Practical wisdom in medicine and health care

How do professionals in medicine and health care know what to do? How should they make the right or a wise decision in morally complex and uncertain situations? And what is the role of the patient in this decision making process? The first five articles in this issue focus on these and similar questions, be it in very different ways. Ricca Edmondson returns to the classic Aristo-telian notion of practical wisdom. References to this notion are rather an invitation to further reflection on morally right behaviour than a concrete guideline to follow. Aristotle describes prudence or practical wisdom (phronesis) as ''knowing the right thing to do in a particular circumstance through understanding the circumstance rightly, knowing what matters, and effective means-end reasoning to bring about what matters .'' Thinking in terms of wisdom refers to forms of reasoning and deliberation in which knowledge, reflection, attitude and life experience are combined with emotional, social, and ethical capacities. The author argues for a threefold Ôwisdom-basedÕ approach. Central to Ricca EdmonsonÕs approach is her focus on the capacities of the self (that is, the professional doing the reasoning), the capacities of the other (patient, colleagues), and the demands of the problem itself. Dan Egonsson also deals with the classic notion of wisdom. He offers an analysis of so-called hypothetical approval, either in the form of preferences or consent. He takes the problem areas prudence, euthanasia and coercive psychiatric care as examples to illustrate his argument. By ÔprudenceÕ he refers to the sphere of personal value or self-interest. An object has prudential value for someone when it makes someoneÕs life better, independently of whether it makes any difference for others and independently of its moral value. The problem, however, is that there are several understandings of the concept of approval. Dan Egonsson discusses three main alternatives, approval as an actual preference, as a rational preference and as consent. Regarding the problem of how to arrive at a wise decision in a morally complex situation, it is common standard in bioethics to use a framework with four phases. If patients are competent, they should be adequately informed and decide for themselves. If they are incompetent, an advance directive might be helpful. If there is no advance directive, caregivers may try to come to a substituted judgement or act according to the best interest principle. Sigurdur KristinssonÕs paper is about the first phase, that is, the …