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PubMed2004

What must we mean by "community"? A processive account.

The term "community" in ethics and bioethics traditionally has been used to designate either a specific kind of moral relationship available to rational agents or, in contrast, the context in which any sense of rational agency can even be understood. I argue that bioethics is better served when both "selves" and "community" are expressed through a more processive language that highlights the functional character of such concepts. In particular, I see the turn to "processive" community in bioethics as a turn towards method, contextualization, and narrative. In clinical practice, such a processive account demands that bioethics concentrate on methods of developing healthy dialogue and deeper understanding from within the problematic situation rather than trying to "fix" problems using ethical tools developed from outside the present situation. "Community," I argue, is in and of the interactive processes of inquiry itself. Such inquiry, such "communitying," requires that we engage individual patients in context; it demands more than simply gaining their permission or mere consent; it demands developing a supportive environment for participation.

Bioethical Issues↗
PubMed1998

Distanced perspectives: AIDS, anencephaly, and AHP.

US court decisions guaranteeing life-sustaining care to anencephalic infants have been viewed with disfavor, and sometimes disbelief, by some ethicists who do not believe in the necessity of life-sustaining support for those without cognitive abilities or an independently sustainable future. The distance between these two views--one legal and inclusive, the other medical and specific--seems unbridgeable. This paper reports on a program using multicriterion decision making to define and describe persons in a way which both acknowledges the differences perceived by many as well as those commonalities insisted on in U.S. court decisions. It does this through application of the Analytic Hierarchy Process to a hierarchy of "humanness" criteria, and secondarily through reference to that concept's subset, personhood.

Acquired Immunodeficiency Syndrome↗
PubMed2005

"... As we forgive those who trespass against us...": theological reflections on sin and guilt in the hospital environment.

In general parlance the term sin has lost its existential meaning. Originally a Jewish-Christian term within a purely religious context, referring to a wrongdoing with regard to God, sin has slowly become reduced to guilt in the course of the secularization process. Guilt refers to a wrongdoing, especially with regard to fellow human beings. It also refers to errors of judgement with what can be tragic consequences. These errors can occur whenever human beings are called upon to act, including the hospital environment. A Christian hospital has to address the issue of how to deal not only with guilt-ridden misdemeanors, but also with wrongdoing unto God, which overshadows every instance of guilt-ridden human behavior. Here, as in every parish, the Church Service is the place to acknowledge sin, confess sin, and forgive sin, beyond the boundaries of the parish itself.

Bioethical Issues↗
PubMed1996

Caring and justice: a study of two approaches to health care ethics.

This article presents an empirical study of approaches to ethical decision-making among nurses and doctors. It takes as its starting point the distinction between the perspectives of care and of justice in ethical thinking, and the view that nurses' thinking will be aligned with the former and doctors' with the latter. It goes on to argue that the differences in these approaches are best understood in terms of the distinction between partialist and impartialist modes of moral thinking. The study seeks to determine the distribution of these modes of thinking between nurses and doctors, and finds that these are no significant differences between them. A 'two-level' philosophical view of the nature of moral thinking is appealed to in order to explain the study findings.

Adult↗
PubMed1998

The utility of futility: the construction of bioethical problems.

The aim of this article is to analyse the contemporary 'futility discourse' from a constructivist perspective. I will argue that bioethics discourse typically disregards the context from which controversies emerge and the processes that inform and constrain such discourse. Constructivists have argued that scientific knowledge is expressive of the dominant paradigm within which a scientific community is working. I will outline an analysis of 'medical futility' as a construction of biomedical and bioethical communities (and their respective paradigms). I will trace the emergence and utilization of futility in the literature. My analysis of the context (i.e. the historical circumstances, the particular actors involved) within which the futility discourse emerged suggests that medical futility was constructed, in part, as a means of enhancing physician domination of a context wherein medical authority was threatened. The actors in this debate express widely divergent frameworks of 'the good', arguing from distinctive representations of moral agency. At times, this controversy has been argued from incommensurate moral horizons wherein the discussants debate incomparable problems. This discussion is related to a study of the 'practice' of futility in the clinical context. Further studies on the construction of bioethical problems are a necessary condition for supporting the truth claims of bioethical arguments.

Adult↗
PubMed2003

What the clinician taught the ethicist: clinical contributions to ethical concerns.

BACKGROUND: Clinical ethics is often assumed to be a one-way relationship in which ethicists consider the appropriate guidelines for clinical practice and research. This unfortunately ignores the important ways clinical practice informs bioethical thinking. MATERIAL/METHODS: This paper considers the relation between clinical and ethical practice through a consideration of whether there are conditions in which Physician Assisted Suicide, or other forms of euthanasia, serve as an ethically accepted response to chronic illness. At one scale it reviews publicly available data on deaths attributed to euthanasia practitioner Jack Kevorkian to consider the medical rationale of those deaths. At another scale, the 'mercy killing' by Canadian farmer Robert Latimer of his daughter is employed as a case study of surrogate decision making. RESULTS: A clinical review of the more than seventy cases attributed to Jack Kevorkian from 1990-98 reveals a client base that did not fit publicly or clinically accepted parameters within which euthanasia is generally understood. Few if any of the patients were near the end stage of a chronic progressive disease. Most were able to travel independently. Palliative care was in some cases problematic. The case of Latimer emphasizes the importance of social as well as medical care in cases of chronic illness, and the importance of palliative care as an alternative to CONCLUSIONS: Clinical ethics is of necessity a two-way street, one in which ethical paradigms influence practitioners and researchers whose expertise, in turn, necessarily educates the non-clinical ethicist.

Bioethical Issues↗