Being and Denial
In trying to make moral sense -- and medical sense, too -- we leave the story behind. We move on to case, to common sense, to rules and rights, and ultimately to theory and metatheory. Each move seems an advance, seems to get us closer to the truth of things. But as this happens, the temptation to wash out the details, to forget the persons and players, is very great. Like the Platonist, we are given to scientific models and to comprehensive abstractions. We search for the one inclusive explanation, as it were. Like the "Theory of Everything" in physics, this becomes our ideal. It is reinforced when, as in medical practice and in ethics, tradition encourages us to reduce the clinical situation to manageable concepts and easily retained simplifications. With the move toward rules, rights, and theories, other practice communities -- philosophy, religion, law -- enter the arena. But nontraditional communities expect admission, too. New players, often anonymous players, are introduced into the clinical situation. Their members now claim a stake, an ownership, in the case. So to the ordinary cast of characters -- patient, family, physician, nurse, chaplain -- is added a nearly indefinite number of participants. Interests are pluralized around different and, often, contradictory ends-in-view. Conflicts of interest thus inhere in the emerging situation as such, and are not just instances of villainy, cupidity, or blindness.
Traditionally, the move away from the story and toward the case served the treatment purposes of the practice community by connecting patient