1st Edition
Elements of Moral Experience in Clinical Ethics Training and Practice Sharing Stories with Strangers
Elements of Moral Experience in Clinical Ethics Training and Practice: Sharing Stories with Strangers is a philosophical and professional memoir of the education, training, and professional development of becoming a clinical ethics consultant. Utilizing a phenomenological and narrative lens, this book offers a fresh and energizing window into the field of healthcare ethics by pairing compelling clinical narratives of what it is like to do clinical ethics consultation with clear reflections and accessible introductions to key philosophical, professional, and humanistic roots for responsible practice. Each chapter contains a firsthand account of a clinical ethics encounter – with vivid detail, verbatim dialogue, and internal monologues that reveal the consultant’s reflections throughout the consultation. Following or at times woven into the clinical story, each chapter explores elements of practice by highlighting philosophical, professional, and humanistic resources that connect to and shape meaning in everyday clinical ethics work, drawing from phenomenologically and narratively oriented ethicists (Richard Zaner, Andrea Frolic, Mark Bliton, and Stuart Finder), influential thinkers in adjacent fields (Alfred Schutz, Kurt Wolff, and Pierre Bourdieu), and creative writers and artists (Barry Lopez, Joe Henry, Audre Lorde, Robert M. Pirsig, and Dar Williams). The innovative structure signposts and illustrates distinct elements of clinical ethics experience and practice, inviting the reader to move through the book in different ways, according to their own learning goals, as graduate students, advanced trainees, practicing clinical ethicists, or ethics educators. By focusing on themes identified in the unique instances or experiences of first-hand accounts, or by tracing the philosophical reflections on grounding and orienting texts from the field, readers can access different elements of clinical ethics practice while the book as a whole models a process for considering and interrogating these elements. Elements of Moral Experience in Clinical Ethics Training and Practice: Sharing Stories With Strangers invites readers to articulate, reflect on, share, and ultimately learn from their own experiences in clinical ethics consultation.
Acknowledgments
Introduction
Elements of Clinical Ethics Practice
Keep Us in Song: Clinical Ethics, Phenomenology, and Sharing Stories with Strangers
PART I
Elements of Discovery
1 Seminar in Strangeness
Observations I: Seminar in Clinical Philosophy, October 2003
Stairwell Stories I: Vanderbilt University Medical Center, Main Hospital Lobby
Observations II: Seminar in Clinical Philosophy, October 2009
The Clinical Part of Clinical Ethics or, Strangeness in the Seminar in Clinical Philosophy
Encountering the Stranger with Alfred Schutz
The Strange Life of Alfred Schutz
Schutz’s Stranger as a Model
Mapping the Unfamiliar World
The Stranger’s Discipline and Elements of Responsibility in Clinical Ethics
What’s So Strange About a Seminar?
2 Clinical Attention as Surrender-and-Catch
Mr. Jones and Me
Never Quite Easy Again: The Surrender of Attention, the Surrender-To of Paying Attention
Disruption and Attention in Clinical Contexts
Mr. Jones and the Experience of Surrender
Intellectualizing the Disruption Away
Encountering Kurt Wolff’s Surrender-and-Catch
Elements of Wolff’s Surrender
Elements of Wolff’s Surrender-to
Clinical Ethics Rounds and the Discipline of Surrender-To
Total Involvement
Suspension of Received Notions
Pertinence of Everything
Identification
The Risk of Harm
Surrender-to as Responsibility for Attention
The Particular Matters for Responsible Practice
Practicing Surrender-to: An Invitation to Reflective Clinical Ethics
Interlude I: Methods for Unknowing: Disruption and Attention
The Orientation of the Stranger
The Problematic of Disruption
From the Stranger’s Strategies to the Surrender-to
Surrender as Method: A Not Entirely Benign Procedure
PART II
Elements of Learning
3 Self-Reflection and Self-Education in Clinical Ethics
Unexpected Invitations in the Neonatal ICU
Not a Solo-Sport: Clinical Self-Reflections and Self-Education with Others
Reflecting on NICU Journals and the Practice of Self-Reflection
Strangers, Surrenderers, and Self-Reflective Dancers
After a Moment: Recollecting and Reflecting on Meanings and Motivations
Andrea Frolic’s Mindful Embodiment
Too Serious for Trial and Error
The Occasion for Practice Emerged
I Could Write a Book…
Reflecting on NICU Journals and the Practice of Self-Education
Harald Ofstad and Self-Education in Moral Development
So, What Can I Figure Out from These?
Isn’t That What Normally Happens?
Always More or Less Dissatisfied: Ofstad’s 10th Characteristic of the Moral Agent
Will I Miss Understanding If I Don’t Ask?
Shared Self-Reflection and Communal Self-Education in Clinical Ethics Practice
4 Affiliation and Attunement and Extra-Ordinary Discourse
Pivotal and Grounding Orientations: Attunement, Understanding, and What Is Meant by “Ethics”
Texts on Attunement
Me and the MOMS: ***Tuesday***
Uncanny Circumstances Require Extraordinary Attention
Me and the MOMS: *** Tuesday, Late Afternoon***
Richard M. Zaner: Attention to the Actual Circumstances at Hand
Moral Factors and Situational Definitions
Acts of Affiliation
Me and the MOMS: ***Wednesday Morning***
Pierre Bourdieu: Communication with the Other and Shared Meaning-Making
Responsibility for Collaborative Construction
Me and the MOMS: ***Thursday***
Mark J. Bliton: Self-Reflexivity and the Trembling of Attunement
Unspeakable Responsibility
What, Then, Is Left?
