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07/16/2013

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 experiencing?
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 conversations.

 I hope this clarifies matters or at least shows how muddled I have become.

Graphic: From Google Images

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