Defending secular clinical ethics expertise from an Engelhardt-inspired sense of theoretical crisis

Theoretical Medicine and Bioethics - The national standards for clinical ethics consultation set forth by the American Society for Bioethics and Humanities (ASBH) endorse an “ethics...     

The social postulate of theoretical ethics

Conclusion Kant believed all and only the guilty should be punished. Other retributivists believed that only guilt should bring punishment down on a person. In neither way is the retributive theory sufficiently distinguished from utilitarianism for, on contingent grounds, the utilitarian may agree with either of these theses. The advantage of PRJ is that it brings out the difference between retributivism and utilitarianism more sharply while at the same time it manages to be a less stern and unyielding view than traditional retributivism. The retributivist need not deny the core of good sense in utilitarianism, and he certainly need not deny the connection between morality and happiness. His view is that punishment does not have to produce good consequences in order to be justified. It suffices that it be deserved and that it not produce a set of clearly bad consequences. If it is true that punishment generally does have bad consequences which more than outweigh its good consequences then retributivists and utilitarians should join hands in their condemnation of punishment. The heart of the difference between the retributivist and the utilitarian is that the latter counts punishment itself as an evil but believes that, generally speaking, it is an evil which is instrumental in the production of enough good to out-weigh its intrinsic demerit. The retributivist does not regard punishment as an evil. The pain of punishment is not by itself a reason for not punishing (so long as it is not excessive). Insofar as utilitarianism is the view that no considerations but those of utility should justify punishment, it is only one side of that counterfeit coin the other side of which is Kant's dictum: ...Woe to him who creeps through the serpent-windings of Utilitarianism to discover some advantage that may discharge him from the Justice of Punishment, or even from the due measure of it.... It is irrational for Kant to rule out concern for utility but it is also irrational for the utilitarian to rule out concern for retribution.I have tried to show in this paper that the two main aspects of a plausible theory of retribution - PRJ and that the punishment should fit the crime - can be vindicated in terms of acceptable beliefs one of which is incompatible with utilitarianism (PRJ), and one of which does not derive the respect we accord it from any connection with utilitarianism. I emphasize, however, what I previously stated, that the retributivist does not have to believe that retributive justice must prevail at all costs. What is asked for is the recognition that one purpose of punishment (and not the one purpose) can justifiably have nothing to do with utility. The sensible retributivist will concede, and gladly, that there are more things in heaven and earth than retribution.     

Casuistry and clinical ethics

For the last century, moral philosophy has stressed theory for the analysis of moral argument and concepts. In the last decade, interest in the ethical issues of health care has stimulated attention to cases and particular instances. This has revealed the gap between ethical theory and practice. This article reviews the history and method of casuistry which for many centuries provided an approach to practical ethics. Its strengths and weaknesses are noted and its potential for contemporary use explored.     

Hermeneutical clinical ethics: A commentary

Essays by Thomasma and ten Have recommend hermeneutical clinical ethics. The use Thomasma makes of hermeneutics is not radical enough because it leaves out basic interpretation of clinical practice and focuses narrowly on ethical principles and rules. Ten Have, while failing to notice that the hyperreality of clinical ethics is a feature of all language, rightly distinguishes four characteristic parameters of a thoroughgoing interpretive clinical ethics: experience, attitudes and emotions, community, and ambiguity. Suggestions are made for implementing hermeneutical ethics in clinical teaching.     

A methodology for teaching ethics in the clinical setting: A clinical handbook for medical ethics

The pluralism of methodologies and severe time constraints pose important challenges to pedagogy in clinical ethics. We designed a step-by-step student handbook to operate within such constraints and to respect the methodological pluralism of bioethics and clinical ethics. The handbook comprises six steps: Step 1: What are the facts of the case?; Step 2: What are your obligations to your patient?; Step 3: What are your obligations to third parties to your relationship with the patient?; Step 4: Do your obligations converge or conflict?; Step 5: What is the strongest objection that could be made to the identification of convergence in step 4 or the arguments in step 4? How can this objection be effectively countered?; and Step 6: How could the ethical conflict, or perceived ethical conflict, have been prevented?     

Primary femininity: clinical advances and theoretical ambiguities

This paper examines the use of the term "primary femininity" in current psychoanalytic thinking. The concept of primary femininity arose in reaction to early theories about female sexuality and development; based on a model of male development, these presented problems when applied to females. The author attempts to demonstrate the clinical advances that have resulted from the idea of primary femininity. At the same time she argues that the idea has been used to carry widely differing meanings, and has reflected many writers' differing frames of reference, which range from gender identity through biological traits, object relations, genital anxieties, and bisexuality. Like the terms it originally was intended to replace or augment, it has come to be used reductionistically or loosely. The author warns against its misuse and argues that primary femininity is not a unitary concept, but rather encompasses a related group of ideas about the female body and mind.     

Phronesis in clinical ethics

This essay argues that while we have examined clinical ethics quite extensively in the literature, too little attention has been paid to the complex question of how clinical ethics is learned. Competing approaches to ethics pedagogy have relied on outmoded understandings of the way moral learning takes place in ethics. It is argued that the better approach, framed in the work of Aristotle, is the idea of phronesis, which depends on a long-term mentorship in clinical medicine for either medical students or clinical ethics students. Such an approach is articulated and defended.     

The Hippocratic Oath and clinical ethics

Its obvious shortcomings aside, this study by H. Steven Moffic, John Coverdale, and Timothy Bayer is disquieting. It comes as no surprise that residents have lapses of cognitive recall. Every medical teacher knows this very well. What is worrisome is that their amnesia concerns the oldest, most revered, and most influential moral statement in the history of the profession...Purely apart from its content, the oath continues to have power as the solemnification of a physician's entry into the profession. It signifies a willingness to submit to a way of life that demands some suppression of self-interest. If studying the oath more explicitly reenforces this solemnification or strengthens the physician's dedication to the welfare of the patient, the effort will be worthwhile.