Journal of Medicine and Philosophy最新文献

This article presents the results of a rigorous critical interpretive review that maps the current literature on phronesis in medicine. The literature in this area involves varied disciplines, centuries, and conceptions and is extensive, but through a focused review, this study seeks to clarify definitions and key distinctions. It thereby aims to elucidate a depth of meaning and understanding regarding phronesis in medicine to inform future work on the topic. Specifically, 12 themes are inductively identified and analyzed from the literature, and organized into three chronological categories of past, present, and future. A narrative summation of the literature to date is then offered, assessing the varied conceptual applications of phronesis to medical practice, the emerging literature on its applicability to organizations, prospects for empirical work on the concept, and its application in medical education.

The longstanding view of doctors as scientists has been an emphasis in the MCAT and medical school training. However, the AAMC recommended recognizing the importance of social and behavioral science for medicine. There is also a growing realization that being a smart problem solver and the physician as scientist model emphasizes a cold cognitive problem-solving paradigm that overlooks other human capacities that may be critical to medical reasoning and decision-making. Considering a smart physician versus a wise physician, intelligence and problem-solving are important, but a wise physician can use other important capacities beyond intelligence and rationality. This could benefit patients by introducing patient and family perspective taking, as well as compassion in doctor-patient interaction. By reconceptualizing professions from the perspective of practical wisdom, this may increase resilience to problems such as burnout. I outline some psychological capacities viewed as important in wise reasoning that are not about traditional views of intelligence. I argue that wise reasoning is not a native talent but a skill that can be developed. I argue that different kinds of experiences can increase aspects of empathy, epistemic humility, perspective taking, and wise reasoning and I examine evidence that wise reasoning may increase resilience.

The practice of medicine is a complex endeavor requiring high levels of knowledge and technical capability, and the capacity to apply the skills and knowledge to do the right thing in the right way, for the right reason, in a particular context. The orchestration of the virtues, managing uncertainty, applying knowledge and technical skills to a particular individual in a particular circumstance, and exercising the virtues in challenging circumstances, are the tasks of practical wisdom. Centuries ago, Aristotle suggested that capacities for wise action are developed through practice, experience, and reflection. Neuroscience and cognitive psychology are now beginning to contribute to our understanding of the complex interplay between emotion, cognition, and behavior that is necessary for wise action, and how this capacity for wise action can be developed. In this paper, I propose that wisdom offers an appropriate true north for medical education. Wisdom shifts the focus beyond the simple acquisition of knowledge and technical skills and integrates essential virtues like compassion, trustworthiness, humility, and the balancing of the virtues, into the professional formation for medical students. Informed by the humanities, the neurosciences, and the social sciences, we must now integrate the skills and practices necessary to the development of practical wisdom into medical education at all levels.

This article defends the centrality of practical wisdom in medical practice by building on a monistic view of moral virtue, termed the "Aretai model," according to which possession of practical wisdom is necessary and sufficient for virtuousness, grounding both moral growth and effective moral behavior. From this perspective, we argue that practical wisdom should be conceived as a cross-situational ethical expertise consisting of four skills:moral perception, moral deliberation, emotion regulation, and moral motivation. Conceiving of practical wisdom as both overall virtuousness and ethical expertise makes it possible to deal adequately with the uniqueness of concrete ethically relevant situations. We contend that this becomes particularly evident in the context of medical practice, both in terms of decision-making and action-taking, especially in the most challenging or contentious clinical cases. We conclude the article by suggesting the potential implications of the Aretai model for continuing education in medical and healthcare professions.

As work on practical wisdom and medicine accelerates, now is a good time to outline some important challenges that any approach to developing an account of this virtue faces. More specifically, I develop five challenges having to do with the existence and nature of practical wisdom, and whether it connects with objective and general normative truths. The main goal is to provide a guide to the challenges themselves and some of the options available for tackling them, rather than trying to resolve them here.

This paper argues that practical wisdom represents a useful framework for understanding the synthesis of the scientific, technical, and moral dimensions of medical practice and may, therefore, guide the meaningful integration of concepts of competence and character into the education and support of both the technical and moral agency of medical professionals. The authors show the importance of practical wisdom in three distinct domains: (1) in effective deliberation in clinical judgments; (2) in helping clinicians flourish by making wise decisions in light of the moral and emotional challenges they face in their practice; and (3) in helping physicians navigate between the rights of patients, the physician's own moral good, and the objective good intrinsic to medicine. To promote the physician's own moral good and the objective good intrinsic to medicine, the authors propose a philosophical position, the agential view, that preserves an essentialist view of medicine but emphasizes the necessity to develop a personal moral philosophy of clinical practice.

The underreporting of suspected adverse drug reactions hinders pharmacovigilance. Solutions to underreporting are oftentimes directed at clinicians and healthcare professionals. However, given the recent rise of public inclusion in medical science, solutions may soon begin more actively involving patients. I aim to offer an evaluative framework for future possible proposals that would engage patients with the aim of mitigating underreporting. The framework may also have value in evaluating current reporting practices. The offered framework is composed of three criteria that are bioethical, social-epistemic, and pragmatic: (i) patients should not be exposed to undue harms, for example, nocebo effects; (ii) data should be collected, analyzed, and communicated while prioritizing pharmacovigilance's aims, that is, free from industry bias; and (iii) proposals should account for existing and foreseeable pragmatic constraints like clinician "buy in" and existing reporting infrastructure. Proposals to engage patients in pharmacovigilance that fulfil or address these criteria are preferable to those that do not.

Physicians are shaped by sociological and philosophical factors that often differ from those of their patients. This is of particular concern in pluralistic societies when navigating ethical disagreements because physicians often misunderstand or even dismiss patient perspectives as being irrational. This paper examines these factors and why many physicians approach ethics as they do while elucidating various patient perspectives and demonstrating how they make sense when considered from a different cultural worldview. Many physicians are trained in contexts that are WEIRD: Western, educated, industrialized, rich, and democratic. These sociological characteristics tend to go hand in hand with the trio of individualism, secularism, and existentialism. These then shape an approach to ethics that focuses on the individual patient, makes no reference to the divine, and focuses on a patient's personal desires. This contrasts significantly with many patients who are collectivistic or religious, and then make rational decisions based on other values. The social fact of pluralism implores physicians to temper confidence in their own cultures while considering others to promote mutual understanding and improved care. This paper concludes with a discussion of how bridges can be built across cultures without sliding into relativism, beginning with recognizing and communicating our shared moral intuitions.

Contemporary healthcare environments are becoming increasingly informationally demanding. This requires patients, and those supporting them, to engage with a broad range of expert knowledge. At the same time, patients must find ways to make sense of this information in the context of their own values and needs. In this article, we confront the problem of communication in our current age of complexity. We do this by focusing on a field that has already had to grapple with these issues directly: genetic counseling. We articulate an empathy-based framework that provides a way to integrate the teaching and counseling models of genetic counseling. As well as being useful for those providing genetic counseling in the era of genomic medicine, this framework has the potential to address challenges of communication in healthcare settings beyond genetic counseling. Furthermore, it has important ramifications for ethical debates about autonomy and decision-making.