Communitarian critics have derided case-based reasoning for ignoring the need to arrive at a shared hierarchy of goods prior to case.

Casuistry and principlism are two of the leading contenders to be considered the methodology of bioethics. These methods may be incommensurable since the former emphasizes the examination of cases while the latter focuses on moral principles. Conversely, since both analyze cases in terms of mid-level principles, there is hope that these methods may be reconcilable or complementary. I analyze the role of principles in each and thereby show that these theories are virtually identical when interpreted in a certain light. That (...) is, if the gaps in each method are filled by a concept of judgment or Aristotelian practical wisdom, these methods converge. (shrink)

A dispute exists about whether bioethics should become a new discipline with its own methods, competency standards, duties, honored texts, and core curriculum. Unique expertise is a necessary condition for disciplines. Using the current literature, different views about the sort of expertise that might be unique to bioethicists are critically examined to determine if there is an expertise that might meet this requirement. Candidates include analyses of expertise based in "philosophical ethics," "casuistry," "atheoretical or situation ethics," "conventionalist relativism," "institutional guidance," (...) "regulatory guidance and compliance," "political advocacy," "functionalism," and "principlism." None succeed in identifying a unique area of expertise for successful bioethicists that could serve as a basis for making it a new discipline. Rather expertise in bioethics is rooted in many professions, disciplines and fields and best understood as a second-order discipline. (shrink)

Bioethics represents a dramatic revision of the centuries-old professional ethics that governed the behavior of physicians and their relationships with patients. This venerable ethics code was challenged in the years after World War II by the remarkable advances in the biomedical sciences and medicine that raised questions about the definition of death, the use of life-support systems, organ transplantation, and reproductive interventions. In response, philosophers and theologians, lawyers and social scientists joined together with physicians and scientists to rethink and revise (...) the old standards. Governments established commissions to recommend policies. Courts heard arguments and legislatures passed laws. This book is the first broad history of the growing field of bioethics. Covering the period 1947-1987, it examines the origin and evolution of the debates over human experimentation, genetic engineering, organ transplantation, termination of life-sustaining treatment, and new reproductive technologies. It assesses the contributions of philosophy, theology, law and the social sciences to the expanding discourse of bioethics. Written by one of the field's founders, The Birth of Bioethics is based on extensive archival research into sources that are difficult to obtain and on interviews with many of the leading figures in the moral debates in medicine. A very readable and comprehensive account of the evolution of bioethics, this book stresses the history of ideas but does not neglect the social and cultural context and the people involved. It will serve the information needs of philosophers, ethicists, social historians, and everyone interested in the origins of some of today's most hotly debated issues. (shrink)

In this engaging study, the authors put casuistry into its historical context, tracing the origin of moral reasoning in antiquity, its peak during the sixteenth and early seventeenth century, and its subsequent fall into disrepute from the mid-seventeenth century.

Since the publication of the first edition of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics there has been much debate about what a proper method in medical ethics should look like. The main rival for Beauchamp and Childress’s account, principlism, has consistently been casuistry, an account that recommends argument by analogy from paradigm cases. Admirably, Beauchamp and Childress have modified their own view in successive editions of Principles of Biomedical Ethics in order to address the concerns proponents of (...) casuistry and others have had about principlism. Given these adjustments to their view, some have claimed that principlism and casuistry no longer count as distinct methods. Even so, many still consider these two conceptions of bioethical methodologies as rivals. Both accounts of the relationship between casuistry and principlism are wrong. These two conceptions of methodology in biomedical ethics are significantly different, but the differences are not the ones pointed out by those who still claim that they are distinct positions. In this article, I explain where the real similarities and differences lie between these two views. (shrink)

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

In this provocative study, Bedau demonstrates the usefulness of "casuistry," or "the method of cases" in arriving at moral decisions. He examines well-known cases, including the aftermath of the sinking of the William Brown in 1841, that compel us to consider questions about who ought to survive when not all can. By doing so, we learn something about how we actually reason concerning such life and death situations, as well as about how we ought to reason if we wish both (...) to be consistent and to properly respect human life. Bedau's elegant book will be a valuable resource for students, philosophers, and general readers. (shrink)

