The Nature of Supererogation and its Application in Medical Practice

Abstract

This thesis emphasises the need for doctors' professional duties to be bound firmly together with their moral obligations; there is danger for the patient when there is a divergence. I believe that the consideration and practice of supererogation acts as a means to further this union. I argue for its inclusion in medical practice.

Acts of supererogation go beyond the requirements of duty. The concept has roots in Christianity, and was most fully developed by St Thomas Aquinas. It came under attack during the Reformation; for Protestants, salvation was not to be earned by good works, it was only bestowed by the grace of God.

The concept has largely disappeared from everyday usage in a secular society, nevertheless there is an expectation that members of the caring professions should embrace it to some extent. Doctors have lost an understanding of the subject, hampered by the professionalization of medicine.

This thesis illustrates the concept in its practical application and provides a framework of three different models of supererogation. I look to the work of K.E.Kirk and Stanley Hauerwas in theology, and I look at the philosophy of Emmanuel Levinas and Iris Murdoch to support my claims. Examples from literary sources, rather than medical case histories which are often too businesslike in tone, illustrate the complexity of what takes place between patient and doctor.

Doctors might fail to see what is important; they need the faculty of moral perception and also imagination to think of what more can be done for patients as well as wisdom to judge if this can be done safely. I believe that my third model of supererogation could be put into practice for the benefit of both patients and doctors.