Kirklin, D; (2005) The Search for Meaning in Modern Medicine. Doctoral thesis , UNSPECIFIED.

Abstract

This thesis argues that an approach to ethical analysis which combines an enhanced appreciation of the context within which illness is experienced with an acknowledgement of the highly constructed and inter-subjective nature of moral reasoning has something of value to offer to impartialist ethicists. A detailed justification of this claim, supported by numerous examples of how this approach can be used in practice, both when using reason to address ethical problems or issues that arise in medicine or the life sciences and when exploring these concerns in educational settings, is provided. The following areas of modern medicine are used to examine these issues in greater detail: the new genetics, end of life issues, organ donation, reproductive medicine, and women’s health. Examples are given of educational initiatives that use the arts and humanities to provide a human context for medicine and for the moral decisions that its practice involves. Through a detailed analyses of a number of contemporary ethical issues, this thesis endeavours to give substance to the claim that ethical examination of the challenges of modern medicine can be enhanced by an examination and awareness of the context within which doctors and patients interact and are asked to make morally relevant decisions. The examples given are by no means exhaustive. Instead they are chosen in an attempt to illustrate the need to ask searching questions about context, framing, and meaning, if the application of impartialist ethical principles is to lead to both sound and persuasive analyses. A practical approach is outlined which draws on these theoretical ideas and is grounded in clinical practice. It is argued that an enhanced appreciation of the context for ethical issues, by informing the ethicist’s choice of framing, language and narrative construct, has the potential to alter the nature of the ethical debate. Moreover, it is argued that the methodologies of narratology can enable a cogent analysis of the immanence of power relations within health care, and that understanding these power relations is an essential step in determining what matters to those affected by illness, and to ensuring that their voice is heard. By the concluding chapter this thesis aims to show that if moral imperatives are to have meaning for those they affect, and to be incorporated into their behaviour and expectations, whether as doctor or patient, then the rich complexities of the language through which ethical debates are conducted, the conceptual realities of patients, families, professional carers and society, and the context within which we all make decisions, will need to be acknowledged by and incorporated into the stories ethicists tell.

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