The last twenty-five years of published literature and curriculum development in bioethics suggest that the field enjoys a successful and stable marriage to philosophical ethical theory. However, the next twenty-five years could be very different. I believe the marriage is troubled. Divorce is conceivable and perhaps likely. The most philosophical parts of bioethics may retreat to philosophy departments, while bioethics continues on its current course toward a more interdisciplinary and practical field.I make no presumption that bioethics is integrally linked to (...) philosophical ethical theory. Indeed, I assume that the connection is contingent and fragile. Many individuals in law, theological ethics, political theory, the social and behavioral sciences, and the health professions carefully address mainstream issues of bioethics without finding ethical theory essential or breathtakingly attractive. This is not surprising. Moral philosophers have traditionally formulated theories of the right, the good, and the virtuous in the most general terms. (shrink)

This article examines the emergence of casuistical case analysis as a methodological alternative to more theory-driven approaches in bioethics research and education. Focusing on The Abuse of Casuistry by A. Jonsen and S. Toulmin, the article articulates the most characteristic features of this modernday casuistry (e.g., the priority allotted to case interpretation and analogical reasoning over abstract theory, the resemblance of casuistry to common law traditions, the ‘open texture’ of its principles, etc.) and discusses some problems with casuistry as an (...) ‘anti-theoretical’ method. It is argued that casuistry so defined is ‘theory modest’ rather than ‘theory free’ and that ethical theory can still play a significant role in casuistical analysis; that casuistical analyses will encounter conflicting ‘deep’ interpretations of our social practices and institutions, and are therefore unlikely sources of increased social consensus on controversial bioethical questions; that its conventionalism raises questions about casuistry's ability to criticize norms embedded in the societal consensus; and that casuistry's emphasis upon analogical reasoning may tend to reinforce the individualistic nature of much bioethical writing. It is concluded that, notwithstanding these problems, casuistry represents a promising alternative to the regnant model of ‘applied ethics’ (i.e., to the ritualistic invocation of the so-called ‘principles of bioethics’). The pedagogical implications of casuistry are addressed throughout the paper and include the following recommendations: (1) use real cases, (2) make them long, richly detailed and comprehensive, (3) present complex sequences of cases, (4) stress the problem of ‘moral diagnosis’, and (5) be ever mindful of the limits of casuistical analysis. Keywords: casuistry, interpretation, methodology, pedagogy CiteULike Connotea Del.icio.us What's this? (shrink)

Book reviewed in this article: The Abuse of Casuistry: A History of Moral Reasoning. By Albert R. Jonsen and Stephen Toulmin.

Book reviewed in this article: Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. By Albert R. Jonsen, Mark Siegler, and William J. Winslade.

This book is about the ethical issues that clinicians encounter as they care for patients and is written to assist those who serve on hospital ethics committees as they deliberate about appropriate action in difficult ethical cases.

This book systematically reviews a variety of methods for addressing ethical problems in medicine, accounting for both their weaknesses and strengths. Illustrated throughout with specific cases or controversies, the book aims to develop an informed eclecticism that knows how to pick the right tool for the right job.

Assesses the ethical problems that doctors face every day and advocates a more universal code of medical ethics, one that draws on the traditions of religion and philosophy.

Several recent attempts to develop models of moral reasoning have attempted to use some form of casuistry as a way to resolve the moral controversies of clinical ethics. One of the best known models of casuistry is that of Jonsen and Toulmin who attempt to transpose a particular model of casuistry, that of Roman Catholic confessional practice, to contemporary moral disputes. This attempt is flawed in that it fails to understand both the history of the model it seeks to transpose (...) and the morally pluralistic context of secular, postmodern society. The practice of casuistry which Jonsen and Toulmin wish to revive is a practice set in the context of a community with a shared set of moral values and structures of moral authority. Without a set of common moral values and rankings, and a moral authority to interpret cases the casuistry of the postmodern age will be pluralistic; that is, there will be many casuistries not just one. Keywords: casuistry, common morality, kinetics, moral authority, moral pluralism, morphology, paradigm cases, taxonomy CiteULike Connotea Del.icio.us What's this? (shrink)

