Particularism in Bioethics, ProfessionalEthics,andMedicine
Institute for Humanities and Social Sciences Research,
Manchester Metropolitan University
All sessions to be held in Business School G.33 Ground Floor Lecture Theatre 4
Thursday 19 June 2014
9.00 – 9.30 Welcome and Registration
9.30 – 10.45 Ulrik Kilhbom (Uppsala): ‘Doing Particularized Bioethics and the Shape of Context’
10.45 – 11.00 Tea and Coffee
11.00 – 12.00 Steve Edwards (Swansea): ‘Moral Realism in Health Care’
12.00 – 13.00 Per Nortvedt (Oslo, UiO): ‘Particularism, Principlism and Professional Evil Doing’
13.00 – 14.00 Lunch
14.00 – 15.15 Alan Thomas (Tilburg): ‘A Life of Virtue or a Life of Principle?’
15.15 – 16.15 Anne Raustol (Oslo, Diakonhjemmet): ‘Partiality and Impartiality in Nursing’
16.15 – 16.30 Tea and Coffee
16.30 – 17.30 Anna Bergqvist (MMU): ‘Particularism and Person Centred Medicine’
17.30 – 18.15 Roundtable Discussion, featuring invited contributions from Dr Michael Loughlin (MMU Cheshire) and Dr Emma Bullock (KCL) among others.
18.15 Workshop Close
Anna Bergqvist Email: A.Bergqvist@mmu.ac.uk
Book of Abstracts
Ulrik Kilhbom: ‘Doing Particularized Bioethics and the Shape of Context’
Abstract: The aim of this talk is to say something helpful about what particularism can bring to bioethical inquiry with special regard to such research with mixed methodologies, i.e., bioethical research involving both empirical and more normative theoretical work. I will attempt this by considering two ethical cases, one clinical case and one public health case, in light of which different theoretical approaches to bioethics will be discussed. Particularism will be in focus with special concentration on how particularist notions such as shape, salience and silencing can be brought to bear on ethical problems and how particularist thought may influence assumptions behind both the design and the interpretation of empirical studies in bioethics.
Steve Edwards (Swansea): ‘Moral Realism in Health Care’
Abstract: For more than 15 years Professor Per Nortvedt has been arguing the case for moral realism in nursing and the health-care context more generally. His arguments focus on the clinical contexts of nursing and medicine and are supplemented by a series of persuasive examples. Following a description of moral realism, and the kinds of considerations that support it, criticisms of it are developed that seem persuasive. It is argued that our moral responses are explained by our beliefs as opposed to moral realities. In particular, two key arguments presented by Nortvedt are challenged: the so-called argument from convergence and the argument from clinical sensitivity. Both of these key planks in the case for moral realism are rejected, and an alternative ‘social conditioning’ account briefly sketched, which, it is claimed, has the same explanatory power as Nortvedt’s thesis but does not rest on an appeal to independently existing moral properties.
Per Nortvedt: ‘Particularism, Principlism and Professional Evil Doing’
Abstract: The paper will address the relationship between a specific theory of value (moral realism) and ethical particularism. The essence of the talk will be to defend a version of naturalism in ethics which I will call perceptual realism. I will address some critique of my position recently presented by Steve Edwards in the Journal of Nursing Philosophy. Finally, I will ask: Is there a moral epistemology that is psychologically realistic and motivationally plausible given particular social, cultural and political influences? The particular breakdown of professional medical ethics in Nazi Germany will be the case for this discussion.
Alan Thomas: ‘A Life of Virtue or a Life of Principle?’
