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)

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)

In the Nicomachean Ethics, Aristotle places the art of medicine alongside other examples of technē. According to Gadamer, however, medicine is different because in medicine the physician does not, properly speaking, produce anything. In The Enigma of Health, rather than introducing Aristotle’s intellectual virtue of phronēsis (practical wisdom) as a way of understanding medical practice, Gadamer focuses on how medicine is a technē “with a difference”. In this paper, I argue that, despite the richness of his insights, this focus prevents (...) Gadamer from reaching an adequate account of health and the practice of medicine, and I demonstrate how making phronēsis central via a phenomenological description furthers our understanding of the art of healing in important ways. The paper begins with an exploration of Gadamer’s understanding of phronēsis and technē (via Heidegger) to provide a foundation for a phenomenological analysis of the art of healing. After considering the shortcomings of Gadamer’s analyses, I introduce a working definition of “health” that both captures the spirit of Gadamer’s insights and prepares the ground for a phenomenological description. Finally, I introduce concepts from Merleau-Ponty in order to establish an adequate account of the relation between technē and phronēsis and a more nuanced understanding of experience as unfolding within the expressive trajectories forged by bodies that are subject to the weight of the past and the weight of the ideal. The art of medicine, I argue, needs to be understood as expressive behavior in the context of historically and socially situated individuals, institutions, and open trajectories of sense. (shrink)

MA Thesis. Biomedical ethics does not lend itself to easy categorisation as either a 'theoretical' or a 'practical' enterprise because inquiry into the quandaries of morality requires both situational and 'translocal' perspectives. These types of investigation bring into question the legitimacy of the theory/practice divide that has dominated intellectual thought since antiquity. This division hinders the development of bioethics by fostering internal dispute within the discipline regarding appropriate methodology and the practice of clinical ethics. In this thesis, I argue that (...) much of these disciplinary disjunctions are due to an undue labeling of bioethics as either 'applied ethics' or 'practical ethics', and a failure to recognise the intricate way in which theory and practice inform each other and are integral and interrelated parts of moral deliberation. I argue for an integration of the theory and practice of bioethics. (shrink)

A kind of ‘neo‐Aristotelianism’ that connects educational reasoning and reflection to phronesis, and education itself to praxis, has gained considerable following in recent educational discourse. The author identifies four cardinal claims of this phronesis‐praxis perspective: that a) Aristotle's epistemology and methodology imply a stance that is essentially, with regard to practical philosophy, anti‐method and anti‐theory; b) ‘producing’, under the rubric of techné, as opposed to ‘acting’ under the rubric of phronesis, is an unproblematically codifiable process; c) phronesis must be given (...) a particularist interpretation; and d) teaching is best understood as praxis in the Aristotelian sense, guided by phronesis. The author argues that these claims have insufficient grounding in Aristotle's own writings, and that none of them stands up to scrutiny. (shrink)

The relevance of the Aristotelian concept ofphronesis – practical wisdom – for medicine and medical ethics has been much debated during the last two decades. This paper attempts to show how Aristotle’s practical philosophy was of central importance toHans-Georg Gadamer and to the development of his philosophical hermeneutics, and how,accordingly, the concept of phronesiswill be central to a Gadamerian hermeneutics of medicine. If medical practice is conceived of as an interpretative meeting between doctor and patient with the aim of restoring (...) the health of the latter, then phronesis is the mark of the good physician, who through interpretation comes to know the best thing todo for this particular patient at this particular time. The potential fruitfulness of this hermeneutical appropriation of phronesis for the field of medical ethics is also discussed. The concept can be (and has been) used in critiques of the conceptualization of bioethics as the application of principle-based theory to clinical situations, since Aristotle’s point is exactly that problems of praxis cannot be approached in this way. It can also point theway for alternative forms of medical ethics, such as virtue ethics or a phenomenological andhermeneutical ethics. The latter alternative would have to address the phenomena of healthand the good life as issues for medical practice. It would also have to map out in detail the terrain of the medical meeting and the acts of interpretation through which phronesis is exercised. (shrink)

It is time to challenge the issue of pleasure associated with the core of medical practice. Its importance is made clear through its opposite: unhappiness—something which affects doctors in a rather worrying way. The paper aims to provide a discussion on pleasure on reliable grounds. Plato’s conception of techne is a convenient model that offers insights into the unique practice of medicine, which embraces in a single purposive action several heterogeneous dimensions. In Aristotle’s Ethics, pleasure appears to play a central (...) role for action’s assessment and intensification. Pleasure is also tightly associated with the Kantian faculty of reflective judgment, which operates at the heart of clinical reasoning. Indeed, practicing medicine means to deal with the particular and the manifold, requiring clinical judgment, but also relying on embodied habitus . With Bourdieu’s notion of habitus , pleasure is the mark of a happy practice, which presupposes a deep involvement in one’s field. Throughout our inquiry, the question of pleasure comes to offer a critical reappraisal of real medical practice and leads to consider ethics more as a component of techne than as a separate realm of concern. (shrink)