Advertisement

Theoretical Medicine and Bioethics

, Volume 36, Issue 5, pp 299–320 | Cite as

Phronesis as an ideal in professional medical ethics: some preliminary positionings and problematics

  • Kristján KristjánssonEmail author
Article

Abstract

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.

Keywords

Phronesis Medical ethics Aristotle MacIntyre Medical ethics education 

Notes

Acknowledgments

I am grateful to Professor Christian Miller and reviewers of the present journal for comments on an earlier draft.

References

  1. 1.
    Russell, D.C. 2009. Practical intelligence and the virtues. Oxford: Oxford University Press.CrossRefGoogle Scholar
  2. 2.
    Flyvbjerg, B. 2001. Making social science matter. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  3. 3.
    Schwartz, B., and K.E. Sharpe. 2010. Practical wisdom: The right way to do the right thing. New York: Riverhead Books.Google Scholar
  4. 4.
    Bondi, L., D. Carr, C. Clark, and C. Clegg (eds.). 2011. Towards professional wisdom: Practical deliberation in the people professions. Farnham: Ashgate.Google Scholar
  5. 5.
    Flaming, D. 2001. Using phronesis instead of ‘research-based practice’ as the guiding light for nursing practice. Nursing Philosophy 2(3): 251–258.CrossRefGoogle Scholar
  6. 6.
    Evans, A. 2014. The good lawyer: A student guide to law and ethics. Cambridge: Cambridge University Press.Google Scholar
  7. 7.
    Shotter, J., and H. Tsoukas. 2014. In search of phronesis: Leadership and the art of judgment. Academy of Management Learning and Education 13(2): 224–243.CrossRefGoogle Scholar
  8. 8.
    Banks, S. 2006. Ethics and values in social work. Basingstoke: Palgrave Macmillan.Google Scholar
  9. 9.
    Dunne, J. 1993. Back to the rough ground: ‘Phronesis’ and ‘techné’ in modern philosophy and in Aristotle. Notre Dame: University of Notre Dame Press.Google Scholar
  10. 10.
    Pellegrino, E., and D. Thomasma. 1993. The virtues in clinical practice. Oxford: Oxford University Press.Google Scholar
  11. 11.
    MacIntyre, A. 1981. After virtue. London: Duckworth.Google Scholar
  12. 12.
    Anscombe, G.E.M. 1958. Modern moral philosophy. Philosophy 33(1): 1–19.CrossRefGoogle Scholar
  13. 13.
    Arthur, J., K. Kristjánsson, H. Thomas, B. Kotzee, A.M. Ignatowicz, and T. Qiu. 2015. Virtuous medical practice. Birmingham: Jubilee Centre for Character and Virtues. http://www.jubileecentre.ac.uk/userfiles/jubileecentre/pdf/Research%20Reports/Virtuous_Medical_Practice.pdf. Accessed March 30, 2015.
  14. 14.
    Kristjánsson, K. 2007. Aristotle, emotions and education. Aldershot: Ashgate.Google Scholar
  15. 15.
    Broadie, S. 1991. Ethics with Aristotle. Oxford: Oxford University Press.Google Scholar
  16. 16.
    Kristjánsson, K. 2015. Aristotelian character education. London: Routledge.Google Scholar
  17. 17.
    Aristotle. 1985. Nicomachean ethics. Trans. T. Irwin. Indianapolis: Hackett Publishing.Google Scholar
  18. 18.
    Curzer, H.J. 2012. Aristotle and the virtues. Oxford: Oxford University Press.CrossRefGoogle Scholar
  19. 19.
    Winch, P. 1958. The idea of social science and its relation to philosophy. London: Routledge.Google Scholar
  20. 20.
    Flyvbjerg, B. 2004. A Perestroikan straw man answers back: David Laitin and phronetic social science. Politics and Society 32(3): 389–416.CrossRefGoogle Scholar
  21. 21.
    Flyvbjerg, B., T. Landman, and S. Schram (eds.). 2012. Real social science: Applied phronesis. Cambridge: Cambridge University Press.Google Scholar
  22. 22.
    Laitin, D.D. 2003. The Perestroikan challenge to social science. Politics and Society 31(1): 163–184.CrossRefGoogle Scholar
  23. 23.
    Montgomery, K. 2006. How doctors think: Clinical judgment and the practice of medicine. Oxford: Oxford University Press.Google Scholar
  24. 24.
    Carr, D. 1995. Is understanding the professional knowledge of teachers a theory-practice problem? Journal of Philosophy of Education 29(3): 311–331.CrossRefGoogle Scholar
  25. 25.
    Pellegrino, E. 1979. The anatomy of clinical judgment: Some notes on right reason and right action. In Clinical judgment: A critical appraisal, ed. H.T. Engelhardt, S.F. Spicker, and B. Towers, 169–194. Dordrecht: D. Reidel Publ. Co.CrossRefGoogle Scholar
  26. 26.
    Waring, D. 2000. Why the practice of medicine is not a phronetic activity. Theoretical Medicine and Bioethics 21(2): 139–151.CrossRefGoogle Scholar
  27. 27.
    Hofmann, B. 2002. Medicine as practical wisdom (phronesis). Poiesis & Praxis 1(2): 135–149.CrossRefGoogle Scholar
  28. 28.
    MacIntyre, A., and J. Dunne. 2002. Alasdair MacIntyre on education: In dialogue with Joseph Dunne. Journal of Philosophy of Education 36(1): 1–19.CrossRefGoogle Scholar
  29. 29.
