This book addresses key topics in social theory such as the basic structures of social life, the character of human activity, and the nature of individuality. Drawing on the work of Wittgenstein, the author develops an account of social existence that argues that social practices are the fundamental phenomenon in social life. This approach offers insight into the social formation of individuals, surpassing and critiquing the existing practice theories of Bourdieu, Giddens, Lyotard and Oakeshott. In bringing Wittgenstein's work to bear (...) on issues of social theory the book shows the relevance of his work to a body of thought to which it has never been applied. The book will be of particular interest to philosophers of the social sciences, a wide range of social theorists in political science and sociology, as well as some literary theorists. (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)

First Published in 1993. Routledge is an imprint of Taylor & Francis, an informa company.

Because of the difficulty posed by the contrast between the search for truth and truth itself, Michael Polanyi believes that we must alter the foundation of epistemology to include as essential to the very nature of mind, the kind of groping that constitutes the recognition of a problem. This collection of essays, assembled by Marjorie Grene, exemplifies the development of Polanyi's theory of knowledge which was first presented in Science, Faith, and Society and later systematized in Personal Knowledge. Polanyi believes (...) that the dilemma of the modern mind arises from the peculiar relation between the positivist claim for total objectivity in scientific knowledge and the unprecedented moral dynamism characterizing the social and political aspirations of the last century. The first part of Knowing and Being deals with this theme. Part two develops Polanyi's idea that centralization is incompatible with the life of science as well as his views on the role of tradition and authority in science. The essays on tacit knowing in Part Three proceed directly from his preoccupation with the nature of scientific discovery and reveal a pervasive substructure of all intelligent behavior. Polanyi believes that all knowing involves movement from internal clues to external evidence. Therefore, to explain the process of knowing, we must develop a theory of the nature of living things in general, including an account of that aspect of living things we call "mind." Part Four elaborates upon this theme. (shrink)

Hartmut Rosa advances an account of the temporal structure of society from the perspective of critical theory. He identifies three categories of change in the tempo of modern social life: technological acceleration, evident in transportation, communication, and production; the acceleration of social change, reflected in cultural knowledge, social institutions, and personal relationships; and acceleration in the pace of life, which happens despite the expectation that technological change should increase an individual's free time. According to Rosa, both the structural and cultural (...) aspects of our institutions and practices are marked by the "shrinking of the present," a decreasing time period during which expectations based on past experience reliably match the future. When this phenomenon combines with technological acceleration and the increasing pace of life, time seems to flow ever faster, making our relationships to each other and the world fluid and problematic. It is as if we are standing on "slipping slopes," a steep social terrain that is itself in motion and in turn demands faster lives and technology. As Rosa deftly shows, this self-reinforcing feedback loop fundamentally determines the character of modern life. (shrink)

Virginia Held assesses the ethics of care as a promising alternative to the familiar moral theories that serve so inadequately to guide our lives. The ethics of care is only a few decades old, yet it is by now a distinct moral theory or normative approach to the problems we face. It is relevant to global and political matters as well as to the personal relations that can most clearly exemplify care. This book clarifies just what the ethics of care (...) is: what its characteristics are, what it holds, and what it enables us to do. It discusses the feminist roots of this moral approach and why the ethics of care can be a morality with universal appeal. Held examines what we mean by "care," and what a caring person is like. Where other moral theories demand impartiality above all, the ethics of care understands the moral import of our ties to our families and groups. It evaluates such ties, focusing on caring relations rather than simply on the virtues of individuals. The book proposes how such values as justice, equality, and individual rights can "fit together" with such values as care, trust, mutual consideration, and solidarity. In the second part of the book, Held examines the potential of the ethics of care for dealing with social issues. She shows how the ethics of care is more promising than Kantian moral theory and utilitarianism for advice on how expansive, or not, markets should be, and on when other values than market ones should prevail. She connects the ethics of care with the rising interest in civil society, and considers the limits appropriate for the language of rights. Finally, she shows the promise of the ethics of care for dealing with global problems and seeing anew the outlines of international civility. (shrink)

Alisdair MacIntyre argues that the virtues necessary for good work are everywhere and always embodied by particular communities of practice. As a general surgeon, MacIntyre’s work has deeply influenced my own understanding of the practice of good surgery. The task of this essay is to describe how the guild of surgeons functions as a more-or-less coherent tradition of moral enquiry, embodying and transmitting the virtues necessary for the practice of good surgery. Beginning with an example of surgeons engaged in a (...) process of moral discernment, I describe how the practice of surgery depends on the cultivation of a certain kind of practical wisdom (phronesis) that effectively orders the techniques of surgery toward particular notions of human flourishing within the limits of what is possible with the particular body on which the surgeon operates. I then argue that one reason why surgeons train in an apprenticeship model of "residency" is to cultivate not only the technical skill but also the practical wisdom to perform good surgery. I conclude by noting that the surgical profession is enduring necessary, but unprecedented, changes in the way it practices and transmits its art; and without deliberate and sustained attention to the character formation of surgeons, the profession runs the risk of creating excellent technicians who are nonetheless ill-equipped to practice wise and good surgery. (shrink)

