La buona medicina sintesi di prudenza e sollecitudine:una riflessione a partire da Paul Ricoeur

Speaking of good medicine is a way to underline the moral dimension of the medical act and to subtract it both from any legalism and relativism of a subjective choice. In fact, deontology is exposed to a double risk: on the one hand, it can be reduced to private conscience and therefore to a scale of values of the doctor; on the other hand, it can be completely transformed and be assimilated into a code of positive laws. In the former case, the space for the decision-making autonomy of the doctor or the patient expands beyond any justifiable limit. In the latter case, deontology, which is actually an asymmetric interpersonal relation, becomes a purely contractual matter, where positive law is considered the only means for protecting oneself from risks and for solving any contentious by using legal proceeding. Neither the one nor the other concept of deontology consider that the professionalism of the doctor and the vulnerability of the patient move within a normative framework with conditions that are necessary but not sufficient, which has to be completed and justified in the light of virtue ethics. Therefore, Paul Ricoeur’s distinction between what is just, legal, and good proves to be of great importance, in particular in those uncertain and conflicting situations that demand delicate decisions from the doctor. It is in this context that prudence or phrónesis makes its appearance. In fact, prudence is indispensable to formulate a judgment that tends towards the best possible decision under specific circumstances, combining the rigor of the general norm with the singularity of the concrete situation. In his essays dedicated to medical art, Ricoeur is outlining something like a real architecture of therapeutic alliance, articulated in three moments: prudential, deontological, and theological. Prudential judgment is inseparable from deontology, which guarantees support and protects the vulnerability of the therapeutic alliance threatened by various requests. On the other hand, medical ethics is not justified if it is not based on an anthropological understanding respectful of the personal integrity and dignity of the patient.