Hall Daniel E
University of Pittsburgh Medical Center, 200 Lothrop Street, Suite F1200, Pittsburgh, PA 15213, USA.
J Med Philos. 2011 Apr;36(2):114-32. doi: 10.1093/jmp/jhr005. Epub 2011 May 16.
Alisdair MacIntyre argues that the virtues necessary for good work are everywhere and always embodied by particular communities of practice. As a general surgeon, MacIntyre's work has deeply influenced my own understanding of the practice of good surgery. The task of this essay is to describe how the guild of surgeons functions as a more-or-less coherent tradition of moral enquiry, embodying and transmitting the virtues necessary for the practice of good surgery. Beginning with an example of surgeons engaged in a process of moral discernment, I describe how the practice of surgery depends on the cultivation of a certain kind of practical wisdom (phronesis) that effectively orders the techniques of surgery toward particular notions of human flourishing within the limits of what is possible with the particular body on which the surgeon operates. I then argue that one reason why surgeons train in an apprenticeship model of "residency" is to cultivate not only the technical skill but also the practical wisdom to perform good surgery. I conclude by noting that the surgical profession is enduring necessary, but unprecedented, changes in the way it practices and transmits its art; and without deliberate and sustained attention to the character formation of surgeons, the profession runs the risk of creating excellent technicians who are nonetheless ill-equipped to practice wise and good surgery.
阿拉斯代尔·麦金太尔认为，出色工作所需的美德在任何时候、任何地方都由特定的实践社群所体现。作为一名普通外科医生，麦金太尔的著作深刻影响了我对出色外科手术实践的理解。本文的任务是描述外科医生同业公会如何作为一种或多或少连贯的道德探究传统发挥作用，体现并传承出色外科手术实践所需的美德。从外科医生进行道德辨别过程的一个例子入手，我描述了外科手术实践如何依赖于某种实践智慧（实践理性）的培养，这种实践智慧在外科医生所操作的特定身体的可能性范围内，有效地将手术技术导向特定的人类繁荣观念。然后我认为，外科医生采用“住院医师”学徒模式进行培训的一个原因是，不仅要培养技术技能，还要培养进行出色外科手术的实践智慧。我在结论中指出，外科行业正在经历其实践和传承其技艺方式的持久且必要但前所未有的变革；如果不刻意且持续地关注外科医生的品格塑造，该行业就有可能培养出优秀的技术人员，然而他们却没有能力进行明智且出色的外科手术。
