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

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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.

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Notes

  1. This has been borne out, in the research centre where I work, in our current studies of the moral basis of a number of different professions, such as teaching, nursing, law, business, and—to a certain extent at least—medicine (see, e.g., [13]). However, notice that I am talking here about academic discourse; there is less evidence that this interest in virtue-based ethics has filtered down to professional ethics education, which still seems largely to be principle-based. I return to this issue in the final section of the paper.

  2. For an overview of those debates, see [14, chs. 3, 11].

  3. See, e.g., [18, pp. 294–295].

  4. See [16, ch. 4].

  5. See, e.g., [10, 23].

  6. See [24] for a defence of that radical thesis in the case of the teaching profession.

  7. See [14, ch. 11] for references and commentary.

  8. See [26] and [27] for further arguments and references to Aristotle’s texts.

  9. Admittedly, in other works, such as his Politics, Aristotle makes more relativistic remarks about justice being relative to constitutions, etc. However, those remarks are typically understood to relate to political incarnations of virtues such as justice, not to justice as explained in the Nicomachean Ethics or the Rhetoric, nor to phronesis as presented in the Nicomachean Ethics.

  10. See [36] for a trenchant critique of this relativist position.

  11. I am assuming here that the two doctors have chosen to pursue the profession for the right moral reason and that they are virtuous agents. Otherwise their deliberation about moral matters—even if it led to a good outcome for their patients—would not qualify as an exercise of phronesis in the first place but rather of the cunning capacity of calculation, as explained in the second section of this paper.

  12. Notice that Annas does not subscribe to a particularist interpretation of phronesis, as defined in the previous section. Although the process she describes here looks like one of particularist self-orchestration, she grants the Aristotelian point that phronesis, like other intellectual virtues, ‘grows mostly from teaching [rather than habituation]’ [17, 1103a14–16], and that the teaching is essentially based on general moral truths.

  13. See further [16, ch. 4].

  14. Cf. [11, p. 153] on the absence of the centrality of tragic conflict in Aristotle.

  15. See [46, pp. 45–47].

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Acknowledgments

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

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  1. Jubilee Centre for Character and Virtues, School of Education, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

    Kristján Kristjánsson

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Correspondence to Kristján Kristjánsson.

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Kristjánsson, K. Phronesis as an ideal in professional medical ethics: some preliminary positionings and problematics. Theor Med Bioeth 36, 299–320 (2015). https://doi.org/10.1007/s11017-015-9338-4

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