Me and the MOMS: ***Thursday Afternoon***
The Conditions for Extra-Ordinary Discourse
Afterwards/After Words
Interlude II: Methods for Learning with Others: Vulnerability and Sharing Stories
From Attunement to Vulnerability
Learning about Our Own Practice Requires Help from Others
Engaging with the Zadeh Project: Peer Review as Peer Learning
Interpersonal and Individual Vulnerability: Reflections on the Zadeh Project and Sharing Stories with Strangers
PART III
Elements of Experience
5 Constituent Vulnerability, Constituent Responsibility
“We Are Power”
Afterwards/After Words
Vulnerability and Responsibility in Clinical Ethics: Connections and Reflections with Hoffmaster, Spiegelberg, and Zaner
The Dance of Vulnerability and Responsibility
Barry Hoffmaster and the Meaning of Vulnerability
Clinical Ethics Consultant’s Responsibility to Vulnerability
Herbert Spiegelberg’s Ethics for Fellow Existers
The Undeserved Unfairness of Happenstance in Clinical Encounters
Richard M. Zaner’s Meditation on Vulnerability
Responsibility En Masse
Stories Are Responsibilities
6 Clinical Storytelling and Fragments of Experiences
Part I: Acknowledgement: It Is Impossible to Speak… and Monstrous Not to Mention 133
Later That Same Day: The “Cameron Story”
Part II: Resolution: Lessons Learned in Sharing Stories
My Story – Clinical Ethics Consultation Service Case Review
Part III: Pursuance: Reflectively Unphilosophical Fragments or, 10 Things for Readers to Know
First: This Is the Hardest Story I’ve Ever Written
Second: Meaning-Making in Clinical Encounters Is Not an Epistemic Project – It Is a Moral Activity Requiring Preparation and Practice
Third: The Arc of This Chapter Is Learning to Tell My Own Story – As a Clinically and Philosophically Relevant Aspect of Practice
Fourth: Storytelling Carries Obligations. So Does Listening
Fifth: I’m Struck by the Multiple Activities at Work in Listening-and-Telling Stories
Sixth: Clinical Storytelling Is Transformative of Story, of Teller, of Listener
Seventh: The Work of Stories Is Shared Over Time
Eighth: Stories We Share Are Also NOT SAFE
Ninth: The Storytelling Reveals that We Can’t Always Account for What We Do and Why
Tenth: Storytelling Is Intersubjective and Rigorous Is Ways We May Not Appreciate
Part IV: Psalm: Invitation to Fragmentation
Sharing Stories with Strangers: Continuing When There Is No Ending
Notes on Storytelling – Clinical and Otherwise
Continuing Because There Is No Ending
Index
Biography
Virginia L. Bartlett is an assistant professor of biomedical sciences and assistant director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles, CA. She is a past chair of the Clinical Ethics Consultation Affairs committee for the American Society for Bioethics and Humanities.
Elements of Moral Experience in Clinical Ethics Training and Practice: Sharing Stories with Strangers will be a significant and important contribution to the practice of clinical ethics consultation. Rather than merely tell readers what is relevant, Virginia Bartlett has invited them to engage with both the common and unique in clinical experiences. Professor Bartlett’s tolerance for the discomforts of taking a clear-eyed look creates this accessibility. With that careful eye and a generous voice, she provides opportunities for a reader to make their own assessment about the ways these stories match up with real life experiences in health care. Not only will the reader learn about the evident and the more subtle ways that a person working as an ethics consultant encounters people, questions, standpoints, even values, and so on, they will also learn about what actually happens in our very human experience of health care.
- Mark J. Bliton, PhD, Director of Medical Bioethics at Kaiser Permanente Los Angeles Medical Center in Los Angeles, CA. He is Editor, with Stuart G. Finder, PhD, of Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project, Springer 2018.
"In this highly engaging and original work, Bartlett uses herself as an example to offer a deeply personal and realistic sense of what it actually is like to do ethics consultation, including the intellectual, emotional, and even physical experiences involved. In so doing, she exquisitely illuminates how clinical ethics practice is itself a kind of moral undergoing – one that entails far more than mastering and applying knowledge or rote skills."
- Stuart G. Finder, Ph.D., Director, Center for Healthcare Ethics, Cedars-Sinai
"In Elements of Moral Experience in Clinical Ethics Training and Practice, Dr. Bartlett shows practitioners of clinical ethics – and practitioners of being human - how to acknowledge their responsibility through the collective recollection of stories that help make sense of what it means to care for one another."
- Joseph B. Fanning, Ph.D., Associate Professor of Medicine, Associate Director, Center for Biomedical Ethics and Society, Vanderbilt University
"This book offers a unique, genre-bending text that would be useful to trainees, graduate students, instructors, and preceptors. There is a deficit of clinical ethics literature focused on the experience, to use the author’s own words, of “doing ethics.” The author’s use of stories from her training and career intermingled with reflection and theory is an innovative way to help students and trainees early in their career better understand the work of clinical ethics."
Stephanie Larson, Lecturer in the Department of English at Case Western University
