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09/12/2016

“Humanists,” Academic Philosophers, Critical Distance, and Clinical Ethicists


The October 2016 Annual Meeting of the American
Society for Bioethics and Humanities (ASBH) announced its theme for the
Washington, D.C., convocation several months ago: “After over half a century of
work, and as ASBH celebrates its coming-of-age, we have chosen to focus on
‘critical distance’ and our ‘insider-outsider’ status at our 18th annual meeting.”
Some may be relatively unfamiliar with these notions of “critical distance” and
“insider-outsider” status.


            In
the early 1970s, when medical center and medical school thought leaders began
hiring “humanists” to teach, round with teams, and attend morning reports and
noon conferences, it was unclear what – if any – specific outcomes might
result. However, the center executives and deans wanted to try something to
help inject human values and humanistic thought into the educational process to
offset the very strong influences of advancing technologies, specialization,
and materialism, and to assure the outraged public in the face of recently
revealed research scandals.


            These pioneer
“humanists” were theologians, religious studies scholars, and philosophers. In
just a few years, the philosophers were predominating in this growing field of applied
ethics educators and scholars. In explaining this transition, Art Caplan wrote:
“It proved very difficult to do bioethics in public in anything approximating a
religious voice. … [I]t quickly became clear that to command the attention of
scientists and physicians, as well as policy-makers, a more secular voice was
required. Philosophy, emerging out of decades of mainly futile wrangling about
meta-ethical issues, was more than happy to oblige … .”
Caplan AL. The birth and
evolution of bioethics. In Ravitsky V, Fiester A, Caplan AL. The Penn Center
Guide to Bioethics.
New York: Springer Publishing Co., 2009, p. 5.


            But, the
philosophers who taught applied ethics or their philosophy colleagues in the
academy challenged medical ethics in the classroom and at the bedside. The
academic philosophers were concerned that the medical school philosophers might
be losing their bearings. This difference of opinion was stated by Harvard
philosophy professor F.M. Kamm in 1988: “[P]hilosophers should try to bring
‘real-life’ problems (and those that have them)
up to the abstractions
of philosophy, rather than just bring philosophy down to the level of the
problems. [Emphasis in original.]” Kamm FM. Ethics, applied ethics, and
applying applied ethics. In Rosenthal DM, Shehadi F, eds. Applied Ethics and
Ethical Theory. Salt Lake City: University of Utah Press, 1988, p. 170.
 To be even clearer, she continued: “[C]reative
solutions to practical problems come only after a period of detaching ourselves
from them to consider more fundamental concepts. … [E]mphasizing the
discovery of solutions to problems conflicts with a detached interest that goes
wherever an illuminating, but not obviously or immediately useful, aspect of a
questions leads one.” Ibid, p. 170-171. “If philosophers who do applied ethics
do not maintain such attitudes, in common with academic philosophers, they run
the risk of being bad philosophers and becoming merely the bearers of
simplified, falsely reassuring news from the theorists.” Ibid, p. 171.


            In thinking
back, it must have been a phenomenal trial for several medical school philosophers
to attempt to satisfy the academic philosophers while taking a new path. For
the academics the question must have been how does one comment upon the matters
at hand without learning so much about related topics and processes or becoming
deeply enmeshed in the milieu that one is no longer an “outsider” but an “
insider” without critical distance? This turf battle must have been particularly
worrisome for some distinguished philosophers who gained national and
international reputations as academic philosophers and who then moved to medical
school and clinical settings. Of course, a good many philosophers and
theologians thought doctors were too close to the problem
  (that is, lacked critical distance) to be
part of any solution. (And quite naturally, some of the doctors thought the theologians
and philosophers lacked a sufficient clinical knowledge base to fully
understand the contexts in which they were involved.) History has shown that
many of the medical school philosophers transitioned and cared little about
what the academic philosophers said anyway.


            By the
early and middle 1980s, other professionals joined the philosophers and
theologians in broadening the bioethics or clinical ethics base and voice:
physicians, nurses, social workers, chaplains and pastoral care workers, and
lawyers, just to name a few. For health care professionals, chaplains, and
lawyers, this notion of “critical distance” as not an overriding factor. If
these bioethicists gave any thought to “detachment,” they probably interpreted
it as “objectivity.”
Objectivity
calls to mind: “impartiality,” “lack of bias,” “fairmindedness,” “neutrality,”
“open-mindedness,” “fairness,” and “justice.”


            Today, as
clinical ethics consultants move toward professionalization, the outsider-insider
issue has lost its relevance. Few may even understand the context of the
initial problem now. Clinical ethics consultants exist in great part to improve
patient care and the patient care experience; they are undoubtedly insiders. And,
whether one thinks in terms of critical distance or not, objectivity in
providing service to others remains critically important.


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