Moral Strength and Professional Courage Are Necessities for Physicians

There may be times when a physician must place herself or himself in a position of risk by taking a stand against external forces that threaten a patient’s clinical care.

Medical students and resident physicians must be taught the importance of social justice in healthcare, as it directly relates to their altruism and sense of duty. Teaching moral courage and behavior in the face of making, and carrying out, ethical decisions on behalf of communities of patients may be best approached through a combination of role modeling and scenario discussions. Giving consideration to actions and options in the face of social injustice may seem overwhelming to those training to become physicians, but the need for moral courage in the face of such injustice must be instilled. If moral distress is indeed a contributor to physician burnout, then we have an obligation to our future physicians to prepare them with the best moral and ethical foundations to act appropriately, with strength and commitment, in their advocacy of patients who cannot act on their own.

In addition to closely adhering to the solid ethical principles of our profession, an additional deterrent to moral distress may well be the fostering of a commitment to embracing the highest order of physician virtues in our personal and professional lives. Moral courage to do the right thing evolves over our lifetime, and each successful effort to advocate for our patients will inform and strengthen our next challenge.

This fictional clinical scenario may seem like the proverbial “David vs. Goliath” encounter, but the physician need not fight this alone. She or he can enlist the support of like-minded, ethical physicians who also believe in the importance of this particular clinical site as one of professional growth and development of physicians, and service to a disadvantaged population. A group of strong and respected clinicians with moral courage generated from moral outrage, advocating together for social justice and offering ethical alternative options for caring for these patients with great health needs, may prevail over such a health system Goliath. As professionals, even when we are acting out of moral courage, we still understand that a reasoned approach to a disagreement will more likely lead to resolution or working alternatives than will confrontation or arguing. Advocating for one patient or a population of patients is more likely to succeed when a range of better options are presented and supported with facts and reason. Social justice is an ethical principle for which one should always stand tall and firm.