PPT37 What to do when the guidelines run out? Is there a role for phronesis (practical wisdom) in palliative medicine?

<h3>Background</h3> Clinical guidelines provide an essential framework upon which healthcare professionals act to provide safe and expert practice. However, in providing complex and personalised medical care, clinicians may find that guidelines do not align with patient wishes. Given we have a clear answer to that first question for medical decision making in general what nuances may be relevant for patient decisions in palliative medicine? Can we explore this uncertainty further and construct a way to navigate ourselves towards a decision with the patient? Does phronesis or ‘practical wisdom’, which is the overarching guide to knowing what to want and what not to want, when the demands of two or more virtues collide, and to integrate such demands into an acceptable course of action’ have a role in Palliative Medicine and are there other virtues to consider? <h3>Methods</h3> A gap analysis of literature featuring the use of phronesis in healthcare was performed. <h3>Results</h3> This analysis yielded 476 articles on phronesis in healthcare and two articles relating phronesis specifically to palliative care. Whilst phronesis has already been ‘prioritised in a variety of discursive fields within philosophy, psychology, education, and professional ethics’ (Vaccarrezza et al, 2023), others ask ‘what does phronesis mean to the medical community when we already have guidelines?’. Conroy et al (2021) suggest that phronesis can be taught and provide a table of virtues for professional decision-making. Furthermore, Jameel’s (2025) Critical Interpretive Literature Review of Phronesis in Medicine argues that phronesis works alongside contextual decisions as a counterbalance to the ‘generalized, often reductive levels of evidence-based medicine. <h3>Conclusion</h3> The contextualisation of phronesis with healthcare professionals is a growing topic of interest. There is a need to explore nuances of phronesis in Palliative Medicine to support patient-led individual best outcomes. <h3>References</h3> Conroy M, Malik AY, Hale C, <i>et al</i>. Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors. <i>BMC Med Ethics</i> 22, 16 (2021). https://doi.org/10.1186/s12910-021-00581-y Sabena Yasmin Jameel, A Critical Interpretive Literature Review of Phronesis in Medicine, -The Journal of Medicine and Philosophy: A Forum for Bioethics and. Han PKJ, Hofmann B. Uncertainty tolerance in healthcare: towards a normative conception. <i>Theor Med Bioeth</i> (2025). https://doi.org/10.1007/s11017-025-09731-4 Öhlén J. Practical Wisdom: Competencies required in alleviating suffering in palliative care. <i>Journal of Palliative Care</i> 2002;<b>18</b>(4):293–299. doi:10.1177/082585970201800408 Philosophy of Medicine, Volume 50, Issue 2, April 2025, Pages 117–132, https://doi.org/10.1093/jmp/jhae045 Randall, Fiona, and Robin Downie, Palliative Care Ethics: A Companion for All Specialties, 2nd edn (Oxford, 1999; online edn, Oxford Academic, 17 Nov. 2011), https://doi.org/10.1093/acprof:oso/9780192630681.001.0001, accessed 11 Nov. 2025 Vaccarezza MS, Croce M, Kristjánsson K. (2023). Phronesis (practical wisdom) as a key to moral decision-making: Comparing two models. Jubilee Centre for Character and Virtues Insight Series. 1.3: What is Phronesis? - Jubilee Centre for Character and Virtues