Definitions
- The ability to experience the attraction to a pleasant good, or the aversion to / discomfort of some small annoyance, and still act in accordance with our ideals.
What is Temperance?
- “Temperance” derives from the Latin “temperantia” coming from the Greek “sophrosyne” meaning “moderation”
- Temperance is NOT abstinence but instead is characterized by SELF-CONTROL and BALANCE
- Temperance uses reason to guide our actions based on our desire for pleasure.
- Temperance is closely connected with humility and prudence.
Why should we practice the virtue of Temperance?
- Temperance enables us to distinguish between goods and persevere in our choice, making a present sacrifice that will benefit us in the future.
- Instead of chasing pleasure for its own sake, temperance allows us to enjoy it for what it is.
- Given the limitation of time, temperance is needed to prevent burnout by not disregarding conflicts of particular goods.
- Temperance helps us understand that lesser goods can sometimes be pursued over the greater good.
Aristotle’s Doctrine of the Mean
Aristotle’s Doctrine of the Mean emphasizes balance as the essence of virtue, symbolized here by a mountain peak with a flag representing the ideal midpoint. Each virtue lies between two opposing vices—deficiency depicted on the left, and excess, on the right slope. For example, courage is the balance between cowardice (deficiency) and recklessness (excess). In a medical context, this principle guides healthcare professionals to strive for the peak of ethical behavior, avoiding the pitfalls of extremes to ensure thoughtful and compassionate care.
Case Studies
You are a busy surgical resident. It happens to be that you have a few minutes off in between operating room cases. You run down to the cafeteria to buy a quick slice of pizza and sit down to eat. You pull out your phone to see if anyone else has texted you - your medical students, attendings, OR techs and nurses. You respond as you eat your lunch. You finish replying to all necessary messages, and so you move onto checking your inbox. You click through various messages, reply quickly to those that could be replied quickly to. You then are about to put down your phone, when your thumb wanders to Facebook, and you spend the next five minutes finishing your slice of pizza while scrolling through various Facebook posts.
You look at your watch - the next case is about to start in a few minutes. You run into the elevator, and as you wait, you pull out your phone again. No messages, but you decide to check the news as the elevator makes a few stops to your final destination.
You scrub, gown up, and start the case with your attending. He’s known to be especially rude to everyone around him, so you prepare yourself for the worst. At one point, the patient’s heart rate starts to drop as both of you are trying to find the last bit of tissue still connected to the inferior vena cava in extracting a tumor. The surgeon goes in to snip the last bit of connective tissue adhering to the blood vessel.
Unfortunately, this results in an oozing of the inferior vena cava and the patient’s blood pressure starts to drop. The massive transfusion protocol is initiated, as it feels like everyone around the OR is moving in orchestrated, coordinated chaos. You hear your attending angrily yelling at the various nurses and/or OR techs. Though the patient ends up being able to be resuscitated, he ends up in the ICU for the next 2 weeks, on a ventilator, and not waking up.
You are rounding on the patient two weeks later with the ICU team. At this point, the patient has not woken up and has not had any cranial nerve responses. You hear the ICU attending say, “well, this family wants everything done. We can talk to them about a tracheostomy.”
Discussion Questions
- What are your initial reflections about and/or reactions to this case?
- What are some of the problems reflected in this case?
- What are some examples of temperance (or lack thereof) in this case? What are the other virtues lacking in this case? (Eg Attention, lack of patience, pride)
How do we foster Temperance?
- Develop an ability to focus and overcome distraction
- Delay checking email, news, or social media
- Focus your attention on friends during conversations with them
- Develop a schedule so that time used well for important tasks