An A–Z of medical philosophy

Something amazing happened in Greece. I don’t mean trying to fall off the edge of the Euro, I mean in the 4th century BC when a distinctive Western consciousness blazed into being. One of the authors of this world was Aristotle. Aristotle (384–322 BC) was a wealthy man (the son of a doctor) who used his privilege to spend his life on a quest to understand the world.

It is easy now for us to scorn Aristotle’s physics, which took a punt on the four elements of earth, air, fire, and water in preference to the atomic model suggested by Democritus et al. But without modern chemistry ancient atomic theories could not explain how things change. The four elements variably combined with the four qualities of cold and hot, wet and dry, could explain anything. And Aristotle’s theories lasted without fundamental correction for nearly 2000 years: longer than Newton (and almost Einstein while the fast Neutrinos were to be believed).

The remarkable thing about Aristotle for us is that he is still a major source of moral philosophy: after two and a half millennia he still informs our ethics. Aristotle’s ethics are based on a very simple notion. We can only achieve the goal of human flourishing, the good life (Eudemonia in Greek) by developing excellence of character.

This rests on a big assumption that has not always been popular in recent decades, but that is now again being taken more seriously. Which is that humans have some basic given nature by which we can reference excellence. This does not have to be a narrow or prescriptive formula, but it is simply to observe that certain ways of being lead to personal flourishing and some other ways do not. Most clinicians who deal with those with addiction problems and personality disorders would tend to agree. If we can identify some sort human flourishing then perhaps we can also identify the excellences or human ‘virtues’ that characterise those people who we find to be flourishing. For Aristotle, character is developed by modelling, training, and persistent practice.

The virtues tend to represent a sensible balance point between opposing vices. For example, courage is not the opposite of cowardice; foolhardiness is the opposite of cowardice. Courage is a well-judged point in between foolhardiness and cowardice that wisely discerns when to fight and when to retreat. As well as courage Aristotle identifies other moral virtues of self-respect, self-control, generosity, good temper, friendliness, truthfulness, and justice. Aristotle also recognises the intellectual virtues of reasoning and of practical wisdom: how to best pursue ends. These moral and intellectual virtues are not isolated characteristics but act together within a unified whole.

For Aristotle a good action is simply the action, in a complex and ambiguous world, which a person who has developed excellence of character will tend to do. Sure, this has a certain circularity, but when the world gets messy that may be the best we can get. For Aristotle, right and wrong mean you yourself are in the frame.

• © British Journal of General Practice 2013