Principlism has been advocated as an approach to resolving concrete cases and issues in bioethics, but critics have pointed out that a main problem for principlism is its lack of a method for assigning priorities to conflicting ethical principles. A version of principlism referred to as 'specified principlism' has been put forward in an attempt to overcome this problem. However, none of the advocates of specified principlism have attempted to demonstrate that the method actually works in resolving detailed clinical cases. (...) This paper shows that when one tries to use it, specified principlism fails to provide practical assistance in deciding how to resolve concrete cases. Proponents of specified principlism have attempted to defend it by arguing that it is superior to casuistry, but it can be shown that their arguments are faulty. Because of these reasons, specified principlism should not be considered a leading contender in the search for methods of making justifiable decisions in clinical cases. (shrink)

Casuistic methods of reasoning in medical ethics have been criticized by a number of authors. At least five main objections to casuistry have been put forward: (1) it requires a uniformity of views that is not present in contemporary pluralistic society; (2) it cannot achieve consensus on controversial issues; (3) it is unable to examine critically intuitions about cases; (4) it yields different conclusions about cases when alternative paradigms are chosen; and (5) it cannot articulate the grounds of its conclusions. (...) Two main versions of casuistry have been put forward, and the responses to these objections depend in part on which version one is defending. Jonsen has advocated a version modeled on the approach to casuistry used by moral theologians in the 15th and 16th century, involving comparison of the case at hand with a single paradigm and a lineup of cases. The present author has advocated another version, drawn from experience with cases in clinical ethics, which involves comparing the case at hand with two or more paradigms. Four of the five objections are unsuccessful when directed against Jonsen'sapproach, and all of them are unsuccessful when directed against the approach involving comparison with two or more paradigms. (shrink)

In this article I am concerned with analogical reasoning in ethics. There is no doubt that the use of analogy can be a powerful tool in our ethical reasoning. The importance of this mode of reasoning is therefore commonly accepted, but there is considerable debate concerning how its structure should be understood and how it should be assessed, both logically and epistemically. In this paper, I first explain the basic structure of arguments from analogy in ethics. I then discuss the (...) diversity of analogical arguments that can be found in ethics. I analyse their structure, assess them from a logical viewpoint, and show how they can be epistemically challenged and defended. The result of this investigation is that, contrary to a commonly held view, analogical reasoning can be a logically valid type of ethical reasoning that can provide reasons for action that are not worse than the reasons provided by any other kind of practical reasoning. (shrink)

Bioethical decision-making depends on presuppositions about the function and goal of bioethics. The authors in this issue of The Journal of Medicine and Philosophy share the assumption that bioethics is about resolving cases, not about moral theory, and that the best method of bioethical decision-making is that which produces useful answers. Because we have no universally agreed upon background moral theory which can serve as the basis for bioethical decision-making, they try to move bioethics away from theory. For them, a (...) good method of bioethical decision-making is one which resolves cases in ways that are justifiable to the parties involved, not necessarily in ways that bring us ‘close’ to the right and the true. The authors consider how the move away from theory and toward actual cases is best accomplished. In particular, the debate in this issue is about specification, specified principlism, and casuistry. (shrink)

Background: Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce. Objectives: To explore clinical ethics committees’ deliberations and to identify areas for improvement. Design: A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data. Participants: Nine hospital ethics committees in Norway. Results and interpretations: Key elements (...) of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient’s situation, the therapists’ perspective, analogous clinical situations, professional uncertainties, the patient’s and relatives’ perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members’ interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations. Conclusion: Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training. (shrink)

