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Cases and culture

The benefits and risks of narrating “life as lived”

By Michael A. Ashby and Leigh E. Rich

In Utilitarianism, John Stuart Mill wrote that “[t]here exists no moral system under which there do not arise unequivocal cases of conflicting obligation” (1957, ¶2.25). This is what makes the practice—as well as the teaching—of bioethics so difficult and the reason that many students and members of the general populace are wont to believe that doing “the right thing” is relativistic. Engaging in careful, protracted moral reflection, particularly in cases that clearly present such “conflicting obligation,” is hard. It is intellectually and emotionally taxing as well as time-consuming, requiring material resources and ongoing, honest dialogue with others. Unfortunately, our modern systems of biomedicine that train health care professionals are hard-pressed to include in curricula (in meaningful and lasting ways) “people skills,” communication skills, and cultural competence, not to mention the philosophical foundations of ethics that might guide practitioners through tough cases. There are, of course, many reasons for this: The biomedical framework has been late (or errant) in formally recognizing and prioritizing these less “clinical” gaps in education; the biomedical industry in many nations leaves little time (and often fails to sufficiently reimburse) for non-mechanistic care; and society in general has increasingly become enamored with being fast, being first, being famous. One need only turn on the television, whether so-called “reality” programs or cable news, to witness contestants, broadcasters, business moguls, or politicians clamoring to cook the best food, sew the best dress, report the latest scandal, and generally beat out the competition before the clock runs out. Not only is there no reason to work together and no time for deliberation in such an environment, today’s world often rewards those who “do what they have to do” to get ahead, the spoils of this mock war going to the most titillating and dramatic, not the most contemplative or most sincere. (For an interesting exploration of the rise of self-aggrandizement and “spectacle” in media, politics, education, science, and culture, see Hedges 2009.) [continued …]

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Ashby, Michael A., and Leigh E. Rich. 2012. Cases and culture: The benefits and risks of narrating “life as lived.” Journal of Bioethical Inquiry 9(4): 371–376.

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