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Are Clinical Ethicists Looking in Wrong Directions?
Clinical ethicists are those who perform ethics consultations
regarding patient care and who also may teach and write about a host of issues
that pertain to that care. These
ethicists are often physicians but also may be philosophers, social workers,
ministers, lawyers, nurses and other occupations but whatever their primary
professions, doing ethics they tend to follow some consensus often developed
amongst themselves to explain and define what is happening and what is ethical.
Issues that are considered are often as basic
and as important in clinical ethics decision-making such as "what is
life" and "what is death" which are, for example, related to
terminating life support and organ procurement. It may be that those ethicists who originate
concepts which others will consider to follow develop explanations and
decisions based on theory and limited, perhaps isolated experiences, rather
than in the direction of the common everyday experience of the meaning and
consequences of life and death. Are
clinical ethicists actually looking for and presenting answers to society in
the wrong direction? Do you think what
you read and hear from ethicists really represent the life which you are
I thought an excellent presentation of this topic was that written to a bioethics listserv today by Steven Miles MD, who is a professor of medicine and bioethics at the University of Minnesota and has written to this blog in the past. I have reproduced, with his permission, his writing. ..Maurice
Personally, I think clinical ethics has accepted a paradigm
of priestly rationalism that is alien to the experienced phenomenon of life. When
my father dies, it is not a biological event, it is a personal one. It is a
social one--the Procrustean constructions of clinical ethics simply do not fit
the dimensions of that experience.
Our rationalism and pursuit of objectivity estranges us from
life. This estrangement is compounded by the fact that most bioethicists write
from the most extreme technological enclave of medicine--tertiary care
treatment centers. In this environment and from this experience, life becomes flattened--two
dimensional in the words of Jacques Ellul. And we would export those expensive
and scarce technological redefinitions of diagnosis and treatment to the
broader community despite the fact that they can not be widely implemented, are
unaffordable, and would be inherently unjustly available or applied.
There is a further problem--call it the Godel (or What is the
square root of -1?) problem. Bioethics' hubristic and extreme embrace of
mastery by rationalism must generate endless cascades of new paradoxes which in
turn spur more extreme rationalism and defy resolution. As we attempt to rationally subjugate the ever expanding tiers of
paradoxes created by our hyperrefined
art--we become both more estranged from lived and experienced phenomenon and we must necessarily declare
that those who are closest to the phenomenon lack the expertise to understand
or address it. In this sense, we expropriate lived-life from those living it.
The resolution to this problem in bioethics is not clear and
certainly not easy. Certainly we need a phenomenological ethics--one which puts
the experience of persons and social units like families at the forefront, one which
constrains machines and machine-logic to the ebbs and flows of quotidian
hope this clarifies matters or at least shows how muddled I have become.
Graphic: From Google Images