Abstract
My critique of the casuist proposal serves to highlight several points of interest. With its insistence on practical reason as at once more grounded in our moral history and more capable of appreciating the exigencies of moral discourse, Jonsen and Toulmin’s approach strikes me as very productive. It nevertheless has certain unanswered problems, as was suggested, and in the end remains too centered on the ethics consultant’s relation to the physician—both of which are simply taken for granted as having priority as regards the identification and resolution of moral difficulties in clinical situations. (It bears notice at the outset that many of the more than 2,500 consultations I conducted between 1981 and my retirement in 2002, involved serious cross-professional and cross-specialty issues: for instance, how quarrels with obstetrics affected which babies were after birth given over to neonatology for care; or, how care for critically ill patients was differently perceived by nurses and by doctors.) Hardly any attention is paid to those persons whose circumstances are most often at issue—patients and their significant others—and almost none to other clinical participants whose words and actions help to constitute the clinical encounter and clearly help to shape the moral issues embedded in any clinical encounter—nurses, physician consultants, therapists, and many others.
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Notes
- 1.
It bears notice at the outset that many of the more than 2,500 consultations I conducted between 1981 and my retirement in 2002, involved serious cross-professional and cross-specialty issues: for instance, how quarrels with obstetrics affected which babies were after birth given over to neonatology for care; or, how care for critically ill patients was differently perceived by nurses and by doctors.
- 2.
There are, as Husserl and, following him, Gurwitsch demonstrate, parts that cannot be thus separated from other parts: for instance, the color and extension of an object. Gurwitsch was critical of Husserl’s way of attempting to account for this type of difference.
- 3.
As gradually became clear to me, moreover, the ‘language’ most suited for expressing these highly complex and concrete interrelationships is that of narrative.
- 4.
And, to some extent, nurses, consultants, and other health professionals, but especially those nurses who are involved in primary care for patients. This of course varies somewhat from hospital to hospital.
References
Cassell, Eric. 1985. Talking with patients, vol. 1: The theory of doctor-patient communication. Cambridge, MA: The MIT Press.
Coulter, Harrison B. I: 1973. The divided legacy: A history of the schism in medical thought, 3 vols. Washington, DC: Wehawken Book Co.
Dilthey, Wilhelm. 1894/1977. Ideas concerning a descriptive and analytic psychology. In Descriptive Psychology and Historical Understanding, ed Wilhelm Dilthey. Trans. R.M. Zaner and K.H. Heiges. The Hague: Martinus Nijhoff.
Frank, Arthur W. 1995. The wounded storyteller: Body, illness, and ethics. Chicago: University of Chicago Press.
Gorovitz, Samuel, and Alasdair MacIntrye. 1976. Toward a theory of medical fallibility. The Journal of Medicine and Philosophy I(1): 51–71.
Gurwitsch, Aron. 1964. Field of consciousness. Pittsburgh: Duquesne University Press.
Gurwitsch, Aron. 1966. Phenomenology of thematics and of the pure ego: Studies of the relation between gestalt theory and phenomenology. In Studies in phenomenology and psychology, ed. Aron Gurwitsch. Evanston: Northwestern University Press.
Husserl, E. 1928/1969. Formal and Transcendental Logic. Trans. Dorion Cairns. The Hague: Martinus Nijhoff.
Jonsen, Albert, and S.J. Toulmin. 1988. The abuse of casuistry. Berkeley/Los Angeles: University of California Press.
Kierkegaard, S. 1944/1957. The concept of dread. Princeton: Princeton University Press.
Kleinman, Arthur. 1988. The illness experience. New York: Basic Books.
La Puma, John, and S.E. Toulmin. 1992. Ethics consultants and ethics committees. Archives of Internal Medicine 149(5):1109–1112.
Liddle, Grant. 1967. “The mores of clinical investigation.” Presidential address. Journal of Clinical Investigation 46(7): 1028–1030.
Marcel, Gabriel. 1935. Être et avoir. Paris: Fernand Aubier, Êditions Montaigne.
Marcel, Gabriel. 1940. Du Refus à l’invocation. Paris: Librairie Gallimard.
Marcel, Gabriel. 1949. Position et approches concrètes du mystère ontologique. Paris: J. Vrin, Philosophes Contemporains.
Pellegrino, Edmund D. 1979. The anatomy of clinical judgments: Some notes on right reason and right action. In Clinical judgment: A critical appraisal, ed. H.T. Engelhardt Jr. et al., 169–194. Boston: D. Reidel Publishing Co.
Pellegrino, Edmund. 1982. Being ill and being healed. In The humanity of the ill: Phenomenological perspectives, ed. V. Kestenbaum. Knoxville: University of Tennessee Press.
Pellegrino, Edmund D. 1983. The healing relationship: The architectonics of clinical medicine. In The moral fabric of the patient-physician relationship, ed. E.A. Shelp, 153–172. Dordrecht: D. Reidel Publishing Co.
Pellegrino, Edmund D., and David C. Thomasma. 1981. A philosophical basis of medical practice. New York/Oxford: Oxford University Press.
Schutz, Alfred, and Thomas Luckmann. 1973. The Structure of the Life-World, Vol. I. Trans. R.M. Zaner and H.T. Engelhardt, Jr. Evanston: Northwestern University Press.
Thomas, W.I. 1928. The child in America: Behavior problems and programs. New York: Alfred Knopf.
Toulmin, S.J. 1982. How medicine saved the life of ethics. Perspectives in Biology and Medicine 25(4, Summer): 736–750.
Zaner, R.M. 1979. The field-theory of experiential organization: A critical appreciation of Aron Gurwitsch. The British Journal for Phenomenology 10(3): 141–152.
Zaner, R.M. 1981. The context of self. Athens: Ohio University Press.
Zaner, R.M. 1985. How the hell did I get here? Reflections on being a patient. In Caring, curing, coping, ed. A. Bishop and J. Scudder, 80–105. Birmingham: University of Alabama Press.
Zaner, R.M. 1988/2002. Ethics and the clinical encounter. Englewood Cliffs: Prentice-Hall, Inc. Republished by Lima: Academic Renewal Press.
Zaner, R.M. 1992. Parted bodies, departed souls: The body in ancient medicine and anatomy. In The body in medical thought and practice, ed. D. Leder, 101–122. Dordrecht/Boston: Kluwer Academic Publishers.
Zaner, R.M. 1996. Listening or telling? Thoughts on responsibility in clinical ethics consultation. Theoretical Medicine 17(3): 255–277.
Zaner, R.M. 2001. Thinking about medicine. In Handbook of phenomenology and medicine, ed. A. Kay Toombs, 127–144. Dordrecht/Boston/London: Kluwer Academic Publishers.
Zaner, R.M. 2012. At play in the field of possibles: An essay on free-phantasy method and the foundation of self. Bucharest: Zeta Books.
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Zaner, R.M. (2015). Voices and Time. In: A Critical Examination of Ethics in Health Care and Biomedical Research. International Library of Ethics, Law, and the New Medicine, vol 60. Springer, Cham. https://doi.org/10.1007/978-3-319-18332-9_6
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