In medical ethics, a large body of work exists on the virtues that enable good medical practice. Medical virtue ethics singles out a number of virtues of the good doctor for attention; among others, these include empathy, care, truthfulness, and justice. According to medical ethicists like Pellegrino and Thomasma, however, phronesis, or “practical wisdom,” occupies a special place among these virtues. For Pellegrino and Thomasma, phronesis is “indispensable” to good medical practice, because it coordinates all the different moral virtues that (...) the doctor must bring to ethical decisions as part of wise moral action.... (shrink)

BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any (...) given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well. (shrink)

Ethical decision making in medicine has recently seen calls to move towards less prescriptive- based approaches that consider the particularities of each case. The main alternative call from the literature is for better understanding of phronesis concepts applied to decision making. A well-cited phronesis-based approach is Kaldjian’s five-stage theoretical framework: goals, concrete circumstances, virtues, deliberation and motivation to act. We build on Kaldjian’s theory after using his framework to analyse data collected from a three-year empirical study of phronesis and the (...) medical community. The data are a set of narratives collected in response to asking a medical community what making ethically wise decisions means to them. We found that Kaldjian’s five concepts are present in the accounts to some extent but that one of the elements, motivation, is constructed as playing a different, though still crucial role. Rather than being an end-stage of the process as Kaldjian’s framework suggests, motivation was constructed as initiating the process and maintaining the momentum of taking a phronesis-based approach. The implications for medical ethics decision-making education are significant as motivation itself is a highly complex concept. We therefore theorise that motivation is required for leading in, continuing and completing the actions of the ethical decision taken. Appreciating the central importance of motivation through the whole of Kaldjian’s framework has implications for cultivating the virtues of phronesis and courage to take the right course of action. (shrink)

In considering what it means to lead organizations effectively and ethically, the literature comprising spirituality at work and spiritual leadership theory has become highly influential, especially in the USA. It has also attracted significant criticism. While in this paper, we endorse this critique, we argue that the strand of literature which purportedly takes a Christian standpoint within the wider SAW school of thought, largely misconstrues and misapplies the teaching of its founder, Jesus. As a result, in dismissing the claims and (...) application of SAW and SLT, there is a real risk that we lose the vital contribution of Christian thought, not least some of the timeless counter-cultural wisdom of Jesus which, we contend, offers a vital foundation to the practice of ethical leadership and business ethics in organizations. In proposing a way forward, two thorny issues which face all leaders are addressed: dealing with ego and closing the gap between what we say and what we do. The more we understand about the dynamics of human nature, the more we learn about the profundity of Jesus’ teachings. We then propose a number of ways in which Jesus-centred ethical leadership can be practised. Each is radical and each implies risk: both the personal risk of inner renewal arising from repentance as a doorway to personal integrity, as well as the risk of opposing unethical practices and promoting the excellence of core practices in the workplace. (shrink)

In considering what it means to lead organizations effectively and ethically, the literature comprising spirituality at work and spiritual leadership theory has become highly influential, especially in the USA. It has also attracted significant criticism. While in this paper, we endorse this critique, we argue that the strand of literature which purportedly takes a Christian standpoint within the wider SAW school of thought, largely misconstrues and misapplies the teaching of its founder, Jesus. As a result, in dismissing the claims and (...) application of SAW and SLT, there is a real risk that we lose the vital contribution of Christian thought, not least some of the timeless counter-cultural wisdom of Jesus which, we contend, offers a vital foundation to the practice of ethical leadership and business ethics in organizations. In proposing a way forward, two thorny issues which face all leaders are addressed: dealing with ego and closing the gap between what we say and what we do. The more we understand about the dynamics of human nature, the more we learn about the profundity of Jesus’ teachings. We then propose a number of ways in which Jesus-centred ethical leadership can be practised. Each is radical and each implies risk: both the personal risk of inner renewal arising from repentance as a doorway to personal integrity, as well as the risk of opposing unethical practices and promoting the excellence of core practices in the workplace. (shrink)

Volume 20, Issue 3, March 2020, Page 73-74.