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Virtue makes us aim at the right target, and practical wisdom makes us use the right means. Aristotle 1
The task of the physician is to solve medical problems, and these problems are often demanding because of the complex manifestations of disease and the vast array of diagnostic and therapeutic alternatives available. Moreover, the presentation of disease as an experience of illness means that patients present themselves to physicians through multiple dimensions of human experience (biological, psychological, social, spiritual), and the unfolding of illness in real time means that decisions are often made in the face of uncertainty due to incomplete information or unclear wishes of patients or their surrogates. These demands of clinical decision making indicate the measure of the physician's need for practical wisdom-the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. My intention in this paper is to suggest that physicians and medical educators can draw from the virtue of practical wisdom to form a more complete understanding of clinical judgement. This fuller understanding can be achieved by integrating clinical judgement with communication about patients' goals of care and ethical reasoning so that clinical decisions stay focused on the particular values and interests of individual patients. Although my discussion centres on physicians, I recognise that nurses and other healthcare professionals are also engaged in the concerns addressed in this paper and that different professional perspectives may lead to contrasting insights. It is my hope that the reader will find this discussion of practical wisdom relevant for all healthcare professionals.
Practical wisdom: Aristotle, Aquinas and contemporary medical ethics
According to Aristotle, the virtue of practical wisdom (phronesis ) is the ability to identify and use the right means to accomplish good ends, with 'good' being defined within an ethics of virtue. 2 It is fundamentally about aligning right means with good ends through an accurate perception of what is required in the practical realities of a particular situation. 3 As a virtue, practical wisdom is a character trait that is developed through practice. 4 Once acquired, it functions as a disposition that motivates...