Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors.
Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors.
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DOI：
10.1186/s12910-021-00581-y
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发表时间：
2021-02-18
影响因子：
2.7
通讯作者：
Turner C
中科院分区：
文献类型：
--
作者：
Conroy M;Malik AY;Hale C;Weir C;Brockie A;Turner C
医学伦理学最近看到了一个驱动器远离多个规范的方法，医生被淹没的指导方针和原则，朝着替代，少道义的观点。这代表了对理论建设的明确呼吁，而不是产生更多的指导方针。实践智慧（Phronesis）为伦理决策提供了一种替代方法，它基于实践者通过先前的实践困境和决策所积累的智慧的应用。实践智慧，作为一种“执行美德”，提供了一种方法来导航实践美德，为任何给定的情况下，以达到对前进的道路上的最终决定。然而，非常有限的经验数据存在，以支持phronesis为基础的医疗决策的理论，并存在什么往往侧重于个人从业者，而不是基于实践的医生社区。主要的研究问题是：对医生来说，为病人和他们的社区做出道德上明智的决定意味着什么？一项为期三年的人种学研究探讨了医生（n = 131）的实践智慧，并利用他们的叙述来发展对伦理决策概念的理论理解。数据收集包括叙述性访谈和观察与医院医生和全科医生在职业发展的各个阶段。分析借鉴了新阿伦特主义，麦金太尔的实践为基础的美德伦理学的概念，并支持了以艺术为基础的电影制作过程。我们发现，个别医生传达了许多不同的实践美德，这些美德被整合成十五个美德连续体，传达参与者的“集体实践智慧”，包括实践美德。由于这些连续体的存在，本研究推进了实践智慧作为一种决策方法的现有理论和实践。鉴于医生在道德决策的背景下感到职业和个人脆弱的论点，以视频系列和基于应用程序的道德辩论资源的形式的连续体可以支持决策之前，期间和之后的反思。潜在的影响是，这些理论研究结果可以被教育工作者和从业者作为一个非规定性的替代方案，以改善伦理决策，从而解决文献中的呼吁，并有利于患者和他们的社区，以及。在线版本包含补充材料，可通过10.1186/s12910-021-00581-y获得。
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 (n = 131) 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. The online version contains supplementary material available at 10.1186/s12910-021-00581-y.
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影响因子：
4.1
作者：
Kaldjian, Lauris Christopher
通讯作者：
Kaldjian, Lauris Christopher
DOI：
10.1007/bf00489446
发表时间：
1996-09-01
期刊：
THEORETICAL MEDICINE
影响因子：
--
作者：
Beresford, EB
通讯作者：
Beresford, EB
生物医学伦理学的原则如何“道德”？ - 对共同道德假设的跨域评估。
影响因子：
2.7
作者：
Christen M;Ineichen C;Tanner C
通讯作者：
Tanner C
影响因子：
5.4
作者：
Brummell, Stephen P.;Seymour, Jane;Higginbottom, Gina
通讯作者：
Higginbottom, Gina
影响因子：
2.7
作者：
Hood, Laraine;Fenwick, Jennifer;Butt, Janice
通讯作者：
Butt, Janice