Richard M. Zaner

Listening or telling? Thoughts on responsiblity in clinical ethics consultation

This article reviews the historical and current controversies about the nature of clinical ethics consultation, as a way to focus on the place and responsibility of ethics consultants within the context of clinical conversation — interpreted as a form of dialogue. These matters are approached through a particularly compelling instance of the controversy that involves several major figures in the field. The analysis serves to highlight very significant questions of the nature and constraints of clinical situations, and the moral responsibility and legal accountability that are especially important for clinical ethics consultants.

Power and hope in the clinical encounter: A meditation on vulnerability

A specific clinical encounter in which the author was an ethics consultant, after a brief summary, provides the basis for a phenomenological delineation and explication of the key ingredients of such encounters. A brief historical reflection on the myths of Gyges and Aesculapius suggests that several of these ingredients are essential to clinical encounters and help constitute their specific moral aspects and challenges. Understood as an interpersonal relationship framed by critical issues of illness experiences, the clinical encounter makes prominent such constitutive features as dialogue, trust, violence, and especially vulnerability and power. The role of the clinical ethicist is found to be often critical in these encounters, in particular because of the need to help patients and doctors identify, understand, and cope productively with fundamental moral phenomena.

Making Music Together While Growing Older: Further Reflections on Intersubjectivity

I am deeply gratified to have been asked to give the Alfred Schutz Memorial Lecture, an occasion that is something of a homecoming for me. Not only was I privileged to have studied with this great and gentle man, albeit merely for a brief three semesters just before his untimely death in 1959, but my very first published article was devoted to Schutz, and, mores the wonder, it was an effort to make sense of his understanding of intersubjectivity,2 published in the Spring (Zaner, 1961 ), at the same time I received my doctorate (and the first Alfred Schutz award for the outstanding dissertation) from the Graduate Faculty of The New School.

On Evoking Clinical Meaning

It was in the course of one particular clinical encounter that I came to realize the power of narrative, especially for expressing clinically presented ethical matters. In Husserlian terms, the mode of evidence proper to the unique and the singular is the very indirection that is the genius of story-telling. Moreover, the clinical consultant is unavoidably changed by his or her clinical involvement. The individuals whose situation is at issue have their own stories that need telling. Clinical ethics is in this sense a way of helping patients, families, and, yes, health providers to discover and give voice to those stories. In this way, clinical ethics is an evoking of meaning. Kierkegaard understood this well: Indirect communication is the language for the unique and the otherwise inexpressible.

Phenomenology and the Clinical Event

Attention to the clinical event for its own sake and as an exemplification are distinguished. Several of its essential features are delineated: situational and contextual determinants, complex asymmetry, inherently moral character, and reflexive nature of any clinical event. Dialogue is suggested as illuminating each of these features.

Thinking about Medicine

The acceptance of many new medical procedures is fueled by their being promoted as ‘treatments’ promising to correct or ameliorate some ‘condition,’ rendered as both awful and ‘medical.’ In vitro fertilization is a clear instance.

How serve the common weal

ist rhetoric. Even an adjective such as human in the phrase human embryo might be seen as potentially biased if the story has previously made it clear (e.g., in a headline or lead sentence) that human embryos are indeed the subject of discussion when “embryos” are subsequently mentioned.1 Therefore, one might hypothesize that journalists tend to minimize words and phrases that evoke ethical considerations. At the same time, news outlets tend to cover conoict and controversy rather than consensus. They tend to cover threats rather than the absence of threats. There is an audience for portrayals of science as an inherently dangerous and somehow antihuman pursuit, and there is no shortage of scientists, scholars, religious leaders, and political activists who will provide journalists with colorful quotations regarding the potential perils of human embryo research. Thus, one might hypothesize that journalists will foreground ethical considerations in their coverage of human embryo research. Unfortunately, Cheshire’s research does little to help us determine which, if any, of these hypotheses of sorts might be fruitfully investigated. Still, his article can be cautiously recommended to researchers who would hope to devise a content analysis procedure with which to assess media coverage of human embryo research. The type of statements that Cheshire assesses are seemingly relevant. Subsequent research would do well to code explicit assertions about the moral status of the embryo (and to code the sources to whom these statements might be attributed). Cheshire is also helpful in noting that many statements seem to tie the moral status of the embryo to whether or not the embryo was somehow wanted or needed by someone. This suggests that the frameworks with which news organizations cover abortion are relevant in understanding news coverage of human embryo research. In brief, much work remains to be done on this important topic. Cheshire provides a start, albeit a slow and hardly exemplary start. Let us hope that this topic will soon be rigorously and assiduously investigated. ■

Surprise! You’re Just Like Me!

Although some scientists’ public announcements of research tend to the hyperbolic, the recent success in cloning technology and its implications for the future have proven to be immensely significant for science, morality, and politics. Indeed, worldwide public reactions to the prospect of human cloning have been as fascinating as the science. This is evident from certain immediate responses to the President’s National Bioethics Advisory Commission, in particular, by the self-described American Bioethics Advisory Commission, and from certain media reports. Both the science and the public responses are analyzed in relation to the long history of medical reflections and research relating to human life, which, it is suggested, needs careful study, and leads to reflections on nineteenth century science, to the earlier work of Francis Bacon, and in turn, to earlier historical ideas from ancient Greek physicians. The connections to in vitro fertilization and embryo transfer are especially relevant for the significant ethical issues, the public reactions to new technology, and the ambivalence in both public and professional literatures.

Illness and the Other

Not long ago I received a call from a physician who wanted me to stop by to see one of his patients — a young man who had been hospitalized a week prior and was adamantly refusing hemodialysis. Although dialysis would surely be beneficial, his refusal would mean he would die.

Medical image management: practical, legal and ethical considerations.

The data acquired by the new medical imaging techniques, in many ways, exceeded our ability to properly store, transmit and use the images produced. As diagnostic imaging procedures become progressively less invasive and traumatic, they are being applied to a much larger patient population. The decrease in memory and other instrumentation costs, along with expanded technological capability of computer systems, has provided medicine an opportunity to create network systems for the storage, processing, recall, and remote location of these diagnostic images. Therefore, problems of access and confidentiality have become increasingly important. This communication will consider certain medical, legal, and ethical aspects of these technologies of data acquisition, storage, manipulation and retrieval.