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)

In this article I scrutinize the question whetherclinical medicine, in order to be considered ahermeneutical enterprise, must be thought of as areading of different texts. Three differentproposals for a definition of the concept of text inmedicine, suggested by other hermeneuticians, arediscussed. All three proposals are shown to beunsatisfying in various ways. Instead of attempting tofind a fourth definition of the concept of textsuitable to a hermeneutics of medicine, I then try toshow that the assumption that one needs to operatewith the (...) concept of text in order to develop ahermeneutics of medicine is false. Clinicalinterpretation can be shown to essentially consist ina dialogical hermeneutics, the pattern of which can befound in the philosophy of Hans-Georg Gadamer. Thiskind of hermeneutics is not a methodology of textreading, but an ontological, phenomenologicalhermeneutics in which understanding is a necessaryfeature of the being-together of human beings in theworld. This being-together in and through languagetakes on a peculiar form in the clinical encounter,since the medical meeting is typically characterizedby an asymmetrical enstrangement and has a specificgoal – health for the patient – absent in other formsof hermeneutics. Central issues of Gadamer''sphilosophy, e.g. fusion of horizons, are shown tofit the structure of clinical practice. (shrink)

Medical ethics nowadays is dominated by a conception of ethics as the application of moral theories and principles. This conception is criticized for its depreciation of the internal morality of medical practice and its narrow view of external morality. This view reflects both a lack of interest in the empirical realities of medicine and a neglect of the socio-cultural value-contexts of medical ethical issues, including the creative development of a broader philosophical framework for a practicable medical ethics. Several alternative approaches (...) and conceptions have been proposed. The unified clinical ethics theory, developed by Graber and Thomasma, is an interesting attempt to synthesize these alternative approaches. It correctly identifies as the crucial problem the present disconnectedness of medical ethics from theoretical philosophy as well as the practice of medicine. In this paper, however, it is argued that the unitary theory should take more serious attention to the hermeneutic character of medicine as well as ethics. This implies that the unitary theory must in fact transform itself into aninterpretive clinical ethics theory. The theoretical characteristics and practical consequences of an interpretive theory of medical ethics are discussed in the present paper. (shrink)

There are several branches of ethics. Clinical ethics, the one closest to medical decisionmaking, can be seen as a branch of medicine itself. In this view, clinical ethics is a unitary hermeneutics. Its rule is a guideline for unifying other theories of ethics in conjunction with the clinical context. Put another way, clinical ethics interprets the clinical situation in light of a balance of other values that, while guiding the decisionmaking process, also contributes to the very weighting of those values. (...) The case itself originates ideas, not only about which value ought to predominate in its resolution, but also provides the origin of clinical rules that can be used in other cases. These are interpretive rules. Some examples of these rules are presented as well. (shrink)

Taking as our starting point Plato'smetaphor of the doctor as philosopher we reflect on some aspects of the epistemological status of medicine. The framework to this paper is the hermeneutics of Hans-Georg Gadamer which shows the paradoxical nature of Western medicine in choosing the body-object as its investigative starting point, while in actual fact dealing with subjects. Gadamer proposes a model of medicine as the art of understanding and dialogue, which is capable of bringing together its various constituent parts, i.e. (...) knowledge, knowing how to do and knowing how to be, in medical practice and in the physician'straining. The paper concludes with a brief discussion of the dyadic figure of the physician as Platonic master of the living totality and wounded healer, capable of activating the patient'sself-healing capacity. (shrink)