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A Humble Task: Restoring Virtue in an Age of Conflicted Interests

DuBois, James M. PhD, DSc; Kraus, Elena M.; Mikulec, Anthony A. MD, MBA; Cruz-Flores, Salvador MD, MPH; Bakanas, Erin MD, MA

Academic Medicine:
doi: 10.1097/ACM.0b013e318294fd5b

Virtues define how we behave when no one else is watching; accordingly, they serve as a bedrock for professional self-regulation, particularly at the level of the individual physician. From the time of William Osler through the end of the 20th century, physician virtue was viewed as an important safeguard for patients and research participants. However, the Institute of Medicine, Association of American Medical Colleges, and other policy groups—relying on social science data indicating that ethical decisions often result from unconscious and biased processes, particularly in the face of financial conflicts of interest—have increasingly rejected physician virtue as an important safeguard for patients.

The authors argue that virtue is still needed in medicine—at least as a supplement to regulatory solutions (such as mandatory disclosures). For example, although rarely treated as a reportable conflict of interest, standard fee-for-service medicine can present motives to prioritize self-interest or institutional interests over patient interests. Because conflicts of interest broadly construed are ubiquitous, physician self-regulation (or professional virtue) is still needed. Therefore, the authors explore three strategies that physicians can adopt to minimize the influence of self-serving biases when making medical business ethics decisions. They further argue that humility must serve as a crowning virtue—not a meek humility but, rather, a courageous willingness to recognize one’s own limitations and one’s need to use “compensating strategies,” such as time-outs and consultation with more objective others, when making decisions in the face of conflicting interests.

Author Information

Dr. DuBois is director and Hubert Maeder Professor, Bander Center for Medical Business Ethics, Saint Louis University, St. Louis, Missouri.

Ms. Kraus is a seventh-year MD/PhD student and coordinator, Bander Center for Medical Business Ethics, Saint Louis University, St. Louis, Missouri.

Dr. Mikulec is professor, Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.

Dr. Cruz-Flores is professor and interim chair, Department of Neurology and Psychiatry, and director, Souers Stroke Institute, Saint Louis University, St. Louis, Missouri.

Dr. Bakanas is associate professor, Department of Internal Medicine, and associate director, Bander Center for Medical Business Ethics, Saint Louis University, St. Louis, Missouri.

Correspondence should be addressed to Dr. DuBois, Bander Center for Medical Business Ethics, Saint Louis University, 3545 Lafayette Ave., St. Louis, MO 63104; telephone: (314) 977-6663; e-mail:

© 2013 by the Association of American Medical Colleges