Does an African American
Perspective Alter Clinical Ethical
Decision Making at the Bedside?
Reginald L. Peniston
THE QUESTION in the title of this chapter is just the type of query for which Friedrich Nietzsche would have had scathing commentary. He might have asked, “Does a German, or Christian, or European perspective alter clinical ethical decision making at the bedside?” He would likely say, “Yes, and in a frightening and self-conscious fashion.” Any perspective tied to group thinking would be an artifice of meaningful ethics. I believe that Nietzsche did engage in a bit of sleight-of-hand when judging motives by outcomes and incentives; however his skepticism and condescension are not traits alien to physicians. My first chief of surgery reportedly said, “You can teach any monkey to operate—surgical judgment is the hard part.” As a surgeon, jealously respectful of philosophers, I regard philosophical reflection as harder still to teach. Bioethicists, especially those who are physicians or physician extenders, reflect on moral issues complicating all aspects of modern health care. I posit that healing processes and encounters exist prior to the realization of a dilemma or moral conflict. The salutary good of biomedicine precedes the angst of moral doubts. The healing arts become refined as a reaction to and reflection of our injury, our insanity, or our corporal corruption. I refer to biomedicine because science and technology