In this analysis of the ethical dimensions of doctors’ participation in macroallocation we set out to understand the skills they use, how they are acquired, and how they influence performance of the role. Using the principles of grounded moral analysis, we conducted a semi-structured interview study with Australian doctors engaged in macroallocation. We found that they performed expertise as argument, bringing together phronetic and rhetorical skills founded on communication, strategic thinking, finance, and health data. They had made significant, purposeful efforts (...) to gain skills for the role. Our findings challenge common assumptions about doctors’ preferences in argumentation, and reveal an unexpected commitment to practical reason. Using the ethics of Paul Ricoeur in our analysis enabled us to identify the moral meaning of doctors’ skills and learning. We concluded that Ricoeur’s ethics offers an empirically grounded matrix for ethical analysis of the doctor’s role in macroallocation that may help to establish norms for procedure. (shrink)

In most socialised health systems there are formal processes that manage resource scarcity and determine the allocation of funds to health services in accordance with their priority. In this analysis, part of a larger qualitative study examining the ethical issues entailed in doctors’ participation as technical experts in priority setting, we describe the values and ethical commitments of doctors who engage in priority setting and make an empirically derived contribution towards the identification of an ethical framework for doctors’ macroallocation work. (...) We conducted semi-structured interviews with 20 doctors, each of whom participated in macroallocation at one or more levels of the Australian health system. Our sampling, data-collection, and analysis strategies were closely modelled on grounded moral analysis, an iterative empirical bioethics methodology that employs contemporaneous interchange between the ethical and empirical to support normative claims grounded in practice. The values held in common by the doctors in our sample related to the domains of personal ethics, justice, and practices of argumentation. Applying the principles of grounded moral analysis, we identified that our participants’ ideas of the good in macroallocation and their normative insights into the practice were strongly aligned with the three levels of Paul Ricoeur’s ‘little ethics’: ‘aiming at the “good life” lived with and for others in just institutions’. Our findings suggest new ways of understanding how doctors’ values might have procedural and substantive impacts on macroallocation, and challenge the prevailing assumption that doctors in this milieu are motivated primarily by deontological considerations. Our empirical bioethics approach enabled us to identify an ethical framework for medical work in macroallocation that was grounded in the values and ethical intuitions of doctors engaged in actions of distributive justice. The concordance between Ricoeur’s ‘little ethics’ and macroallocation practitioners’ experiences, and its embrace of mutuality, suggest that it has the potential to guide practice, support ethical reflection, and harmonise deliberative practices amongst actors in macroallocation generally. (shrink)

Cet article vise à décrire les rapports dialectiques entre l’idéologie et l’utopie dans la philosophie sociale de Paul Ricœur et à les interroger sous l’angle de la critique. L’article montre le rôle de la critique dans le cadre de la philosophie ricœurienne et décrit la présence de plusieurs types, fonctions et objets de la critique dans cette philosophie, en soulignant l’importance, dans le contexte de ses rapports avec la théorie critique, de la critique généalogique, normative et reconstructive. Rappelant que les (...) formes pathologiques d’idéologie et d’utopie doivent être critiquées, mais aussi que les idéologies et les utopies, au sens positif, peuvent aussi être des outils critiques, l’article vise à cerner certains problèmes non résolus de l’approche ricœurienne à cette question mais aussi à montrer que la fonction critique de la philosophie ricœurienne a beaucoup à nous apprendre encore aujourd’hui. (shrink)

This article attempts to show the continuing practical relevance of hermeneutics through the example of legal interpretation. The article begins with the very concrete nature of legal hermeneutics that forms everyday legal practice – the interrelation of meaning and application – and expands at a more theoretical to show how legal hermeneutics, and hermeneutics more generally, offers what Ricoeur calls an interpretive “choice in favor of meaning.” The choice in favour of meaning underscores the restorative character of hermeneutics that legal (...) hermeneutics can epitomize. The article concludes with some of the challenges facing contemporary legal hermeneutics. (shrink)