Coercion, Conversation, and the Casuist: A Reply to Jay Katz

Abstract

The practical world of clinical medicine, like all other practical worlds, is inhabited by unacknowledged theoretical demons. A central task of philosophical reflection is to recognize and, where necessary and possible, exorcise them. Men and women in medicine typically view their work as empirically-oriented, a-philosophical, presuppositionless, practical, and free of demons and ghosts. A practical consequence of this innocent and pervasive perspective is that inhabitants of the temples of Aesculapius think philosophical reflection irrelevant and occasionally intrusive; to them it is at best a burdensome cultural knapsack — functional in a pinch, but (like most carried across campus these days) not very decorative. We cannot, however, proceed without assumptions, and philosophy is the critical examination of key assumptions. To push the simile to extremes is bad form, but one slight shove may be permitted: the knapsack, if it contains some survival gear, may at times be respected and therefore the bearing of it worthwhile. Busy with the demanding care, for example, of critically ill patients, one’s philosophical assumptions are seldom worrisome to practical health professionals, who do not often think of themselves of their behavior as shaped by their unrecognized or unexamined presuppositions. Fortunately there are exceptions.