Abstract:This paper is a further development of two previous pieces of work (Moore 2002, 2005) in which modern virtue ethics, and in particular MacIntyre’s (1985) related notions of “practice” and “institution,” have been explored in the context of business. It first introduces and defines the concept of corporate character and seeks to establish why it is important. It then reviews MacIntyre’s virtues-practice-institution schema and the implications of this at the level of the institution in question—the corporation—and argues that the concept (...) of corporate character follows from, but is a novel development of, MacIntyre’s schema. The paper contrasts corporate character and virtues with the more familiar concepts of corporate culture and values. The constitutive and substantive elements of corporate character, including the essential corporate virtues, are then drawn out and illustrated with reference to the cases explored in Koehn (1998). Finally, the paper acknowledges and counters a specific criticism of this approach. (shrink)

Clinical decision making is a challenging task that requires practical wisdom—the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. The author draws from Aristotle and Aquinas to describe the virtue of practical wisdom and compare it with clinical judgement. From this comparison, the author suggests that a more complete understanding of clinical judgement (...) requires its explicit integration with goals of care and ethical values. Although clinicians may be justified in assuming that goals of care and ethical values are implicit in routine decision making, it remains important for training purposes to encourage habits of clinical judgement that are consciously goal-directed and ethically informed. By connecting clinical judgement to patients' goals and values, clinical decisions are more likely to stay focused on the particular interests of individual patients. To cultivate wise clinical judgement among trainees, educational efforts should aim at the integration of clinical judgement, communication with patients about goals of care, and ethical reasoning. But ultimately, training in wise clinical judgement will take years of practice in the company of experienced clinicians who are able to demonstrate practical wisdom by example. By helping trainees develop clinical judgement that incorporates patients' goals of care and ethical reasoning, we may help lessen the risk that ‘clinical judgement’ will merely express ‘the clinician's judgement.’. (shrink)

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

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 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)

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)

Provider claims to conscientious objection have generated a great deal of heated debate in recent years. However, the conflicts that arise when providers make claims to the "conscience" are only a subset of the more fundamental challenges that arise in health care practice when patients and providers come into conflict. In this piece, the author provides an account of patient-provider conflict from within the moral tradition of St. Thomas Aquinas. He argues that the practice of health care providers should be (...) understood as a form of practical reasoning and that this practical reasoning must necessarily incorporate both "moral" and "professional" commitments. In order to understand how the practical reasoning of provider should account for the needs and commitments of the patient and vice versa, he explores the account of dependence provided by Alasdair MacIntyre in his book Dependent Rational Animals. MacIntyre argues that St. Thomas’ account of practical reasoning should be extended and adapted to account for the embodied vulnerability of all humans. In light of this insight, providers must view patients not only as the subjects of their moral reflection but also as fellow humans upon whom the provider depends for feedback on the effectiveness and relevance of her practical reasoning. The author argues that this account precludes responsive providers from adopting either moral or professional conclusions on the appropriateness of interventions outside the individual circumstances that arise in particular situations. The adoption of this orientation toward patients will neither eradicate provider-patient conflict nor compel providers to perform interventions to which they object. But this account does require that providers attend meaningfully to the suffering of patients and seek feedback on whether their intervention has effectively addressed that suffering. (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)

Summary: Wat betekent de alomtegenwoordige rol van techniek in onze cultuur voor mensen? Er zijn drie benaderingen van deze vraag te onderscheiden: uitwendigheid, mediatie en transhumanisme. Deze verschillen in de mate van verwevenheid die ze tussen mensen en techniek waarnemen. De mediatiebenadering blijkt het best in staat de nieuwe menselijke conditie te verhelderen: mensen geven niet meer autonoom vorm aan hun bestaan, maar alleen in verwevenheid met technologie.

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)

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)

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 article aims to initiate a discussion on the demarcation of the ethics of care. This discussion is necessary because the ethics of care evolves by making use of insights from varying disciplines. As this involves the risk of contamination of the care ethical discipline, the challenge for care ethical scholars is to ensure to retain a distinct care ethical perspective. This may be supported by an open and critical debate on the criteria and boundaries of the ethics of care. (...) As a contribution, this article proposes a tentative outline of the care ethical discipline. What is characteristic of this outline is the emphasis on relational programming, situation-specific and context-bound judgments, a political–ethical perspective, and empirical groundedness. It is argued that the ethics of care is best developed further by means of an intradisciplinary approach. Two intradisciplinary examples show how within the frame of one discipline, other disciplines are absorbed, both with their body of knowledge and their research methodology. (shrink)