This article elaborates on the relation between ethical casuistry and common law reasoning. Despite the frequent talk of casuistry as common law morality, remarks on this issue largely remain at the purely metaphorical level. The article outlines and scrutinizes Albert Jonsen and Stephen Toulmin’s version of casuistry and its basic elements. Drawing lessons for casuistry from common law reasoning, it is argued that one generally has to be faithful to ethical paradigms. There are, however, limitations for the binding force of (...) paradigms. The most important limitations—the possibilities of overruling and distinguishing paradigm norms—are similar in common law and in casuistry, or so it is argued. These limitations explain why casuistry is not necessarily overly conservative and conventional, which is one line of criticism to which casuists can now better respond. Another line of criticism has it that the very reasoning from case to case is extremely unclear in casuistry. I suggest a certain model of analogical reasoning to address this critique. All my suggestions to understand and to enhance casuistry make use of common law reasoning whilst remaining faithful to Jonsen and Toulmin’s main ideas and commitments. Further developed along these lines, casuistry can appropriately be called “common law morality.”. (shrink)

‘Applied ethics’, as that expression is now used, is a single rubric for a large range of different theoretical and practical activities. Such rubrics function partly as a protective device both within the academic community and outside it; a name of this kind suggests not just a discipline, but a particular type of discipline. In the case of ‘applied ethics’ the suggestive power of the name derives from a particular conception of the relationship of ethics to what goes on under (...) the rubric of ‘applied ethics’. Not everyone who conducts activities under that rubric owes allegiance to this conception and there are doubtless some who would repudiate it as strongly as I do. But it is that dominant conception from which most work in this area derives or aspires to derive its philosophical legitimacy. What is that conception? (shrink)

The law serves functions that are not often taken seriously enough by ethicists, namely feasibility and practicability. A consequence of feasibility is that most laws do not meet the demands of ideal ethical theory. A consequence of practicability is that law requires elaborated and explicit methodologies that determine how to do things with norms. These two consequences form the core idea behind this book, which employs methods from legal theory to inform and examine debates on methodology in applied ethics, particularly (...) bioethics. It is argued that almost all legal methods have counterparts in applied ethics, which indicates that much can be gained from comparative study of the two. The author first outlines methods as used in legal, focusing on deductive reasoning with statutes as well as analogical reasoning with precedent cases. He then examines three representative kinds of contemporary ethical theories, Beauchamp and Childress’s principlism, Jonsen and Toulmin’s casuistry, and two versions of consequentialism—Singer’s preference utilitarianism and Hooker’s rule-consequentialism—with regards to their methods. These examinations lead to the Morisprudence Model for methods in applied ethics. (shrink)

Both communitarianism and casuistry have sought to restore ethics as a practical science—the former by incorporating various traditions into a shared definition of the common good, the latter by considering the circumstances of each situation through critical reasoning. Mark G. Kuczewski analyzes the origins and methods of these two approaches and forges from them a new unified approach. This approach takes the communitarian notion of the person as its starting point but also relies upon the narrative and analogical tools of (...) case-based reasoning. He separates out the rhetoric that is incongruent with the Aristotelian aspirations of each method to show that the two are complementary, and that consensus can emerge from fragmentation. He then applies his resulting method to three major problems in bioethics: the difficulties that the issue of personal identity poses for advance directives, the role of the family in medical decision making, and the refusal of treatment because of religious beliefs. He analyzes the need to assume a communitarian notion of the person as a starting point for the application of casuistic insights. Combining theoretical, practical, and scholarly insights, this book will be of interest to philosophers, political and social scientists, and bioethicists. (shrink)

Highlights of this edition include: / Important new material addressing federal privacy regulations, disclosure of medical errors, limits on residents'...

