The field of bioethics is a little poorer this week as it mourns the death of Edmund Pellegrino, MD who died on June 13th at the age of 92. Dr. Pellegrino served as the president of the Catholic University of America from 1978 to 1982, only the second layman to hold the position, and served as the founder and director of Georgetown University’s Center for Clinical Bioethics. He also sever as chairman of the President’s Council on Bioethics under President Bush.
For me however, Edmund Pellegrino is most significant for his effort to bring a robust virtue ethic to the field of bioethics, a field which has been largely dominated by principalism (Beauchamp and Childress) or utilitarianism (Singer). This virtue-based bioethics asked important teleological questions about the ends or goals (the teloi, if you will) of medicine. Drawing on the work of Alasdair MacIntyre, Pellegrino identified medicine as a practice, a collective activity oriented towards certain internal goods which are realized through the development of virtues or “standards of excellence” that are integral to the activity in question. This view of medicine as a practice allowed him to argue that medicine really did have an “internal morality,” that is, a set of moral guidelines constitutive of the practice of medicine itself rather than externally imposed. Pellegrino was particularly critical of the impact on market forces on the practice of medicine which often compelled the physician to act in ways contrary to the ends of medicine, that is, the good of the patient in a holistic sense (physical, psychological, spiritual).
As a practice, the skills needed to be a good physician extend beyond the practice of medicine into the rest of human existence. As such, Pellegrino asked not just “what makes a good physician?” but also “how can a physician be both good at her practice and a good person?” Virtues such as honesty, beneficence, endurance, and especially prudence guide the physician in the practice of medicine by making her good ontologically. Of course, virtue alone cannot guide behavior but virtue does help root and guide the operative duties in medicine. Without prudence, for example, how would one know which duties pertained to a given situation? Without courage, how could one ever follow through on the application of a given duty (say, truth-telling) when circumstances became difficult?
Jim Childress, my teacher and mentor at UVa, brought me into the field of bioethics and gave me my initial love for the field, for which I will always be grateful. But it was Edmund Pellegrino who gave me my method of doing bioethics. I especially found the way in which he brought the distinctively Christian virtues to the filed of medicine particularly compelling. It is Pellegrino (and the others who have collaborated and followed) that I give my students each semester in my own bioethics class. May his soul and the souls of all the faithfully departed rest in peace.