BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any (...) given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well. (shrink)

Ethical decision making in medicine has recently seen calls to move towards less prescriptive- based approaches that consider the particularities of each case. The main alternative call from the literature is for better understanding of phronesis concepts applied to decision making. A well-cited phronesis-based approach is Kaldjian’s five-stage theoretical framework: goals, concrete circumstances, virtues, deliberation and motivation to act. We build on Kaldjian’s theory after using his framework to analyse data collected from a three-year empirical study of phronesis and the (...) medical community. The data are a set of narratives collected in response to asking a medical community what making ethically wise decisions means to them. We found that Kaldjian’s five concepts are present in the accounts to some extent but that one of the elements, motivation, is constructed as playing a different, though still crucial role. Rather than being an end-stage of the process as Kaldjian’s framework suggests, motivation was constructed as initiating the process and maintaining the momentum of taking a phronesis-based approach. The implications for medical ethics decision-making education are significant as motivation itself is a highly complex concept. We therefore theorise that motivation is required for leading in, continuing and completing the actions of the ethical decision taken. Appreciating the central importance of motivation through the whole of Kaldjian’s framework has implications for cultivating the virtues of phronesis and courage to take the right course of action. (shrink)

Debates regarding theory and practice in social work have often avoided detailed discussion regarding the nature of knowledge itself and the various ways this can be created. As a result, positivistic conceptions of knowledge are still assumed by many to be axiomatic, such that context-dependent and practitioner-oriented approaches to knowledge creation and use are assumed to lack epistemological rigor and credibility. By drawing on epistemology, this theoretical paper outlines the case for a renewed approach to knowledge definition, creation and use (...) within social work by reference to pragmatism. Pragmatism has the potential to act as an organizing theoretical framework, taking account of the role of both ontology and epistemology, acting as a functional methodology for the further enhancement of practice-based knowledge. (shrink)

Phronesis has become a buzzword in contemporary medical ethics. Yet, the use of this single term conceals a number of significant conceptual controversies based on divergent philosophical assumptions. This paper explores three of them: on phronesis as universalist or relativist, generalist or particularist, and natural/painless or painful/ambivalent. It also reveals tensions between Alasdair MacIntyre’s take on phronesis, typically drawn upon in professional ethics discourses, and Aristotle’s original concept. The paper offers these four binaries as a possible analytical framework for classifying (...) and evaluating accounts of phronesis in the medical ethics literature. It argues that to make sense of phronesis as a putative ideal in professional medical ethics—for example, with the further aim of crafting interventions to cultivate phronesis in medical ethics education—the preliminary question of which conception of phronesis is most serviceable for the aim in question needs to be answered. The paper identifies considerable lack of clarity in the current discursive field on phronesis and suggests how that shortcoming can be ameliorated. (shrink)

The philosopher Martin Heidegger argued that the truthful life was at risk of being lost in Western technological culture in the name of increasing control, efficiency, and agility. As the risk is actualised, so the human essence as truth maker is obscured and life itself feels poorer. This thesis draws on Heideggerian philosophy to demonstrate the loss in two dominant styles of contemporary strategic management: the world-picturing and, more recent, agile style. It builds a theory of post-agile strategic practice, which (...) I call adaptive, to address this loss. Consistent with Heideggerian philosophy, I utilise a transformative disclosure methodology and a literary, paradigmatic case reading method to address the questions: Why is agile strategic management so unsatisfying? How do Heideggerian scholars shed light on this dissatisfaction? How do Heideggerians understand the emerging style and what strategic management practices can I propose for the future? After introducing agile strategic management and the impoverishment of life that it fosters, I set out how Heidegger’s philosophy of truth, thinking, and the sacred both sheds light on the problem and suggests a remedy for it. I closely read paradigmatic texts of the world-picturing and agile strategic management styles to demonstrate how business strategy theorisation lines up with extraordinary closeness to Heidegger’s philosophical assessment. I then analyse three Heideggerian prototypes for an adaptive style of strategy practice, concentrating on one paradigmatic text to identify their principal weakness: the omission of the sacred. I illustrate and contrast paradigmatic cases of both the agile and adaptive styles drawn from the beer industry and draw on the adaptive case to construct a theory of adaptive strategy practice, which addresses the problem of the loss of truth, suggesting pedagogical and strategic management practices. I conclude by summarising its findings and contributions, noting some limitations and connections to other studies and suggesting further lines of research. (shrink)

The term Responsible Research and Innovation has recently gained currency, as it has been designated to be a key-term in the European research framework Horizon 2020. At the level of European research policy, Responsible Research and Innovation can be viewed as an attempt to reach a broader vision of research and innovation as a public good. The current academic debate may be fairly enriched by considering the role that phronesis may have for RRI. Specifically, in this paper we argue that (...) the current debate might be fruitfully enriched by making a categorial shift. Such a categorial shift involves moving away from the temptation to interpret responsible research and innovation in a technocratic way towards a more pluralistic vision that is rooted in the idea of phronesis. In the present context phronesis points the attention to the cultivation and nurturement of the researcher’s formation as a type of engagement with the actual practice of researching, a practice in which researchers are called to apply judgment and exercise discretion in specific and often unique situations without the re-assuring viewpoint of the technician. (shrink)

The fact that social welfare professions including social work, youth work and community work deal with the lives and relationships of human beings is far from controversial. What is contentious is that in light of increasing intellectual work on the nature of social practices there is a failure in the human services literature to adequately examine the interdependencies and entanglements between conceptualisations of the stuff that the helping professions deals with and understandings of practice. This article examines the nexus and (...) mediations between the phenomena and practice of social service work. The case is made that human services and the human beings they deal with are often imagined and represented in one-dimensional, unambiguous, calculable and orderable ways that align with neo-liberal inspired and technical approaches to practice. I argue that these accounts are inadequate and I suggest that practices of care and the people engaged in such practices should be constituted as complex, unpredictable, wicked and emergent. A key to good practice in the people professions is acknowledging and attending to this complexity and aporia. (shrink)