Abstract

In my experience with individuals confronting the ravages of traumatic disease and injury, I have found that the languages and expectations of medical, legal, and economic institutions frequently do not address individuals' deep concerns regarding mortality, suffering, and meaning. Caregivers who practice within these institutions often struggle against the necessary but spiritually stifling conventions of a market-based medical morality. ;This dissertation attempts to develop an alternative, aspirational language for thinking about clinical ethics. I begin by exploring how achieving intimacy in clinical spaces can be both intrinsically worthwhile and instrumental in the moral development of physicians. The convergence of sufferers and healers in clinical spaces is shown to provide unique opportunities for reflection and conversation. ;I then characterize some of the dominant models of doctor-patient relationships. The contract model has become the received view of medical practices. Many moral theorists in bioethics draw heavily on contractarian understandings of health care, emphasizing libertarian conceptions of the individual. Recently, however, critics have turned to literary and phenomenological concepts as a way of enlarging the moral discourse within the practice of medicine. The encounter model---which I develop in this work---offers one way of reconstructing the robust moral complexities of clinical interactions. ;At the heart of my analysis of clinical encounters is a moral theory in which the medical profession represents a uniquely human concern for those who are vulnerable and wounded. This theory involves a synthesis and development of recent contributions from scholars interested in restoring narrative and contextual dimensions to clinical conversations. I argue that doctors are witnesses to suffering and are therefore morally responsible to an appeal made by suffering patients. The dynamics of appeal and response are both a source of moral authority for the medical profession and a source of responsiveness for the reflective practitioner. I argue that attention to the questions of meaning and suffering that arise in the context of serious illness can breed the sort of interpersonal awareness and concern that contractarian approaches to clinical ethics tend to disregard