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PubMed1993

A qualified bioethic: particularity in James Gustafson and Stanley Hauerwas.

Most theoretical approaches in bioethics begin with a theory that articulates and defends basic principles or rules that are more or less systematically related and that seek to yield more or less precise conclusions with regard to specific acts, cases, or policies. Concerns about the agent and descriptions of the context of action stand on the margins of the theory. This is ironic, given the overwhelming importance and impact the training of health care professionals has upon them and upon the practice of health care as a whole, and given the fact that many advocates of the theories themselves concede that one's beliefs and how one describes a situation and weighs "facts" and values relevant to the case strongly determine one's conclusions. While morality may not lead ineluctably to religion, as Kant believed, bioethics does appear inevitably to involve particularity. I examine the work of James M. Gustafson and Stanley Hauerwas to analyze two views of the role of particularity in bioethics. I then show the relevance of their work for addressing some problems with the practicality and concreteness of current models in bioethics.

Bioethics↗
PubMed1993

An Eastern Orthodox approach to bioethics.

This article seeks to identify some of the major perspectives in Eastern Orthodox Christianity which provide direction for bioethical-decision making. The article first identifies some historical, theological, and liturgical sources in the Eastern Orthodox tradition which have implications for bioethics. The manuscript also seeks to address the question of the place of religious bioethics within public discussion of issues in bioethics and health care policy.

Bioethics↗
PubMed1993

Talking ethics with strangers: a view from Jewish tradition.

The work of H. Tristram Engelhardt provides an important set of reflections for bioethics in a secular context. Taking Engelhardt's work as its point of departure this article explores the challenges that Jewish ethicists face in contributing to bioethics in a secular context. The article explores how the Jewish tradition can address issues in bioethics in ways that are true to its tradition and at the same time accessible and relevant to "moral strangers" in a secular society.

Abortion, Legal↗
PubMed1994

Observations on the epistemological status of bioethics.

Different definitions of bioethics in American and Italian literature are reported. It is argued that they refer to three different conceptions of the epistemological status of bioethics: the first conceives of it as an application of moral principles to biomedical problems, the second as a methodology for the working out of clinical judgement, the third as a broader and interdisciplinary public inquiry. It is suggested that each approach grasps a part of the truth, for each singles out one level of the bioethical work. Bioethics is in fact a complex, three-level form of knowledge. The misunderstanding of this complexity has led to some confusion and to conflicts of attribution among those who are concerned with it.

Beneficence↗
PubMed1995

Virtue and truth in clinical science.

Since the time of Hippocrates, medical science sought to develop a practice based on "knowledge rather than opinion". However, in the light of recent alternative approaches to healing and a philosophy of science that, through thinkers like Kuhn, Rorty, and Foucault, is critical of claims to objective truth, we must reappraise the way in which medical interventions can be based on proven pathophysiological knowledge rather than opinion. Developing insights in Foucault, Lacan, and Wittgenstein, this essay argues for a recovery of the Aristotelian idea of a techne, where there is a dynamic interplay between praxis and conceptualization. The result is a post-Kuhnian epistemology for medical science that recognizes the evaluative dimension of knowledge, but that also looks to a Platonic conception of the good as the ultimate constraint on human thought, thus avoiding the radically self-contained accounts of truth found in some post-modern thinkers.

Biomedical Research↗
PubMed1995

Breast cancer genetic screening and critical bioethics' gaze.

This paper illustrates a role that bioethics should play in developing and criticizing protocols for breast cancer genetic screening. It demonstrates how a critical bioethics, using approaches and reflecting concerns of contemporary philosophy of science and science studies, may critically interrogate the normative and conceptual schemes within which ethical considerations about such screening protocols are framed. By exploring various factors that influence the development of such protocols, including politics, cultural norms, and conceptions of disease, this paper and the critical bioethics' approach it endorses illuminate and critically assess some of the competing worldviews informing protocol development. One of the frequently neglected worldviews in traditional bioethics' treatment of protocols concerning breast care is constituted by women's own views of their breasts and breast cancer, both within the technologically-oriented social practice of American medicine and in light of the social construction of their breasted experience in American society. This paper attempts to redress and critically assess this neglect on the part of traditional bioethics. Finally, in contrast to traditional bioethics, critical bioethics critically interrogates its own normative and conceptual commitments. In this final capacity, a critical bioethics' approach makes a valuable contribution to the evolution of bioethics.

