ABSTRACT
The educated public as well as the physician need a grasp of what medical knowledge may be, together with the norms and mechanisms that should guide its humane and wise use. The peculiar epistemological difficulties in using the general laws of medical scientific knowledge to make particular clinical decisions are well formulated by Alasdair MacIntyre and Samuel Gorowitz in their analysis of the inherent fallibility of medicine. To be good, a medical decision should be in the "best interest" of the patient. That interest is not limited to bodily integrity, survival, or even cure of life-threatening illness. The end toward which medical decision tends is as much an exercise in moral judgment as in scientific. Medical knowledge is a composite of whatever knowledge is needed to arrive at a right and good healing action and of executing that action with perfection. Optimal use of medical knowledge in the clinical setting rests therefore on optimization, not only scientifically but morally.
