Abstract

The question I investigate concerns the ethics of clinical ethics consultation. To begin, I reconstruct and critically assess a widespread understanding of clinical medical ethics, one most prominently advanced by Mark Siegler. That examination reveals an overtly political strategy designed to reinforce physician authority. Next, John La Puma's work is discussed. Arguably the most prominent of Siegler's students, and certainly the most prolific, La Puma appears attentive to the problems in Siegler's view regarding clinical judgment. I conclude, however, that La Puma assumes a relatively flexible system of formal rules and more extensive informal codes which define the concepts and procedures of medical consultation and which he simply transcribes for ethics consultation. ;Albert Jonsen and Stephen Toulmin have apparently endorsed this medicalized strategy. They contend that the view of ethics advocated by these physicians represents a "new" casuistry consistent if not identical to their own theory. I show that the casuist method of clinical ethical decision making simply appropriates features of the diagnostic apparatus embedded in the political economy of the enterprise of medicine and makes the role of ethicist parasitic on that of the physician as expert. Their casuistry, I argue, merely serves as a means to reinforce the standardized apparatus of professional authority exercised in medical procedures and concepts. ;Finally, I sketch an alternative way to think about how experience with other persons informs ethical decision making. On the basis of an extensive and nuanced account of an ethics consultation, I argue that to consult as a clinical philosopher in any situation is, necessarily, to be focused on that individual situation for its own sake. Clinical philosophy, as a result, must be done by attending strictly to what appears as it appears: the issues, concerns, and questions expressed, in their own terms, by those individuals whose situation it is