Biomedical Research↗
PubMed1996

Literature and medical ethics.

The essays in this Journal issue offer examples of how textual analysis, literary theory, and the reading and writing of literature can contribute to an understanding of ethical issues in medicine. The editors' purpose in such an issue is to stimulate discussion between philosopher-ethicists and literary scholars whose work concerns this topic. With the concluding essays by editors Clouser and Hawkins, this discussion begins.

Ethics↗
PubMed1996

Literature and ethical medicine: five cases from common practice.

This essay is composed of five stories written by practicing physicians about their patients. Each clinical story describes a challenging ethical condition-potential abuse of medical power, gravely ill and probably over-treated newborns, iatrogenic narcotic addiction, deceived dying people. Rather than singling out one ethical conflict to resolve or adjudicate, the authors attempt, through literary methods, to grasp the singular experiences of their patients and to act according to the deep structures of their patients' lives. Examining these five stories with simple literary tools-attention to narrative frames, time, plot, and desire-reveals the mechanisms through which acts of writing and reading contribute to clinical clarity and ethical actions.

Adult↗
PubMed1996

Darren's case: narrative ethics in Perri Klass's Other Women's Children.

During the past fifteen years, the relationship between literature and medical ethics has evolved from the occasional use of stories as a substitute for the traditional case study in medical ethics to the emergence of a narrative approach to ethical analysis and decision making. Thus far, literary theory has been more important to narrative medical ethics than have works of literature themselves. Perri Klass's novel Other Women's Children deserves special scrutiny, however, because an analysis of it demonstrates ways that a narrative approach could enhance traditional philosophical and legal approaches to resolving ethical dilemmas in medicine.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Dax redacted: the economies of truth in bioethics.

Most ethicists have paid little attention to the rhetorical features of case presentations. In order to examine the constructed nature of bioethics cases, this paper examines the literary characteristics of four presentations of Donald "Dax" Cowart's story. By comparing tellings of the same case, a pattern of redaction is revealed by which the tellers conceal the very features that would challenge the perspectives taken in their arguments. In conclusion, the issue of the applied nature of bioethics is examined.

Adult↗
PubMed1996

Narrative, literature, and the clinical exercise of practical reason.

Although science supplies medicine's "gold standard," knowledge exercised in the care of patients is, like moral knowing, a matter of narrative, practical reason. Physicians draw on case narrative to store experience and to apply and qualify the general rules of medical science. Literature aids in this activity by stimulating moral imagination and by requiring its readers to engage in the retrospective construction of a situated, subjective account of events. Narrative truths are provisional, uncertain, derived from narrators whose standpoints are always situated, particular, and uncertain, but open to comparison and reinterpretation. Reading is thus a model for knowing in both morality and clinical medicine. While principles remain essential to bioethics and science must always inform good clinical practice, the tendency to collapse morality into principles and medicine into science impoverishes both practices. Moral knowing is not separable from clinical judgment. While ethics must be open to discussion and interpretation by patients, families, and society, it is nevertheless substantively and epistemologically an inextricable part of a physician's clinical practice.

Ethics↗
PubMed1996

Philosophy, literature, and ethics: let the engagement begin.

