Bishop Jeffrey P, Rees Charlotte E
Institute of Clinical Education, Peninsula Medical School, Knowledge Spa, Royal Cornwall Hospital, Universities of Exeter and Plymouth, Truro, TR1 3HD, UK.
Adv Health Sci Educ Theory Pract. 2007 Aug;12(3):391-9. doi: 10.1007/s10459-007-9064-4. Epub 2007 May 26.
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.
“利他主义”一词常被随意使用，这导致我们对医学生的期望产生矛盾。在这篇反思性论文中，我们从道德哲学和社会心理学的角度对“利他主义”概念进行批判，并质疑其在医学教育文献（尤其是源自美国的文献）中被不加质疑的使用。我们将论证，“利他主义”是一种具有特定历史的社会建构，源于康德哲学，并在社会心理学等新学科中延续。就目前而言，“利他主义”似乎意味着完全的自我牺牲——这一立场与英国监管机构最近的建议相矛盾，后者认为毕业生应该照顾好“自我”并实现工作与生活的平衡。在本文中，我们认为将“利他主义”作为医学生的学习成果是不可取的，我们还认为“利他主义”不是一种可观察到的、能够被衡量的行为。相反，我们建议医学教育工作者采用一个从社会心理学文献中借鉴而来的、更为平衡的术语，即亲社会行为。我们认为，虽然“亲社会行为”关注的是有益于他人的行为，但它不会以牺牲自我为代价。此外，它关注的是学生的可观察行为而非其内在动机，因此是可衡量的。我们在文章结尾讨论了基于美德伦理学的医生培养，即在社会与专业领域就医学的目的及其美德展开对话的背景下，年轻医生的品格在这一对话的熔炉中得以塑造。因此，这种亲社会行为的核心是实践智慧或审慎的概念，包括平衡诸如自我照顾等自身利益与他人利益。