Did the Gulf War defend moral principle or Western oil interests? Is violent pornography an act of free speech or an act of violence against women? In _Casuistry and Modern Ethics_, Richard B. Miller sheds new light on the potential of casuistry—case-based reasoning—for resolving these and other questions of conscience raised by the practical quandaries of modern life. Rejecting the packaging of moral experience within simple descriptions and inflexible principles, Miller argues instead for identifying and making sense of the ethically (...) salient features of individual cases. Because this practical approach must cope with a diverse array of experiences, Miller draws on a wide variety of diagnostic tools from such fields as philosophy of science, legal reasoning, theology, literary theory, hermeneutics, and moral philosophy. Opening new avenues for practical reasoning, Miller's interdisciplinary work will challenge scholars who are interested in the intersections of ethics and political philosophy, cultural criticism, and debates about method in religion and morality. (shrink)

Case methods of reasoning are persuasive, but we need to address problems of bias in order to use them to reach morally justifiable conclusions. A bias is an unwarranted inclination or a special perspective that disposes us to mistaken or one-sided judgments. The potential for bias arises at each stage of a case method of reasoning including in describing, framing, selecting and comparing of cases and paradigms. A problem of bias occurs because to identify the relevant features for such purposes, (...) we must use general views about what is relevant; but some of our general views are biased, both in the sense of being unwarranted inclinations and in the sense that they are one of many viable perspectives. This reliance upon general views to determine relevancy creates additional difficulties for defenders who maintain that case methods of moral reasoning are not only useful, but more basic, reliable or prior to other forms of moral reasoning. If we cannot identify the case's relevant features and issues independently of our general views or biases, we need further explanation about why a case method or casuistry should be viewed as prior to or more basic or reliable than other forms of moral reasoning. Problems of bias also arise for other methods of reasoning. In medical science, case reviews are regarded as an unreliable way to form generalizations, and methods such as clinical trials are used to address bias. (shrink)

This essay focuses on how casuistry can become a useful technique of practical reasoning for the clinical ethicist or ethics consultant. Casuistry is defined, its relationship to rhetorical reasoning and its interpretation of cases, by employing three terms that, while they are not employed by the classical rhetoricians and casuists, conform, in a general way, to the features of their work. Those terms are (1) morphology, (2) taxonomy, (3) kinetics. The morphology of a case reveals the invariant structure of the (...) particular case whatever its contingent features, and also the invariant forms of argument relevant to any case of the same sort: these invariant features can be called topics. Taxonomy situates the instant case in a series of similar cases, allowing the similarities and differences between an instant case and a paradigm case to dictate the moral judgment about the instant case. This judgment is based, not merely on application of an ethical theory or principle, but upon the way in which circumstances and maxims appear in the morphology of the case itself and in comparison with other cases. Kinetics is an understanding of the way in which one case imparts a kind of moral movement to other cases, that is, different and sometimes unprecedented circumstances may move certain marginal or exceptional cases to the level of paradigm cases. In conclusion, casuistry is the exercise of prudential or practical reasoning in recognition of the relationship between maxims, circumstances and topics, as well as the relationship of paradigms to analogous cases. (shrink)

There has been a growing interest in casuistry since the ground breaking work of Jonsen and Toulmin. Casuistry, in their view, offers the possibility of securing the moral agreement that policy makers desire but which has proved elusive to theory driven approaches to ethics. However, their account of casuistry is dependent upon the exercise of phronesis. As recent discussions of phronesis make clear, this requires attention not only to the particulars of the case, but also to the substantive goods at (...) stake in the case. Without agreement on these goods attention to cases is unlikely to secure the productive consensus that Jonson and Toulmin seek. (shrink)

For a number of reasons, casuistry has come into vogue in medical ethics. Despite the frequency with which it is avowed, the application of casuistry to issues in medical ethics has been given virtually no systematic defense in the ethics literature. That may be for good reason, since a close examination reveals that casuistry delivers much less than its advocates suppose, and that it shares some of the same weaknesses as the principle-based methods it would hope to supplant.

For the last century, moral philosophy has stressed theory for the analysis of moral argument and concepts. In the last decade, interest in the ethical issues of health care has stimulated attention to cases and particular instances. This has revealed the gap between ethical theory and practice. This article reviews the history and method of casuistry which for many centuries provided an approach to practical ethics. Its strengths and weaknesses are noted and its potential for contemporary use explored.