Ethics and the Clinical Encounter explores the moral dimensions of clinical medicine and the phenomenon of illness, to determine what ethics must be in order to be fully responsive to clinical encounters. Written in a lively and conversational style with minimal technical terminology, and enhanced by actual experience or real clinical situations, this volume lays out a clinical ethics methodology both in practical and theoretical terms.Here's what the experts had to say: Professor Zaner has provided us with a remarkably lucid (...) and trenchant discussion of the interface of philosophy and the field of medicine. He brings into play an extraordinary range of historial knowledge, extensive observations based on firsthand experience with medical practices, and an acute sense of philosophical argumentation. This is a work that will be an exemplary and indispensable text in the philosophy of medicine for years to come. -- Calvin Schrag... it is a highly original contribution usable in a number of fields.... It really has no competition.... The genius of Zaner's approach is to ground ethics from the 'bottom up' and to direct us to the concrete particulars of therapeutic encounters wherein lie moral and ethical matters... meaty, challenging, and ultimately rewarding.... -- Paul R. DokeckiRichard M. Zaner founded the Center for Clinical and Research Ethics at Vanderbilt University Medical Center. Having established Vanderbilt's first Hospital Ethics Committee, he served as co-chair of VUMC's Ethics Committee since its inception in 1990. Zaner has published five original books, edited ten, and translated four more, and has published more than 100 sections of books and professional journals. (shrink)

Early in the first volume of his Ideen zu einer reinen Phiinomeno logie und phiinomenologischen Philosophie, Edmund Husserl stated concisely the significance and scope of the problem with which this present study is concerned. When we reflect on how it is that consciousness, which is itself absolute in relation to the world, can yet take on the character of transcendence, how it can become mundanized, We see straightaway that it can do that only by means of a certain participation in (...) transcendence in the first, originary sense, which is manifestly the transcendence of material Nature. Only by means of the experiential relation to the animate organism does consciousness become really human and animal (tierischen), and only thereby does it achieve a place in the space and in the time of Nature. l Consciousness can become "worldly" only by being embodied within the world as part of it. In so far as the world is material Nature, consciousness must partake of the transcendence of material Nature. That is to say, its transcendence is manifestly an embodiment in a material, corporeal body. Consciousness, thus, takes on the characteristic of being "here and now" (ecceity) by means of experiential (or, more accurately, its intentive) relation to that corporeal being which embodies it. Accordingly, that there is a world for consciousness is a conse quence in the first instance of its embodiment by 2 that corporeal body which is for it its own animate organism. (shrink)

Early in the first volume of his Ideen zu einer reinen Phiinomeno logie und phiinomenologischen Philosophie, Edmund Husserl stated concisely the significance and scope of the problem with which this present study is concerned. When we reflect on how it is that consciousness, which is itself absolute in relation to the world, can yet take on the character of transcendence, how it can become mundanized, We see straightaway that it can do that only by means of a certain participation in (...) transcendence in the first, originary sense, which is manifestly the transcendence of material Nature. Only by means of the experiential relation to the animate organism does consciousness become really human and animal (tierischen), and only thereby does it achieve a place in the space and in the time of Nature. l Consciousness can become "worldly" only by being embodied within the world as part of it. In so far as the world is material Nature, consciousness must partake of the transcendence of material Nature. That is to say, its transcendence is manifestly an embodiment in a material, corporeal body. Consciousness, thus, takes on the characteristic of being "here and now" (ecceity) by means of experiential (or, more accurately, its intentive) relation to that corporeal being which embodies it. Accordingly, that there is a world for consciousness is a conse quence in the first instance of its embodiment by 2 that corporeal body which is for it its own animate organism. (shrink)

This honest, forthright, and beautifully-written book introduces readers to the human variations on medical topics spoken of in abstract in the daily news--euthanasia, assisted suicide, abortion, "extreme procedures", genetic testing, experimental surgeries--and to the people who must agonize over those decisions regarding themselves and their loved ones.

Four prominent views of the nature and methods of clinical ethics (especially in consultation forums) are reviewed; each is then submitted to a criticism intended to show both weaknesses and strengths. It is argued that clinical ethics needs to be responsive to the specific complexities of clinical situations. For this, the need for an expanded notion of practical reason within unique situations is emphasized, one whose aim is to facilitate decision-making on the part of those directly responsible for them and (...) consonant with their own respective moral frameworks and conceptions of what is most worthwhile. Keywords: Casuistry, clinical ethics, consultation, decision-making, dialogue, facilitator, practical reason, relationships CiteULike Connotea Del.icio.us What's this? (shrink)

This article reviews the historical and current controversies about the nature of clinical ethics consultation, as a way to focus on the place and responsibility of ethics consultants within the context of clinical conversation — interpreted as a form of dialogue. These matters are approached through a particularly compelling instance of the controversy that involves several major figures in the field. The analysis serves to highlight very significant questions of the nature and constraints of clinical situations, and the moral responsibility (...) and legal accountability that are especially important for clinical ethics consultants. (shrink)

The essays in this volume apply philosophical analysis to address three kinds of questions: What are the implications of genetic science for our understanding of nature? What might it influence in our conception of human nature? What challenges does genetic science pose for specific issues of private conduct or public policy?

