Kari Milch Agledahl, Reidun Førde, and Åge Wifstad have authored an article in the very fine journal Medicine, Health Care, and Philosophy entitled Clinical essentialising: a qualitative study of doctors’ medical and moral practice.
Here is the Abstract:
While certain substantial moral dilemmas in health care have been given much attention, like abortion, euthanasia or gene testing, doctors rarely reflect on the moral implications of their daily clinical work. Yet, with its aim to help patients and relieve suffering, medicine is replete with moral decisions. In this qualitative study we analyse how doctors handle the moral aspects of everyday clinical practice. About one hundred consultations were observed, and interviews conducted with fifteen clinical doctors from different practices. It turned out that the doctors’ approach to clinical cases followed a rather strict pattern across specialities, which implied transforming patients’ diverse concerns into specific medical questions through a process of ‘essentialising’: Doctors broke the patient’s story down, concretised the patient’s complaints and categorised the symptoms into a medical sense. Patients’ existential meanings were removed, and the focus placed on the patients’ functioning. By essentialising, doctors were able to handle a complex and ambiguous reality, and establish a medically relevant problem. However, the process involved a moral as well as a practical simplification. Overlooking existential meanings and focusing on purely functional aspects of patients was an integral part of clinical practice and not an individual flaw. The study thus questions the value of addressing doctors’ conscious moral evaluations. Yet doctors should be aware that their daily clinical work systematically emphasises beneficence at the expense of others—that might be more important to the patient.
There are a number of important points to be drawn even from this short description. First, the reduction of ethics to what has been referred to as "disaster" or "quandary" ethics in applied settings impoverishes the discourse, IMO. Practicing how to live requires understanding of the deep ethical content in our daily lives, from moment-to-moment. It is not as if we simply flit around extra-normatively in general, and only need think about the good when and if a dilemma arises. This is partly why I tend to like virtue ethics, because if the good life is intimately connected to character, there is a continuity, a processual aspect to ethics that can unfortunately be obscured by a resolute focus on acts and principles.
(This is not to suggest preference for the latter implies disaster ethics, although it may facilitate it, IMO).
Second, the process of objectification which is at the core of the clinical gaze has unquestionably produced a host of social and individual goods, but it is not a free lunch. There is a significant dark side, one which can in many cases -- and some kinds of cases more than others -- result in the derogation of subjective experience, of the phenomenology of illness itself. This is a topic near and dear to my heart, and something I actively work on in a number of different ways.
Third, the process of objectification may itself be important at least in part because it reduces complexity and ambiguity to a more concrete, more manageable set of phenomena. But there may be some matters of great ethical content that are lost in the translation.
These comments are obviously brief and perhaps even cryptic, but a blog post is not really the proper medium for expanding upon them in fuller detail.
In any case, the article is highly recommended, and, even better, is available at this time full-text, open-access.
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