According to Aristotle, an oncologist treating a patient with metastatic cancer should reason in a prudent manner about the case.   In this context prudence refers to appropriate moral conduct, which Aristotle asserts is a combination of emotions and actions that are not only not excessive and not deficient for the situation, but also are a mean between those extremes.  The fact that, in the given example, the patient and the oncologist disagree about the next step in the management of the patient’s malignancy is a complicating factor that only accentuates the need for prudence (otherwise known as practical wisdom).

How can the oncologist reason the “right” way to feel and act in this difficult scenario? An excellent option for the oncologist is to discuss this complicated situation with a trusted mentor. Of course, such a mentor should be a quintessential master of practical wisdom, epitomizing intelligence and common sense and virtue forged by vast medical and life experience.

What would a prudent mentor advise the oncologist is the correct emotion to feel toward this unfortunate patient? The master would advise the oncologist that compassion is the “right” (or mean) emotion in this case. Compassion is defined as an affective state that one feels in response to deep awareness of the suffering of others coupled with the desire to alleviate the misfortune.

What deeds would a prudent mentor advise the oncologist are the “right” (or mean) actions toward this unfortunate patient?  The master would advise the medical oncologist that, in this situation, appropriate ambition, using Aristotle’s terminology, is the virtuous mean of moral conduct, whereas the unvirtuous extremes of moral conduct are lack of ambition (the vice of deficiency) and over-ambition (the vice of excess).   As Aristotle defined ambition as “fond of honour” and viewed honour as fame, glory, and/or esteem earned via “noble deeds,” the task for the medical oncologist is to determine what actions shall result in the esteem of the patient, the patient’s family, and the other physicians involved in the patient’s care. Fortunately, the answer to this query is simple, for oncologic research has shown that the desired honour is easily obtained if the oncologist ascertains the ends of the patient, reviews with the patient the indications, risks, benefits, and logistics of the various options to achieve the ends, and recommends — based on the oncologist’s experience — the specific course the oncologist thinks is the most likely to result in the accomplishment of the ends. Not exploring the patient’s ends (relieve symptoms only) and/or not informing the patient about the various options to achieve those ends (hospice, palliative systemic therapy, aggressive end-of life care without hospice) would be actions consistent with the vice of lack of ambition. Substituting the oncologist’s ends (prolong life and relieve symptoms) for the patient’s ends and only discussing the option (aggressive palliative systemic therapy) relevant to the oncologist’s ends would be actions consistent with the vice of over-ambition.

In conclusion, to feel and act in a manner consistent with Aristotle’s virtuous means of emotion (compassion) and appropriate ambition (action), a prudent oncologist must be deeply aware of and desire to alleviate a patient’s suffering, determine a patient’s goals, discuss the various options to achieve those goals, and finally recommend the management course the oncologist thinks is the most likely to achieve the goals.