Stories Matter: The Role of Narrative in Medical Ethics

By Rita Charon; Martha Montello | Go to book overview

CHAPTER 16

RECONSIDERING ACTION: DAY-TO-DAY ETHICS IN THE WORK OF MEDICINE

JOHN D.LANTOS

Leon Kass recently expressed some doubts about whether bioethics, as a discipline, has changed the way American doctors practice medicine, think about healing, care for the sick and suffering, or act toward patients. Kass entitled his essay “Where’s the Action?” thus challenging bioethicists to examine what they do professionally, how what they do changes what doctors do, and whether the activities of bioethics might not be marginal or irrelevant to the “real” action of medicine.

“In the practice of ethics today,…” Kass wrote, “the action is mostly talk…. It seeks to analyze and clarify moral argumentation; to establish or criticize grounds for justifying our decisions; to lay down rules and guidelines, principles and procedures for addressing ethical dilemmas; and, in some cases, to construct comprehensive theories of conduct centering around fundamental norms, called autonomy or utility or duty or equality or benevolence.” 1 There is nothing inherently wrong with this compulsive theorizing, he suggests, but there is nothing about it that inevitably or even plausibly leads to right action. Theory can become an end in itself. Kass goes on to ask rhetorically, “What is the connection between this practice of ethical discourse, now vigorously pursued by ethicists and their collaborators, and ethical practice, that is, the deeds of medical practitioners, hospital administrators, public health officials, and the countless citizens who have dealings with them?” And his implicit answer is, “Not much.”

In thus examining the impact of bioethics upon medicine, Kass was not particularly interested in the sorts of actions that frequently are the focus of bioethical theory. He was not looking to see whether doctors were performing euthanasia, withdrawing mechanical ventilation from terminally ill patients, or meticulously seeking informed consent for tests and procedures. Instead, he was more interested in the everyday, lower-profile actions, those that do not flow from conscious theorizing but that are instead the result of embedded ethical presumptions reflected in the least deliberative of our actions.

In Kass’s spirit of inquiry, we really learn about medical ethics by observing how doctors greet their patients, whether they make eye contact with them, and whether they refer to patients by their first names or by honorifics. We see ethical

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