Engagement and suffering in responsible caregiving: On overcoming maleficience in health care

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as ‘clinical phronesis,’ i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of ‘virtue ethics,’ yet one that is informed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their “disengaged” form (reflecting the malaise of “modern medicine”). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the ‘silent world of doctor and patient’ — provides may deny or refuse any ‘given’ connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of ‘calculative reasoning’ only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can ‘save the life of medical ethics’ — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can ‘prevent the death of medical ethics.’     

Modesty without Illusion

The common image of the fully virtuous person is of someone with perfect self-command and self-perception, who always makes correct evaluations. However, modesty appears to be a real virtue, and it seems contradictory for someone to believe that she is modest. Accordingly, traditional defenders of phronesis (the view that virtue involves practical wisdom) deny that modesty is a virtue, while defenders of modesty such as Julia Driver deny that phronesis is required for virtue. I offer a new theory of modesty—the two standards account—under which phronesis and modesty are reconciled. Additionally, since the two standards account involves reflection on moral ideals, I provide an account of the proper nature of moral ideals.     

Normativity unbound: Liminality in palliative care ethics

This article applies the anthropological concept of liminality to reconceptualize palliative care ethics. Liminality possesses both spatial and temporal dimensions. Both these aspects are analyzed to provide insight into the intersubjective relationship between patient and caregiver in the context of palliative care. Aristotelian practical wisdom, or phronesis, is considered to be the appropriate model for palliative care ethics, provided it is able to account for liminality. Moreover, this article argues for the importance of liminality for providing an ethical structure that grounds the doctrine of double effect and overcomes the impasse of phronesis in the treatment of the terminally ill.     

The VIA inventory of strengths,positive youth development,and moral education

ABSTRACT

The VIA Inventory of Strengths and the VIA model were originally developed to assess and study 24 character strengths. In this paper, I discuss how the VIA Inventory and its character strength model can be applied to the field of moral education with moral philosophical considerations. First, I review previous factor analysis studies that have consistently reported factors containing candidates for moral virtues, and discuss the systematic structure and organization of VIA character strengths. Second, I discuss several issues related to the VIA model, including a lack of previous studies that directly support the moral justifiability of the model and the presence of a fundamental virtue component required for optimal moral functioning in virtue ethics, phronesis, practical wisdom, in the model. Finally, I propose future directions for research on the VIA model in order to address the aforementioned issues and facilitate the application of the model in moral education.     

Clinical wisdom in psychoanalysis and psychodynamic psychotherapy: a philosophical and qualitative analysis

To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons "wise." Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle's intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis and psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom.     

Can more business ethics teaching halt corruption in companies?

Abstract

This article deals with the question of whether an increased teaching of business ethics can/will have a positive effect on the fight against corruption in companies. It is written from a (South) African perspective. Statistics about the alarming state of corruption in South African businesses are provided in the beginning. A Hegelian approach to the problem, in terms of which theory can and does influence practice, is compared to a Marxist approach, in terms of which theory is only a reflection of practice. The author chooses a position that mediates between these two extremes. In the end, he develops a model that relies heavily on the idea of an ethics of responsibility that draws on Aristotle’s idea of phronesis (practical wisdom based on deliberation). The practical implications of these ideas for the utilization of business ethics teaching in companies are consequently spelt out. While more teaching of this discipline cannot guarantee better morals in a company, it can better equip all involved to deal with the ever-increasing moral problems that business people have to deal with.     

Gendered Purity and Embodied Sexual Flourishing: Moral Agency,Development, and Prudence

Current popular accounts of sexual morality for adolescents based simply on purity or self-determination cannot adequately anchor a Christian sexual ethic, although positions based on both notions hope to facilitate sexual health among young females. Here I critique both popular Christian purity movements and a popular feminist critique of these purity movements (based upon self-determination) and suggest the virtue of prudence as a corrective. Situated within the Catholic theological tradition, prudence (practical wisdom) acknowledges the process of human moral and sexual development and is robust enough to negotiate the concrete complexities of sexual activity and the social realities in which such activity takes place. Further, it honours an embodied sense of female sexual self-determination: females as moral agents directed towards sexual flourishing.     

