From principles to principals: The new direction in medical ethics

Many alternatives or supplements to principalism seek to reconnect medical ethics with the thoughts, feelings, and motivations of the persons directly involved in ethically troublesome situations. This shift of attention, from deeds to doers, from principles to principals, acknowledges the importance of the moral agents involved in the situation — particular practitioners, patients, and families. Taking into account the subjective, lived experience of moral decision-making parallels recent efforts in the teaching of medicine to give the patient's subjectivity — his or her personal experience of being sick or disabled — epistemological parity with scientific medicine's objective, biomedically-oriented view of the person's sickness or disability.Moreover, the shift from principalism to principals signals a growing realization that ethical problems in the profession of medicine are inseparable from its practice. Philosophers and other humanists working in medicine should resist the temptation to institutionalize a professional role as solver of ethical problems, clarifier of values, or mediator of disputes and work instead to help practitioners practice medicine reflectively.     

Postmodernist theory and the physician-patient relationship

The author discusses the postmodernist claim that the grand theories have lost credibility, even in the field of medical science and practice. Rather than representing a shared reality among physician and patient, illness represents two quite distinct realities — the meaning of one being significantly and distinctively different from the meaning of the other. However, existential clinical narratives can function as important bridges between the world of the patient and the world of the physician. Such narratives provide important information regarding the patient's biographical situation and, particularly, the personal and cultural meanings which are a function of the biographical situation. At the same time, these narratives provide physicians with useful information for the practice of medicine.     

On being educated in the west: The disruption in self as a narrative and authenticity and inauthenticity of self

In this article I have argued that the issue of the effect of education on one getting educated is an ontological one. I make my case with the help of Heidegger's concepts of Dasein, and man's-being-in-the-world. I first argue that tradition is constitutive of one's being, and that man's being is in-a-tradition, and then make the case that education is located in tradition, and that education is a process by which one is initiated into that tradition. As a consequence getting educated in a tradition outside one's own has the effect of dislocating the being of the one getting educated.     

Reducing Political Dehumanization by Pairing Facts With Personal Experiences

The media is increasingly blamed for inflaming political animosity, but it may also bridge partisan divides—with the right strategies. Past research highlights the outgroup-experience effect: Sharing personal experiences (and not facts) helps to reduce partisan animosity. However, sharing facts is a pillar of good journalism and is essential for mediated political communication. Across four studies in two countries, we show that journalists, and citizens on social media sites, can share facts about contentious political issues (gun and climate policy), while simultaneously increasing tolerance and reducing dehumanization of political opponents. We extend the outgroup-experience effect by introducing factual content alongside personal experiences of political adversaries (i.e., a combination approach). These effects are replicated in both the United States and Germany although in Germany the personal experience intervention is only beneficial for people with more extreme attitudes.     

A teleological interpretation of Bonhoeffer's concept of “A World Come of Age”

This paper explores Dietrich Bonhoeffer's concept of “the nonreligious interpretation of biblical terms in a world come of age,” best known from his Letters and Papers from Prison (LPP). As a case study of its possibilities, we will survey South African thinkers who have explored the concept in rapidly changing contexts. Our leading question is whether academic theology can develop a teleological narrative for a nation that has “come of age.” When a nation or culture becomes so secular that it “outgrows” a traditional use of biblical terms, can those terms be reinterpreted to provide a teleological narrative for the nation? Bonhoeffer can be a resource for academic theologians to address issues in public theology, especially the suffering and oppression of communities still in pain despite a democratic system.     

