Critiques of Casuistry and Why They Are Mistaken

Casuistic methods of reasoning in medical ethics have been criticized by a number of authors. At least five main objections to casuistry have been put forward: (1) it requires a uniformity of views that is not present in contemporary pluralistic society; (2) it cannot achieve consensus on controversial issues; (3) it is unable to examine critically intuitions about cases; (4) it yields different conclusions about cases when alternative paradigms are chosen; and (5) it cannot articulate the grounds of its conclusions. Two main versions of casuistry have been put forward, and the responses to these objections depend in part on which version one is defending. Jonsen has advocated a version modeled on the approach to casuistry used by moral theologians in the 15th and 16th century, involving comparison of the case at hand with a single paradigm and a lineup of cases. The present author has advocated another version, drawn from experience with cases in clinical ethics, which involves comparing the case at hand with two or more paradigms. Four of the five objections are unsuccessful when directed against Jonsen'sapproach, and all of them are unsuccessful when directed against the approach involving comparison with two or more paradigms.     

What really separates casuistry from principlism in biomedical ethics

Since the publication of the first edition of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics there has been much debate about what a proper method in medical ethics should look like. The main rival for Beauchamp and Childress’s account, principlism, has consistently been casuistry, an account that recommends argument by analogy from paradigm cases. Admirably, Beauchamp and Childress have modified their own view in successive editions of Principles of Biomedical Ethics in order to address the concerns proponents of casuistry and others have had about principlism. Given these adjustments to their view, some have claimed that principlism and casuistry no longer count as distinct methods. Even so, many still consider these two conceptions of bioethical methodologies as rivals. Both accounts of the relationship between casuistry and principlism are wrong. These two conceptions of methodology in biomedical ethics are significantly different, but the differences are not the ones pointed out by those who still claim that they are distinct positions. In this article, I explain where the real similarities and differences lie between these two views.     

Casuistry as methodology in clinical ethics

This essay focuses on how casuistry can become a useful technique of practical reasoning for the clinical ethicist or ethics consultant. Casuistry is defined, its relationship to rhetorical reasoning and its interpretation of cases, by employing three terms that, while they are not employed by the classical rhetoricians and casuists, conform, in a general way, to the features of their work. Those terms are (1) morphology, (2) taxonomy, (3) kinetics. The morphology of a case reveals the invariant structure of the particular case whatever its contingent features, and also the invariant forms of argument relevant to any case of the same sort: these invariant features can be called topics. Taxonomy situates the instant case in a series of similar cases, allowing the similarities and differences between an instant case and a paradigm case to dictate the moral judgment about the instant case. This judgment is based, not merely on application of an ethical theory or principle, but upon the way in which circumstances and maxims appear in the morphology of the case itself and in comparison with other cases. Kinetics is an understanding of the way in which one case imparts a kind of moral movement to other cases, that is, different and sometimes unprecedented circumstances may move certain marginal or exceptional cases to the level of paradigm cases. In conclusion, casuistry is the exercise of prudential or practical reasoning in recognition of the relationship between maxims, circumstances and topics, as well as the relationship of paradigms to analogous cases.     

Amenable to reason: Aristotle's rhetoric and the moral psychology of practical ethics.

An Aristotelian conception of practical ethics can be derived from the account of practical reasoning that Aristotle articulates in is Rhetoric and this has important implications for the way we understand the nature and limits of practical ethics. an important feature of this conception of practical ethics is its responsiveness to the complex ways in which agents form and maintain moral commitments, and this has important implications for the debate concerning methods of ethics in applied ethics. In particular, this feature enables us to understand casuistry, narrative, and principlism as mutually supportive modes of moral inquiry, rather than divergent and mutually exclusive methods of ethics. As a result, an Aristotelian conception of practical ethics clears the conceptual common ground upon which practical ethicists can forge a stable and realistic self-understanding.     