关于伦理道德与智慧

伦理道德与智慧的关系是一个有着重要的理论和现实意义的课题。伦理、道德与智慧都有联系,但本身都不是智慧。伦理智慧与道德智慧相通,但两者不是同一种意义上的智慧。伦理智慧与道德智慧具有多方面的社会价值,提倡伦理智慧和道德智慧有助于当代中国的社会改革和全面进步,为此需要对中国传统伦理思想和道德价值进行批判性的反思。     

Vices of Inattention

abstract Why do we routinely betray moral commitments that, in some sense, we authentically embrace? One explanation involves inattention: failure to attend to morally important aspects of our lives. Inattention ranges from an unmotivated lack of focus, or “simple” inattention, to more purposeful and wilful self‐deception. Self‐deception has received exhaustive and insightful treatment by philosophers and psychologists; what remains unexamined is the less complex, but more pervasive phenomenon of simple inattention. Since inattention is at least equally important in accounting for our routine moral failures, this gap is an important one to fill. In this essay I examine moral dimensions of inattention: what makes it problematic, what vices it reflects, what duties we have to overcome it, and how we might try to do that. I argue that inattention obscures responsibilities to prevent harm, erodes autonomy, manifests a lack of virtue, and undermines integrity. For these reasons, we have obligations of attentiveness. I propose that we should attend (at least) to apparent violations of our moral values in which we are personally implicated, which we have power to affect, and to which we have been directed by clues that something is amiss. I end with practical suggestions for enhancing our attentiveness.     

The destiny of modern virtue ethics

The revival of Aristotelian virtue ethics since the 1980s does not signify that it goes back to its original form; rather, it is generally manifested in three different variations: The first is a variation of what is known as communitarianism, the second is universalism, and the third is phronesis. On the social level of morality, the serious attempt of modern virtue ethics towards improving the moral spirit of society is laudable. However, its method and reasoning deviates greatly from the demands of modern society’s integration of its operating rules and regulations, and concept of values; hence all of its attempts can hardly escape the fate of becoming just a fantasy. Yet, on the level of dealing with ethic conflicts and moral paradox, modern virtue ethics—via interpreting the theory of phronesis by Aristotle—proposes the valuable thought of a balanced morality that principlism should concern itself with and nourish itself from.     

Why the Practice of Medicine is Not a Phronetic Activity

This essay argues that the practice of medicine is not a phronetic activity in the original Aristotelian sense of that term. Jonsen and Toulmin are two philosophers who have conflated the techne of medicine with phronesis. This conflation ignores Aristotle's crucial distinction between techne and phronesis and his use of the medical analogy. It is argued that medical reasoning is similar to phronesis but does not exemplify it. Phronesis will not save the life of medical ethics. The concept could be utilized as a moral prosthetic.     

Testimony,simulation, and the limits of inductivism

Although theorists disagree about precisely how to characterize the link between anger and moral judgment, that they are linked is routinely taken for granted in contemporary metaethics and philosophy of emotion. One problem with this assumption is that it ignores virtues like patience, which thinkers as different as Cassian, ?āntideva, and Maimonides have argued are characteristic of mature moral agents. The patient neither experience nor plan to experience anger in response to (at least some) wrongs. Nevertheless, we argue, they remain capable of judging such actions to be wrong. This indicates that a different account of the relationship between anger and moral judgment is required. We conclude by proposing one such account, showing how a metaethicist who was more attentive to the normative ethics of anger might set about reconstructing her position.     

Further Notes on Feminist Ethics and Pluralism: A Reply to Lindgren

In a comment on my paper, “Moral Understandings: Alternative Epistemology for a Feminist Ethics” (1989) Ralph Lindgren questions the wisdom of confronta' tional rhetoric in my paper and much feminist moral philosophy, and the consistency of this stance with pluralism about ethics. I defend both the rebellious rhetoric and the inclusivity of my own approach, but suggest that pluralism in moral philosophy is harder to define than Lindgren's comments suggest.     

