Fowers Blaine J, Novak Lukas F, Selim Marah, Chandran Latha, Kristjánsson Kristján
Department of Educational and Psychological Studies, University of Miami, Coral Gables, USA.
Miller School of Medicine, University of Miami, Miami, USA.
Theor Med Bioeth. 2025 Apr;46(2):121-136. doi: 10.1007/s11017-024-09695-x. Epub 2024 Dec 1.
Virtue-based ethics prioritizes phronesis (practical wisdom) because, as rules have become less action-guiding, good judgment (phronesis) becomes more necessary as a guiding meta-virtue. The view of phronesis that MacIntyre proposed in After Virtue (hereafter, AV phronesis) has been applied in medical ethics despite his substantial deviations from his source (Aristotle) in After Virtue. In this paper, we clarify the differences between the neo-Aristotelian and AV phronesis views and argue for a neo-Aristotelian phronesis with four functions (constitutive, adjudicative, emotion regulative, and blueprint). In referring to neo-Aristotelians, we refer to the recent scholars that who hark back strongly to Aristotle and have amended some of Aristotle's less palatable views by adding insights from current empirical science to the domains that he left vague. Then we discuss how AV phronesis and neo-Aristotelian phronesis differ, focusing on the distinction between technical (i.e., alterable means toward patient health such as medication choices) and phronetic (i.e., actions that are inseparable from patient health) actions in medicine. This distinction is understated in AV phronesis, but central to neo-Aristotelian phronesis. Accordingly, the neo-Aristotelian approach makes an important and unique contribution to physician ethical development.
基于美德的伦理学将实践智慧（实践明智）置于优先地位，因为随着规则在指导行动方面的作用减弱，良好的判断力（实践智慧）作为一种指导性的元美德变得愈发必要。麦金太尔在《追寻美德》（以下简称《AV实践智慧》）中提出的实践智慧观点，尽管与他在《追寻美德》中的思想源头（亚里士多德）存在重大偏差，但已被应用于医学伦理学。在本文中，我们阐明了新亚里士多德主义的实践智慧观与《AV实践智慧》观之间的差异，并论证了一种具有四种功能（构成性、裁决性、情感调节性和蓝图性）的新亚里士多德主义实践智慧观。在提及新亚里士多德主义者时，我们指的是那些强烈追溯到亚里士多德，并通过将当前实证科学的见解添加到他留下的模糊领域，对亚里士多德一些不太受欢迎的观点进行修正的当代学者。然后，我们讨论《AV实践智慧》与新亚里士多德主义实践智慧观的差异，重点关注医学中技术性（即实现患者健康的可改变手段，如药物选择）和实践明智性（即与患者健康不可分割的行动）行动之间的区别。这种区别在《AV实践智慧》中未得到充分强调，但在新亚里士多德主义实践智慧观中至关重要。因此，新亚里士多德主义方法对医生的道德发展做出了重要且独特的贡献。
