Practical wisdom in medicine: defending a multidimensional, integrated view of an indispensable virtue.

Abstract

By defending practical wisdom (phronesis) as a multidimensional virtue that complements the moral virtues, we offer a critique of "practical wisdom eliminativism", with special attention to the context of medicine, arguing that the core dimensions of practical wisdom enjoy broad consensus. As the meta-virtue that demonstrates excellence in ethical decision-making, practical wisdom recognizes and employs the best means to achieve good and worthwhile ends by integrating goals, perception of context, moral virtues, deliberation, reason-guided emotion, and motivation. In medicine, practical wisdom encompasses patient-centered deliberation directed toward ends of health and flourishing that promote the patient's good. To counter the notion that practical wisdom is a redundant concept (the eliminativist view), we provide philosophical arguments, evidence from medical practitioners, and psychometric data from a detailed empirical study of US and UK adults. Practical wisdom has survived for more than 2300 years as a unified and unifying intellectual meta-virtue that guides the moral virtues. We believe the reasons we put forward explain why phronesis should be expected to endure as a meaningful, multidimensional concept reflecting the nature of moral deliberation in response to practical challenges in life and medicine.