Out of the consulting room and into the world: hermeneutic dialogue, phronesis, and psychoanalytic theory as practice

One of the relics of positivism has been an underappreciation of the moral and ethical dimensions of psychoanalytic theory and practice. In a positivist metapsychology, cure and therapeutic gain were often defined instrumentally, with relatively little consideration given to aspects of human experience (e.g., moral, cultural, spiritual) that did not fit within a positivist framework. Conceptual and paradigmatic shifts in psychoanalysis have occurred, in part, because of the inability of the classical model to provide a language that adequately captures deeply felt human values and beliefs. Aided by hermeneutic and postmodern influences, many contemporary psychoanalytic theories are beginning to focus greater attention on the notion that analytic therapy is empowered by a set of ethical convictions, beliefs, and commitments, which are tied to a certain understanding of the good life. Along these lines, the author argues that developing a fresh understanding of the moral and ethical dimensions of psychoanalysis requires elaborating a new ontology of human subjectivity and social life. The author offers a sketch of how this gargantuan task might be started by integrating psychoanalysis within a hermeneutic perspective on dialogue, by suggesting that it would be helpful to view psychoanalysis as promoting Aristotelian practical wisdom or phronesis, and by rethinking psychoanalytic theory and interpretation as a form of practice.     

Buddhist Non-Cognitivism

The purpose of this essay is twofold. First, I plan to argue that in light of Buddhist epistemology and metaphysics, it would be an inherent contradiction to the Buddhist tradition as whole to defend the cognitivist view that moral knowledge is possible. Quite the contrary, this essay will demonstrate that, in light of Buddhist theories of knowledge and metaphysical philosophies of no-self and emptiness, Buddhist ethics only makes coherent sense from a standpoint of non-cognitivism. Second, from the arguments that support a non-cognitivist reading of Buddhist ethics, I plan to show that such a standpoint does not entail moral nihilism. Rather, what we find in Buddhism is a middle-way ethic of pluralism. Herein I shall argue that the moral life of Buddhism non-cognitively arises within skandha of feelings, yet is conditioned by the cognitive nature of Buddhist wisdom.     

I. Kant after Virtue 1

Maclntyre's refurbishing of Aristotelian ethics aims to restore both intelligibility and rationality to moral discourse. In After Virtue he concentrates on showing how intelligible action requires that lives be led within institutional and cultural traditions. But he does not offer a developed account of practical reason which could provide grounds for seeking some rather than other intelligible continuations of lives and traditions. Despite Maclntyre's criticisms of Kant's ethics, a Kantian account of practical reasoning may complement his account of intelligibility. An appropriate interpretation of Kantian ethics is outlined, which escapes Maclntyre's criticisms, allows both for the universal character of basic moral principles and for the historical variability of intelligible action, and which makes moral worth or virtue the centre of the moral life. The refurbishing of Aristotelian ethics may be achieved by a Kantian completion.     

Fifty Shades of Grace: The Crafting of Sexual Wisdom

Abstract

Each of us has lived sexual experience that gives us embodied knowledge. This embodied knowledge is a primary source for the creation of practical sexual wisdom. We learn by doing, bumping up against others and mining the consequences to create a personal ethic. Grace accompanies us along the way. In this article a model of sexual-spiritual integration is proposed in which embodied knowledge is in critical-liminal conversation with other sources of knowledge to create practical sexual wisdom in a poetic and phronetic process. Such integration is an example of the moral creativity of the human being and derives from the function of sexuality in the person, the story-telling tendency of the brain to create identity, and the narrative intelligibility of human life. Implications for theological education (providing safe space, information, and invitations to critical and liminal reflection) are briefly discussed before particular graces (desire, vulnerability, honesty and wrestling) are explored and illustrated by stories and poems.     

<Emphasis Type="Bold">Virtue Ethics and Being Morally Moved</Emphasis>

This essay shall discuss the moral feeling of “being morally moved” (daode gandong 道德感动) and explore its philosophical significances in understanding the nature of virtue ethics, especially that of Confucian ethics as exemplary ethics. I would like to argue that the feeling of being morally moved, similar to other feelings such as resentment or indignation, should be seen as one of the most important testimonies or manifestations of our morality or moral consciousness. It has played a very important role of moral judgment and moral cultivation in the history of Chinese moral philosophy and in its everyday moral practices. Instead of being a testimony of morality as cold laws or norms, “being morally moved” is a testimony to our moral virtues, and it should be a living motive of our moral actions as well.