accessed 20th June 2005.
Penner, L. A., Dovidio, J. F., Piliavin, J. A., & Schroeder, D. A. (2005). Prosocial behaviour: multilevel perspectives. Annual Review of Psychology, 56, 365–392.
Rachlin, H. (2002). Altruism and selfishness. Behavioural and Brain Sciences, 25, 239–296.
Rees, C. (2003). Altruism—Measuring the non-existent? Medical Teacher, 25, 210–211.
Rees, C.E., Knight, L.V., & Wilkinson, C.E. (2006). User involvement is a sine qua non, almost, in medical education: Learning with rather than just about health and social care service users. Advances in Health Sciences Education. doi: 10.1007/s10459-006-9007-5.
Ritchie, K. (1988). Professionalism, altruism and overwork. Journal of Medicine and Philosophy, 13, 447–455.
Roche, W. P., Scheetz, A. P., Dane, F. C., Parish, D. C., & O’Shea, J. T. (2003). Medical students’ attitudes in a PBL curriculum: trust, altruism and cynicism. Academic Medicine, 78, 398–402.
Royal College of Physicians (2005). Doctors in society. Medical professionalism in a changing world. London: Royal College of Physicians in London.
Savulescu, J. (2004). Editor’s note: How can we make a difference? The perils of heroism. Journal of Medical Ethics, 30, 52.
Shapiro, J. & Rucker, L. (2003). Can poetry make better doctors? Teaching the humanities and arts to medical students and residents at the University of California, Irvine, College of Medicine. Academic Medicine, 78, 953–957.
Smith, L. G. (2005). Medical professionalism and the generation gap. American Journal of Medicine, 118, 439–442.
Van de Camp, K., Vernooij-Dassen, M., Grol, R., & Bottema, B. (2006). Professionalism in general practice: development of an instrument to assess professional behavior in general practitioner trainees. Medical Education, 40, 43–50.
Wall, T. D., Bolden, R. I., Borrill, C. S., Carter, A. J., Golya, D. A., Hardy, G. E., Haynes, C. E., Rick, J. E., Shapiro, D. A., & West, M. A. (1997). Minor psychiatric disorder in NHS trust staff: occupational and gender differences. British Journal of Psychiatry, 171, 519–523.
Whitcomb, M. (2004). More on resident duty-hours limits. Academic Medicine, 79, 377–378.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bishop, J.P., Rees, C.E. Hero or has-been: Is there a future for altruism in medical education?. Adv Health Sci Educ Theory Pract 12, 391–399 (2007). https://doi.org/10.1007/s10459-007-9064-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-007-9064-4