Towards an ethics of authentic practice

Abstract

This essay asks how we might best elaborate an ethics of authentic practice. Will we be able to agree on a set of shared terms through which ethical practice will be understood? How will we define ethics and the subject's relation to authoritative structures of power and knowledge? We begin by further clarifying our critique of evidence-based medicine (EBM), reflecting on the intimate relation between theory and practice. We challenge the charge that our position amounts to no more than 'subjectivism' and 'antiauthoritarian' theory. We argue that an ethical practice ought to question the authority of EBM without falling into the trap of dogmatic antiauthoritarianism. In this, we take up the work of Hannah Arendt, who offers terms to help understand our difficult political relation to authority in an authentic ethical practice. We continue with a discussion of Michel Foucault's use of 'free speech' or parrhesia, which he adopts from Ancient Greek philosophy. Foucault demonstrates that authentic ethical practice demands that we 'speak truth to power.' We conclude with a consideration of recent biotechnologies, and suggest that these biomedical practices force us to re-evaluate our theoretical understanding of the ethical subject. We believe that we are at a crucial juncture: we must develop an ethics of authentic practice that will be commensurable with new and emergent biomedical subjectivities.

What does physicians' clinical expertise contribute to oncologic decision‐making? A qualitative interview study

“…Learning from their own and other colleagues' experiences constitutes a major part of the physicians' professional development. The confrontative picture of the relationship between individual clinical experience and evidence‐based standards sometimes displayed in the literature is, therefore, not mirrored by the study results. Instead, the oncologists indicate that they use their individual expertise and intuition particularly in those situations where a solid data basis is missing or where the patient's clinical situation is so complex that it cannot be fully captured by evidence‐based guidelines.…”

Nursing as ‘disobedient’ practice: care of the nurse's self, parrhesia, and the dismantling of a baseless paradox

“…Despite its ramifications in the public realm, it begins as a private endeavour. Parrhesiastic self‐examination leads to the willingness to learn and educate oneself for one's benefit, for a purpose that is self‐determined, ‘fluid and mobile, … contextual and responsive’ (Murray et al ., , p. 687); a purpose that is in keeping with one's sense of ethical and political agency, rather than a set of external norms or standards.…”

“…As such, Murray et al . (, p. 687), citing Hannah Arendt, contend that:

It is an ethical and inescapable obligation to be‐with‐oneself … I have an infinite obligation to myself first because I cannot get free of myself, I cannot stop up my ears to this speech, as it were. I am condemned to live with myself.

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Evidence‐based healthcare, clinical knowledge and the rise of personalised medicine

“…The authors' immediate concern is to define their use of the word ‘authenticity’ and what sort of ethics relate to it, re‐iterating their defence of the role of theory in the applied sciences, arguing that without theory, practice is blind and demonstrating that, without critical theoretical insight into the epistemological and political assumptions that underpin the logic of EBM, EBM amounts to an unethical and dangerous practice [47]. The authors engage directly with Miettinen and Miettinen [49] in terms of the latter authors' central arguments and advance three counter‐arguments to Miettinen and Miettinen's thinking on the nature of evidence, authority and professional integrity, before proceeding to examine the nature of the relationship between an ‘ethics of authentic practice’ and ‘authority’, by drawing on a range of philosophical sources such as Derrida, Arendt and Foucault [47]. They are clear that rapid advances in modern Medicine threaten to outstrip our intellectual and ethical capacities to make sense of them from an existential position, increasing, perhaps, the urgency with which an ethics beyond good and evil, beyond authoritarianism and anti‐authoritarianism needs to be developed and they call for the immediate dismantling of the power and moral authority of EBM in the name of an ethics of authentic practice.…”