Where the Ethical Action Is

Kennedy Institute of Ethics journal, 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.

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.

This article aims to trace back some of the theoretical foundations of medical ethics that stem from the philosophies of Aristotle, Immanuel Kant, John Stuart Mill and John Rawls. The four philosophers had in mind rational and autonomous human beings who are able to decide their destiny, who pave for themselves the path for their own happiness. It is argued that their philosophies have influenced the field of medical ethics as they crafted some very important principles of the field. I discuss the concept of autonomy according to Kant and JS Mill, Kant's concepts of dignity, benevolence and beneficence, Mill's Harm Principle (nonmaleficence), the concept of justice according to Aristotle, Mill and Rawls, and Aristotle's concept of responsibility.

Journal of Medical Ethics, 1999

A number of recent publications by the philosopher David Seedhouse are discussed. Although medicine is an eminently ethical enterprise, the technical and ethical aspects of health care practices can be distinguished, therefore justifying the existence of medical ethics and its teaching as a specific part of every medical curriculum. The goal of teaching medical ethics is to make health care practitioners aware of the essential ethical aspects of their work. Furthermore, the contention that rational bioethics is a fruitless enterprise because it analyses non-rational social events seems neither theoretically tenable nor to be borne out by actual practice. Medical ethics in particular and bioethics in general, constitute afield of expertise that must make itself understandable and convincing to relevant audiences in health care. (7ournal of Medical Ethics 1999;25:340-343)

Medical Education, 1991

Virtue ethical approaches are commonly concerned with the subject becoming virtuous. This requires time and continuous practice. It involves habituation. In this regard, the development of virtues shares features with the development of practical skills. In both cases, we learn by doing. Despite the fact that the learning of practical skills is an interest for phenomenologists such as Maurice Merleau-Ponty (2006), surprisingly little dialogue has taken place between virtue ethics and phenomenological traditions. Such a dialogue arises in this text. A phenomenological analysis can deepen our understanding of how the practical know-how of virtues can feed into the subject ’ s embodied existence and perception. It can throw new light on the debated phenomenon of moral perception. And it can matter for medical ethics education. A few previous studies have elaborated a phenomenology of virtue that examines what it is like to be a virtuous person (Annas 2008) or out lined a phenomenology of skill-acquisition where acting ethically is seen as a skill (Dreyfus and Dreyfus 2004). Such studies have contributed with insights as regards the role of moral know-how in moral development. They have not, however, examined bodily dimension of learning to act ethically and becoming virtuous, in any detail. The chapter examines, phenomenologically, the role of the body when becoming virtuous and what incorporation of virtues-as-skills would mean for perception. This can further explain the phenomenon of moral perception, contribute to the discussion of alternative approaches to medical ethics and particularly so to the discussion of ethical competence and the learning of ethics in medical education.

Journal of Medical Ethics, 1991

2012

A code of ethics is used by individuals to justify their actions within an environment. Medical professionals require a keen understanding of specific ethical codes due to the potential consequences of their actions. Over the past thirty years there has been an increase in the scope and depth of ethics instruction in the medical profession; however the teaching of these codes is still highly variable. This inconsistency in implementation is problematic both for the medical practitioner and for the patient; without standardized training, neither party can be assured of the practitioner's overall depth of knowledge. Within the field of ethics certain principles have reached a consensus of importance. Incorporation of these concepts in meaningful ways via a consistent curriculum would provide students with an appropriate skill set for navigating their ethical environment. Moreover, this curriculum should also be extended to residents and professionals who may have missed formal ethical training. This would provide a consistent framework of knowledge for practitioners, creating a basis for clear judgment of complex issues.

Perspectives in Biology and Medicine, 2005

For over a century, medicine has prided itself on its scientific orientation and technological accomplishments. But a conceptual crack lies at the foundation of contemporary medicine, one that may be characterized as a conflict between medicine's scientific epistemology and its moral philosophy. Moral refers to value, and more specifically in the clinical setting, to how facts must be ordered by the values attached to them. A "moral epistemology" seeks to bring these two domains into closer proximity. Clinical facts always reside in a complex array of systems that confer specific and often unique meanings to any finding. An integration of unsteady norms and the intuitive inference arising from the individuality of disease expression require that judgments order facts into their proper placement. And beyond this relaxed view of objectivity, clinical care must also incorporate judgments arising from the patient's (as well as the physician's) social and psychological realms that are removed from scientific concerns.Together, these various kinds of value judgments erect the scaffold of clinical care, in which a more complex moral epistemology emerges. A comprehensive biopsychosocial model of illness and its treatment articulates this integrated orientation, but until medicine embraces a philosophy that legitimates the full integration of facts and values, the appeal of such an approach will remain limited and its application ineffective. "F ACTS" ARE ALWAYS PROCESSED-interpreted, placed into some overarching context-whether a scientific theory or an ill person. Inextricable from context, facts must assume their meaning from a universe of other valued facts. In a sense, value is the glue that holds our world together, for knowledge is inexorably valued; it is both useless and irrelevant divorced from the reality