Prudence is very necessary in daily life and it is often necessary to cultivate it. His teaching has been emphasized since the Greek classics. We wonder if enough is taught at home, at school, during the study of medical sciences and we appeal to Haynes, Pellegrino and Maio in search of virtues, acts and clinical habits that link prudence with ethics and humanism.

Prudence is all practical knowledge applicable and suitable for the direction of customs. In Greek it is called “fronesis” and in Latin it is called “prudentia”. Reference is made to the man who foresees, who knows in advance, who acts with cautious knowledge, the foresighted, reflective man.^1–3 The Royal Spanish Academy defines it in three ways: Temperance, caution, moderation; Sanity, good judgement; and Cardinal Virtue that allows to distinguish good from bad.⁴

Aristotle 384 BC points out, the distinguishing feature of the prudent man is to be able to deliberate and to judge in a convenient way about the things that can be good and useful for him, contributing in general to his virtue and happiness. He introduces the term "Phronexis" in his Nicomachean Morals, and underlines, the prudent man is the one who knows how to act well. "He qualifies her as the Mother of all Virtues".² Marcus Aurelius 121 AD-180 AD, Roman Emperor, Stoic philosopher, his work Meditations is a source of inspiration for many politicians, as well as a treatise on the philosophy of duty, which clearly describes how to maintain equanimity, in the midst of conflict using prudence.⁵ Baltasar Gracián 1601, shows us in his interpretation of life, man's relationship with himself and with those around him, in his work "The art of prudence." It uses 300 tips related to prudent attitudes in different circumstances of daily life, recommends mastering reactions and emotions.⁶

Prudence, which teaches decision-making, provides human beings with self-control. It also helps to identify the situations that are convenient and those that are not. It helps to think before acting -self-control-, which prompts the person to measure the consequences of actions.⁵

Aristotle proposes prudence as an intellectual virtue, to which are added the virtues Strength, Temperance and Justice, which have been part of collective thought since ancient times, completing the list of intellectual virtues and he calls her the Mother of all Virtues.^2,3 "The virtue of prudence is what educates us to reflect well and thus decide well".⁵

Prudence is the base virtue for the development of the other moral virtues, In order to educate children in virtues, it is necessary to experience them by parents, that is, to demonstrate with our actions that one is virtuous. TheEducation of prudence requires that parents develop in their children what Saint Thomas calls quasi-integral parts,⁷ among them we have: memory, intelligence, docility, sagacity, reason, foresight, circumspection and caution. Foresight "is the main part of prudence, since all the other things required for it are necessary, in order to order something directly and to make us cautious";⁸ In this way, the foresighted person is the one who orders the media in such a way that they have a hierarchy according to the reality sought, therefore, their actions will be prudent in the line of not wasting the opportunities or circumstances that arise in disorderly or directionless actions.^7–9

By reflecting on the importance of values, their recognition from which it is expected to enrich the natural and social environment of the classroom, we are laying the foundations in the formation of every human being, and the scale of values ​​of each student will be the one that ultimately determines their thoughts and future behavior.⁹ Values ​​must always be taught, and it is with the values ​​with which we are building our identity, and what will be our future life, learning to be ourselves; but, the school is the one that will systematically strengthen the values ​​brought from home.¹⁰ The scale of values ​​of each student will ultimately determine their thoughts and behavior. The lack of a well-defined value system is a shared responsibility of the family and the school.

Haynes details the work of teachers in his book Ethics and School,¹¹ in which he criticizes the acceptance of a series of beliefs without questioning them and transmitting them to the youngest as part of their education, leaving aside prudence. The main objective of this book is to help students of education faculties, future teachers, to reflect on the ethics of their practice, give them the opportunity to speak and discuss the propriety of their acts, emphasizing ethics, in a dialogue with people who may think differently. A starting point is to observe to what extent our attitudes are covered with these values, and to specify the degree of implication that we assume in daily practice.¹²

What do medical schools promote about teaching in favor of prudence?

