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Pleasure in medical practice

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Abstract

It is time to challenge the issue of pleasure associated with the core of medical practice. Its importance is made clear through its opposite: unhappiness—something which affects doctors in a rather worrying way. The paper aims to provide a discussion on pleasure on reliable grounds. Plato’s conception of techne is a convenient model that offers insights into the unique practice of medicine, which embraces in a single purposive action several heterogeneous dimensions. In Aristotle’s Ethics, pleasure appears to play a central role for action’s assessment and intensification. Pleasure is also tightly associated with the Kantian faculty of reflective judgment, which operates at the heart of clinical reasoning. Indeed, practicing medicine means to deal with the particular and the manifold, requiring clinical judgment, but also relying on embodied habitus. With Bourdieu’s notion of habitus, pleasure is the mark of a happy practice, which presupposes a deep involvement in one’s field. Throughout our inquiry, the question of pleasure comes to offer a critical reappraisal of real medical practice and leads to consider ethics more as a component of techne than as a separate realm of concern.

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Notes

  1. One can find, in Devettere's essay (1993), an interesting approach of happiness as the goal of ethics for physicians. Unfortunately for our purpose, his article does not address the issue of pleasure.

  2. In the Statesman, Plato uses the paradigm of the weaver to describe the techne of the royal politician. As the physician is also used as a model for the statesman, we might suggest that physician is also a sort of weaver.

  3. In fact, there are five intellectual virtues: nous and sophia will not be discussed here.

  4. Plato’s conception of techne involves both issues.

  5. We will challenge this conception and see later that phronesis comes closer to reflective judgment which is specially required when the question 'how to apply general abstract knowledge' remains unanswered.

  6. Challenging the issue of health as a production lies beyond the scope of this essay.

  7. “We deliberate about things that are in our control and are attainable by action” (NE, 1112a).

  8. “We deliberate about things in which our agency operates, but does not always produce uniform results; for instance about questions of medicine and of business; and we deliberate about navigation more than about athletic training, because it has been less completely reduced to a science; and similarly with other pursuits also. (…)And we deliberate more about the arts than about the sciences, because we are more uncertain about them.” (NE, 1112b).

  9. For that matter, we can notice that the king in Plato’s Statesman is also granted with phronesis, although this trait is not further discussed (1921, 272c).

  10. “In a word, our moral dispositions are formed as a result of the corresponding activities. (…) our actions, as we have said, determine the quality of our dispositions” (NE, 1103b).

  11. “We must take as a sign of states of character the pleasure or pain that ensues on acts” (NE, 1104b).

  12. In this section, Aristotle uses words derived from energeia (translated as ‘activities’). The meaning subsumes making (poiesis) and doing (praxis).

  13. Indeed, ‘practical reason’ in Kantian thought is different from faculty of judgment, the latter seeming closer to phronesis as ‘practical reasoning’ in Aristotle.

  14. Descombes’ thesis on practical thinking is based on Nicomacheans Ethics: « The first principles of action are the end to which our acts are means” (NE, 1140b).

  15. The right action for a patient is not deduced from general rules, but rather discovered in the clinical process. Henry (2006) addresses this question and challenges Pellegrino's conception of phronesis as a distinct value imposed onto the act of clinical judgment.

  16. The importance of tacit knowledge for clinical practice has been thoroughly studied by Henry (2006).

  17. Return to one’s roots? Yves Bonnefoy, relying on Pindar (3rd Pythian), point out that “Asclepius learned [medicine of an artisan] from the Centaur ‘with profound mêtis’: this mêtis is efficacious knowledge about things, an accurate glance, a quick appreciation of the propitious moment” (Bonnefoy 1992, p. 149).

  18. For metis, it is the connivance with reality, and not the excellence of the character, which confers its efficiency.

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Acknowledgments

The author would like to thank Isabelle Mattmuller, Marion Thomas, James Brannan, Michel Constantopoulos and Todd Meyers for friendly advice in the preparation of the manuscript.

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  1. Institut de Recherches Interdisciplinaires sur les Sciences et la Technologie, Strasbourg University, Strasbourg, France

    Jean-Christophe Weber

  2. Department of Internal Medicine, Hôpitaux Universitaires de Strasbourg, 1, place de l’hôpital, 67091, Strasbourg Cedex, France

    Jean-Christophe Weber

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Weber, JC. Pleasure in medical practice. Med Health Care and Philos 15, 153–164 (2012). https://doi.org/10.1007/s11019-011-9338-8

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