Double effect,all over again: The case of Sister Margaret McBride

As media reports have made widely known, in November 2009, the ethics committee of St. Joseph’s Hospital in Phoenix, Arizona, permitted the abortion of an eleven-week-old fetus in order to save the life of its mother. This woman was suffering from acute pulmonary hypertension, which her doctors judged would prove fatal for both her and her previable child. The ethics committee believed abortion to be permitted in this case under the so-called principle of double effect, but Thomas J. Olmsted, the bishop of Phoenix, disagreed with the committee and pronounced its chair, Sister Margaret McBride, excommunicated latae sententiae, “by the very commission of the act.” In this article, I take the much discussed Phoenix case as an occasion to subject the principle of double effect to another round of philosophical scrutiny. In particular, I examine the third condition of the principle in its textbook formulation, namely, that the evil effect in question may not be the means to the good effect. My argument, in brief, is that the textbook formulation of the principle does not withstand philosophical scrutiny. Nevertheless, in the end, I do not claim that we should then “do away” with the principle altogether. Instead, we do well to understand it within the context of casuistry, the tradition of moral reasoning from which it issued.     

Casuistry in medical ethics: Rehabilitated,or repeat offender?

For a number of reasons, casuistry has come into vogue in medical ethics. Despite the frequency with which it is avowed, the application of casuistry to issues in medical ethics has been given virtually no systematic defense in the ethics literature. That may be for good reason, since a close examination reveals that casuistry delivers much less than its advocates suppose, and that it shares some of the same weaknesses as the principle-based methods it would hope to supplant.     

The Problem of Counterfactuals in Substituted Judgement Decision‐Making

The standard by which we apply decision‐making for those unable to do so for themselves is an important practical ethical issue with substantial implications for the treatment and welfare of such individuals. The approach to proxy or surrogate decision‐making based upon substituted judgement is often seen as the ideal standard to aim for but suffers from a need to provide a clear account of how to determine the validity of the proxy's judgements. Proponents have responded to this demand by providing the truth‐conditions for the substituted judgement in terms of counterfactual reasoning using a possible worlds semantics. In this paper, I show how these underpinnings fail to support the substituted judgement approach as a reasonable standard for decision‐making. Firstly, I show how this counterfactual element has been poorly interpreted. I then explain how various accounts have failed to reflect problems and limitations associated with providing an interpretation of their truth‐conditions using counterfactuals. Finally, I argue that, even when we attend to the initial problems of providing a counterfactual analysis, it still deeply problematic as a means of determining the validity of substituted judgements for two main reasons. Firstly, making determinate judgements as to the truth‐value of these judgements will often not be possible and, secondly, there is a strong requirement when interpreting many counterfactual claims to charitably accede to their being true. I conclude that substituted judgements, as interpreted through counterfactual reasoning and possible worlds semantics, do not therefore provide an adequate standard for surrogate decision‐making.     

Humanitarian Intervention, Altruism, and the Limits of Casuistry

This essay argues that the ethics of humanitarian intervention cannot be readily subsumed by the ethics of just war without due attention to matters of political and moral motivation. In the modern era, a just war draws directly from self-benefitting motives in wars of self-defense, or indirectly in wars that enforce international law or promote the global common good. Humanitarian interventions, in contrast, are intuitively admirable insofar as they are other-regarding. That difference poses a challenge to the casuistry of humanitarian intervention because it makes it difficult to reason by analogy from the case of war to the case of humanitarian intervention. The author develops this point in dialogue with Michael Walzer, the U.S. Catholic bishops, and President Clinton. He concludes by showing how a casuistry of intervention is possible, developing a motivational rationale that draws on the Golden Rule.     

Casuistry and its communitarian critics.

Communitarian critics have derided case-based reasoning for ignoring the need to arrive at a shared hierarchy of goods prior to case resolution. They claim that such a failure means that casuistry depends on either a naive metaphysical realism or an ethical conventionalism. Casuistry does embrace a certain unobjectionable moral realism and can require appeals to narrative histories, but despite this dependence on the surrounding culture, casuists possess a way to remain critical of society through the concept of practical wisdom and the use of a moral taxonomy. Therefore, casuistry's viability depends upon the existence and employment of this Aristotelian virtue. Furthermore, the casuistry that emerges is a sophisticated type of communitarianism rather than a free-standing method.     

