Academic journal article Argumentation and Advocacy

Bioethics: A "New" Prudence for an Emergent Paradigm?

Academic journal article Argumentation and Advocacy

Bioethics: A "New" Prudence for an Emergent Paradigm?

Article excerpt

Stephen Toulmin has pioneered what is by now a familiar view of medicine as a fundamentally moral enterprise. Argumentation theorists will recognize Toulmin's (1981) attention to bioethical discourse that attends value-laden medical practice as one aspect of his broader project to theorize viable models of practical reasoning to supplant abstract modes of formal logic. Toulmin's focus on the ethical issues surrounding contemporary medicine serves to highlight bioethical discourse as an important context for applying practical reasoning principles. (1) This attention to bioethics intersects argumentation scholars' long-standing interest in how the field can contribute to theoretical and pragmatic understandings of deliberation, how argumentation can serve as a tool in effective and ethical decisionmaking. Bioethics, positioned as a paradigmatic case of practical moral reasoning, offers scholars a prism through which to theorize argumentation tools in the service of justificatory deliberative practices.

In this essay, I begin from Toulmin's significant insights into the relevance of bioethical discourse for practical reasoning models of argumentation to make a two-pronged claim: One, although Toulmin has directed important theoretical attention to a bioethical model, I will argue that he, with Albert Jonsen, has focused too narrowly on casuistry, or case morality, as the appropriate mode of reasoning within that model. While bioethical deliberations appropriately attend to case particulars and contingencies when deciding high stakes, technologically-driven, and value-laden issues, any focused attention on casuistry faces considerable limitations. These shortcomings relate to particular understandings that Toulmin and Jonsen hold of casuistic practice and bioethics practitioners. I hope to show that casuistic reasoning as a favored mode of bioethical reasoning suffers from its connection to classical phronesis, which gives rise to some untenable assumptions for contemporary bioethical and practical reasoning. These include the view that relevant cultural norms are stable as they apply to particular cases, that sufficient settled convictions exist to form a consensus on key deliberative points, and that the phronimos' "practiced eye" of experience provides a trustworthy and sufficient guide to ethical deliberation through practical wisdom.

If casuistry is limited by its classical connections to phronesis, what might successful deliberation look like in contemporary bioethical contexts? In a second claim, I call for bioethical reasoning to exploit an even greater role for narratively-informed dialogical virtues to sketch a model of it. These virtues do not merely elicit a data base for analogical reasoning in deliberation; they also, I will argue, forge a crucial dialogical link to an expanded field of experiential wisdom and understanding. An increased focus on dialogical virtues shapes a "new" phronimos for the bioethical model, one whose practiced ear is cultivated through deliberative patterns that are themselves a practice of ethical activity to enlarge deliberators' critical thinking through self scrutiny and moral imagination. (2) This expanded view of the prudential deliberator better serves an expansive bioethical discourse that is built on conflict, is not sustained by consensus, and is an exemplar for broader theoretical inquiry into practical moral deliberation.

To defend these claims of limitation and reformulation, I have organized the essay into three sections: First, after an introduction to the contested nature of the term "bioethics" itself and implications of that conflict for deliberation, I offer some theoretical and methodological connections between casuistry and prudence. Next, I look to a well publicized bioethics case. Through the case I speculate that bioethics' increased focus on casuistic reasoning has limited justificatory value because it is heavily reliant on a straightforward recovery of classical prudence to guide its practice. …

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