Abstract
I want to pick up where I left off in Chap. 3. In some respects, it is peculiar that, in the face of the resounding backlash against ‘Big Ethics,’ as it was often called in the 1970s, some physicians continued to entertain the notion that philosophers should, and some of them argued must, become “involved” in clinical medicine. Around the same time (early 1980s) as Alan Fleischman was putting his program for residents in place, for instance, the pediatrician Tomas Silber stated his belief that without such actual, regular involvement in clinical affairs, what he termed the “data base” for understanding, much less contending productively with, the moral issues he regarded as inherent to the daily practice of at least pediatric medicine, would be plainly missing. Precisely that “base” is necessary, he argued, for the medical tasks at hand in any clinical situation. Thus, quite understandably, Silber lamented the “absence of these professionals”—that is, philosophers—“from our daily lives,” although, with Siegler, he endorsed the idea that physicians must for their part immerse themselves in philosophy and theology (Silber TJ, Pediatric Ann 10:13–14, 1981).
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- 2.
This switch from “typification” to “paradigm” obscures precisely what Jonsen otherwise wants to emphasize: the common uncertainties ingredient to such situations as attract his attention—which ‘paradigm’ hardly makes patent.
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In Jonsen and Toulmin’s study, this point is even clearer. For instance, they state that the “first substantive task [of casuistry] is to agree just which ‘paradigm’ best fits the circumstances in question” (Jonsen and Toulmin 1988, p. 308). By “fit” it is clear they mean “apply,” as is stated explicitly a bit later: “Deciding what type case, or paradigm, best applies in any given circumstance,” even though this is said to be “only the first step…” (pp. 311, 312). My point is merely that it is quite difficult to see much difference between the casuist and the applied ethics models their argument for a difference seems a matter of smoke and mirrors.
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Zaner, R.M. (2015). Openings into Clinical Ethics. In: A Critical Examination of Ethics in Health Care and Biomedical Research. International Library of Ethics, Law, and the New Medicine, vol 60. Springer, Cham. https://doi.org/10.1007/978-3-319-18332-9_5
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