Cairns, D. My own life.--Chapman, H. The phenomenon of language.--Embree, L. E. An interpretation of the doctrine of the ego in Husserl's Ideen.--Farber, M. The philosophic impact of the facts themselves.--Gurwitsch, A. Perceptual coherence as the foundation of the judgment of prediction.--Hartshorne, C. Husserl and Whitehead on the concrete.--Jordan, R. W. Being and time: some aspects of the ego's involvement in his mental life.--Kersten, F. Husserl's doctrine of noesis-noema.--McGill, V. J. Evidence in Husserl's phenomenology.--Natanson, M. Crossing the Manhattan Bridge.--Spiegelberg, H. (...) Husserl's way into phenomenology for Americans: a letter and its sequel.--Zaner, R. M. The art of free phantasy in rigorous phenomenological science.--Cairns, D. An approach to Husserlian phenomenology.--Cairns, D. The ideality of verbal expressions.--Cairns, D. Perceiving, remembering, image-awareness, feigning awareness.--Bibliography of the writings of Dorion Cairns (p. [263]-264). (shrink)

Physicians have for some time been questioning the prevailing view of medicine as applied biology. It is urged that medicine needs to be reconceived so as to provide appropriate emphasis on the patient's experience and understanding of illness. After reviewing these arguments and the scientific paradigm underlying the received view in light of certain themes in medicine's history and of current thinking, Pellegrino's thesis is analyzed: medicine should be understood as an inherently moral enterprise, a form of praxis focused on (...) "the healing relationship". Understanding the illness experience and the professed healer's "compassion" supports Pellegrino's view, and suggests that the healing relationship is perhaps best conceived as a form of dialogue. Keywords: compassion, dialogue, healing relationship, illness experience, interpretation CiteULike Connotea Del.icio.us What's this? (shrink)

Much has happened in the years since I wrote much of the previous Chapters, especially in the world of health care, medicine in particular but even more in medical and bio-medical research. The latter, indeed, is substantially responsible for many of the significant changes in clinical practice, diagnosis and prognosis in recent times. On reflection, it remains somewhat unclear to me that these changes, such as they may be, will also alter the moral themes and basic approach of the preceding (...) Chapters. But since so much has in fact happened, it seemed to me only appropriate to include the following reflections on what had come to be known early in the past two decades as the ‘new genetics’ Is human nature obsolete? Genetics, bioengineering, and the future of the human condition. MIT Press, Boston, pp 177–207, 2004). (shrink)

After a brief, personal reflection on Aron Gurwitsch’s life and his many influences on my career, I devote this lecture to some of the central themes of a phenomenology of medicine. Its core is the clinical encounter, which displays a certain structure I term the asymmetry of power (physician) and vulnerability (patient, family)—a complex contextual imbalance characterized by multiple points of view, hence points for reflective entrance. These are then interpreted phenomenologically in terms of epoché and reduction (practical distantiation), evidence, (...) reflection, and other related themes. I conclude with a suggestion about “the fundamental method” of phenomenology, free fantasy variation. (shrink)

A specific clinical encounter in which the author was an ethics consultant, after a brief summary, provides the basis for a phenomenological delineation and explication of the key ingredients of such encounters. A brief historical reflection on the myths of Gyges and Aesculapius suggests that several of these ingredients are essential to clinical encounters and help constitute their specific moral aspects and challenges. Understood as an interpersonal relationship framed by critical issues of illness experiences, the clinical encounter makes prominent such (...) constitutive features as dialogue, trust, violence, and especially vulnerability and power. The role of the clinical ethicist is found to be often critical in these encounters, in particular because of the need to help patients and doctors identify, understand, and cope productively with fundamental moral phenomena. (shrink)

After a brief, personal reflection on Aron Gurwitsch's life and his many influences on my career, I devote this lecture to some of the central themes of a phenomenology of medicine. Its core is the clinical encounter, which displays a certain structure I term the asymmetry of power and vulnerability —a complex contextual imbalance characterized by multiple points of view, hence points for reflective entrance. These are then interpreted phenomenologically in terms of epoché and reduction, evidence, reflection, and other related (...) themes. I conclude with a suggestion about "the fundamental method" of phenomenology, free fantasy variation. (shrink)

In an overview of the essays in this project, a number of clinical ethics issues receive emphasis. (1) One cluster concerns the ethical concerns presented within the relationship between the providers (doctor, nurse, etc.) and patient (and family), as distinct from those associated with being a clinical ethics consultant invited into a situation to assist. (2) Distinct from these are ethical issues intrinsic to the ways in which clinical encounters are variously written about (from chart notes to published articles). (3) (...) Finally, there is a set of issues connected with the major characteristics of clinical encounters, in view of which it is imperative to be specifically attentive to the fine details and complex interactions among patient, doctor, family, and others, within a specific social context. Keeping these matters in mind helps to clarify the differences between consulting (talking and listening) and writing about consultations, as well as among the various kinds of writing about clinical encounters. (shrink)

