Tacit components of medical ethics: Making decisions in the clinic

When a patient visits his doctor there is, as well as a By contrast, my contention is simply that the shared spoken dialogue, also an unspoken, or tacit, dialogue Judeo-Christian heritage is pluralistic in its implicabetween them. This may not be evident unless that tions. While this heritage may contain a common dialogue breaks down when the psychological or sense of moral obligation between persons, the moral terms of reference of each are seen to be moral obligations obtaining between medical prodifferent. The author of this paper tries to elucidate fessionals and their patients is less clear and often the framework in which physician and patient think, problematical. The assumption that there exists and in so doing allow an understanding of why the between physicians and patients an anchor of physician may appear to be rigid and authoritarian common reference in which moral reasoning is in his dealing with his patients and the patient grounded is an unwarranted generalization. uncooperative. The conventional approach to medical ethics, exemplified at its best by Ramsey and by Smith, '... I distrust the universals that are not reached by focuses upon the application of rules or principles way of profound respect for the significant features to particular cases. This approach takes it for and outcomes of human experience as found in granted that the task of ethics is the delineation and human institutions, traditions, impelling interests clarification of choices; it is essentially the task of and occupations.' interpreting rules or principles in such a way as to JOHN DEWEY illuminate the various moral implications which different choices involve. Such a process is, of course, fundamental to ethics. Yet this particular