Nonlinearity of healing: Healing narratives of Filipino therapists-in-training who self-identify as wounded healers

Due to the stigma therapists-in-training face within the field owing to their woundedness, and the dearth of psychological literature on the healing of wounded healers (WHs), this study examined the healing journeys of nine Filipino therapists-in-training who self-identify as WHs. Narrative Identity framework was utilized to analyse the healing narratives gathered from nine semi-structured interviews with therapists-in-training. Results focussed on the healing narratives and how these shaped the identity and development of these future practitioners. The healing narratives of therapists-in-training were generally composed of four chapters: (a) identifying the wounded-client identity and its wounds, (b) entering the counselling field brings the emergence of the healer-therapist identity, (c) nonlinearity of healing transforms into a fluid WH, and (d) continuing the healing journey. These never-ending and nonlinear journeys shaped how therapists-in-training perceived and constructed or deconstructed their identification, with their dual identities influencing their practice. Additionally, their healing journeys contributed to their development as therapists who continue to heal from their woundedness. This study contributes to the literature regarding therapists-in-training who self-identify as WHs through the emphasised healing process. Moreover, this study may both lessen the stigma surrounding therapists-in-training's woundedness and help colleagues, educators, mentors and supervisors within the counselling field to better help trainees through the creation of open spaces, classes and training programmes that may help in enhancing their well-being and utilising their woundedness to increase, rather than impair, their therapeutic ability.     

Medical Decision-Making: An Argument for Narrative and Metaphor

This study examines the processes ofdecision-making used by intensive care(critical care) specialists. Ninety-ninespecialists completed a questionnaire involvingthree clinical cases, using a novel methodologyinvestigating the role of uncertainty andtemporal-related factors, and exploring a rangeof ethical issues. Validation and triangulationof the results was done via a comparison studywith a medically lay, but highly informed groupof 37 law students. For both study groups,constructing reasons for a decision was largelyan interpretative and imaginative exercise thatwent beyond the data (as presented), commonlyresulting in different reasons supporting thesame conclusions and similar reasons supportingopposite conclusions. The skills of ethicalimagination and interpretation were related toan individual's prior lived experience,construed in the broadest sense. Application ofthese skills of ethical imagination andinterpretation always occurred, to some degree,in a state of uncertainty and almost alwaysinvolved temporal relationships.Using these results, a theory of ethicaldecision-making is proffered. Three levels ortypes of reasoning processes may be present.Type I decision-making involves the applicationof rules, usually in a deductive fashion. TypeII decision-making is characterised by aprocess where a plurality of reasons arebalanced, weighed and sifted with each other.Type III decision-making is intimately linkedwith respondents lived experiences and `crafts'the content of type I and II reasoningprocesses, via the application of ethicalimagination and interpretation. Relationshipsbetween these three types of reasoningprocesses, and with narrative ethics, are alsodiscussed.     

Traversing boundaries: clinical ethics,moral experience,and the withdrawal of life supports

While many have suggested that to withdraw medical interventions is ethically equivalent to withholding them, the moral complexity of actually withdrawing life supportive interventions from a patient cannot be ignored. Utilizing interplay between expository and narrative styles, and drawing upon our experiences with patients, families, nurses, and physicians when life supports have been withdrawn, we explore the changeable character of boundaries in end-of-life situations. We consider ways in which boundaries imply differences – for example, between cognition and performance – and how the encounter with boundaries can generate altered meanings important for understanding decisions and actions in these contexts. We conclude that the reliance on mere roles to support the moral weight of withdrawing medical interventions is inadequate. Roles that lead us to such moments are exceeded by the responsibility encountered in such moments. And here, we suggest, is the momentous character of withdrawal: it presents the grave astonishment, the trembling awe, in the not-being-there of the other in death.     

Richard Zaner’s “Troubled” Voice In <Emphasis Type="Italic">Troubled Voices</Emphasis>: Poseur,Posing, <Emphasis Type="Italic">Possibilizing</Emphasis>?

This essay considers Richard Zaner’s storytelling in Troubled Voices as a form of possibilizing which uses the stories to exemplify important moral themes such as contingency and freedom. Distinguishing between activities of moral discovery through the telling of a story and “posing” in the sense of writing to tell the “moral” of the story, I suggest that something crucial goes on for Zaner in his own tellings. Several of the more insistent implications Zaner reveals about the moral relationships encountered in the activity of clinical ethics consultation are examined in that light, especially regarding this question: is it more beneficial, or harmful, to articulate elements of core meanings and values that are entailed in individual viewpoints, which, prior to an ethics consultant’s participation, may have remained unspoken and possibly unacknowledged?