Hermeneutics of medicine in the wake of Gadamer: the issue of phronesis.

Abstract

The relevance of the Aristotelian concept of phronesis--practical wisdom--for medicine and medical ethics has been much debated during the last two decades. This paper attempts to show how Aristotle's practical philosophy was of central importance to Hans-Georg Gadamer and to the development of his philosophical hermeneutics, and how, accordingly, the concept of phronesis will be central to a Gadamerian hermeneutics of medicine. If medical practice is conceived of as an interpretative meeting between doctor and patient with the aim of restoring the health of the latter, then phronesis is the mark of the good physician, who through interpretation comes to know the best thing to do for this particular patient at this particular time. The potential fruitfulness of this hermeneutical appropriation of phronesis for the field of medical ethics is also discussed. The concept can be (and has been) used in critiques of the conceptualization of bioethics as the application of principle-based theory to clinical situations, since Aristotle's point is exactly that problems of praxis cannot be approached in this way. It can also point the way for alternative forms of medical ethics, such as virtue ethics or a phenomenological and hermeneutical ethics. The latter alternative would have to address the phenomena of health and the good life as issues for medical practice. It would also have to map out in detail the terrain of the medical meeting and the acts of interpretation through which phronesis is exercised.