Abstract

This dissertation attempted to establish the moral significance of metaphors for moral deliberation and conduct in medicine. I strove to demonstrate the validity of two propositions: that metaphors have philosophical importance and heuristic value beyond their poetic or linguistic functions and that metaphors have normative significance and can affect thought and guide actions. These two propositions outline a new and radical conception of the role of metaphor in human thought and conduct, and of the significance of metaphor for morality. ;The center of my inquiry was the normative function of the dominant medical metaphors of death and dying employed by contemporary physicians. I showed that physicians conceptualize the phenomena of death and dying by the use of metaphors and identified three prevalent metaphors used in end-of-life care: the WAR, the TORTURE, and the ART metaphors. Through an analysis of the relationship between these metaphors and the moral and professional conduct of physicians, I showed that the metaphors of death and dying have normative significance. They shape physicians' attitudes to the dying, guide their reasoning and behavior, and influence their decisions concerning end-of-life care. I demonstrated that the metaphors express certain societal interests, cultural and moral values, and prevailing professional beliefs. ;I investigated the specific moral implications of each metaphor for the treatment of the critically and terminally ill patients, paying special attention to the ways in which the metaphor shapes and constrains the moral deliberation of physicians. In a medical context, the concept of death acquires strong moral connotations. Currently, there is not a single medical conception of death but a multitude of metaphors of death and dying. The different metaphors of death were shown to be context-dependent and to affect how physicians understand their tasks and responsibilities, how they categorize the patient's condition and how they choose between alternative modes of treatment. I concluded that the dominant medical metaphors of death and dying are primarily physician-centered and do not address adequately the needs and experiences of the dying patients.