Ethics And The Clinical Encounter

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Ethics and the Clinical Encounter explores the moral dimensions of clinical medicine and the phenomenon of illness, to determine what ethics must be in order to be fully responsive to clinical encounters. Written in a lively and conversational style with minimal technical terminology, and enhanced by actual experience or real clinical situations, this volume lays out a clinical ethics methodology both in practical and theoretical terms.
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Product Details

  • ISBN-13: 9780788099397
  • Publisher: CSS Publishing
  • Publication date: 2/1/2004
  • Pages: 356
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.74 (d)

Table of Contents

Foreword: Progress in Ethics vii
Preface x
Chapter 1 Medicine's Challenge to Ethics 1
The Initial Idea 1
The Philosopher's Response 4
Applied Ethics 6
The Backlash Against Ethics 9
The Backlash Continues 11
"Clinical" Versus "Biomedical" Ethics 13
A Clinical Example 14
Critique of the Case 14
Heterogeneity of Moral Views 16
Medicine's Dilemma 18
The Challenge: A First Look 19
Toward Another Approach: A Case Study 21
Developing a Responsive Ethics 27
Chapter 2 The Moral Dimension of Medicine: Preliminary Reflections 29
The Complex Field of Medical Work 30
An Illustrative Case 32
The Social Context of Patients 34
Several Clues to Being Morally Responsive 36
The Moral Resolve and Its Specifications 38
Sources of Moral Conflict 41
Review: Case and Comment 44
The Moral Basis of Medicine: Another View 50
Chapter 3 "How the Hell Did I Get Here?": The Patient's Place in the Therapeutic Dyad 53
A Phenomenology of Illness: Outline 53
Patients Present Themselves 56
"What's Wrong with Me?" "Do You Really Care?" 62
Tears in the Fabric of Daily Life 65
Unavoidable Trust 69
The Experience of Being Cared For 71
Soundings at Uncertain Levels 75
Who Is My Stranger? 80
Power and Vulnerability 84
The Helping Relation as Promise 86
"Telling" Illness: Gratitude and Luck 88
Chapter 4 Patient Discourse and Medicine's History 92
The Complexity of the Field 92
Medicine's Two Sides: A Historical Irony 94
The Text of the Clinical Context 96
The Stages of Clinical Judgment 99
Deficiency of the Received View 102
The Displacement of the Patient 104
Cartesian Dualism 106
The Cartesian Puzzle 108
Descartes as Medical Consultant 110
Descartes's Anatomy and Physiology 112
Dualism Revisited 114
The Body-Machine Analogy 117
The Living Body, the Dead Cadaver: The "Subtle Hoax" 120
The Oddity of Ordinary Life 123
The Post-Cartesian Context 126
The Elusive Everyday: A Historical Theme 127
Chapter 5 Themes from Medicine's History: Interpretive Reconsiderations 130
Human Anatomy: A First Look 132
Between Descartes and Bichat 135
Conflict of Interpretation in Ancient Medicine 137
The First Clue: Interpretation of Symptoms 140
The Dogmatic Doctrine 142
The Empiric Tradition 146
The Descartes-Bichat Difference Revisited 150
Chapter 6 The Anatomist's Conceit, the Body's Cunning 154
Reductivism and Dualism in Current Medicine 155
The Anomaly of Gallows Humor 157
The Soma and the Corpse 159
The Historical Thematic 162
The Postmortem in Medieval Medicine 164
Mind and Body as Historical Artifacts 165
The Corpse and the Soul 168
The Empiric-Dogmatic Dispute Revisited 170
The Therapeutic Dyad Reconsidered 172
A Review of the Terrain 174
Chapter 7 Skepticism in Medicine 177
Hellenistic and Hippocratic Empiricism 177
Medical Methodism 180
The Skeptic's Circumstantial Understanding 182
The Historical Irony of the Human Corpse 184
The Place of Galen 188
Anatomy in the Ancient World 190
The Retreat of Life (Soul) 197
The Improvement of Man 199
Chapter 8 Ethics in Ancient Medicine 202
Medical Morality and Medical Power 202
The Hippocratic Oath and Medical Morality 205
Hippocratic Morality 210
The Ethics of Methodism 219
Summing Up 221
Chapter 9 Clinical-Liaison Ethics: Part I 224
"Why Won't You Let Me Die?" 225
Everyone Did What They Could, Right? 234
What Went Wrong? 236
Ethics as Clinical Liaison 242
Enablement 248
Chapter 10 Clinical-Liaison Ethics: Part II 251
The Work of Helping Strangers 251
Dilemmas of Necessary Distancing 255
The Aftermath of Distancing: Good Times and Bad 259
Addressing Aftermaths 263
Clinical Conversation: A Clue 266
Description in Clinical-Liaison Ethics 267
A Rule of Method 269
Interpretation in Clinical-Liaison Ethics 270
A Second Rule of Method 272
Understanding Moral Themes 273
Topical, Interpretive, and Motivational Schemata 275
The Documentary Method 279
Chapter 11 Trust and Care: Toward a Moral Foundation 283
Review of the Terrain 283
The Idea of the Autonomous Moral Agent 285
Assumptions Underlying Autonomy 288
A Case in Point: The Dialysis Patient 293
Falling Ill 295
The Idea of "Moral Chance" 297
"Accident of Birth" and Moral Imbalance 300
Awakening a Moral Sense: "Good Fortune Obligates" 303
Awakening a Moral Sense: Gratitude and Response 305
The Twofold Meaning of Awakening a Moral Sense 307
The ESRD-Dialysis Patient's "Good Fortune" 308
Illness and the Moral Order 310
Intent in Patient-Physician Discourse 312
Affiliative Feeling: "Put Youself in My Shoes" 315
A Final Word 319
Bibliography 321
Index 329
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