Historically, philosophy has been the point of origin of the various sciences. However, once developed, the sciences have increasingly become autonomous, although often taking some paradigm from leading philosophies of the era. As aresult, in recent times the relationship of philosophy to the sciences has been more by way of dialogue and critique than a matter of spawning new sciences. This volume of the Selected Studies brings together a series of essays which develop that dialogue and critique with special reference (...) to the insights of phenomenological philosophy. Phenomenology in its own way has been interfaced with the sciences from its outset. Perhaps the most widely noted relation, due in part to Edmund Husserl's characterization of the beginning steps of phenomenology as a "descriptive psychology," has been with the various psychologies. It is weIl known that the early Gestaltists were influenced by Husserl and, later, the Existential psychologies acknowledged the impact of Martin Heidegger and Jean-Paul Sartre, to mention but two philosophers. And, of course, Husserl's lifetime concern for the foundations of logic and mathe maties, especially as these (the former in particular) were developed into a foundational "theory of science," has figured prominently in these dialogues. 2 INTRODUCTION Less directly but more currently, the impact of phenomenology upon the disciplines has begun to be feIt in a whole range of the sciences. (shrink)

After expressing gratitude to each contributor, and briefly commenting on each, I probe several main themes of my work, addressing the question of the apparent difference between my earlier philosophical and later clinical writings. Central to both is the reflexivity of the human agent, and that each exhibits a form of practice regardless of the specific aims embedded in each. I then address the theme of narrative writing as my work has developed over the past several decades – at the (...) heart of which are questions of self and integrity. (shrink)

This study is a phenomenological inquiry into several relatively unexplored phenomena, including certain key methodological issues. It seeks to elicit and explicate the grounds of free-fantasy variation, which Husserl insists contains his “fundamental methodological insight” since it articulates “the fundamental form of all particular transcendental methods…” In the course of pursuing the full sense of this method and its grounds, the essay also uncovers the origins and eventual presence of “self” and explores the multiple connections among self, mental life, embodiment (...) and the surrounding world. To that end, it is necessary to take seriously Husserl’s otherwise odd declaration that “‘feigning’ [‘Fiktion’] makes up the vital element of phenomenology as of every other eidetic science…”, and thus that every philosopher must “fertilize” his or her “fantasy” through works of art and history as well as other areas and practices of human life. The essay offers an in-depth probing of several striking but largely unexplored phenomena: exemplifying and possibilizing, and concludes with an exploration of one of the most pervasive themes in phenomenological inquiry: intersubjectivity. (shrink)

Phenomenology in the United States is in a state of ferment and change. Not all the changes are happy ones, however, for some of the most prominent philosophers of the first generation of phenomenologists have died: in 1959 Alfred Schutz, and within the past two years John \Vild, Dorion Cairns, and Aron Gur witsch. These thinkers, though often confronting a hostile intel lectual climate, were nevertheless persistent and profoundly influential-through their own works, and through their students. The two sources associated (...) with their names, The Graduate Faculty of The New School for Social Research, and the circle around John Wild first at Harvard and later at Northwestern and Yale, produced a sizable portion of the now second gener ation American phenomenological philosophers. In a way, it was the very hostility of the American philo sophical milieu which became an important factor in the ferment now taking place. Although the older, first generation phenome nologists were deeply conversant with other philosophical move ments here and abroad, their efforts at meaningful dialogue were largely ignored. Determined not to remain isolated from the dominant currents of Anglo-American philosophy in par ticular, the second generation opened the way to a dialogue with analytic philosophers, especially through the efforts of the Society for Phenomenology and Existential Philosophy, led by 2 INTRODUCTION such men as James M. Edie and Hubert Dreyfus and, in other respects, Herbert Spiegelberg and Maurice Natanson. (shrink)

This book is a critical examination of certain basic issues and themes crucial to understanding how ethics currently interfaces with health care and biomedical research. Beginning with an overview of the field, it proceeds through a delineation of such key notions as trust and uncertainty, dialogue involving talk and listening, the vulnerability of the patient against the asymmetric power of the health professional, along with professional and individual responsibility. It emphasizes several themes fundamental to ethics and health care: (1) the (...) work of ethics requires strict focus on the specific situational understanding of each involved person. (2) Moral issues, at least those intrinsic to each clinical encounter, are presented solely within the contexts of their actual occurrence; therefore, ethics must not only be practical but empirical in its approach. (3) Each particular situation is in its own way imprecise and uncertain, and the different types and dimensions of imprecision and uncertainty are critical for everyone involved. (4) Finally, medicine and health care more broadly are governed by the effort to make sense of the healer's experiences with the patient, whose own experiences and interpretations are ingredient to what the healer seeks to understand and eventually treat. In addition to providing a way to develop ethical considerations in clinical life and research projects, the book proposes that narratives provide the finest way to state and grapple with these themes and issues, whether in classrooms or real-life situations. It concludes with a prospective analysis of newly emerging issues presented by and within the new genetics, which, together within a focus on the phenomenon of birth, leads to an clearer understanding of human life. (shrink)