Hermeneutics of Medicine in the Wake of Gadamer: the Issue of Phronesis

Abstract

The relevance of the Aristotelian concept of phronesis--practical wisdom--for medicine and medical ethics has been much debated during the last two decades. This paper attempts to show how Aristotle's practical philosophy was of central importance to Hans-Georg Gadamer and to the development of his philosophical hermeneutics, and how, accordingly, the concept of phronesis will be central to a Gadamerian hermeneutics of medicine. If medical practice is conceived of as an interpretative meeting between doctor and patient with the aim of restoring the health of the latter, then phronesis is the mark of the good physician, who through interpretation comes to know the best thing to do for this particular patient at this particular time. The potential fruitfulness of this hermeneutical appropriation of phronesis for the field of medical ethics is also discussed. The concept can be (and has been) used in critiques of the conceptualization of bioethics as the application of principle-based theory to clinical situations, since Aristotle's point is exactly that problems of praxis cannot be approached in this way. It can also point the way for alternative forms of medical ethics, such as virtue ethics or a phenomenological and hermeneutical ethics. The latter alternative would have to address the phenomena of health and the good life as issues for medical practice. It would also have to map out in detail the terrain of the medical meeting and the acts of interpretation through which phronesis is exercised.

Student participation in health professions education research: in pursuit of the Aristotelian mean

“…Through the 'virtuous' oversight of REBs, students participating in education research may come to learn about the principles of ethical research conduct differently than if they were either passive observers or part of the investigation team; they may become more acutely aware of the rights of study participants and the risks participants face after having been study participants themselves; they may gain an understanding of research ethics in a manner different from instruction they would receive in the classroom setting. This development of practical wisdom, phronesis, by students within education contexts would support and parallel discussions in the current literature highlighting the need for phronesis in clinical practice (Dekkers and Gordijn 2007;Flaming 2001;Svenaeus 2003).…”

More to the story: how the medical humanities can learn from and enrich health communication studies

“…17 Fredrik Svenaeus refers to this process as medical hermeneutics. Drawing on the philosophical work of Hans-Georg Gadamer, which emphasizes that all interpretation is mediated by language and centers around "the dialogic meeting between persons who strive toward mutual understanding," 18 Svenaues helps us to see that the clinical encounter is not simply an opportunity for information exchange, but rather a "coming together" of clinician and patient-of the two separate interpretative "horizons" of scientific medical knowledge and the lived experience of illness-for the purpose of creating a mutual understanding that contributes to the health of the patient. Because the process of coming to know what is the matter with someone who is sick or suffering is an interpretive endeavor involving two or more people, practitioners are "not first and foremost scientists who apply biological knowledge, but rather interpreters-hermeneuts of health and illness.…”

Dannelse til lege - Pasientkontakt og profesjonalitet i første fase av medisinstudiet

“…Alle tre kan utvikles gjennom laeringsprosesser og klok veiledning, men fronésis ble regnet som den høyeste og mest krevende. Froné-sis er evnen til å finne løsninger i komplekse menneskelige situasjoner hvor interesser og forståelser står mot hverandre, som i en samtale med sykt barn og mor, eller i ledelse av en sykehusavdeling (Svenaeus, 2003). Fronésis viser seg ved at den profesjonelle både kan tenke ut fornuftige mål, gitt alle hensyn som må tas, og finne midlene for å nå målet (Dunne, 2001).…”

“…Den som har fronésis er i stand til å kombinere «intuisjon, visdom, planlegging, diskresjon, manipulering, smarthet, årvåkenhet, opportunisme, ulike praktiske ferdigheter, og mange års erfaring … i situasjoner som er forbigående, varierende, truende eller dobbeltbunnede, situasjoner som ikke tillater presis måling, eksakt kalkyle eller rigorøs logikk» (Dunne, 2001, s. 257). Enhver med klinisk erfaring vil se at fronésis er en medisinsk relevant kompetanse (Svenaeus, 2003). Når noen blir syk trenger de rådsnare leger som kan skape orden i kaos.…”