Contributions of neo-Aristotelian phronesis to ethical medical practice.

Virtue-based ethics prioritizes phronesis (practical wisdom) because, as rules have become less action-guiding, good judgment (phronesis) becomes more necessary as a guiding meta-virtue. The view of phronesis that MacIntyre proposed in After Virtue (hereafter, AV phronesis) has been applied in medical ethics despite his substantial deviations from his source (Aristotle) in After Virtue. In this paper, we clarify the differences between the neo-Aristotelian and AV phronesis views and argue for a neo-Aristotelian phronesis with four functions (constitutive, adjudicative, emotion regulative, and blueprint). In referring to neo-Aristotelians, we refer to the recent scholars that who hark back strongly to Aristotle and have amended some of Aristotle's less palatable views by adding insights from current empirical science to the domains that he left vague. Then we discuss how AV phronesis and neo-Aristotelian phronesis differ, focusing on the distinction between technical (i.e., alterable means toward patient health such as medication choices) and phronetic (i.e., actions that are inseparable from patient health) actions in medicine. This distinction is understated in AV phronesis, but central to neo-Aristotelian phronesis. Accordingly, the neo-Aristotelian approach makes an important and unique contribution to physician ethical development.