Toward a naturalized clinical ethics (original) (raw)
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Towards a naturalized clinical bioethics
Kennedy Institute of Ethics Journal Vol. 22, No. 4, 289–306 , 2012
Clinical ethicists tend to see themselves as moral experts to be called in when clinicians encounter a particularly difficult moral problem. Drawing on a naturalized moral epistemology, we argue that clinicians already have the moral knowledge they need—the norms and values that guide clinical practice are built right into the various health care professions. To reflect on their practice, clinicians need to (a) be aware of their own professional norms and values; (b) be able to express them to their colleagues, their patients, and the patients’ families; and (c) work together with these other actors to provide ethically responsible care. The ethicist’s job is to use her own training in three kinds of philosophical reflection as the basis for teaching clinicians how to think about what they do.
Bridging the Tower: Theory, Practice, and the Need for Conversation in Medical Ethics
Fields such as medical ethics have long suffered from a disconnect between theory and application. “Real-world” practitioners understand the day-to-day realities that inspire and inhibit their actions, and “ivory tower” scholars sometimes fall into the trap of presuming that non-scholars cannot understand theory or, worse yet, that ethical theory need not be informed by practical experience. There are plenty of applied ethicists across disciplines bridging this divide, yet problems persist amongst faculty who underestimate the interest and capacity of medical and nursing students, and even amongst academic administrators who presume ethics is too obscure a topic to warrant seminar-style discussion. For many nurses, philosophy is intimidating. Yet with each new semester I find that most of my nursing students need not have worried about how they might grasp what are foreign-sounding terms like deontology, teleology, and utilitarianism. They already understand the concepts and have employed them in their lives — usually both personally and professionally. I have also found that most nurses could themselves populate a textbook with true-life examples demonstrating every such concept I challenge them to consider. Like most philosophers, I bring a blend of critical analysis, theory, and logical consistency to the courses I teach. My goal is to expose medical professionals to the processes that guide their decision-making, to the historical context of patient autonomy, and to potential dilemmas that await them in their careers as they strive for professional excellence. It is not enough to memorize cases, dates, theorists, and terminology. For the experience to truly be transformative – to successfully equip and empower students to reflect on the implications of their actions on patients, colleagues, and the profession in general – the union of theory and practice is essential. The process is most effective when students are encouraged to share and reflect on their experiences in the context of improving their moral decision-making. With such input, those scholars tweaking the theoretical approaches to today’s problems can better grasp the feasibility of their theories. The theories can evolve and as originally hoped, influence behavior, when given the opportunity to be taken seriously in the lives of the moral agents. The field of bioethics and philosophy in particular could benefit from listening to the professionals who are living ethical dilemmas every day. This paper will provide a series of brief excerpts from student stories demonstrating the relevancy of moral theory as typically applied to issues in health care. It is an example of an on-going conversation amongst disciplines that we must engage in at the academic level in order to truly appreciate and fulfill the promise of humanity in medicine.
Ethicians, ethicists and the goals of clinical ethics consultation
Internal and emergency medicine, 2006
We believe that clinical ethics consultation (CEC) has as its goal the delivery of healthcare in a manner consistent with the moral rules and the moral ideals. Towards this end, CEC pursues the instrumental ends of clarifying the limits of acceptable ethical disagreement and facilitating a choice among ethically acceptable alternatives. In pursuing these ends, healthcare ethics consultation (HEC) and CEC services confront three broad categories of questions: (1) questions of professional duty; (2) questions of law; and (3) questions of general morality. Professional duty questions concern what has been referred to as the "internal morality of medicine", and include questions such as the medical legitimacy of the goal(s) being pursued, or the acceptability of the means being employed. Questions of law concern themselves with what the law requires, permits or prohibits. Questions of general morality include all those not falling within the scope of the above categories. We s...
Chapitre 1. Clinical Ethics as Practice
Journal International de Bioéthique, 2009
This paper discusses the importance of the practical turn represented by the development of clinical ethics for the field of bioethics. It discusses, first, the distinctive way that clinical ethics exhibits the practical turn in ethics. Second, it argues that primary purpose of clinical ethicists is to devise actionable approaches or “solutions” to ethical questions and issues arising in the course of patient care in addressing ethical conflicts, dilemmas, issues, and questions about cultural, personal, religious, and societal values. And, third, the paper explores the concerns about the qualifications of those who provide clinical ethics services, because the work of clinical ethics is done not only by academically trained bioethicists, but also by a broad range of health professionals on ethics consultation services and hospital ethics committees.
Moral Theory and Theorizing in Healthcare Ethics
Ethical Theory and Moral Practice
Written nearly a quarter of a century apart, the musings of Stephen Toulmin and Glenn McGee might be seen as scholarly bookends. Back in 1982, Toulmin (1982) penned a widely cited article “How medicine saved the life of ethics”. The success or otherwise of medical ethics led McGee (2006), another leading American scholar, to write an Editorial in 2006 asking “Will bioethics take the life of philosophy?”.The papers collated for this special issue seek to address an aspect of the problematic issues Toulmin and McGee raise. They stem from the first workshop in a series of three, held in Swansea (UK), of a Research Network on “The Role of Moral Theory in Health Care Ethics”, funded by the Arts and Humanities Research Council, UK. The initial stimulus for the research project was caused mainly by several concerns regarding the current state of applied ethics in general, and health care ethicsHealth care ethics is the name given to the broader field of which medical ethics is a part. It is t ...
Medicine and the Call for a Moral Epistemology, Part II: Constructing a Synthesis of Values
Perspectives in Biology and Medicine, 2008
The demands and needs of an individual patient require diverse value judgments to interpret and apply clinical data. Indeed, objective assessment takes on particular meaning in the context of the social and existential status of the patient, and thereby a complex calculus of values determines therapeutic goals. I have previously formulated how this moral thread of care becomes woven into the epistemological project as a "moral epistemology." Having argued its ethical justification elsewhere, I offer another perspective here: clinical choices employ diverse values directed at an array of goals, some of which are derived from a universal clinical science and others from the particular physiological, psychological, and social needs of the patient. Integrating these diverse elements that determine clinical care requires a complex synthesis of facts and judgments from several domains. This constructivist process relies on clinical facts, as well as on personal judgments and subjective assessments in an ongoing negotiation between patient and doctor. A philosophy of medicine must account for the conceptual basis of this process by identifying and addressing the judgments that govern the complex synthesis of these various elements.
Moral Expertise in the Clinic: Lessons Learned from Science and Medicine
possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this paper we discuss how similar concerns have recently threatened to undermine expertise in medicine and science. In contrast we argue that the application of values is needed to exercise medical, scientific and moral expertise. As long as these values are made explicit worries about a pretense to authority in the context of a liberal democracy are ill-conceived. In conclusion we argue for an expertise that is epistemically diverse.
Medical education, 2009
Objectives In order to teach medical students to engage more fully with patients, we offer ethics education as a tool to assist in the management of patient health issues.Methods We propose that many dilemmas in clinical medicine would benefit by having the doctor embark on an iterative reasoning process with the patient. Such a process acknowledges and engages the patient as a moral agent. We recommend employing Kant’s ethic of respect and a more inclusive definition of patient autonomy drawn from philosophy and clinical medicine, rather than simply presenting dichotomous choices to patients, which represents a common, but often suboptimal, means of approaching both medical and moral concerns.Discussion We describe how more nuanced teaching about the ethics of the doctor–patient relationship might fit into the medical curriculum and offer practical suggestions for implementing a more respectful, morally engaged relationship with patients that should assist them to achieve meaningful health goals.