The teaching of prudence and other values ​​has been absorbed by Medical Ethics and Bioethics (EMB). However, the existence of an enormous gap between the theoretical courses, disconnected from the reality experienced by the students in the clinical field who travel daily¹³ has been verified. The State Council of medical students of Zaragoza has developed recommendations in an Ethics Guide for clinical practices, which indicate that prudence means acting with good judgment, without haste, taking into account ethical and humanistic circumstances. Students should think before acting, and seek advice when questions arise.¹⁴ The humanization of medical decisions should be taught to students until it constitutes a habit and is internalized in their daily work, “that they consider the human being as an individual with dignity, autonomy and freedom, which must be respected with prudence in all acts doctor".

What perception of professionalism do medical students have?

Studies on the perception of professionalism by students according to the definition of the American Board of Internal medicine on a scale to identify the most important values ​​related to professionalism were responsibility towards patients, respect for them and their families, integrity and prudence.¹⁵ Similarly, studies carried out on 6th year students of the Universidad Nacional Mayor de San Marcos allowed them to choose as priority values ​​to respect the privacy, confidentiality and dignity of patients, honesty and integrity, not counting Prudence among the most important values.¹⁶

How do we delineate medical professional prudence?

There is a mutual interiority between the ethical and technical dimensions in health practice. It is necessary to adopt a personal perspective in addition to technical or ethical habits, which allows us to judge the actions of others using the virtue of prudence, and to capture in the concrete context the good to choose. Prudence is influenced by the global ethical character of people, by deliberative capacity and knowledge of ethical principles. This will make it easier for us to make decisions and consider a given action as good or bad. The deliberation, judgment and determination of the action carried out by reason supported by prudence, will define the ethical character of the health profesional.¹⁷

Longley has introduced this virtue nationally in Wales in an effort to capture the Vision of Four Principles in Healthcare: do not use tests and treatments of little added value, health personnel can operate freely at the top of their license , the harmful variants will be eradicated, and where patients, the public and professionals work in camaraderie to improve the health and well-being of the population.¹⁸ The medical act must be true by including the psychological and social components, as opposed to a simple technical act.In the words of Pellegrino, this is the moment of clinical truth, an exercise in practical judgment, prudence and, ultimately, ethics.¹⁹ Maio proposes that prudence is the ethical principle on which the practice of medicine is based. Prudence, broadly defined as caution, has also been used in different ways such as wisdom, judgment, cunning, common sense, care, fatigue, circumspection, being right, economy and abstinence. She has been one of the four virtues mentioned by Plato, later incorporated in the Christian tradition as Cardinal Virtues together with Temperance, Fortitude and Justice.²⁰

What is the relationship between prudence and ethics?

The professional ethical model can be applied to make decisions with patients in cases of clinical uncertainty, when the evidence is low or very low. This model is based on the professional virtues of integrity and candor of the clinician and the virtue of prudence of the patient, in the moral management of medical uncertainty and the trial of the intervention. These facts combine justified medical restraint and patient autonomy, with the goal of accepting unintended decisions from patients and physicians. This model helps to improve the quality of decisions by reducing the unacceptable variable that can result from an unintended decision-making by patients and physicians when the evidence is low or very low.^21–23

The error in medicine

When reviewing Prudence as a virtue, we cannot get rid of the Error and adverse events in medicine: errors in the administration of medicines, errors in diagnosis, in the management of infections and in surgical procedures must be considered, as well asany failure that has caused some type of harm to the patient.^24,25 No medical specialty is exempt from it, which is why medicine is considered a science of probabilities, and requires extreme prudence with all medical acts, even more so when Dilemmas arise or the race is starting.

Among all the virtues of the doctor, prudence -phronesis- is the one that helps to apply the general rule to the particular situation, allowing the action to be correct, as well as technical, to be good, thus assuming the nexus between the intellectual and moral virtues.²⁶

The review of Prudence as a virtue has led us to look for it in the classics, to review its teaching at home, school and during the transit through the clinical field, appreciating its insufficiency. The perception of virtues associated with professionalism is evaluated in medical students and prudence is not always included, which is recovered in the professional field. The use of the professional ethical model is recommended to make decisions in cases of clinical uncertainty based on the integrity and candor of the clinician and the virtue of the patient's autonomy. The error and clinical adverse events are reviewed, emphasizing that no specialty is exempt from committing it and that of all the virtues of the doctor, Prudence -phronesis- must accompany us with humanism in all medical acts.

None.

None.

The author declares that there are no conflicts of interest.

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