Fricker shows that virtue epistemology provides a general epistemological idiom in which these issues can be forcefully discussed.

In recent years, virtue theories have enjoyed a renaissance of interest among general and medical ethicists. This book offers a virtue-based ethic for medicine, the health professions, and health care. Beginning with a historical account of the concept of virtue, the authors construct a theory of the place of the virtues in medical practice. Their theory is grounded in the nature and ends of medicine as a special kind of human activity. The concepts of virtue, the virtues, and the virtuous (...) physician are examined along with the place of the virtues of trust, compassion, prudence, justice, courage, temperance, and effacement of self-interest in medicine. The authors discuss the relationship between and among principles, rules, virtues, and the philosophy of medicine. They also address the difference virtue-based ethics makes in confronting such practical problems as care of the poor, research with human subjects, and the conduct of the healing relationship. This book woith the author's previous volumes, A Philosophical Basis of Medical Practice and For the Patient's Good, are part of their continuing project of developing a coherent moral philosophy of medicine. (shrink)

This chapter maps the terrain of thematic analysis, a method for capturing patterns across qualitative datasets. We identify key concepts and different orientations and practices, illustrating why TA is often better understood as an umbrella term, used for sometimes quite different approaches, than a single qualitative analytic approach. Under the umbrella, three broad approaches can be identified: a “coding reliability” approach, a “codebook” approach, and a “reflexive” approach. These are often characterized by distinctive – sometimes radically different – conceptualizations of (...) what a theme is, as well as methods for theme identification and development, and indeed coding. We then provide practical guidance on completing TA within our popular approach to TA, discussing each phase of the six-phase approach we have developed in relation to a project on men, rehabilitation, and embodiment. We conclude with a discussion of key concerns related to ensuring the TA you do – within whatever approach – is of the highest quality. (shrink)

Andrew Sayer undertakes a fundamental critique of social science's difficulties in acknowledging that people's relation to the world is one of concern. As sentient beings, capable of flourishing and suffering, and particularly vulnerable to how others treat us, our view of the world is substantially evaluative. Yet modernist ways of thinking encourage the common but extraordinary belief that values are beyond reason, and merely subjective or matters of convention, with little or nothing to do with the kind of beings people (...) are, the quality of their social relations, their material circumstances or well-being. The author shows how social theory and philosophy need to change to reflect the complexity of everyday ethical concerns and the importance people attach to dignity. He argues for a robustly critical social science that explains and evaluates social life from the standpoint of human flourishing. (shrink)

A systematic introduction to discourse analysis as a body of theories and methods for social research. Introduces three approaches and explains the distinctive philosophical premises and theoretical perspectives of each approach.

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

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 (a modification of the Aristotelian phronèsis) 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)

To practice medicine and ethics, physicians need wisdom and integrity to integrate scientific knowledge, patient preferences, their own moral commitments, and society's expectations. This work of integration requires a physician to pursue certain goals of care, determine moral priorities, and understand that conscience or integrity require harmony among a person's beliefs, values, reasoning, actions, and identity. But the moral and religious pluralism of contemporary society makes this integration challenging and uncertain. How physicians treat patients will depend on the particular beliefs (...) and values they and other health professionals bring to each instance of shared decision making. This book offers a framework for practical wisdom in medicine that addresses the need for integrity in the life of each health professional. In doing so, it acknowledges the challenge of moral pluralism and the need for moral dialogue and humility as professionals fulfil their obligations to patients, themselves, and society. (shrink)

In clinical moral decision making, emotions often play an important role. However, many clinical ethicists are ignorant, suspicious or even critical of the role of emotions in making moral decisions and in reflecting on them. This raises practical and theoretical questions about the understanding and use of emotions in clinical ethics support services. This paper presents an Aristotelian view on emotions and describes its application in the practice of moral case deliberation.According to Aristotle, emotions are an original and integral part (...) of (virtue) ethics. Emotions are an inherent part of our moral reasoning and being, and therefore they should be an inherent part of any moral deliberation. Based on Aristotle's view, we examine five specific aspects of emotions: the description of emotions, the attitude towards emotions, the thoughts present in emotions, the reliability of emotions, and the reasonable principle that guides an emotion. We then discuss three ways of dealing with emotions in the process of moral case deliberation. Finally, we present an Aristotelian conversation method, and present practical experiences using this method. (shrink)

