C. C. W. Taylor presents a clear and faithful new translation of one of the most famous and influential texts in the history of Western thought, accompanied by an analytical and critical commentary focusing on philosophical issues. In Books II to IV of the Nicomachean Ethics Aristotle gives his account of virtue of character, which is central to his ethical theory as a whole and a key topic in much modern ethical writing.

This work by Pierre Bourdieu develops the anthropological theory which has formed the basis of his scientific research. It discusses the problems posed by "structuralist" philosophers in order to solve or dissolve them.

Synthesizing forty years' work by France's leading sociologist, this book exemplifies Bourdieu's unique ability to link sociological theory, historical information, and philosophical thought. It makes explicit the presuppositions of a state of 'scholasticism', a certain leisure liberated from the urgencies of the world. Philosophers have brought these presuppositions into the order of discourse, more to legitimate than analyze them, and this is the primary systematic, epistemological, ethical, and aesthetic error that Bourdieu subjects to methodological critique. Pascalian because he, too, was (...) concerned with symbolic power, he refused the temptation of foundationalist thinking, attended to 'ordinary people', and was determined to seek the reason for seemingly illogical behavior rather than simply condemning it. Bourdieu charts a negative philosophy, whose intellectual debt to such other 'heretical' philosophers as Wittgenstein, Austin, Dewey, and Peirce, renews traditional questioning of concepts of violence, power, time, history, the universal, and the purpose and direction of existence. (shrink)

This essay argues that the practice ofmedicine is not a phronetic activity in theoriginal Aristotelian sense of that term. Jonsen andToulmin are two philosophers who have conflated thetechne of medicine with phronesis. Thisconflation ignores Aristotle's crucial distinctionbetween techne and phronesis and his useof the medical analogy. It is argued that medicalreasoning is similar to phronesis but does notexemplify it. Phronesis will not save thelife of medical ethics. The concept could be utilized as amoral prosthetic.

In this incisive book, Michel de Certeau considers the uses to which social representation and modes of social behavior are put by individuals and groups, describing the tactics available to the common man for reclaiming his own autonomy from the all-pervasive forces of commerce, politics, and culture. In exploring the public meaning of ingeniously defended private meanings, de Certeau draws brilliantly on an immense theoretical literature to speak of an apposite use of imaginative literature.

argues that ancient Greek medicine had a significant effect on the way in which Plato conceived of ethics, and (2) explores some ways in which Plato integrated medical concepts such as "health" into his ethics. Specific parallels between ancient medicine and such concepts as eudaimonia , soul, nature and convention, etc., are discussed, as is the relation between conceptions of health and medical treatment. Keywords: ancient medicine, ethics, health, Plato CiteULike Connotea Del.icio.us What's this?

The objective of this article is to investigate whether the concept of techne is fruitful as a framework to analyze some of the pressing challenges inmodernmedicine. To do this, the concept of techne is scrutinized, and it is argued that it is a concept that integrates theoretical, practical and evaluative aspects, and that this makes it particularly suitable to analyze the complex activity of modern medicine. After applying this technical framework in relation to modern medicine, some of its general consequences (...) are elaborated. In particular, it is argued that the concept of techne is appropriate to address the constitutive role of technology in medicine. Techne thus appears to be as fruitful a philosophical concept today as it was in antiquity. (shrink)

Many physicians assert that new cost-control mechanisms inappropriately interfere with clinical decision-making. They claim that high costs arise from poorly practiced medicine, and argue that effective utilization of resources is best promoted by advancing the scientific and ethical ideals of medicine. However, the claim is not warranted by empirical evidence. In this essay, I show how it rests upon aesthetic considerations associated with diagnostic elegance. I first consider scientific rationality generally. After a review of analytical empiricist and socio-historical approaches in (...) the philosophy of science, a form of Kant's aesthetic is used to explain how scientific discovery and justification are linked, and to show how meta-theoretical considerations associated with the goals and method of science work together with exemplars of practice. This analysis enables us to understand how the ideals of medicine as a science guide the initial patient history and physical exam in such a way that a parsimonious use of tests is indicated. Aesthetic considerations unite the basic scientific and ethical commitments of the modern medical paradigm and are central for rightly understanding clinical judgment. (shrink)

To achieve its goals of managing andrestricting access to psychiatric care, managedcare organizations rely on an instrument, theoutpatient treatment report, that carriessignificant implications about how they viewpsychiatric patients and psychiatric care. Inaddition to involving ethical transgressionssuch as violation of patient confidentiality,denial of access to care, spurious use ofconcepts like quality of care, and harassmentof practitioners, the managed care approachalso depends on an overly technical,instrumental interpretation of human beings andpsychiatric treatment. It is this grounding ofmanaged care in technical reason that I (...) willexplore in this study. I begin with a reviewof a typical outpatient treatment report andshow how, with its dependence on the DSM-IV,on behavioral symptoms and patient`functioning'', on the biomedical model ofpsychiatric illness, and on gross quantitativemeasures, the report results in a crude,skeletonized view of the human being as acongeries of behavioral symptoms and functions. I then develop the managed care construal ofhuman existence further by showing itsgrounding in technical reason, exploring thelatter in its modern embodiment and deriving itand its opposite, practical reason, fromAristotle''s distinction between technical andpractical reason, techne and phronesis. Inthis analysis of the role of technical reasonin managed care, I point out that managed caredid not have to develop its rationale de novobut could rather lift its arguments, e.g. thebiomedical model, from contemporary psychiatryand simply apply them in a restrictive manner. Finally, I conclude this study by arguing forpsychiatry''s status as a discipline ofpractical knowledge. (shrink)

