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Communicating shared value in healthcare: Wisdom from Aristotle's transcendent third

Dr. Peter DePergola ( is Founder and President of V.I.P. Bioethics and Director of Clinical Ethics at Baystate Health in Springfield, MA. He is also Assistant Professor of Medicine at University of Massachusetts Medical School in Worcester, MA; Assistant Professor of Medical Humanities at College of Our Lady of the Elms in Chicopee, MA; and Research Scientist in Neuroethics for the American Academy of Neurology, which is based in Minneapolis, MN.

When clinicians fail to meet the expectations of grieving families, it is rarely due to medical error. Instead, it is often the result of an underdeveloped vision and underappreciated value that both parties share but seldom communicate to one another. Fortunately, modern healthcare need only trace its roots to ancient Greece to retrieve the balm for this astigmatism of goods.

In Books VIII and IX of his Nicomachean Ethics,[1] Aristotle addresses the topic of friendship, dividing it into three forms: (1) utility, (2) pleasure, and (3) pursuit of the good. At the first level, relationships of utility inevitably give rise to mechanical functionality: they are formed without genuine regard for mutuality and, hence, fizzle out when operational expectations go unfulfilled. As such, these relationships are terminated when they cease to be of immediate practical use.[2] At the second level, relationships of pleasure turn on emotions that draw individuals together via the gratifying qualities admired in one other, such as physical beauty or intellectual acumen. Like relationships of utility, however, these relationships similarly disintegrate when hedonic expectations go unmet.[3]

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