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Nursing Ethics
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The Birth of Tragedy in Pediatrics: a Phronetic Conception of Bioethics

Franco A. Carnevale

School of Nursing, Wilson Hall, McGill University, 3506 University Street, Montreal, Quebec, Canada H3A 2A7, franco.carnevale{at}mcgill.ca

Accepted standards of parental decisional autonomy and child best interests do not address adequately the complex moral problems involved in the care of critically ill children. A growing body of moral discourse is calling for the recognition of `tragedy' in selected human problems. A tragic dilemma is an irresolvable dilemma with forced terrible alternatives, where even the virtuous agent inescapably emerges with `dirty hands'. The shift in moral framework described here recognizes that the form of conduct called for by tragic dilemmas is the practice of phronesis. The phronetic agent has acquired a capacity to discern good agency in tragic circumstances. This discernment is practiced through the artful creation of moral narratives: stories that convey that which is morally meaningful in a particular situation; that is, stories that are `meaning making'. The phronetic agent addresses tragic dilemmas involving children as a narrator of contextualized temporal embodied human (counter)stories.

Key Words: bioethics • children • critical care • pediatrics • phronesis • tragedy

Nursing Ethics, Vol. 14, No. 5, 571-582 (2007)
DOI: 10.1177/0969733007080203
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