Courage: a neglected virtue in the patient-physician relationship

Soc Sci Med. 1984;18(4):351-60. doi: 10.1016/0277-9536(84)90125-4.


The contribution that the virtues can make to the moral life in general and to the moral community constituted in the patient-physician relationship more specifically is gaining increased scholarly attention. This paper explores the meaning and relevance of the virtue of courage for patients and physicians. Courage is presented as a virtue for physicians in addition to the excellences of competence and compassion and a virtue for patients in addition to the excellences of compliance and gratitude. In agreement with Alasdair MacIntyre, courage is held to be necessary, at times, to our expression of care and concern for one another. The patient-physician relationship is shown to be a context in which care and concern is expressed, a context in which courage can be a relevant virtue. Certain conditions are listed as necessary to courage: freedom, fear, risk, uncertainty, an endangered good and a morally worthy end. Equivalents to these necessary conditions are discussed and held to be potentially present in patient-physician encounters. Physicians are pictured as a 'sustaining presence' who have duties toward patients of 'encouragement' that can be fulfilled in ways relative to the requirements of each circumstance. Patients are held to have a duty to learn about the nature of human existence and to develop the character necessary to its negotiation. Patients and physicians can be agents of courage who come together in a context of care and concern where certain goods are preserved even, at times, in the midst of loss. Thus, courage is presented as a relevant and important moral virtue for the patient-physician relationship in which those qualities that define who we are as a moral community are expressed and sustained.

KIE: Shelp discusses the virtue of courage as manifested in the physician patient relationship. He comments briefly on other virtues associated with physicians and patients, defines courage, and outlines the prerequisites for courageous conduct. He then explores the traditional nature of the therapeutic relationship, in which the physician symbolizes relief and protection from mortality to the ill, vulnerable patient. Shelp concludes that when clinical skills prove useless, physicians may be called upon courageously to admit their limitations and to function as a "sustaining presence" to patients in helping them find the courage to negotiate the realities of illness and death.

MeSH terms

  • Moral Obligations*
  • Morals*
  • Physician-Patient Relations*
  • Social Values*