Where Have All the Proportionalists Gone?

Interest in proportionalism as an important trend in Catholic moral theology seems to have faded in the recent decade. This has led some to view it as a movement that was somehow defeated. I suggest that proportionalism's influence can still be seen in contemporary Catholic ethics, most noticeably in the current interest in virtue ethics, casuistry, and feminist ethics. I argue that proportionalism encouraged a reappraisal of the methodology for evaluating moral action in a direction that was more hospitable to concerns about the particularity and context of the agent.     

Historical explanation,folk psychology,and narrative

Abstract

The aim of this article is to review the recent popularity of casuistry as a model of moral inquiry. I argue that proponents of casuistry do not endorse the particularist epistemology that seems to be implied by their position, and that this is why casuistry does not seem to present something really new in comparison to ‘top-down’ generalist approaches. I contend that casuistry should develop itself as a (moderately) particularist position and that the challenge for the defender of casuistry is to come up with ideas that strengthen the (‘intuitionist’) model of rationality that underlies most forms of particularism.     

Can phronesis save the life of medical ethics?

There has been a growing interest in casuistry since the ground breaking work of Jonsen and Toulmin. Casuistry, in their view, offers the possibility of securing the moral agreement that policy makers desire but which has proved elusive to theory driven approaches to ethics. However, their account of casuistry is dependent upon the exercise of phronesis. As recent discussions of phronesis make clear, this requires attention not only to the particulars of the case, but also to the substantive goods at stake in the case. Without agreement on these goods attention to cases is unlikely to secure the productive consensus that Jonson and Toulmin seek.     

Philosophical methodology and strikes.

...how do we train residents to employ ethical reasoning? This is a good question, not only for the problem of strikes, but also for all medical training. The best method is inductive, since that most closely parallels the clinical reasoning processes that define the reality of medical practice. The strengths of inductive reasoning are that it most closely matches the realities of practice, it arises from the particular circumstances of the case, and it leads to a casuistic conclusion that applies more directly than abstract reasoning models to the problem at hand. The weaknesses, though, require that inductive models include a check and balance.     

Integrating justice and care in animal ethics

In this paper I argue that the standoff between justice and care approaches to animal ethics presents us with a false dilemma. We should take justice's focus on reasoning from principles, and care's use of sympathetic awareness, as two integrated deliberative capacities necessary for the consideration of arguments for extending moral concern to animals. Such an integrated approach rests on a plausible account of the psychology of moral deliberation. I develop my argument as follows. Section I summarizes the nature of the debate between justice and care approaches to animal ethics, focusing on Brian Luke's arguments against justice approaches. Section II provides pro-justice rebuttals to Luke's objections. These rebuttals, while largely successful against Luke's objections, do not account for the intuition that sympathy does play a central epistemological role in animal ethics. Section III explains how sympathy cognitively simulates the perspective of the other, and thus can play an epistemological role in animal ethics. I argue that the abilities to simulate the perspective of the other and to reason from moral principles can complement each other. In section IV, I argue that though it may not be desirable to use both sympathy and reasoning from principles in all moral deliberation, it is a desirable aim when offering, and considering, moral arguments for what I will term the "extensionist project" of extending over moral concern to animals. I make this idea plausible by elucidating the claim that arguments for this project are best thought of as second-order deliberations about our first-order deliberative life.     

Collective Reasoning and the Discursive Dilemma

Abstract

The paper begins with a discussion of Philip Pettit's distinction between individualistic and collectivistic reasoning strategies. I argue that many of his examples, when correctly analysed, do not give rise to what he calls the discursive dilemma. I argue for a collectivistic strategy, which is a holistic premise-driven strategy. I will concentrate on three aspects of collective reasoning, which I call the publicity aspect, the collective acceptance aspect, and the historical constraint aspect: First, the premises of collective reasoning, unlike the premises of a private individual, have to be public in some sense. Second, the group members collectively accept the public premises, and thereby commit themselves to following them in their collective practical reasoning.Third, a person need not be consistent with his earlier private judgements, he is free to change his mind, but prior collective judgements, if not collectively abandoned, constrain the member's future judgements and decisions. I conclude that collective practical reasoning can be accounted for without collectivist ontological commitments.     

