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

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