Journal Discussion Clinical Experts as Moral Agents

The “Anatomy of Clinical Judgments ” is a testament to the enduring influence of Edmund Pellegrino [1]. Pellegrino identifies a number of distinctions that challenge traditional ways of understanding medical practice. Like a good philosopher (his protestations of the label notwithstanding), he uses these distinctions not only to advance his own particular view of clinical judgment (which will be sketched below), but to do what distinctions drawn well generally do: invite—or rather demand—new ways of thinking about old problems. The “Anatomy of Clinical Judgments ” opens up a space for exploring the nature of clinical judgment. Though more than a quarter of a century old, this space is still being explored today. Long before medicine became an academic interest for many with a philosophical bent, Edmund Pellegrino recognized that clinical judgment—and by extension, clinical expertise—sat on a fulcrum in the debate over the character of medicine. Pushed too far one way, the physician becomes a defender of mystical intuition [2]. At best, the physician’s appeal to the “art of medicine ” is seen as a quaint anachronism and at worst as an attempt to maintain social, moral, or epistemic privilege [3]. Pushed too far in th