A Flourishing Practice?

Toon, Peter

doi:10.26530/oapen_625890

Cited by 31 publications

(36 citation statements)

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“…Building on Jonsen and Toulmin [13] a number of authors [14][15][16][17][18] have developed theoretical accounts of judgement in medicine based on Aristotle's account of phronesis being the kind of practical wisdom that is needed to promote the good in morally di cult situations.…”

Section: Introductionmentioning

confidence: 99%

“…Montgomery [16], Kaldjian [15] and Toon [17] offer book-length studies arguing that phronesis plays an important role in medical decision-making. Although there has been a drive to theorise about the importance of empirically-informed ethics [23][24][25], including phronesis [26], attempts to study clinical-judgement as phronesis using empirical data are rare [27].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors

Conroy

Malik

Hale

et al. 2020

Preprint

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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, sometimes referred to as the ‘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 and MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.FindingsWe 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 on phronesis as a decision-making approach because only now a theoretical ‘collective practical wisdom’ exists. ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, our contribution in the form of a 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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors

Conroy

Malik

Hale

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…But when we face those challenges in life best understood in terms of health it moves, at least for a while, to centre stage.' 10 If we accept Toon's thesis then issues of human relationships are no longer in the periphery of our medical vision but…”

Section: Time For Another Culture Shiftmentioning

confidence: 99%

“…Narrative-based medicine has never found a strong home within the medical world. for Peter Toon's new book 10 A Flourishing Practice? Toon uses MacIntyre's After Virtue to analyse the medical world and to propose how we can reshape it.…”

Section: Applying Virtue Theorymentioning

confidence: 99%