Abstract: Jonathan Dancy has suggested that it would be a “cosmic accident” it a particularist account of ethics and a generalist account of ethics were both true of our ordinary ethical practices. Can we say more than this – are there any practical reasons for preferring one of these views over the other? (On the assumption that they are equally good as explanations of our practice.) Reflection on the nature of virtue, practical intelligence and whether a good life ought to be beneficial for the virtuous person shows that our account of virtue and particularist judgment operate in harmony with each other. Generalism, by contrast, is likely to be destructive of a life of virtue. Virtuous people decide what to do in any situation with reference to an overall sense of worthwhileness; intelligent people have the meta-level capacity to manage their own intellectual resources. Practical intelligence – where these two features come together – contributes to be the development of virtue. The only plausible form of generalism, that sees us as guided by a compact set of highly abstract principles, would be a fruitful source of ethical error and would, therefore, impede the development of a life of virtue satisfactory to the agent. On reflection, it would be better to be a particularist about the nature of practical judgement for what are, themselves, ethical reasons.
Anne Raustøl: ‘Partiality and Impartiality in Nursing’
Abstract: We see a growing move towards more person centred health care ethics. This tendency may be a reaction to increasingly rule-governed health care systems and quality assurance systems. However, nursing has a long tradition for focusing on the individual patient in its professional ethics, also long before the “monster” of New Public Management entered the health care scene.
There are important lessons to be learnt from the professional practice of nursing, where care for the individual patient is central. On the other hand, a focus on a concern for the individual patient can become imbalanced. Professional roles are centrally governed by impartial concerns as well as partial concern for the individual patient. In this paper, I point out that professional ethics must accommodate for an unavoidable tension between partiality and impartiality, instead of trying to resolve it by relying too one-sidedly on either person-centred partiality or rule-based impartiality. Such balanced accommodation requires sound professional-moral judgement.
Anna Bergqvist: ‘Particularism and Person Centred Medicine’
Abstract:Moral particularism is a philosophical tradition that emphasizes the significance of context in understanding the dynamics of practical rationality and decision-making. According to particularists, moral thought and judgement neither need nor should be principle-based but rather requires the exercise of discernment on a case-by-case basis. This parallels recent developments in debates over the role of judgement in professional ethics and medical epistemology.
Academic researchers from disciplines as diverse as epidemiology and bioethics have attempted to devise models of clinical reasoning to assist practitioners in vital decision-making. In particular, the evidence-based medicine (EBM) movement has made significant impact on thinking and policy regarding clinical reasoning, promoting the application of research-evidence from randomised controlled trials to clinical decision-making. There remains, however, a gap between the EMB model (and variants upon it) and the practice it aims to inform. Recent attention given to personalised and person-centred medicine represents a shift in focus from acquiring statistically reliable knowledge of a general nature to an interest in the complex and potentially unique features of real cases in the search for a more integrated ‘humanistic’ approach to care. This paper focuses on certain key methodological questions that are raised by the distinctive particularist philosophical model as applied to medical epistemology. I argue that we can make progress by problematizing the use of concepts such as perspective and narrative in debates concerning evidence-based medicine its person-centred alternative.
The Institute for Humanities and Social Science Research
The workshop is being run under the auspices of the Institute for Humanities and Social Science Research (IHSSR), which facilitates interdisciplinary philosophical and empirical research in the medical humanities. The workshop also serves as a start-up networking event to establish a collaborative transnational research network comprising MMU (UK), Tilburg University (The Netherlands), Uppsala University (Sweden), University of Oslo and Diakonhjemmet University College (Norway).
The network has strong links with a series of IHSSR funded workshops during 2014, led by Dr Loughlin, on the topic ‘Evaluative Perception and Clinical Reasoning: Incorporating and Understanding of the Uniqueness of Cases in Clinical Decision-Making and Policy’. It also builds on previous IHSSR funded collaborative research activities between Drs Bergqvist and Raustol, a collaboration that also involved an externally funded ERASMUS Staff Mobility teaching activity scheme on moral discernment and particularism in nursing by Bergqvist at Diakonhjemmet in Oslo during Spring 2014.
The organisers gratefully acknowledge the generous support of the Society of Applied Philosophy, the Mind Association, and the MMU Institute for Humanities and Social Science Research (IHSSR).