    Peterson, C., and M.E.P. Seligman. 2004. Character strengths and virtues: A handbook and classification. Oxford: Oxford University Press.Google Scholar
  30. 30.
    Schwartz, B., and K.E. Sharpe. 2006. Practical wisdom: Aristotle meets positive psychology. Journal of Happiness Studies 7(3): 377–395.CrossRefGoogle Scholar
  31. 31.
    Kristjánsson, K. 2013. Virtues and vices in positive psychology: A philosophical critique. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  32. 32.
    Baltes, P.B., and U.M. Staudinger. 2000. Wisdom: A metaheuristic (pragmatic) to orchestrate mind and virtue toward excellence. American Psychologist 55(1): 122–136.CrossRefGoogle Scholar
  33. 33.
    Ardelt, M. 2004. Wisdom as an expert knowledge system: A critical review of contemporary operationalizations of an ancient concept. Human Development 47(5): 257–285.CrossRefGoogle Scholar
  34. 34.
    Kotzee, B., and A.M. Ignatowicz. 2015. Measuring ‘virtue’ in medicine. Medicine, Health Care and Philosophy. doi: 10.1007/s11019-015-9653-6.Google Scholar
  35. 35.
    Glück, J., S. König, K. Naschenweng, et al. 2013. How to measure wisdom: Content, reliability, and validity of five measures. Frontiers in Psychology 4(405): 1–13.Google Scholar
  36. 36.
    Carr, D. 2015. Educating for the wisdom of moral virtue. http://www.jubileecentre.ac.uk/userfiles/jubileecentre/pdf/conference-papers/Varieties_of_Virtue_Ethics/Carr_David.pdf. Accessed March 30, 2015.
  37. 37.
    Nussbaum, M.C. 1988. Nature, function, and capability. Oxford Studies in Ancient Philosophy 1(1): 145–184.Google Scholar
  38. 38.
    Nussbaum, M.C. 1995. Aristotle on human nature and the foundations of ethics. In World, mind, and ethics: Essays on the ethical philosophy of Bernard Williams, ed. J.E.J. Altham and R. Harrison, 86–131. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  39. 39.
    Nussbaum, M.C. 1990. Aristotelian social democracy. In Liberalism and the good, ed. R.B. Douglass, G.M. Mara, and H.S. Richardson, 203–252. London: Routledge.Google Scholar
  40. 40.
    Irwin, T.H. 1990. Aristotle’s first principles. Oxford: Clarendon Press.CrossRefGoogle Scholar
  41. 41.
    Hacker-Wright, J. 2015. Skill, practical wisdom, and ethical naturalism. Ethical Theory and Moral Practice. doi: 10.1007/s10677-015-9566-8.Google Scholar
  42. 42.
    Annas, J. 2011. Intelligent virtue. Oxford: Oxford University Press.CrossRefGoogle Scholar
  43. 43.
    Swartwood, J.D. 2013. Cultivating practical wisdom. PhD dissertation, University of Minnesota. http://conservancy.umn.edu/bitstream/154543/1/Swartwood_umn_0130E_13707.pdf. Accessed March 30, 2015.
  44. 44.
    Carr, D. 2002. Feelings in moral conflict and the hazards of emotional intelligence. Ethical Theory and Moral Practice 5(1): 3–21.CrossRefGoogle Scholar
  45. 45.
    Carr, D. 2009. Virtue, mixed emotions and moral ambivalence. Philosophy 84(1): 31–46.CrossRefGoogle Scholar
  46. 46.
    Hursthouse, R. 1999. On virtue ethics. Oxford: Oxford University Press.Google Scholar
  47. 47.
    Marcum, J.A. 2012. The virtuous physician: The role of virtue in medicine. Dordrecht: Springer.CrossRefGoogle Scholar
  48. 48.
    Kaldjian, L.C. 2014. Practicing medicine and ethics: Integrating wisdom, conscience, and goals of care. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  49. 49.
    Beresford, E.B. 1996. Can phronesis save the life of medical ethics? Theoretical Medicine 17(3): 209–224.CrossRefGoogle Scholar
  50. 50.
    Hutson, J.M., and N.A. Myers. 1999. The relationship between ethics and phronesis. Pediatric Surgery International 15(5–6): 320–322.CrossRefGoogle Scholar
  51. 51.
    Tyreman, S. 2000. Promoting critical thinking in health care: Phronesis and criticality. Medicine, Health Care and Philosophy 3(2): 117–124.CrossRefGoogle Scholar
  52. 52.
    Kaldjian, L.C. 2010. Teaching practical wisdom in medicine through clinical judgement, goals of care, and ethical reasoning. Journal of Medical Ethics 36(9): 558–562.CrossRefGoogle Scholar
  53. 53.
    Bryan, C.S., and A.M. Babelay. 2009. Building character: A model for reflective practice. Academic Medicine 84(9): 1283–1288.CrossRefGoogle Scholar
  54. 54.
    Kinghorn, W.A. 2010. Medical education as moral formation: An Aristotelian account of medical professionalism. Perspectives in Biology and Medicine 53(1): 87–105.CrossRefGoogle Scholar
  55. 55.
    Boudreau, J.D., and A. Fuks. 2015. The humanities in medical education: Ways of knowing, doing and being. Journal of Medical Humanities. doi: 10.1007/s10912-014-9285-5.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Jubilee Centre for Character and Virtues, School of EducationUniversity of BirminghamEdgbaston, BirminghamUK

Personalised recommendations