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Using practical wisdom to facilitate ethical decision-making : a major empirical study of phronesis in the decision narratives of doctors
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Conroy, Mervyn, Malik, Aisha, Hale, Catherine, Weir, Catherine, Brockie, Alan and Turner, Chris (2021) Using practical wisdom to facilitate ethical decision-making : a major empirical study of phronesis in the decision narratives of doctors. BMC Medical Ethics, 22 (1). 16. doi:10.1186/s12910-021-00581-y ISSN 1472-6939.
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Official URL: https://doi.org/10.1186/s12910-021-00581-y
Abstract
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 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, as an '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. The 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 (nā=ā131) 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, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process. We 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 and practice on phronesis as a decision-making approach due to the availability of these continua. Given the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based 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.
Item Type: | Journal Article | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
SWORD Depositor: | Library Publications Router | ||||||
Journal or Publication Title: | BMC Medical Ethics | ||||||
Publisher: | BMC | ||||||
ISSN: | 1472-6939 | ||||||
Official Date: | 18 February 2021 | ||||||
Dates: |
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Volume: | 22 | ||||||
Number: | 1 | ||||||
Article Number: | 16 | ||||||
DOI: | 10.1186/s12910-021-00581-y | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 5 April 2022 | ||||||
Date of first compliant Open Access: | 5 April 2022 |
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