The uncertainty of certainty in clinical ethics

  • Erich H. Loewy

Abstract

Physicians accept fallibility in technical matters as a condition of medical practice. When it comes to moral considerations, physicians are often loathe to act without a good deal more certitude and seem less willing to accept error. This article argues that ethics is intrinsic to medical decision making, that error is the inevitable risk of any action and that inaction (clearly action by default) carries even greater risk of error. Whether in the moral or the technical sphere, error must be accepted by physicians as part of the learning process which informs and enriches future decisions. Moral virtue, it is concluded, resides more in the making of a decision and in the agony of making it than it does in the potentially fallible decision itself.

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References notes

  1. 1.
    Dewey, J.Logic, the Theory of Inquiry. New York, Henry Holt, 1938.Google Scholar
  2. 2.
    Benbassat, J. & Schiffman, A. “An Approach to Teaching the Introduction to Clinical Medicine.”Ann. Int. Med, 84: 477–481; 1976.PubMedGoogle Scholar
  3. 3.
    Kassirer, J.P. & Gorry, G.A. “Clinical Problem Solving: A Behavioral Analysis.”Ann. Int. Med., 89: 245–255, 1978.PubMedGoogle Scholar
  4. 4.
    Kassirer, J.P. “Sounding Board: Teaching Clinical Medicine in Iterative Hypothesis Testing.” NEJM, 309(15): 921–923, 1983.PubMedGoogle Scholar
  5. 5.
    Elstein, A.S., Shulman, L.S., Sprofka, S.A.Medical Problem Solving: An Analysis of Clinical Reasoning. Cambridge, MA: Harvard University Press, 1978.Google Scholar
  6. 6.
    Gorovitz, S.A., Macintyre, A. “Towards a Theory of Medical Fallibility.”J. Med. & Phil., 1(1): 51–71, 1976.Google Scholar
  7. 7.
    Fox, R.C. “The Evolution of Medical Uncertainty.”Millbank Memorial Fund Quarterly, 58(1): 1–49, 1980.Google Scholar
  8. 8.
    Pellegrino, E.D. “Toward a Reconstruction of Medical Morality: The Act of Profession and the Fact of Illness.”J. Med. & Phil., 4(1): 32–55, 1979.Google Scholar
  9. 9.
    Loewy, E.H. “Teaching Ethics to Medical Students During the Internal Medicine Clerkship.”J. Med. Educ. (In Publication, 1986).Google Scholar
  10. 10.
    Churchill, L.R. “Bioethical Reductionism and Our Sense of the Human.”Man & Med., 5(4): 229–249, 1980.Google Scholar
  11. 11.
    Levy, D. “Prognosis in Non-Traumatic Coma.”Ann. Int. Med., 94: 293–301, 1981.PubMedGoogle Scholar
  12. 12.
    Higashi, K. et al. “Five Year Follow-Up Study of Patients with Persistent Vegetative State.”J. Neuro. Neurosurg. & Psych, 44: 552–554, 1981.Google Scholar
  13. 13.
    Rosenberg, G.A., Johnson, S.F., Brenner, R.P. “Recovery of Cognition After Prolonged Vegetative State.”Ann. Neuro, 2: 167–168, 1977.Google Scholar
  14. 14.
    Wouk, H.The Caine Mutiny. New York: Mentor Books, 1975.Google Scholar
  15. 15.
    Loewy, E.H. “Physicians and Patients: Moral Agency in a Pluralist World.”Journal of Medical Humanities & Bioethics, Vol. 7, No. 1, Spring/Summer 1986.Google Scholar

Copyright information

© Human Sciences Press 1987

Authors and Affiliations

  • Erich H. Loewy
    • 1
  1. 1.University of Illinois College of Medicine at PeoriaUSA

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