Most contemporary accounts of clinical ethics do not explain why clinicians should be ethical. Those few that do attempt an explanation usually claim that clinicians should be ethical because ethical behavior provides an important good for the patient – better care. Both these approaches ignore the customary traditional reason for being ethical, namely, the good of the moral agent. This good was commonly called ‘happiness’. The following article shows how the personal happiness of the moral agent provided a major reason (...) for being ethical in the ancient philosophical and biblical traditions and how it continues to play a role in the more modem rights-based, Kantian and utilitarian theories. This history suggests that the personal happiness of the clinician, rightly understood, is a legitimate and important goal of clinical ethics. Keywords: Christian ethics, clinical ethics, deontology, Greek ethics, happiness, rights, utilitarianism CiteULike Connotea Del.icio.us What's this? (shrink)

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of (...) clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine. (shrink)

SummaryThe congruence between medicine and philosophy which we find in the Protagoras and the Treatise on Ancient Medicine as well as the tensions symbolized in the dialectic between Eryximachus and Diotima will always be with us. The congruence and the divergence of these ancient disciplines are both important to human well-being. By opposing one another, medicine and philosophy can each balance the other's pretension to universality. By converging, they illumine some of the most important questions of human existence. This essay (...) has examined ways in which medicine and philosophy can converge in our times as philosophy and medicine, philosophy in medicine, and philosophy of medicine. The present moment in our intellectual history is particularly propitious for the nurture of the engagement of medicine and philosophy. The most fruitful form of that interaction may be in the philosophy of medicine, which is a definable discipline with a set of issues specific to it. If the obvious intellectual dangers can be avoided, those who practice medicine, those who think about it, and those who are served by it can gain deeper insight into the nature and the purpose of medicine as well as the nature of the profession and of man himself. Perhaps—positioned as it is, at the intersection of the sciences, the humanities, and technology—medicine can become “… a medium and the focus in which the problems of wisdom and science meet” (Buchanan 1938, p. 194). (shrink)

Care is widely thought to be a role virtue for health care professionals (HCPs). It is thought that in their professional capacity, HCPs should not only take care of their patients, but should also care for their patients. I argue against this thesis. First I show that the character trait of care causes serious problems both for caring HCPs and for cared-for patients. Then I show that benevolence plus caring action causes fewer and less serious problems. My surprising conclusion is (...) that care is a vice rather than a virtue for HCPs. In their professional capacity HCPs should not care for their patients. Instead HCPs should be benevolent and act in a caring manner toward their patients. Keywords: care, ethics, virtue CiteULike Connotea Del.icio.us What's this? (shrink)

This paper explores the notion of ‘expert’ health care practitioner in the context of critical thinking and health care education where scientific rather than philosophical inquiry has been the dominant mode of thought. A number of factors have forced are appraisal in this respect: the challenge brought about by the identification of complex ethical issues in clinical situations; medicine's `solving' of many of the simple health problems; the recognition that uncertainty is a common and perhaps innate feature of clinical practice; (...) debate about the concepts of illness and disease; plus insights from psychology,sociology and medical anthropology. Together these have prompted alternative ways of thinking which have the aim of identifying the best rather than the right decision (where best equates to good and right equates to correct in the sense of true or approved). It is argued that phronesis adds a necessary corrective dimension to modern Western medicine's over-emphasis on techne and is one of the factors that differentiates novice from expert practitioner. However, this attracts certain conflicts of interest: phronesis can only be gained and assessed from experience of praxis; agencies with legitimate interests in medicine such as government and professional registering bodies require more substantive criteria. (shrink)

In terms of Aristotle's intellectual virtues, the process of clinical reasoning and the discipline of clinical medicine are often construed as techne (art), as episteme (science), or as an amalgam or composite of techne and episteme. Although dimensions of process and discipline are appropriately described in these terms, I argue that phronesis (practical reasoning) provides the most compelling paradigm, particularly of the rationality of the physician's knowing and doing in the clinical encounter with the patient. I anchor this argument, moreover, (...) in Pellegrino's philosophy of medicine as a healing relationship, oriented to the end of a right and good healing action for the individual patient. (shrink)

All the powerful influences exertedby the subjective-interpersonal dimension onthe organic or technical-functional dimensionof sickness and health do not make anintersubjective test concerning medicaltherapeutic results impossible. Theseinfluences are not arbitrary; on the contrary,they obey laws that are de facto sufficientlystable to allow predictions and explanationssimilar to those of experimental sciences.While, in this respect, the rules concerninghuman action are analogous to the scientificlaws of nature, they can at any time be revokedby becoming aware of them. Law-like andreproducible regularities in the sciences ofman (...) are by no means separated from a patient'spersonal-hermeneutic mediation. This makes itpossible for human beings to modify, improve orsometimes even entirely (or better almostentirely) suspend these psychological,sociological, ethnological, medical,regularities. For this reason the sciences ofman including medicine are under the obligationof constantly inspecting the continuingvalidity of the rules on which theirpredictions and explanations are based, namelyby indirect, statistical methods. Thisrequires a synergistic collaboration ofextra-clinical and clinical tests through whichmedicine can obtain a good level ofintersubjective testability. (shrink)

There has been a growing interest in casuistry since the ground breaking work of Jonsen and Toulmin. Casuistry, in their view, offers the possibility of securing the moral agreement that policy makers desire but which has proved elusive to theory driven approaches to ethics. However, their account of casuistry is dependent upon the exercise of phronesis. As recent discussions of phronesis make clear, this requires attention not only to the particulars of the case, but also to the substantive goods at (...) stake in the case. Without agreement on these goods attention to cases is unlikely to secure the productive consensus that Jonson and Toulmin seek. (shrink)