The sophia and phronesis of modern medicine
Durham, North Carolina, United States
|The Doctor. Luke Fildes, 1891. Tate Gallery, London. Via Wikimedia.|
My first clinical experience was working as a hospice aide my sophomore year of college. During that experience I watched my first patient suffer—physically and spiritually—and eventually die. Not bound by the time constraints of more formal medical settings, I was able to walk with my patient through her suffering. I could hold her hand when she was in need of human comfort. I could play her music from her childhood when she was agitated or anxious. I could prepare her favorite meals, open her window to let the summer breeze and the chirping of birds into her room, and call her family so that she could hear their voices. I could even read from her prayer devotional to offer a spiritual salve. Mostly, I sat in her presence, provided witness to her suffering, and eased what burdens I could.
Humor, metaphor, and a fabricated joy are commonly employed to separate oneself from the reality of another’s suffering and the lack of agency to relieve it. By embellishing and softening such experiences, one puts a veil between themselves and the moral injury that witnessing pain can often inflict. I recall my exaggerated joy while working as a hospice aide, fixating on the occasional moments when my patient was lucid enough to communicate with her family while glossing over the evidence of her body shutting down. In retrospect, I am unsure if this approach was best for my patient and her family. It drew me away from the reality of her illness, decreasing my witness to her suffering. By grasping onto what life she had left, I might have led her and her family to neglect processing her imminent death.
Alternatively, I could have viewed the situation as it truly was and endured whatever truth the situation entailed, though this truth may have been painful and wrought with suffering. This approach relates to two virtues heavily emphasized in the Judeo-Christian tradition: wisdom and suffering well. Wisdom within medical practice can be a double-edged sword: by the wisdom passed down through medicine’s teaching lineage, we can learn to distance ourselves from the reality of suffering. However, by practical wisdom, we can come to enter into the truth of another’s burdens and be renewed through the fullness of a patient’s human experience.
In the Christian tradition, wisdom has been defined as “seeing the world as Christ did from the cross.”2 Secularly, this can mean seeing the world for the totality and richness that it encompasses, acknowledging that in our world individuals experience an immense spectrum of sorrow and joy, suffering and celebration, isolation and friendship, despair and love. Physicians rely heavily upon wisdom, both the formal wisdom of our preclinical curriculum—that technical or scientific wisdom the ancient Greeks referred to as sophia—and phronesis, a pragmatic or prudential wisdom.
In his Nicomachean Ethics, Aristotle describes sophia as theoretical wisdom which relies upon observable principles in the natural world and, with them, speculates how they may apply in different scenarios. Notably, sophia relies on another intellectual faculty outlined by Aristotle, nous, the “aspect of man that apprehends natural truths and laws of nature.”1 Whereas nous apprehends the world, sophia goes a step further, synthesizing the laws of nature to generate a more general body of technical or scientific theory. He further specifies phronesis; also listed as a cardinal virtue in Christian traditions, phronesis, or prudence, enables man to assess the physical and metaphysical constraints of his situation, then discern and carry out the good which ought to be pursued at that moment. It is the great orderer of virtues, offering scope and context to one’s life and providing a basis for all subsequently developed virtues.
Medicine, at its best, synthesizes these two forms of wisdom. By sophia, we learn the intricacies of the body, its pathologies, and corresponding interventions to restore the body to health. By phronesis, we can come to apply this technical knowledge appropriately. Moreover, phronesis can enable us to see the metaphysical fruits of medical care, enter well into our patients’ sufferings, and gain crucial insight into the value of humanity.
Many questions can be raised, drawing on the concepts of sophia and more so phronesis, in how physicians ought to act prudently in entering into a patient’s life, death, or suffering. Importantly, we want to accomplish this without objectifying or trivializing a patient’s very real bodily experience of pain or spiritual strife in the face of terminal illness and death. As we are adopted into this profession, for instance, we learn to write in a manner that is practical. We document that “the patient denies” recreational drug use, or that xxx mg of xxx medication was administered to xxx patient.
We might employ this style of writing as an act of humility and charity, so as to forget ourselves and put the patient first. Yet might we utilize the style for our own benefit? The passive voice diminishes our role in an encounter, linguistically distancing us from the patient’s pain. Furthermore, our reports are riddled with words that reduce the human patient to a physical body or divided system, and acronyms reduce those reductive words further.
If words have concrete meaning, then the words we employ imply our practice is unaware of or disoriented from its end: the human person, body and soul. And if words have meaning, have some tangible effect, then the words we say must reciprocally affect us as physicians or trainees. What sufferings are ignored, moments of human connection passed by the wayside, and spiritual quandaries left un-wondered because our obsession with the body clouds our view of the human soul? Or is it that we are reticent to admit the same death our patients fear is something we fear ourselves—something we cannot measure, quantify, or fit into a black and white binary?
Agape—love that wills the highest good of another—requires us to draw near to the recipient of our love in order to know them thoroughly and thus care more deeply. If the words we use and the passivity of our voice separate us from encounters with our patients, agape might equip us to break through systems and routines and to reach into the suffering of another. Phronesis with agape can aid medical practitioners in walking with a patient through suffering and uphold their desire to ease the burden of another’s cross.
- Aristotle and W.D. Ross. The Nicomachean Ethics (New York: Oxford University Press, 2009), 72-88.
- Cuddy, Catejan. “Sapientia, Reality, and Knowledge.” (The Splendor of Wisdom Retreat, Dominican House of Studies, Washington, D.C., October 5, 2022).
MEAGHAN O’CONNOR is a graduate of the University of South Carolina, where she majored in biology and minored in neuroscience. She is a current first-year medical student at the Duke University School of Medicine. Clinically, her interests lie in pediatrics, palliative care, and hematology-oncology.
Submitted for the 2022–23 Medical Student Essay Contest
Spring 2023 | Sections | End of Life