- Title
- An examination of moral decision-making in medicine, informed by a Habermasian paradigmatic approach: implications for medical education
- Creator
- Walker, Paul Jerome
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2015
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- This thesis explores how individual medical practitioners might make morally good decisions in clinical practice. It is predicated on the understanding that clinical encounters between clinicians and patients should be seen primarily as inter-relations among persons and, as such, are necessarily moral encounters. The thesis proposes therefore that moral decision-making in clinical practice needs to be based more consciously in an inter-relational framework, referred to within as intersubjectivity. The epistemological paradigm of Jürgen Habermas is proposed and justified as offering suitable theoretical grounding for such an approach to moral decision-making in clinical practice. This paradigm consists of Habermas’ “ways” of knowing theory, his discourse theory of morality and his principles of communicative action, emanating in the kind of intersubjectivity that can be described as ‘consensus-seeking’. It is argued that the relevance of such a consensus-seeking approach is especially apparent in an era in which there is greater cognizance of a plurality of values than has been the case in earlier eras. In addition, such an approach has potential to embed clinical decision-making in the concrete realities of the illness at hand, including the nature of the disease itself and its prognosis, as well as contingent circumstances and cultural values. Thus, this thesis argues that moral decision-making in clinical situations should look beyond established normative ethical frameworks towards an approach more aligned to Habermasian principles. A Habermasian-inspired approach, framed in this thesis as Proportionism, is built around the need to balance intrinsic, a priori rules with the pragmatics of considering empirical consequences. Given that our contemporary era is characterised by pronounced value pluralism, it will be argued that the Proportionist approach can be applied to moral decision-making in clinical settings through an inclusive, non-coercive and self-reflective dialogue within the community affected. This is effectively the praxis (practical action) that results from the Habermasian paradigm in clinical settings, wherein the clinician aims to maximise the good(s) of the patient. The aim is to reach an unforced consensual decision among the participants, consistent with Habermas’ discourse theory of morality and principles of communicative action. Finally, application is made of the Habermasian paradigm to the pedagogy of medical education. Thus, an emancipatory change is proposed for medical education, one which is designed to instil in student doctors the need to minimize power differentials between them and their patients in order to ensure optimal empowered dialogue, with all stakeholders, around moral decision-making.
- Subject
- ethics; decision-making; Habermas; medicine; morals
- Identifier
- http://hdl.handle.net/1959.13/1309844
- Identifier
- uon:21952
- Rights
- Copyright 2015 Paul Jerome Walker
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT02 | Thesis | 1 MB | Adobe Acrobat PDF | View Details Download |