Baum-Baicker Cynthia, Sisti Dominic A
Scattergood Program for the Applied Ethics of Behavioral Healthcare, University of Pennsylvania Center for Bioethics, Philadelphia, USA.
J Clin Ethics. 2012 Spring;23(1):13-27.
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.
几千年来，精确界定智慧一直是哲学家们不断努力的任务。对智慧心理维度的研究揭示了一些使杰出人物显得“明智”的特征。当代生物伦理学家在借鉴并调整亚里士多德的实践智慧这一理智德性以应用于医学情境时采用了这一概念。在本文中，我们通过阐述精神分析和精神动力心理治疗实践背景下作为实践智慧的临床智慧，在心理学和医学伦理学的学术研究基础上进行拓展。在定性数据的支持下，我们认为精神卫生保健中的临床智慧概念具有医学伦理学中实践智慧标准模型所提供的几个关键伦理维度，并且尽管被忽视，但它是基于德性的医学伦理学更广泛发展的一个有用参考点。我们提出临床智慧的特征是实用技能，包括但不限于对平衡的觉察、对悖论的接纳以及一种对他人怀有深深敬意的特殊临床态度。我们为完善培训项目以及加倍努力为临床精神卫生保健实习生提供长期指导机会以培养临床智慧提供了一些建议。
