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PubMed1992

Why physicians should not do ethics consults.

Increasing complexities facing physicians negotiating the bedside decision continue to fuel the debate over who is the appropriate party to offer ethics consults, should one be needed, during the decision-making process. Some very good arguments have been put forth on behalf of clinical ethicists as being the proper and best party to engage in ethics consultations. However, serious questions remain about the role of the clinical ethicist and his ability to provide the necessary level of objectivity called for in an ethics consult. I argue that the clinician's professional psyche, or mode of thinking as a professional, leaves him little room to maneuver as an objective and detached third party ethics consultant. Several factors are cited and discussed that greatly influence the analyses applied to a case problem by physicians. The most formidable of these factors are habits and the practice of defensive medicine. I conclude that clinical ethicists are less suited for the overall tasks required of an objective consultant in medical cases that appear to involve insurmountable ethical issues.

Decision Making↗
PubMed1992

Reflections of a reluctant clinical ethicist: ethics consultation and the collapse of critical distance.

The obvious appeal and growing momentum of clinical ethics in academic medical centers should not blind us to a potential danger: the collapse of critical distance. The very integration into the clinical milieu and the processes of clinical decision making, that clinical ethics claims as its greatest success, carries the seeds of a dilution of ethics' critical stance toward medicine and medical education. The purpose of this paper is to suggest how this might occur, and what potential contributions of ethics to medicine might be sacrificed as a result. Medical sociology will be used for comparison. Sociologists have found that they may function either as students and critics of established medical practices and educational philosophies, or as collaborative participants in them--but rarely both. It may be that professional ethics is most effective when it plays the role of 'stranger' rather than insider, and is continually able to question the most basic assumptions and values of the enterprise with which it is associated. As with medical sociology, ethics and humanities must ask to what extent their desire for acceptance in the clinic requires their acceptance of the clinic: specifically, acceptance of basic assumptions about optimal ways of organizing medical education, socializing physicians-in-training, providing care, and even of defining medical ethics itself. The paper concludes by recommending that ethics reassert its 'strangeness' in the medical milieu even as it assumes a more prominent role within the medical center.

Clinical Medicine↗
PubMed1992

Does the philosophy of medicine exist?

There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine. Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the "philosophy of medicine", this is not enough to establish that consensus exists as to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field. In order to constitute a field, an inquiry must be well-integrated with other cognate inquiries and disciplines, have an established canon of key books, textbooks, anthologies and articles, and a set of distinctive and defining problems. The philosophy of medicine as it currently exists fails to satisfy these criteria and, thus, fails to exist as a field of inquiry. The non-existence of the philosophy of medicine is unfortunate. Medicine and philosophy would both benefit from the development of the philosophy of medicine as a field. The philosophy of medicine is an essential foundation for bioethics, it should provide insights into some of the key problems of the philosophy of science such as the nature of explanation and theoretical evolution, and, ought help to shape the goals as well as the methods used in both experimentation and research in medicine and the health sciences.

Bioethics↗
PubMed1992

Philosophy of medicine--from a medical perspective.

In this commentary on the article by Arthur L. Caplan [1] the philosophy of medicine is viewed from a medical perspective. Philosophical studies have a long tradition in medicine, especially during periods of paradigmatic unrest, and they serve the same goal as other medical activities: the prevention and treatment of disease. The medical profession needs the help of professional philosophers in much the same way as it needs the cooperation of basic scientists. Philosophy of medicine may not deserve the status of a philosophical subspecialty or field, but is so closely linked to the main trends of contemporary medical thinking that it must be regarded as an emerging (or reemerging) medical subdiscipline.

Ethics, Medical↗
PubMed1990

Interpretive bioethics: the way of discernment.

This paper critically appraises the applied action-guide approach to bioethics and finds it wanting in two ways: it is tethered to a social contract view of the doctor-patient relationship that is largely incompatible with experiences of illness and care; and, as a formalist doctrine, it lacks critical edge and tends toward accommodationism. An alternative approach is recommended that involves interpreting moral experience by means once associated with the rhetorical arts--practical reasoning, hermeneutics, casuistry, and thick description.

Bioethics↗