Phronesis and the physician: A defense of the practical paradigm of clinical rationality.

摘要

The thesis of this inquiry is: clinical rationality is practical rationality. In defending this practical paradigm, which finds its exemplar in Aristotle's phronesis, I criticize the more prevalent scientific paradigm. Central to the latter is the claim that the rationality of clinical reasoning is secured by abstract, general scientific knowledge and, in the application of this knowledge to the resolution of clinical problems, by strict adherence to scientific methods and evaluative criteria. Moreover, in its more expansive version, this paradigm also incorporates the claim that clinical medicine is a science.;Rejecting these claims, I contend that clinical medicine is a healing relationship and that its end or telos is a right and good healing action for this patient. Although scientific knowledge, methods, and evaluative criteria are integral to this end, I argue that in its exclusive appeal to these dimensions of clinical rationality, the scientific paradigm misconceives the teleology--as well as the epistemology and ontology--of process and discipline.;The scientific paradigm's flaws, along with the practical paradigm's promise, may be articulated as follows. First, the scientific paradigm neglects--and the practical paradigm recognizes--the significance of clinical experience in the ancient senses of empeira, the accumulated experience of many particulars, and peira, the experience of this particular. In appealing exclusively to scientific knowledge, method, and criteria, this paradigm effaces the subjective agency of the physician, who brings knowledge, method, and experience to the achievement of a right and good healing action for the individual patient. Second, the scientific paradigm entails an impoverished ontology: it effaces the patient's particularity by conceiving the patient as a mere locus of biological processes, discoverable, explicable, and predictable under the aegis of the anonymous human body per se. Unlike the practical paradigm, the scientific paradigm occludes recognition of other clinically significant phenomena of human embodiment, including the unique, embodied self and the lived body.;Given the telos of a right and good healing action for this patient, the epistemic significance of experience, and the ontologic priority of the unique, embodied self, I argue for a clinically specific phronesis, the practical paradigm's core concept.