Medicine as practical wisdom (phronesis)

Modern medicine faces fundamental challenges that various approaches to the philosophy of medicine have tried to address. One of these approaches is based on the ancient concept of phronesis. This paper investigates whether this concept can be used as a moral basis for the challenges facing modern medicine and, in particular, analyses phronesis as it is applied in the works of Pellegrino and Thomasma. It scrutinises some difficulties with a phronesis-based theory, specifically, how it presupposes a moral community of professionals. It is argued that Pellegrino and Thomasma’s concept of phronesis corresponds to a Hippocratic concept of téchnê, and that this latter concept seems to address many of the challenging issues Pellegrino and Thomasma also address. Thus, if modern medicine is to find its philosophical model in ancient concepts, it appears that the Hippocratic téchnê is closer to the ancient concept of medicine than the Aristotelian phronesis, and that it might avoid many of the pitfalls of a phronesis-based approach. Zusammenfassung Die moderne Medizin scheint fundamentalen Herausforderungen gegenüberzustehen. Mit diversen Ansätzen hat die Philosophie der Medizin versucht, diesen Herausforderungen zu begegnen. Ein solcher Ansatz basiert auf dem alten Konzept der Phronesis. Dieser Artikel geht der Frage nach, ob dieses Konzept der modernen Medizin als moralische Grundlage bei der Lösung ihrer Probleme dienen kann. Die Analyse gilt insbesondere den Anwendungsformen der Phronesis in den Arbeiten von Pellegrino und Thomasma. Es werden einige Schwierigkeiten der auf Phronesis B. Hofmann Center for Medical Ethics, Faculty of Medicine, University of Oslo, Box 1130, Blindern, 0318 Oslo, Norway e-mail: [email protected], Tel.: +472-2844645, Fax: +472-2844661 B. Hofmann, is also at the Department of Health Care, University College of Gjovik, PO Box 191, N-2802 Gjovik, Norway (e-mail: [email protected]) I am most thankful to Professors Julia Annas, Jan Helge Solbakk and Søren Holm for their valuable comments on drafts of this paper. Original paper Poiesis Prax (2002) 1: 135–149 Springer-Verlag 2002 DOI 10.1007/s10202-002-0012-3