This article seeks to revisit the distinction between the words ethics and morals. First, we understand the word ethics to be focused on the way we seek to live our own life, and hence to connote a relativistic and essentially subjective perspective, whereas we understand the word morals to be focused on the way we should live our lives together, especially through sensitivity to viewpoints other than our own. Second, we perceive a usefulness in such a differentiation when the ethical (...) values of those in a dilemmatic situation are conflicted in order to prioritize moral decision making in contemporary society. We argue that in our current era, characterized by a multiplicity of faiths and by pronounced value pluralism, a philosophical basis for moral decision making needs to be clearly attuned with intersubjectivity and interconnectivity among people. It should be able to determine principles of conduct toward others, no matter how one’s own ethical values, conceptions of the good, or life choices might differ from those of others. To do this, we relocate ethical decision making away from an essentially monological reflection on our own values and purposes into a social space wherein we have an inclusive, noncoercive, and reflective dialogue. (shrink)

The historical emphasis of medical ethics, based on substantive frameworks and principles derived from them, is no longer seen as sufficiently sensitive to the moral pluralism characteristic of our current era. We argue that moral decision-making in clinical situations is more properly derived from a process of dialogic consensus. This process entails an inclusive, noncoercive, and self-reflective dialogue within the community affected. In order to justify this approach, we make two claims—the first epistemic, and the second normative. The epistemic claim (...) follows from Habermas’ “ways” of knowing. We argue that the dialogue emanating from this episteme focuses on the relevant facts about the patient, as well as on the values attached to these facts, thus allowing facts and their meanings to serve as the basis for reflective action appropriate to the circumstances. The normative claim follows from Habermas’ discourse theory of morality and communicative action. It determines that clinical decision-making should be approached from the perspective of the actual reality of people in their situation of illness, set in their socio-cultural background, and hence be grounded in the second-person perspective. Relocating ethical decision-making from a monological space into one characterized by dialogue is especially appropriate to the clinical encounter. (shrink)

The case study: a family requests that their grandmother, who does not speak English, is not informed of her terminal diagnosis focusses mostly on the issues of autonomy of patient and truth telling but fails to highlight the most ethically salient feature of the case; the clinician did not talk to the patient. The case study notes that the patient spoke a dialect of Cantonese and felt that translation services might not have been readily available. This is unacceptable practice given (...) the easy availability of professional telephone interpreters. In addition, it rendered the rest of the discussion academic as without a professional interpreter the clinician had no idea exactly what the family member who was interpreting was saying to their grandmother. This is an excellent case to discuss the ethics of the care of culturally and linguistically diverse people and the importance of interpreter use in patients with limited English proficiency. This case is also a good illustration of a limitation of Clinical Ethics Committees. A common norm is that there is no patient involvement in the deliberations of the committee. Without any patient involvement, it is very difficult to understand the patient’s position and impossible to engage in dialogue to find an agreed management plan. (shrink)