What Reason Can Do for Clinical Moral Perception

Abstract

The need for expansive, generous clinical moral perception and for mutual regard and respect in physician-patient and physician-physician relationships is the central lesson of the valuable target article by Rentmeester and George (2009). But their approach-how they discern and frame problems, how they analyse and argue about problems, and how they develop recommendations for handling problems and for institutional responses to prevent problems-evinces an equally important lesson about the nature of method and reason in bioethics in particular and medicine and morality in general (and, indeed, elsewhere). That lesson concerns the need for a more open, experiential orientation to people and problems, including moral problems, and for a supporting enriched, non-formal conception of reason to design, direct, and develop bioethical positions.The approach of Rentmeester and George (2009) emphasizes that physicians as well as patients are vulnerable human beings who experience emotions that can either support or hinder doctor-patient relationships. In particular, emotional distress can distort judgement and corrode, if not block, relationships. Their aim is to help physicians recognize their emotional distress and manage it in ways that prevent or at least mitigate its deleterious consequences. That goal is a dramatic contrast and corrective to narrow bioethical analyses of the physician-patient relationship that confine it to a locus of decision-making authority, where doctors engage in expert deliberation based on applying general principles such as 'do no harm' and 'respect autonomy' with the outcomes of rational diagnosis and patients apply rational analysis within the constraints of what they learn and comprehend to reach their decisions. That kind of analysis reduces patient and physician to ciphers in a grand theoretical exercise.Underpinning that exercise and rendering it rational is a conception of applied ethics in which the conclusions of both patients and physicians are deduced from general principles combined with local clinical conditions. Rationality here is understood formally and identified with logic or utility maximisation. This hegemonic conception of ratio-

Let's Blame the Physicians … Again: Physician Legalism and Countertransference

“…The refusal of freedom and objectification of human responsibility (for self and other) as autonomy which this habit engenders provides important support for the troublesome ethical framework of the applied ethics model in contemporary bioethics (Hoffmaster and Hooker 2009;Schultz and Carnevale 1966;Schultz and Flasher 2009;Veatch. 1991).…”

Counter-Transference and the Clinical Ethics Encounter: What, Why, and How We Feel During Consultations

“…Others have encouraged a similar process with nonpsychiatric physicians in order to improve patient care, prevent physician burnout, and expand clinical moral perception. 25,26 When consultants identify cases that are likely to create emotional distress in themselves or cause them to lose sleep at night, they, by themselves or with the assistance of a colleague and in a situation conducive to thoughtfulness, may ask themselves a series of guided questions to aid in their reflection: 1) How is the patient/family/surrogate reacting to me? 2) Is this unique or similar to their previous interactions with other members of the healthcare team?…”