Clinical pragmatism: bridging theory and practice

This response to Lynn Jansen's critique of clinical pragmatism concentrates on two themes: (1) contrasting approaches to moral epistemology and (2) the connection between theory and practice in clinical ethics. Particular attention is paid to the status of principles and the role of consensus, with some closing speculations on how Dewey might view the current state of bioethics.     

A Moral Framework for Multicultural Education in Healthcare

The goal of this paper is two-fold. First, I begin by reviewing several of themajor points of emphasis among health educatorsas they begin to incorporate multiculturalissues into healthcare education. I thenconsider the role of moral relativism, which iscurrently being endorsed by some healtheducators, as the foundation for resolvingcross-cultural conflicts in healthcare. Iargue that moral relativism is ultimatelyinconsistent with the stated goals inmulticultural curricular proposals and fails toprovide an effective framework for consideringmoral conflicts in cross-cultural settings. Instead, I propose that those methods seekingto establish a common morality, built uponmutually shared values, offer the mostpromising means of resolving cross-culturalconflicts. This leads to my second goal, tocompare recent work in moral pragmatism withwhat is now widely known in bioethics as moral``principlism.' I argue that while proponentsof principlism and pragmatism each seek toestablish a common foundation for moraldeliberation, they fail to appreciatesignificant similarities between theirrespective approaches. Instead of offeringtwo completely unique and independent methodsof moral deliberation, I suggest thatprinciplism and pragmatism embrace commonthemes that point us in a positive direction,providing an effective framework useful forconsidering cross-cultural conflicts inhealthcare.     

Pragmatism as a research program--a reply to Arras

This paper is a reaction to an article by John Arras published earlier in this journal. In this article Arras argues that freestanding pragmatism has little new to offer to bioethics. We respond to some of Arras' arguments and conclude that, although he overstates his case at certain points, his critique is, broadly speaking, correct. We then introduce and discuss an alternative approach to pragmatist ethics, one which puts to work the ideas and insights of pragmatism conceived as a broad philosophical movement, without lapsing into a canon dependent approach. The approach we propose exhibits a number of characteristics that differ from Arras'saccount of freestanding pragmatism and offers something new to bioethics.     

German Readers of Dewey – Before 1933 and After 1945

Few pedagogical theories and practices have met with such strongreactive ambivalence in Germany as Dewey's. As it contained theideas of democracy and pragmatism it clashed with the monarchial andidealistic patterns of school-practice and pedagogic theory right fromthe beginning. On the other hand, reformists of all kinds wereoverwhelmed with enthusiasm. But even in the democratic phases of political development this ambivalence continued. The traditionof setting metaphysical and religious backgrounds stood in the way of a free examination of Dewey. Therefore, the reception has, upuntil now, been signed by mistakes and misinterpretations, but also by a minority of fruitful debates.     

Pragmatism,bioethics and the grand American social experiment

There is tension in bioethics between two strains of pragmatism. The most prominent strain, following John Dewey, proposes a content-rich ethos of controlled, collective moral inquiry. A second strain, descending from Charles Peirce and Josiah Royce, favors an open-ended approach where diverging moral communities evolve without extensive inter-communal oversight. This essay defends the second strain. The Deweyan approach, I argue, exhibits a problematic quasi-foundationalist character insofar as it canonizes a dubious constellation of "liberal" political values and seeks to establish these values by interposing a consensus of moral experts where genuine inter-communal dialogue, and compromise, would be more fruitful. I hold that the alternative approach of Peirce and Royce is preferable, and truer to the fundamental commitments of classical American pragmatism. Recognizing the epistemic fallibility of various content-rich moral-political formulations, Peirce and Royce hope to cultivate and sustain moral inquiry by allowing each moral community (1) to generate and test its own moral system (as long as it does so peaceably) and (2) to freely make or refuse to make collaborative arrangements with other moral communities. This approach is illustrated in a brief discussion of the Oregon Medical Experiment.     

Values and the scientific culture of behavior analysis

As scientists and practitioners, behavior analysts must make frequent decisions that affect many lives. Scientific principles have been our guide as we work to promote effective action across a broad spectrum of cultural practices. Yet scientific principles alone may not be sufficient to guide our decision making in cases with potentially conflicting outcomes. In such cases, values function as guides to work through ethical conflicts. We will examine two ethical systems, radical behaviorism and functional contextualism, from which to consider the role of values in behavior analysis, and discuss potential concerns. Finally, we propose philosophical pragmatism, focusing on John Dewey's notions of community and dialogue, as a tradition that can help behavior analysts to integrate talk about values and scientific practices in ethical decision making.     

