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eference to phronesis, since Aristotle’s main purpose in developing this concept is thatthe application of abstract principles in the field of practical, ethical knowledge is insufficient.Indeed, the appropriation of phronesis can be taken as a critique of the idea thatthe profession of bioethics is at all possible, if “bioethicist” is taken to mean a person whohas specialized, theoretical knowledge in medical ethics -- knowledge that is not based onpractical experience. Medical ethics cannot only be “epistemic”; it must also be “phronetic.”Gadamerian phronetic hermeneutics of medicine will, in this regard, join an everloudeningchorus of criticism directed against applied ethics as conceptualized and carriedout during the last two decades in the field of medicine. 28 The favorite target of thiscriticism is Tom Beauchamp’s and James Childress’s Principles of Biomedical Ethics, awork that has done much to foster the image of medical ethics as a rather mechanicalpractice. 29 The view of the authors is that clinical decisions should be made inaccordance with four fundamental ethical principles: do good, do not harm, respectautonomy, and be just. On closer inspection, all four of these principles are seen to requirephilosophical theories for the explication of their fundamental concepts; in addition andneedless to say, there is no neutral way of balancing these four theory-laden principles.Therefore, the prima facie principles do not save us the trouble of devising a personalethics that will allow us to choose between different views that cannot be substantiatedin any neutral or objective way. The authors of the book are of course aware of theseproblems and do not regard their book as a road map leading to the only right decisionin every difficult situation; rather, they want to advocate a way of starting to thinksystematically about ethical dilemmas encountered in the clinic. Sadly enough, this is notalways the way their book has been received in the field of bioethics.The Phenomenology of Health and SicknessLet us now return to Gadamer’s late work The Enigma of Health. How does Gadamerhimself address the issues of medical ethics? I would say that he does so in at least twoseparate yet interconnected ways, neither of which bears much resemblance to mainstreamwork on the contemporary bioethical scene.The first of these approaches consists precisely in going back to ancient philosophy andAristotle. His discussion of Aristotelian themes and concepts is very similar to the approachwe already find in Truth and Method and other works of his, except for one thing: he nowexplicitly addresses medical practice (Heilkunst), and not only practice in general. Gadamermakes the point that medical practice -- in its ancient as well as in its contemporary form --never “makes” anything in the sense of techne, but rather helps to re-establish a healthybalance which has been lost. Medical practice therefore is closer to phronesis than totechne:Techne is that knowledge which constitutes a specific and tried ability in the contextof producing things. It is related from the very beginning to the sphere of production,and it is from this sphere that it first arose. ... Now within the parameters of a concept28Three main critical voices are: Albert R. Jonsen and Stephen Toulmin, The Abuse of Casuistry:A History of Moral Reasoning (Berkeley, Calif.: University of California Press, 1989); Pellegrino andThomasma, The Virtues in Medical Practice, and Richard M. Zaner, Ethics and the Clinical Encounter(Englewood Cliffs, N.J.: Prentice Hall, 1988).29Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 4th ed. (Oxford:Oxford University Press, 1994).179