Sterbewünsche von palliativ versorgten Menschen in schwerer Krankheit
Investigations in Hermeneutical Bioethics
PhD Thesis by Kathrin Ohnsorge
Promotor: prof. dr. G.A.M. Widdershoven; Co-promotor: prof. dr. C. Rehmann-Sutter
Accepted by the VU University Medical Centre Amsterdam, Dept. of Medical Humanities 2015
Health care practice gives rise to many morally challenging situations and involves complex ethical choices that bioethics attempts to answer. In a period in which we cannot longer premise that we simply share higher principles or the same epistemic ground of moral experiences, recurring to foundational values or principles as a model for moral judgment appears not longer to be reasonable. But even if it seems inappropriate - given moral pluralism - to rely on an ultimate foundation for ethical justification, we nevertheless need to be accountable to each other. We still have the basic ethical task of giving each other reasons to justify our respective moral claims and commitments, and of working out from there how best to proceed together in finding solutions to ethically complex issues.
If we renounce from an ultimate foundational and deductive approach to ethics, what remains is nothing more (but also nothing less) than to start from the plurality of our moral understandings and to undertake validation within the thick descriptions of our moral practices. It then becomes more important to make explicit our guiding normative understandings around a moral question and test them against others through inclusive dialogical processes, rather than relying on an abstract ethical justification, which assumes ‘objectivity’, reflecting a singular perspective.
This thesis is based on the idea that hermeneutic bioethics implies epistemological and anthropological premises that make ethics a dialogical practice rather than a set of theories that can be monologically applied. By stressing the primacy of practical over theoretical knowledge, hermeneutics assumes that our representations of things are grounded in our non-explicit, practical engagement with the world (Heidegger 1927). Through the things we do, we acquire elementary and experiential knowledge, moral knowledge included. This knowledge is not primarily general, cognitive or conscious, but particular, practical, and embodied. By engaging in social practices and sharing a particular life-world, we take up local skills of moral perception, we learn how to attribute moral meaning, engage in moral commitments, what others expect from us, and what we expect from others. Rather than existing a priori, moral knowledge emerges primarily through shared living in social practices. Through our different moral experiences, local traditions and communities, we develop moral understandings that make us interpret moral situations, behavior and choices in particular ways and help us to find resolutions of solving moral issues.
On these epistemological and anthropological grounds, I have defined in the introduction four consequences that are characteristic for practicing hermeneutic bioethics. I will in the following refer to these for points to answer to the central question of the thesis (see below). The four points are:. First, hermeneutic bioethics sustains that practical moral problems can only be significantly addressed if ethical evaluation remains dedicated to the participants’ local practical ethical knowledge and the subjective meanings a particular moral practice has for them. From a hermeneutic perspective, ethical investigation should therefore begin with a joint effort to explore the subjective meanings and moral understandings experienced by participants actually concerned with a moral problem. These subjective moral understandings play an ongoing role throughout the entire process of ethical evaluation. Second, the plurality of moral experience, epistemic background-conditions and moral interpretations implies the need for an ethical evaluation through a dialogical process in which participants explain and negotiate moral interpretations. As a consequence, hermeneutics envisions ethical evaluation as a shared process of mutually accounting to one another for one’s moral actions or positions by exploring each other’s moral points of view, particular reasoning and underlying values, by dialogically testing particular moral knowledge and ethical claims against those of others including wider ethical principles. Third, through this dialectical, reciprocal process of going back and forward between perspectives, by opening to another persons’ moral experiences and convictions, the dialogue partners are able to explain themselves, question their own points of view and those of others, integrate new insights and even revise their position. Consequently, this leads to moral learning and new moral understandings, which allow participants to then determine which is the ethically wisest way to proceed together. Fourth, the role of the bioethicist in a hermeneutic perspective is not that of a specialist who advises on ethically right solutions or justifications, rather it is that of a “scholar” who leads and sustains the critical-dialogical process of ethical evaluation.
(From the Conclusions chapter)
Buchpublikation: research.vu.nl/en/publications/investigations-in-hermeneutic-bioethics