The promises and perils of pragmatism: commentary on Fins, Bacchetta, and Miller

Fins, Bacchetta, and Miller's clinical pragmatism has several appealing features: an emphasis on dialogue, a commitment to consensus, a focus on particular individuals rather than persons in general, and a strong interest in the process as well as the product of moral decision making. Nevertheless, for all its protests to the contrary, clinical pragmatism has a tendency to privilege medical facts over nonmedical values, to conflate appropriate medical decisions with right moral decisions, and to conceive problems at the bedside in terms of "getting" patients and families to "go along" with the treatment plans of clinicians. In sum, there is within clinical pragmatism the potential for physicians to take back some of the power they ceded to patients during the height of the patients' rights and autonomy movement. Provided that clinicians guard against the temptation to use clinical pragmatism manipulatively, however, the method promises, more than most other methods of moral problem solving, to help increasingly diverse individuals make good moral decisions about patients' care under conditions of enormous uncertainty.     

Biography as an Art Form: The Story of Helen Flanders Dunbar,M.D., Ph.D., B.D., and Med. Sci. D

Helen Flanders Dunbar (1902–1959) was a physician, medieval and Renaissance scholar, theologian, and founder of the American Psychosomatic Society and its journal Psychosomatic Medicine. Her contributions are not currently well known but deserve recognition from all those involved or interested in the dialogue between medicine and spirituality. This essay explores Dunbar’s personal history and professional achievements. It focuses particular attention on a feminist perspective regarding her life and work. It will conclude with a discussion of how biography, as an art form, transforms both author and audience. This essay was originally presented as the Second Annual J.R. Williams Memorial Lecture on Spirituality and Medicine at the Tulane School of Medicine in fall 2013.     

Helen Flanders Dunbar: Physician,medievalist, enigma

Helen Flanders Dunbar was a psychiatrist, an early leader in the field of psychosomatic medicine, and a prophetic proponent of supervised clinical training for clergy. She was a prolific writer educated in theology and medieval studies as well as medicine. Yet she remains largely an enigma despite her achievements. This article explores Dunbar's life and attempts an explanation of why her person and ideas are not widely recognized today.     

John Dewey in France

The present article on John Dewey aims at pursuing thetraces of the reception of Dewey's work in France. Itis intended as a survey of the writers who have takennote of Dewey and his ideas, and is meant to functionas a sort of additive inventory, with no claim tocomprehensiveness. Some of the articles mentioned wereunfortunately unavailable for direct examination andare thus listed merely for purposes of information.Although the educational and philosophical writings ofJohn Dewey are actually indivisible, Dewey's oeuvrehas not been read in France and Europe generally as ofa piece, but has largely been registered in terms ofthose parts which have relevance to education andteaching. Indicative of this is the fact that it tookuntil 1975 for Democracy and Education (1916) –the book which, in Dewey's own view, most clearlypresented his linking of pedagogy and philosophy(Delledalle, 1975; Suhr, 1994) – to be published inFrance. Gérard Delledalle, the translator ofDemocracy and Education, is the only person so far inFrance to have dealt systematically with the whole ofDewey's writings. He has translated other works byDewey and has written several books on him, dealingexpressly with Dewey's philosophy of pragmatism as thefoundation of his theory of education.It is actually inadequate to restrict the reception ofDewey's work to France alone. Rather, one should speakof francophone Europe, for the first translations ofDewey's educational writings into French were made byAdolphe Ferriére, Ovide Decroly and ÉdouardClaparéde – a Swiss, a Belgian, and a Frenchman.It was thanks to them that Dewey's thoughts oneducation began to make an impact on the francophonemovement for school reform in the early twentiethcentury.Discussion of his theory of education is typified inFrance as well by a division into proponents of aconcept of `learning by doing' indebted to Dewey(particularly in France) and representatives ofauthoritarian forms of education, which reject Dewey.Although French thought has not yet concerned itselfclosely with pragmatism, Dewey's opponents believed(and still believe) that they could denounce him andhis theories simply by levelling the charge of``pragmatism.' This dualistic mode of thinking whichappears to be deeply rooted in France has proved to bean obstacle to the reception of Dewey and has led toneglect and rejection of his theories.     

The Global Community, Religion, and Education: The Modernity of Dewey's Social Philosophy

As a starting point this paper takes Dewey's nowadays oftenstressed modernity and examines his social philosophy againstthe background of the current debates on republicanism andcommunitarianism. Particularly, the anaysis of Dewey's The Public and its Problem (1927) concludesthat the attention being paid to Dewey is problematic asspecific religious assumptions – explicitly developedin A Common Faith (1934) – lie in the backgroundof his social philosophy, and are hardly being recognized.However, as it shall be shown, without considering thereligious basis, neither Dewey's social philosophy norhis educational theory can be properly understood.     

John Dewey and the savage mind: uniting anthropological, psychological, and pedagogical thought, 1894-1902

In 1902 influential American philosopher John Dewey wrote a short essay on anthropolo-gists'view of the savage mind, arguing that it had had been unfairly dismissed as inchoate and incapable, when in fact the savage had much to teach scholars about the "present mind." The ideas presented in Dewey's essay were not only theoretical; they also served as the basis for his entire curriculum his famous laboratory school at the University of Chicago. Thus, the author argues that Dewey's pedagogical thought informed his anthropological thought, and vice versa.     

