Wisdom

Question 1

What is the function of Practical Wisdom?

Answer 1

To use the right means to a good end

Question 2

Five aspects of Practical Wisdom in Medicine

Answer 2

1. Pursuit of worthwhile ENDS (GOALS) derived from a concept of human flourishing
2. Accurate PERCEPTION OF CONCRETE CIRCUMSTANCES detailing the specific practical situation at hand
3. Commitment to MORAL PRINCIPLES AND VIRTUES that provide a general normative framework
4. DELIBERATION that integrates ends (goals), concrete circumstances, and moral principles and virtues
5. MOTIVATION to act in order to achieve the conclusions reached by such deliberation

Question 3

Attention of Intervention vs Goals

Answer 3

Interventions usually gets MUCH attention and Goals usually get TOO LITTLE

***Treatment should emerge from discussion of overall goals of care

Question 4

Common treatment goals during the course of a progressive disease

Answer 4

Early Stage: Cure disease, Prolong life, Preserve Function, Palliate Symptoms

Middle Stage: Prolong life, Preserve Function, Palliate Symptoms

Late Stage: Palliate Symptomes

Question 5

What are the 7 goals of Care toward the End of Life?

Answer 5

1. Be Cured
2. Live longer
3. Improve or maintain function/quality of life/independence
4. Be comfortable
5. Achieve life goals
6. Provide support for family/caregiver
7. Clarify diagnosis or prognosis

Mnemonic: “CLFCLF”

Question 6

What are two additional dimensions to treatment decisions?

Answer 6

Probability of outcomes

Willingness to endure suffering

Question 7

Clinical Judgment

Answer 7

Inductive and iterative process of information processing that: 1. Transforms data, 2. Into a differential diagnosis, 3. Identify the most likely diagnosis, 4. Justify an approach to its treatment

Question 8

Clinical Ethical Reasoning

Answer 8

1. State problem plainly
2. Gather/organize data (e.g. medical facts, medical goals, patient’s goals/preferences, context)
3. Ask: Is the problem ethical?
4. Ask: Is more information or dialogue needed?
5. Determine the best course of action, and support it with reference to sources of ethical value

Question 9

Judgment based on Principles of duty

Answer 9

Judgment about MORAL OBLIGATION about actions that are right, wrong, obligatory.

“An action may be right even it does not promote the greatest possible balance of good over evil for self, society, or the universe”

Question 10

Judgement based on consequences (consequentialism)

Answer 10

Judgments about what GOODS are worth pursing, e.g. utilitarianism

“An action is right if it promotes the greatest possible balance of good over evil for self, society, or the universe”

Question 11

Judgments based on virtues

Answer 11

Judgments about PERSONS, MOTIVES, INTENTIONS, TRAITS OF CHARACTER

“An action is right if it is what a virtuous person would do in the circumstances”

Question 12

What is Medicine’s Social Contract?

Answer 12

Used to describe the reciprocal rights and privileges between professions and society

Question 13

Legal Regulation of Medical Practice

Answer 13

1. States: Licensure
2. Hospitals: Restricting and limiting practice
3. Professional Organization
4. Malpractice legislation

Question 14

3 priorities toward a framework of practical wisdom in clinical medicine

Answer 14

Patient, professional, society

First priority: the patient’s good