Physician, Know Thyself: The Role of Reflection in Bioethics and Professionalism Education

Wasson, Katherine; Bading, Eva; Hardt, John; Hatchett, Lena; Kuczewski, Mark G.; McCarthy, Michael; Michelfelder, Aaron J.; Parsi, Kayhan

doi:10.1353/nib.2015.0019

Cited by 19 publications

(28 citation statements)

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“…Ours is, as a result, an individualized, privatized version of modernity, with the burden of pattern-weaving and the responsibility for failure falling primarily on the individual's shoulders. 149 For all its flaws, I choose to retain the notion of deinstitutionalization because the term signifies the "foregrounding" of moral agency, through the "routine contemplation of counterfactuals" (Giddens).…”

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“…148 Zygmunt Bauman, Liquid Modernity (Cambridge: Polity Press, 2012), 7. 149 Bauman, Liquid Modernity, 7-8. Elsewhere, Bauman spells out the existential implications of "liquid" institutional life: "Ours are the times of strongly felt moral ambiguity.…”

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“…Carver's? 150 It is also reflected in the many positive decisions which must be made in order to avoid death in the ICU. 151 Even after someone has been placed in home hospice care, it is not uncommon for her to end up dying in the hospital.…”

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“…150 It is also reflected in the many positive decisions which must be made in order to avoid death in the ICU. 151 Even after someone has been placed in home hospice care, it is not uncommon for her to end up dying in the hospital. Hospice nurses and physicians often must urge home caretakers to call them instead of emergency services, for a knee-jerk 911 call will undo previous efforts to enable a home dying.…”

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“…Where once there were scripts for dying, we are now thrown back upon our own resources. Unhinged from strong institutions of family and church, sequestered in private hospital rooms and shielded from public view, these decisions must be made in a highly subjective manner, often accompanied by considerable existential 150 "Slow codes" are generally condemned by medical ethicists and physicians. For an ethical defense of "slow codes" see John D. Lantos and William L. Meadow, "Should the "Slow Code" Be Resuscitated?"…”

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Burdened Agency and End-of-Life Ethics: A Theological Analysis

Pickell

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This dissertation highlights central changes that have arisen with respect to common experiences of dying in modern, Western, industrialized societies. It argues (in Chapter 1) that late-modern dying is marked by a phenomenon called "burdened agency," which means that individuals (patients, proxies, and health care professionals) are increasingly expected to make decisions about the nature and timing of death. Moreover, such decisions are experienced as especially burdensome in a highly-reflexive social context, such as our own, in which death and dying have been largely de-institutionalized. When social and cultural norms fail to provide guidance to the dying, individuals are forced to seek meaning in an intensely private, individualistic and reflexive way. But the conditions of our modern dyingincluding the social isolation of the elderly and dying, social taboos about discussing death, the changing disease burden and illness trajectories, societal assumptions regarding human suffering and the use of technology, and other institutional realities-generally serve as hindrances to such meaningmaking, and leave individuals in a precarious existential position as they seek to navigate the agency they so ambivalently possess.This dissertation further argues (in Chapter 2) that the most prevalent "scripts" for dying today, including the technological dying of the Intensive Care Unit (ICU), hospice and palliative medicine, and physician-assisted suicide and euthanasia, all have shortcomings which must be acknowledged. Additionally, each script reflects moral norms that are embedded in the "modern social imaginary." Interestingly, the practices of dying in our society reflect substantive notions about human personhood and moral agency that are characteristically modern, including the relationship of freedom and authenticity to human dignity, the affirmation of everyday life, and a commitment to avoidance of suffering. These notions seem self-evident to many today, but they also assume a mode of moral agency that is active, marked by control over nature and contingency. This view is hard to square with the eventuality of death.The central chapters of this dissertation explore and analyze three Christian perspectives on death and dying. As the predominant practices and discourses surrounding death and dying reflect latent views of human agency and personhood, so do theological notions of death reflect particular assumptions about what it means to be human and what it means to be a moral agent. Chapters 3-5 describe the relationship between death, dying, and human agency with respect to the tradition of Roman Catholic moral theology, 20 th century Swiss Protestant theologian Karl Barth, and the contemporary theological ethicist Stanly Hauerwas. Chapter 3 suggests that Roman Catholic moral theology, especially after Vatican II, encourages a "spirituality of martyrdom," which views death under the aspect of submission, and which sees such surrender as a "witness" to divine providence and goodness. Chapter 4 presents...

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