The goal is to isolate points of philosophical interest in the preceding articles on narrative medical ethics in order to focus subsequent dialogue between the two disciplines. Ethics is an enterprise that has over the centuries developed a somewhat malleable structure, comprising characteristics, methods, lines of reasoning, rules, principles, assumptions, and arguments. This structure provides the framework within which many disciplines contribute to ethics through the exercise of their particular interests, skills, and methods. Challenging or changing the structural components requires arguments of a traditional sort appropriate to the discipline of ethics. Three tenets are proposed as comprising the "received view" or credo of the literature and ethics movement. Each is examined. Then the individual articles in this issue are explored to the end of ferreting out points that would be fruitful points of discussion between philosophy and literature folks pursuing their mutual interest in ethics.

Ethical Analysis↗
PubMed1996

Literature, philosophy, and medical ethics: let the dialogue go on.

This is a reply to Dan Clouser's philosophical commentary on the essays in this issue. Important assumptions that condition his perspective on the essays are identified and analyzed. Attention is drawn to his unhistorical emphasis on the exclusive importance of philosophy in ethical thought, and his resulting insistence that any discipline wishing to contribute to biomedical discourse must adopt the assumptions and methodologies of philosophy. Clouser's "three tenets" are examined, and then the question of what literature, considered in terms of its own aims and methodologies, has to offer to medical ethics. Genuine dialogue about medical ethics between philosophers and literary scholars is both desirable and important, but becomes possible only if the methods and insights of each discipline are honored in the pursuit of the overall goals they hold in common.

Ethical Analysis↗
PubMed1982

Three models of group choice.

The notion of group responsibility has received some vary fruitful examination in recent years. But there still remains an important commonsense objection to this notion. Moral responsibility for an action is ordinarily linked to and held to depend upon the action's being the product of an act of choice on the part of the agent. The thrust of the objection here is that it is extremely difficult to understand how intentional acts like acts of choice can be properly attributed to a group. The notion of a group "consciousness" does not seem a very satisfactory resolution of this problem. In this paper I shall propose that there are actually three distinct processes, as well as many hybrid combinations of them there, by which groups "make choices." That is, when we look at the activities of groups, we discover three different kinds of analogues to the act of choice of the individual person. I shall be illustrating each of these models with examples of health care decisions. In addition, I shall also try to illustrate how the level of personal moral responsibility of each of the individuals making up the group, i.e., each one's responsibility for the group's action, can be seen to flow from the particular role that an individual plays within the process of "group choice" that is involved. In this way, I hope to shed light not only on the topics of group choice, group responsibility, and the interplay of personal and group responsibility, but also to show concretely the valuable role that these themes can play in our understanding of the moral elements of the health care setting.

Choice Behavior↗
PubMed1982

Interdisciplinary bioethics: but where do we start? A reflection of epochè as method.

It is generally accepted that bioethics is an interdisciplinary science. Why this is so and what it means is not always clear or agreed upon and, in this author's view, its implications are insufficiently researched. On the basis of involvement in projects which were labelled interdisciplinary, the author reflects upon the method of interdisciplinarity, especially to its starting point. It is suggested that interdisciplinarity cannot thrive unless it curbs, from the very start, the inevitable reductions of all monodisciplinary approaches. This effort is called methodical epoché, ideally the temporary suspension of all known methods. Its purpose is to achieve an interdisciplinary way of stating the question. Until then no breakdown of the global question by particular methods of single disciplines ought to be attempted. Realistic variations of this ideal are also discussed.

Bioethics↗
PubMed1983

Experimentalism in bioethics research.

Basson's commentary on my proposals regarding the structure and function of research in bioethics provides a welcome opportunity for extended comparison of standard approaches with the suggestions made in 'What Bioethics Should Be.' I begin by noting a common assumption underlying our respective views. I then address points of fundamental difference, indicating why the experimental method proposed in my original essay presents a potentially more productive strategy for examining moral issues in biomedicine. In the latter respect, I certainly disagree with Basson's contention that "we are unable to test" metaethical hypotheses "against reality" (Basson, p. 185) - a proposition which seems no more defensible than the equally untenable claim that we cannot refine methods of natural science research through examination of their usefulness in advancing our understanding of the correlation of events in nature.

Bioethics↗