Christian bioethics, secular bioethics, and the claim to cultural authority.

Though the papers in this volume for the most part address the question, "What is Christian about Christian Bioethics", this paper addresses instead a closely related question, "How would a Christian approach to bioethics differ from the kind of secular academic bioethics that has emerged as such an important field in the contemporary university?" While it is generally assumed that a secular bioethics rooted in moral philosophy will be more culturally authoritative than an approach to bioethics grounded in the contingent particularities of a religious tradition, I will give reasons for rejecting this assumption. By examining the history of the recent revival of academic bioethics as well as the state of the contemporary moral philosophy on which it is based I will suggest that secular bioethics suffers from many of the same liabilities as a carefully articulated Christian bioethics. At the end of the paper I will turn briefly to examine the question of how, in light of this discussion, a Christian bioethics might best be pursued.     

Freestanding Pragmatism in Law and Bioethics

This paper represents the first installment of alarger project devoted to the relevance of pragmatism forbioethics. One self-consciously pragmatist move would be toreturn to the classical pragmatist canon of Peirce, James andDewey in search of substantive doctrines or methodologicalapproaches that might be applied to current bioethicalcontroversies. Another pragmatist (or neopragmatist) move wouldbe to subject the regnant principlist paradigm to Richard Rorty'ssubversive assaults on foundationalism in epistemology andethics. A third pragmatist method, dubbed ``freestandingpragmatism' by its proponents, embraces a ``pragmatist' approachto practical reasoning without discernable moorings either to theclassical canon or to Rorty's neopragmatism. This thirdpragmatist approach to method in practical ethics is the subjectof this article. I begin with an examination of freestandingpragmatism in the theory of judicial decision making. I arguethat this version of legal pragmatism – so described on account ofits commitments to contextualism, instrumentalism, eclecticism,and freedom from grand theory – bears a striking resemblance tomuch self-described pragmatist work in bioethics today. Ifurther argue that if this is what we mean by ``pragmatism,' thenin a certain sense ``we are all pragmatists now.'     

A Synthetic Approach to Bioethical Inquiry

This paper attempts to sort out some of the current tensions and ambiguities inherent in the field of bioethics as it continues to mature. In particular it focuses on the question of the methodological relevance of theory or ethical principles to the domain of clinical ethics. I offer an approach to reasoning about moral conflict that combines the insights of contemporary moral theorists, the philosophy of American pragmatism, and the skills of rhetorical deliberation. This synthetic approach locates a proper role for moral theory in the practice of clinical ethics, thus linking abstract philosophical ideas about morality, humanity, suffering, and health to specific deeds, actions, and decisions in the concrete lives of particular individuals. The aim of this synthetic approach of bioethical inquiry is a rapprochement between theoretical knowledge in moral philosophy and the contextualized, relational, and practical understanding of what morality demands of us in our daily lives. I argue for a conception of bioethical inquiry that takes morality to be a study of certain practical, socially embedded concerns about matters of right and wrong, good and evil, as well as a study of the moral theories by which these actual concerns can be explored and critically evaluated.     

Clinical pragmatism: a method of moral problem solving

This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in moral problem solving are discussed.     

Eco on Dewey

This study seeks to examine Umberto Eco's views of the key ideas in John Dewey's Art as Experience. Eco's proferred suggestion of transactional psychology as a corrective to Dewey's views is criticized as a misreading of Dewey's position.     

Between Peirce (1878) and James (1898): G. Stanley Hall,the origins of pragmatism,and the history of psychology

This article focuses on the 20‐year gap between Charles S. Peirce's classic proposal of pragmatism in 1877–1878 and William James's equally classic call for pragmatism in 1898. It fills the gap by reviewing relevant developments in the work of Peirce and James and by introducing G. Stanley Hall, for the first time, as a figure in the history of pragmatism. In treating Hall and pragmatism, the article reveals a previously unnoted relation between the early history of pragmatism and the early history of the “new psychology” that Hall helped to pioneer. © 2009 Wiley Periodicals, Inc.     

PRAGMATISM,REALISM, AND RELIGION

Pragmatism is often thought to be incompatible with realism, the view that there are knowable mind‐independent facts, objects, or properties. In this article, I show that there are, in fact, realist versions of pragmatism and argue that a realist pragmatism of the right sort can make important contributions to such fields as religious ethics and philosophy of religion. Using William James's pragmatism as my primary example, I show (1) that James defended realist and pluralist views in metaphysics, epistemology, ethics, and philosophy of religion, and (2) that these views not only cohere with his pragmatism but indeed are basic to it. After arguing that James's pragmatism provides a credible and useful approach to a number of basic philosophical and religious issues, I conclude by reflecting on some ways in which we can apply and potentially improve James's views in the study of religion.