To discuss moral behavior in organizations, a growing number of authors turn to a ‘virtue ethics’ approach. Central to this approach is the so-called moral character of individuals in organizations: a well-developed moral character enables organizational members to deal with the specific moral issues they encounter during their work. If a virtue ethics perspective is seen as relevant, one may ask how organizations can facilitate that their members can exercise and develop their moral character. In this paper, we argue that (...) the way tasks are defined and interlinked has a profound influence on “exercising and developing moral character”—it can enhance and frustrate it. In order to show how structures may support organizational members to exercise and develop their moral virtues, the paper first describes what it means to exercise and develop virtues in an organizational setting and what is required for it. Next, the paper sets out to explain how specific values on different structural parameters at different structural levels relate to exercising virtues in organizations. (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 medical ethics, a large body of work exists on the virtues that enable good medical practice. Medical virtue ethics singles out a number of virtues of the good doctor for attention; among others, these include empathy, care, truthfulness, and justice. According to medical ethicists like Pellegrino and Thomasma, however, phronesis, or “practical wisdom,” occupies a special place among these virtues. For Pellegrino and Thomasma, phronesis is “indispensable” to good medical practice, because it coordinates all the different moral virtues that (...) the doctor must bring to ethical decisions as part of wise moral action.... (shrink)

This paper proposes a new perspective on the methodology of qualitative inquiry in ethics, especially the interaction between empirical work and theory development, and introduces standards to evaluate the quality of this inquiry and its findings. The kind of qualitative inquiry the authors are proposing brings to light what participants in practices of care and welfare do and refrain from doing, and what they undergo, in order to offer ‘stepping stones’, political-ethical insights that originate in the practice studied and enable (...) practitioners to deal with newly emerging moral issues. As the authors’ aim is to study real-life complexity of inevitably morally imprinted care processes, their empirical material typically consists of extensive and comprehensive descriptions of exemplary cases. For their research aim the number of cases is not decisive, as long as the rigorous analysis of the cases studied provides innovative theoretical insights into the practice studied. Another quality criterion of what they propose that should be called ‘N=N case studies’ is the approval the findings receive from the participants in the practice studied. (shrink)

Care ethics as initiated by Gilligan, Held, Tronto and others has from its onset been critical towards ethical concepts established in modernity, like ‘autonomy’, alternatively proposing to think from within relationships and to pay attention to power. In this article the question is raised whether renewal in this same critical vein is necessary and possible as late modern circumstances require rethinking the care ethical inquiry. Two late modern realities that invite to rethink care ethics are complexity and precariousness. Late modern (...) organizations, like the general hospital, codetermined by various systems are characterized by complexity and the need for complexity reduction, both permeating care practices. By means of a heuristic use of the concept of precariousness, taken as the installment of uncertainty, it is shown that relations and power in late modern care organizations have changed, precluding the use of a straightforward domination idea of power. In the final section a proposition is made how to rethink the care ethical inquiry in order to take late modern circumstances into account: inquiry should always be related to the concerns of people and practitioners from within care practices. (shrink)

The scope of this essay is to introduce and explain the methodology underlying the Lanza Foundation Protocol for the analysis of clinical cases. The essay is divided in three parts. Part one examines the Protocol's methodology within the whole evolutionary framework of argumentation in bioethics. Particular attention is given to the most significant methodologies developed in European bioethics. Part two describes the system of argumentation which serves as a frame for both approaches, namely, the normative and the hermeneutical. Finally, the (...) third part presents in an analytic fashion the operations which define the Protocol itself. The Protocol is the result of an interdisciplinary effort and it provides a detailed grid for analyzing and tackling the ethical components of clinical cases. The Protocol is primarily directed toward Ethics Committees in their consulting activity, yet it has been proven of considerable importance at an educational level also, particular in continuing education programs for health care professionals. (shrink)