The context as a moral rule in medical ethics

Abstract

A purely deductive medical ethics cannot properly account for the varieties of circumstances which arise in medical practice. By contrast, a purely inductive medical ethics lacks sufficient guidance from ethical principles. In resolving ethical dilemmas in medicine, most often an appeal is made to middle-level axioms and methodological rules to mediate between theory and practice. I argue that this appeal must be augmented by considerations of context, such considerations, in effect, constituting a moral rule based on the social structure of medical practice. A contextual grid is proposed which assists the process of weighing values in resolving cases.

KIE: A major difficulty in developing a workable medical ethic is that a purely deductive ethic cannot be applied to individual patients and is useless to practicing physicians, while an inductive approach to treatment dilemmas lacks guidance from ethical principles. Thomasma delineates and critiques attempts by several thinkers to bridge the distance between abstract principles and individual cases, identifying these attempts as acceptance of absolutist principles, casuistry, and development of intermediate norms. He then presents his own contextual grid for medical ethics as a means by which to locate a moral problem and the values and principles at issue within that locus. After laying down the assumptions upon which it is based, he diagrams a possible grid, provides some examples of its contents, and describes the grid's usefulness as a bridge between the abstract and the concrete.