Wandering Virtues: Modesty, Patience, and Loyalty in Clinical Medicine By Alan Christopher Murphy Dissertation Submitted to the Faculty of the Graduate School of Vanderbilt University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY in Religion May, 2016 Nashville, Tennessee Approved: Larry Churchill, Ph.D. Victor Anderson, Ph.D. Volney Gay, Ph.D. Keith Meador, M.D. Copyright © 2016 by Alan Murphy All Rights Reserved ACKNOWLEDGMENTS These few pages are hardly sufficient to convey my thanks to the numerous people who have made this dissertation possible. The customary brevity of the acknowledgments section stands in sharp contrast to the depth of my appreciation. Pride of place goes to my dissertation director, Larry Churchill, who has been unfailingly generous, judicious, and wise in his guidance to me since I first met him three years ago, not only with respect to this dissertation, but also with respect to the field of medical ethics and to the moral life. Each of the other members of my committee has similarly contributed to my professional and personal development far beyond the limits of this dissertation. Without Victor Anderson’s invitation to Vanderbilt four years ago and sage advice since then, I would never have had the chance to begin this dissertation. Without Volney Gay’s insights, my understanding of ethics, psychology, and religion would have been sadly diminished. And without Keith Meador’s invitation to Vanderbilt’s Center for Biomedical Ethics and Society, I would not have found what I now regard as my natural academic and professional home. Many others at Vanderbilt have supported me during my studies. Though he never officially held the title, James Byrd has acted as a third advisor, keeping me on track and helping me fulfill my service obligations in ways that were hopefully beneficial to the university and that certainly have been beneficial to me. Karen Eardley has effectively been yet another advisor: without her, I would probably still be trying to register for my first semester of classes. The entire staff of Vanderbilt’s Office of Risk and Insurance Management is wonderful, but I would be remiss if I did not expressly thank Melissa Ahler, Betty Barrow, Sandy Bledsoe, Diane Moat, and iii Holly Larson for allowing me to do the best student job imaginable and for teaching me so much about compassionate, professional medicine along the way. I owe a special debt to the people of Vanderbilt’s Center for Biomedical Ethics and Society. In addition to their support for my research and writing, Profs. Churchill and Meador have welcomed me warmly into the life of the Center. Joe Fanning has been unstinting with his time and support as he has prepared me for the practical work of clinical ethics. Russell McIntire Jr. not only gave me the invaluable chance to teach in my field, but taught me what it is to be an educator all the way through. Elizabeth Heitman has shaped this dissertation and my thinking about medical ethics with her timely advice and encouragement. Kate Payne has generously shared her tremendous experience and expertise in clinical ethics consultation with me since joining the Center last year. Jessica Bratt Carle and John Compton have sharpened my thinking about many things, including this dissertation, in the numerous conversations they have graciously shared with me. And everyone at the Center knows that the whole office would fall apart without Denise Lillard’s diligence and good humor. While I am proud to complete this dissertation and begin the professional life for which the Center has prepared me, I am sad to leave a place that has become a home away from home and to leave people who have given me so much. Last (but by no means least), I thank my family members for the unflagging encouragement they have given me since long before I knew Vanderbilt was in my future. My parents-in-law, Mark and Carla Sullivan, have exhibited patience and confidence bordering on the heroic as they have encouraged their daughter’s husband in his (debatably rash) pursuit of a Ph.D. in the humanities. My brother, Ryan Murphy, though specialized in the far more practical iv fields of architecture and engineering, has over the years given me exceptionally incisive feedback on my work, to my great benefit. My parents, Richard and Patricia Murphy, have supplied tremendous material support over decades of education. Even more importantly, Mom and Dad have supported me with their virtues when my own have failed me; my faith, fortitude, hope, and prudence did not carry me here on their own. Finally, my wife, Kristen Sullivan, is a blessing to me and to everyone she meets. It is no exaggeration to write that I could not have done any of this without her. Many of the authors I consider herein have theories about what motivates people to put on virtue, but I have little personal need for this theorizing: I am lucky to share my life with the person who is my foremost reason to strive to be better than I am. This dissertation is devoted to the virtues of modesty, patience, and loyalty, but it is possible only because my family is exemplary with respect to love, the greatest virtue of all. v TABLE OF CONTENTS Page ACKNOWLEDGMENTS ......................................................................................................................................... iii Introduction ................................................................................................................................................................. 1 Chapter 1. Two Landmarks in the Field of Virtue ......................................................................................................... 4 Introduction to the First Chapter ................................................................................................................. 4 Eudaimonia ........................................................................................................................................................... 8 Aristotle’s Account of Eudaimonia ..................................................................................................... 10 Neo-Aristotelian Interpretations of Eudaimonia .......................................................................... 14 Thomas Aquinas’s Theological Revision of Eudaimonia ............................................................ 18 Present-Day Theorists Dissatisfied with Eudaimonia ................................................................. 19 The Unity of the Virtues ................................................................................................................................. 24 Plato’s Account of the Unity of the Virtues ...................................................................................... 25 Present-Day Platonic Accounts of the Unity of the Virtues ....................................................... 28 Aristotle’s Account of Phronesis ......................................................................................................... 31 Later Aristotelian Accounts of Phronesis ........................................................................................ 33 Present-Day Complaints against Phronesis .................................................................................... 37 Limited Unity of the Virtues ................................................................................................................. 45 Chapter Conclusion ........................................................................................................................................ 52 2. Wandering Virtues .......................................................................................................................................... 54 Surveying the Terrain beyond the Landmarks of Eudaimonia and the Unity of the Virtues 54 A General Definition of Virtue ..................................................................................................................... 55 Aristotle’s Definition of Virtue ............................................................................................................. 56 David Hume’s Description of Virtue .................................................................................................. 58 Christine Swanton’s Humean Virtue ................................................................................................. 59 Judith Andre’s Contemporary Buddhist Virtue ............................................................................. 60 A Working Definition of Virtue ............................................................................................................ 62 Defining Wandering Virtues Constructively .......................................................................................... 64 The Source of the Label .......................................................................................................................... 65 A Formal Definition of Wandering Virtues ..................................................................................... 66 Charity, an Antithesis of Wandering Virtue .................................................................................... 69 Courage, Almost a Wandering Virtue ................................................................................................ 71 Hope, Possibly a Wandering Virtue .................................................................................................... 72 vi Defining Wandering