Practical wisdom

Do we know how general practitioners decide what to do when caring for patients who are at the end of their life?

In the masterclass November 30, 2016, organised by the foundation Critical Ethics of Care, professor Andries Baart sketched the dynamics of decision making of general practitioners at the death bed of their patients. In response to a contentious, and in the Dutch media much debated case history, he and care ethicist Guus Timmerman performed qualitative research to get more insight in what guides thinking and acting of general practitioners in daily practice. This resulted in revealing ten important themes of interest for this physician. To name a few:

The focus is not only on the patient, but also on the relatives and friends
The general practitioner tries to understand what is at stake for the patient
The general practitioner is not only a physician, but also a human being with emotions and a personal point of view about dignity and dying
The general practitioner is aware of the importance of being able to act flexible and responsive

Besides that, the complexity of decision making is described and explained.
In general, diminishing the suffering of the patient guides the actions of the physician. But assessing suffering involves not only rational and objective criteria. Social, cultural, moral and context specific considerations are even more important. These considerations are not fixed and can change in time because the situation of the patient and the family, and also of the physician, often changes in time. Therefore decision making is a ongoing process, back and forth, with interruptions and uncertainty, sometimes gradually and sometimes like ‘taking a leap’. Good care is a combination of medical expertise, protocols and reason. The process is illustrated by the meandering river in the landscape.

In the second part of the masterclass the need of a reflective attitude towards protocols was illustrated in other domains of health care, in social work and in education. It became evident that there is a discrepancy between presumed reality – work as imagined- and daily reality – work as done. The professional is challenged to observe carefully, give meaning to a specific situation and decide how to act.

Attendees of this masterclass all agreed that protocols and rules are important and helpful, but that good care and welfare and good education need wise application of it. The question if practical wisdom can be learned and taught raised more discussion. Andries formulated the sharp question how to distinguish practical wisdom from practical foolishness.

In conclusion: it is important for professionals to enrich their vocabulary in accounting for their actions when deviating from the rules. The presented research in this masterclass provided a good starting point.

The master class was organized by the Foundation Critical Ethics of Care, that facilitates the international research network Critical Ethics of Care and the website Ethicsofcare.org.
The spoken language is Dutch and you may watch both the lecture of Baart and the entire videoregistration of the masterclass