The Priesthood of Bioethics and the Return of Casuistry

Abstract

Several recent attempts to develop models of moral reasoning have attempted to use some form of casuistry as a way to resolve the moral controversies of clinical ethics. One of the best known models of casuistry is that of Jonsen and Toulmin who attempt to transpose a particular model of casuistry, that of Roman Catholic confessional practice, to contemporary moral disputes. This attempt is flawed in that it fails to understand both the history of the model it seeks to transpose and the morally pluralistic context of secular, postmodern society. The practice of casuistry which Jonsen and Toulmin wish to revive is a practice set in the context of a community with a shared set of moral values and structures of moral authority. Without a set of common moral values and rankings, and a moral authority to interpret cases the casuistry of the postmodern age will be pluralistic, that is, there will be many casuistries not just one.

A Historical Perspective of Casuistry and its Application to Contemporary Biomedical Ethics

“…Over time, casuistry, as a model of moral reasoning, fell out of favor except in a few particular circles within Roman Catholicism, Judaism, and some denominations of Protestantism. 18 To this day. Raget's Thesaurus lists the following synonyms , among others, for casuistry: equivocation, mystification, word-fencing, hair-splitting, claptrap, mumho-jumbo, empty-talk, quibbling, chicanery, subterfuge , and cop-out.…”

The Face of Suffering

“…On the other hand, examining those occurrences while carefully neutralizing any possible bias due to other relevant factors may yield results having little to do with the daily, human world which is full of such relevant factors. Such an imaginary moral theater may fail to resemble the real world, as the actors brought to the stage are not genuine human beings as we all know them When, for example, the patient -provider relationship is reconstructed in terms of a legal contract, health care providers correctly refute any conclusions beforehand based on such an ethical thought-experiment The same can be said for Rawls' attempt to devise a theory of justice by first imagining a world of human beings who know nothing about their human condition (neither their gender, age, race, physical and mental condition etc , nor the social, geographical, historical and other contextual variables of their existential situation), and by wondering next how these men »behind their veil of ignorance« would decide about allocation of scarce resources and the like [Rawls 1971] 2 < Much of what is said in later chapters has many similarities with Wellman's thoughtexperiments While an attempt is made to better account for relevant facts, thought experiments imply probability which can be reduced only by reproducing the experiment The reader will need to recapitulate the experiment If, in the end, the reader can underwrite the results, the general conclusions will be validated, as much as duplication validates scientific claims Casuistry If we are looking for a method of reasoning that allows us to draw compelling conclusions from the circumstances of the unique situation, other than by means of deductive or inductive strategies, we may turn to casuistry, if only because the name suggests a casebased approach Casuists, thus Jonsen and Toulmin summarize in their recent overview study The Abuse of Casuistry A history of moral reasoning, insist that " circumstances make the case " [Jonsen and Toulmin 1988, ρ 254] The authors suggest to define casuistry as "the analysis of moral issues, using procedures of reasoning based on paradigms and analogies, leading to the formulation of expert opinions about the existence and stringency of particular moral obligations, framed in terms of rules or maxims that are general but not universal or invariable, since they hold good with certainty only in the typical conditions of the agent and circumstance of action" [p 257] M This complex 24 Vitek has listed five features of proper though-stimulating examples in moral philosophy Complexity, priority, relevance, accessibility and resonance [Vitek 1992] 25 In this section on casuistry, I dwell mostly on Jonsen and Toulmin's versions of casuistry, in spite of their theory not being the sole contemporary casuistic approach to bioethics [see for example, Brody 1988], and in spite of criticism that their theory would be anachronistic for relying too heavily on a medieval model ot society which no longer applies [Wildes 1993] Brody's more modern, pluralistic version of casuistry may reflect more closely contemporary clinical-ethical decision-making as it actually occurs in health care institutions, but it seems (continued )…”

La casuística: Un ensayo histórico-metodológico en busca de los antecedentes del estudio de caso

“…Esa disputa reproduce muchos de los viejos argumentos ya exhibidos por pascalianos y casuistas (vid. Kucsewski, 1998;Strong, 1999;Tallmon, 1994;Wildes, 1993;McKinney, 1995). Por ejemplo.…”

“…Nuevos campos, no sólo los de la ética y la moral, están siendo considerados, usando la casuística como una aproximación metodológica emergente: estudios sobre la paz, ecología, prensa (Boeyink, 1991), ingeniería (Pavlovic, 1985), medicina y bioética (Tomilinson, 1994;Wildes, 1993) y estudios feministas (Sichol, 1992). Así pues, no sería arriesgado hablar del retorno de la casuística o que ha vuelto a estar de moda.…”