I argue here that Weberian disenchantment is manifest in the triumph of instrumental reason and the expansion of analytic enquiry, which now dominates not simply those sciences upon which medicine depends, but medical practice itself. I suggest ways that analytic enquiry, also referred to here as anatomical reasoning, are part of a particular ideology—a way of seeing, speaking about, and inhabiting the world—that often fails to serve the health of patients because it is incapable of “seeing” them in the moral (...) sense described by Iris Murdoch and others. I use the work of James Elkins and Wendell Berry to call for the recovery of a way of seeing the human body as both other and more than an object of scientific enquiry and social control. (shrink)

A brain death case is presented and reinterpreted using the narrative approach. In the case, two Japanese parents face a dilemma about whether to respect their daughter’s desire to donate organs even though, for them, it would mean literally killing their daughter. We argue that the ethical dilemma occurred because the parents were confronted with two conflicting narratives to which they felt a “narrative responsibility,” namely, the responsibility that drives us to tell, retell, and coauthor the (often unfinished) narratives of (...) loved ones. We suggest that moral dilemmas arise not only from conflicts between moral justifications but also from conflicts between narratives and human relationships. (shrink)

Pellegrino and Thomasma have proposed a normative medical ethics founded on a conception of the end of medicine detached from any broader notion of the telos of human life. In this essay, I question whether such a narrow teleological account of medicine can be sustained, taking as a starting point Pellegrino and Thomasma’s own contention that the end of medicine projects itself onto the intermediate acts that aim at that end. In order to show how the final end of human (...) life similarly alters intermediate ends, such as the end of medicine, I describe Thomas Aquinas’s concept of pain and explain how his remedies for pain derive from his account of the telos of human life. In turn, this account has implications for the way in which physicians who accept such a telos would manage their patients’ pain. If a comprehensive telos for human life is necessary to make sense of even such a routine aspect of medical care, then medical ethicists may not be able to sidestep questions about the good life for human beings. (shrink)

The past 10 years have seen considerable developments in the use of narrative in medicine, primarily through the emergence of the so-called narrative medicine. In this article, I question narrative medicine’s self-understanding and contend that one of the most prominent issues is its lack of a clear epistemological framework. Drawing from Gadamer’s work on hermeneutics, I first show that narrative medicine is deeply linked with the hermeneutical field of knowledge. Then I try to identify which claims can be legitimately expected (...) from narrative medicine, and which ones cannot be. I scrutinize in particular whether narrative medicine can legitimately grasp the patient’s lived experience of his or her illness. In the last section of this article, I begin to explore the potential usefulness of this epistemological clarification. This analysis allows for a further understanding of what is really at stake with narrative medicine, and thus to identify when it may be convenient, and when it may not. Furthermore, this clarification opens up promising new possibilities of dialogue with critics of the field. I conclude that narrative medicine finds its proper place as a possible tool available to mediate dialogue, which is at the heart of the clinical encounter in medical practice. (shrink)

Is personal moral inconsistency a challenge to overcome or embrace? This paper opts for the latter and argues for the Virtue of Encompassing the Contrary (VEC). According to VEC, an individual can balance and realize opposite values or virtues through time virtuously. This paper discusses critically various explanations given for moral inconsistency: Circumstantial Relativism, Moral Opportunism, the Consequentialist Solution, Moral Ambivalence, Kant’s Imperfect Duty and Dancy’s Moral Particularism. The paper argues that VEC fares better in answering the moral challenge of (...) inconsistent behavior. (shrink)