In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to be insufficient. However, this solution is (...) unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

Recent publications have argued that practical wisdom is increasingly important for medical practices, particularly in complex contexts, to stay focused on giving good care in a moral sense to each individual patient. Our empirical investigation into an ordinary medical practice was aimed at exploring whether the practice would reveal practical wisdom, or, instead, adherence to conventional frames such as guidelines, routines and the dominant professional discourse. We performed a thematic analysis both of the medical files of a complex patient and (...) her daughter’s diary. We did find practical wisdom, but only sporadically, whereas it has proved to be essential for professional care. This deficit appeared to result from several factors like: the organization of the practice; established routines; a hierarchical culture; and a traditional medical discourse. Moreover, we discerned various negative consequences. More empirical research into practical wisdom in everyday medical practices is needed for the benefit of professional and morally good care for every patient. (shrink)

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)

In Science as a Profession and Vocation, Max Weber presents a clear task to scientists: he claims that they have the responsibility to present uncomfortable knowledge to politicians, students and o...

Aristotle’s philosophical insights into ethics, wisdom and practice have drawn the attention of scholars. In the current professional context where ethics are often compromised, this debate assumes a necessary urgency. This subject is highly relevant to business schools, given the general neglect of this quality in executive management development. Our research involved an analysis of contemporary literature on phronesis in the management scholarship, practice and teaching domains. Our definition of phronesis identifies themes and paradoxes distilled from this literature. Stories are (...) by nature multi-layered and paradoxical, embracing ambiguity and contradiction, so we incorporate narrative as essential to our enquiry. While it appears to be easily grasped, phronesis is complex, nuanced and paradoxical, seen as an unorganised set of characteristics in the management scholarship domain. We argue that the neglect of phronesis in modernity flows from the challenging nature of developing it, itself the consequence of its indistinctness. It calls for Einstein’s words “I would give my life for the simplicity on the other side of complexity”. This article argues that developing this virtue as a form of practical wisdom, should be an integral part of executive management development if we are to cultivate morally responsible leadership. A typology of managerial phronesis will encourage contextually appropriate leadership excellence based on the virtue-attributes of managers-as-scholars. The typology we propose is based on a Grounded Theory synthesis of relevant literature. We adopt a phenomenological stance. Through incorporating Grounded Theory second order themes, we offer a grainier understanding of the qualities of managerial phronesis. (shrink)

Across the European research area and beyond, efforts are being mobilized to align research and innovation processes and products with societal values and needs, and to create mechanisms for inclusive priority setting and knowledge production. A central concern is how to foster a culture of “Responsible Research and Innovation” among scientists and engineers. This paper focuses on RRI teaching at higher education institutions. On the basis of interviews and reviews of academic and policy documents, it highlights the generic aspects of (...) teaching aimed at invoking a sense of care and societal obligation, and provides a set of exemplary cases of RRI-related teaching. It argues that the Aristotelian concept of phronesis can capture core properties of the objectives of RRI-related teaching activities. Teaching should nurture the students’ capacity in terms of practical wisdom, practical ethics, or administrative ability in order to enable them to act virtuously and responsibly in contexts which are often characterized by uncertainty, contention, and controversy. (shrink)

In contemporary society, as in classical Greece, we need citizens that deliberate well both for themselves and for society overall. Different competitors contend about the right principles in the theory of education. This paper holds that ‘character education’, descending from the ancient ethics of virtues, still represents the best option available for people who want to deliberate well for the common good. A special place in deliberation is taken by legal reasoning because the law is central in the distribution of (...) goods in our society. Rather than focusing only on rules and principles I follow the EV approach and focus on the qualities of the good decision-maker, the reasonable judge. The intellectual virtues of phronesis and techné combine those personal and professional qualities that we want at work in any judge. But it is the exercise of the civic art of rhetoric that expresses at best the public dimension of the reasonable judge. (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)

The aim of this article is to provide an overview of various discourses relevant to developing a construct of collective _phronesis_, from a (neo)-Aristotelian perspective, with implications for professional practice in general and business practice and business ethics education in particular. Despite the proliferation of interest in practical wisdom within business ethics and more general areas of both psychology and philosophy, the focus has remained mostly on the construct at the level of individual decision-making, as in Aristotle’s _Nicomachean Ethics_. However, (...) he also made intriguing remarks about _phronesis_ at the collective level in his _Politics_: remarks that have mostly eluded elaboration. The aim of this article is practical and revisionary, rather than exegetical and deferential, with respect to Aristotle. Nevertheless, just as most of the literature on individual _phronesis_ draws on Aristotle’s exposition in the _Nicomachean Ethics_, the obvious first port of call for an analysis of collective _phronesis_ is to explore the resources handed down to us by Aristotle himself. The lion’s share of this article is, therefore, devoted to making sense of Aristotle’s somewhat unsystematic remarks and the lessons we can draw from them about collective managerial _phronesis_ and business ethics education. (shrink)

This essay introduces the present special issue on wisdom and moral education, which draws on a conference held in Oxford in 2017. Some of the seven contributions (by Sanderse; Ferkany; and Hatchimonji et al.) make use of the Aristotelian concept of phronesis, or practical wisdom, while others focus more on the wisdom concept as it has developed in contemporary psychology (Huynh and Grossman; Ardelt; and Brocato, Hix and Jayawickreme). One (by Swartwood) straddles the distinction between the two. All the contributions, (...) however, address in different ways practical questions about how wisdom can be evaluated and how it relates to issues of moral development and education. (shrink)

Virtue ethics has long provided fruitful resources for the study of issues in medical ethics. In particular, study of the moral virtues of the good doctor—like kindness, fairness and good judgement—have provided insights into the nature of medical professionalism and the ethical demands on the medical practitioner as a moral person. Today, a substantial literature exists exploring the virtues in medical practice and many commentators advocate an emphasis on the inculcation of the virtues of good medical practice in medical education (...) and throughout the medical career. However, until very recently, no empirical studies have attempted to investigate which virtues, in particular, medical doctors and medical students tend to have or not to have, nor how these virtues influence how they think about or practise medicine. The question of what virtuous medical practice is, is vast and, as we have written elsewhere, the question of how to study doctors’ moral character is fraught with difficulty. In this paper, we report the results of a first-of-a-kind study that attempted to explore these issues at three medical schools in the United Kingdom. We identify which character traits are important in the good doctor in the opinion of medical students and doctors and identify which virtues they say of themselves they possess and do not possess. Moreover, we identify how thinking about the virtues contributes to doctors’ and medical students’ thinking about common moral dilemmas in medicine. In ending, we remark on the implications for medical education. (shrink)

In Aristotelian virtue theories, phronesis is foundational to being good, but to date accounts of how this particularly important virtue can emerge are sketchy. This article plumbs recent thinking in Aristotelian virtue ethics and developmental theorizing to explore how far its emergence can be understood developmentally, i.e., in terms of the growth in ordinary conditions of underlying psychological capacities, dispositions, and the like. The purpose is not to explicate Aristotle, nor to assimilate Aristotelian ideas to cognitive developmental moral theorizing, but (...) to draw on both to build an independently plausible theory of practical intelligence and its development. It is argued that one fruitful direction attends to the psychology of virtues Aristotle associates with practical intelligence, including comprehension, understanding, sense, and cleverness, instead of Aristotle’s remarks distinguishing fully virtuous persons from the continent, incontinent and the many. (shrink)