Amongst traditionally-available frameworks within which end-of-life decisions in Intensive Care Units (ICU) are situated, we favour Ordinary versus Extra-ordinary care distinctions as the most helpful. Predicated on this framework, we revisit the concepts of personhood and autonomy. We argue that a full account of personhood locates its foundation in relationships with others, rather than merely in “rationality”. A full account of autonomy also recognises relationships with others, as well as the actual reality of the patient’s situation-in-the-world. The fact that, when (...) critically ill, the patient may no longer be able to take an active role in decision-making does not bring about the end of their personhood, or of their autonomy. Because the patient’s autonomy is intimately linked to their relationships with others, once critical illness supervenes, respect for their autonomy devolves to those others with whom the patient is in relationship. In practical application, this means that there must be a dialogue, as the end-of-life of the critically-ill patient in ICU comes into view. Such dialogue should be grounded on this understanding in order to conform best to moral philosophical principles. Ideally the dialogue will involve all those with whom the patient is in relationship and, practical difficulties within an ICU notwithstanding, will aim to be inclusive, non-coercive and reflective as it seeks to maximise the good of the patient in their unique context. (shrink)

This item has been retired at the request of its author.

Much has been written about the role of hospital ethics committees. Ethics committees may have begun in Seattle in the early 1960s, but they were reified in. New Jersey by the Quinlan Court in the 1970s and thrived in the national bioethics movement of the 1980s.In this flurry of ethics activity, several new forms of ethics committees have evolved. New forms of ethics committees include patient care-oriented ethics committees. Many ethicists are familiar with mission-oriented ethics committees. Such committees have taken (...) on new roles, and Include PROs, IPCs, and HREAPs. In general, these committees are regulatory in nature and may often rely on rules and regulations to assess patient cases, research protocols, and health professional practices. (shrink)

Philosophers have often noted that science displays an uncommon degree of consensus on beliefs among its practitioners. Yet consensus in the sciences is not a goal in itself. I consider cases of consensus on beliefs as concrete events. Consensus on beliefs is neither a sufficient nor a necessary condition for presuming that these beliefs constitute knowledge. A concrete consensus on a set of beliefs by a group of people at a given historical period may be explained by different factors according (...) to various hypotheses. A particularly interesting hypothesis from an epistemic perspective is the knowledge hypothesis: shared knowledge explains a consensus on beliefs. If all the alternative hypotheses to the knowledge hypotheses are false or are not as good in explaining a concrete consensus on beliefs, the knowledge hypothesis is the best explanation of the consensus. If the knowledge hypothesis is best, a consensus becomes a plausible, though fallible, indicator of knowledge. I argue that if a consensus on beliefs is uncoerced, uniquely heterogeneous and large, the gap between the likelihood of the consensus given the knowledge hypothesis and its likelihoods given competing hypotheses tends to increase significantly. Consensus is a better indicator of knowledge than "success" or "human flourishing". (shrink)

This paper is predicated on the understanding that clinical encounters between clinicians and patients should be seen primarily as inter-relations among persons and, as such, are necessarily moral encounters. It aims to relocate the discussion to be had in challenging medical decision-making situations, including, for example, as the end of life comes into view, onto a more robust moral philosophical footing than is currently commonplace. In our contemporary era, those making moral decisions must be cognizant of the existence of perspectives (...) other than their own, and be attuned to the demands of inter-subjectivity. Applicable to clinical practice, we propose and justify a Habermasian approach as one useful means of achieving what can be described as dialogic consensus. The Habermasian approach builds around, first, his discourse theory of morality as universalizable to all and, second, communicative action as a cooperative search for truth. It is a concrete way to ground the discourse which must be held in complex medical decision-making situations, in its actual reality. Considerations about the theoretical underpinnings of the application of dialogic consensus to clinical practice, and potential difficulties, are explored. (shrink)

The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social–historical construction (ASBH Core Competencies for Health Care Ethics Consultation , 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011 ). Core Competencies fails to recognize that the ethics of health care ethics consultants is not ethics in (...) the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered. (shrink)

People have concerns, and ethicists often respond to them with philosophical arguments. But can conceptual constructions properly address fears and anxieties? It is argued in this paper that while it is possible to voice, clarify, create and—to a certain extent—tackle concerns by arguments, more concrete practices, choices, and actions are normally needed to produce proper responses to people’s worries. While logical inconsistencies and empirical errors can legitimately be exposed by arguments, the situation is considerably less clear when it comes to (...) moral, cultural, and emotional norms, values, and expectations. (shrink)

Prompted by recent comments on the moral authority of dialogic consensus, we argue that consensus, specifically dialogic consensus, possesses a unique form of moral authority. Given our multicultural era and its plurality of values, we contend that traditional ethical frameworks or principles derived from them cannot be viewed substantively. Both philosophers and clinicians prioritize the need for a decision to be morally justifiable, and also for the decision to be action-guiding. We argue that, especially against the background of our pluralistic (...) society, it is only via unforced dialogue and properly founded argumentation, aiming for consensus, that we can ascribe rightness or wrongness in a normative fashion to dilemmatic situations. We argue that both the process of dialogue, properly constituted, and the consensual outcome itself have moral authority vested within them. Finally, we argue that the consensual decision made is able to withstand moral scrutiny and is action-guiding, without claiming absolute moral authority in other contexts. (shrink)

A traditional proposition in the philosophy and the sociology of science wants that consensus between specialists of a scientific discipline is a reliable indicator of their access to genuine knowledge. In an interesting reassessment of this principle, Aviezer Tucker has analyzed the implications and the significance of this thesis in relation to historical research, and has established that parts of the historiographical community that display high degrees of consensus among their practitioners can be described in terms of the same relationship (...) existing in empirical sciences between the exemplification of significant level of agreement and shared knowledge. After a concise summary of Tucker’s general view of the relationship between consensus and knowledge and an analysis of its discussion by Boaz Miller, this paper proposes a critical discussion of the limits and the virtues of this approach and concludes that it is possible to assume that a theory of the sort outlined by Tucker and Miller may describe in an exhaustive way the dynamics of the consensual communities only after some important caveats and integrations. In the closing section, a brief review of Tucker’s picture of historiographical consensus will be proposed. (shrink)