Analogical Reasoning in Ethics

In this article I am concerned with analogical reasoning in ethics. There is no doubt that the use of analogy can be a powerful tool in our ethical reasoning. The importance of this mode of reasoning is therefore commonly accepted, but there is considerable debate concerning how its structure should be understood and how it should be assessed, both logically and epistemically. In this paper, I first explain the basic structure of arguments from analogy in ethics. I then discuss the diversity of analogical arguments that can be found in ethics. I analyse their structure, assess them from a logical viewpoint, and show how they can be epistemically challenged and defended. The result of this investigation is that, contrary to a commonly held view, analogical reasoning can be a logically valid type of ethical reasoning that can provide reasons for action that are not worse than the reasons provided by any other kind of practical reasoning.     

Casuistic Reasoning in Expert Narratives on Healthy Eating

Individualisation of healthy eating is a broad tendency in Western culture and is becoming a popular ideal in nutrition science. Public perception of dietary knowledge is central to this individualisation and many experts now aim to present dietary knowledge in a way which relates to individual experience, as well as a casuistic style in which particular cases are discussed in relation to general, universal principles. Analysis of casuistic narrative styles in the public communication about healthy eating by experts makes explicit their flexible use of both particular cases and universal claims, in which clinical and personal cases are narratively employed by the experts to invite readers to personally consider dietary knowledge. Such casuistic narration by experts relates human agency and particular bodies to universal concepts in a way that has generative and critical functions with respect to dietary knowledge and understanding. The public articulation of clinical narratives by experts make salient the intersubjective emergence and accumulation of dietary knowledge between expert reasoning and lay understanding. Personal narratives have an essential role in presenting casuistic reasoning through experts’ personal lives and making their own bodies relevant to public communication about healthy eating. This emphasises the experts’ personal agency in relationship to common norms and general knowledge. Furthermore, both clinical and personal narratives are used by experts in their assessment of the shortcomings in public health messages. Experts’ casuistic narration thus does not merely construct credibility but has epistemic functions in constructing dietary knowledge tangible with respect to actual eating practices.     

Educated intuitions. Automaticity and rationality in moral judgement

Moral judgements are based on automatic processes. Moral judgements are based on reason. In this paper, I argue that both of these claims are true, and show how they can be reconciled. Neither the automaticity of moral judgement nor the post hoc nature of conscious moral reasoning pose a threat to rationalist models of moral cognition. The relation moral reasoning bears to our moral judgements is not primarily mediated by episodes of conscious reasoning, but by the acquisition, formation and maintenance – in short: education – of our moral intuitions.     

Case method and casuistry: The problem of bias

Case methods of reasoning are persuasive, but we need to address problems of bias in order to use them to reach morally justifiable conclusions. A bias is an unwarranted inclination or a special perspective that disposes us to mistaken or one-sided judgments. The potential for bias arises at each stage of a case method of reasoning including in describing, framing, selecting and comparing of cases and paradigms. A problem of bias occurs because to identify the relevant features for such purposes, we must use general views about what is relevant; but some of our general views are biased, both in the sense of being unwarranted inclinations and in the sense that they are one of many viable perspectives. This reliance upon general views to determine relevancy creates additional difficulties for defenders who maintain that case methods of moral reasoning are not only useful, but more basic, reliable or prior to other forms of moral reasoning. If we cannot identify the case's relevant features and issues independently of our general views or biases, we need further explanation about why a case method or casuistry should be viewed as prior to or more basic or reliable than other forms of moral reasoning. Problems of bias also arise for other methods of reasoning. In medical science, case reviews are regarded as an unreliable way to form generalizations, and methods such as clinical trials are used to address bias.