Some Narrative Methodologies for Clinical Ethics

Abstract

The increasing role played by medical ethicists in the clinical setting both as teachers and consultants has brought with it a demand for new methodologies that speak more precisely to the multiple problems encountered in actual attempts at case resolution. Some of these moves have to do with a revival of the truly classic case study approach to ethics, casuistry. This approach is anchored in the revelatory text of Jonsen and Toulmin, The Abuse of Casuistry. A fine example of this methodology is an article in The Journal of Clinical Ethics, “Gathering Information and Casuistic Analysis.” Conjoined to this approach is a renewed interest in virtue ethics. The groundwork for this was laid by MacIntyre's masterful history of its demise in After Virtue. A clear and concise application of this ancient but always new approach is given in Pellegrino and Thomasma's book The Virtues in Medical Practice. This way of doing ethics is particularly congenial to the practice of healthcare ethics in that it understands that virtue is just a rather fancy name for a good habit or skill. Since the practice of clinical medicine is quintessentially the learning and application of a range of often highly complex patterns of professional abilities and skills, a virtue ethics approach will allow for the concomitant development of a whole set of ethical skills. But both casuistry and virtue ethics may well be seen to be operative in a larger context now known as narrative ethics.