Doctoral Dissertations

Date of Award

12-2013

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Philosophy

Major Professor

John Hardwig

Committee Members

David Reidy, Glenn Graber, Maricarmen Malagon-Rogers

Abstract

The focus of this dissertation is the search for consensus in the context of clinical ethics—physician-patient interactions, ethics consultations, and ethics committee meetings focused on a particular patient’s care. I argue that consensus, when achieved through a process of shared deliberation that I outline, is the hallmark of the morally correct decision.

While philosophers have generally denigrated consensus as a guide to morally correct decisions, hospital ethics committees and President’s Councils charged with making recommendations about how to resolve moral conflicts in the clinical setting have clearly valued and aimed at the achievement of consensus. Assuming this search for consensus is not wrong-headed, bioethicists owe clinicians an account of the proper role of consensus in clinical decisions. My aim in this project is to carefully examine and define the role that consensus ought to play in guiding our moral decision-making.

In this project, I define and defend clinical pragmatism, a consensus oriented approach to clinical ethics. Following a critical examination of two approaches that defend consensus as centrally important in ethical deliberations, I define consensus and distinguish it from other types of agreements to clarify the kind of agreement I wish to defend. Consensus can be reached in various ways, and not all are morally defensible. So, I develop an account of the necessary conditions—shared deliberation, tempered equality, freedom from undue influence, and mutual respect—for arriving at a consensus that is the morally correct decision in the clinical setting. I argue that, when pursued in this way, the search for consensus has moral value even when consensus proves elusive.

I defend the thesis that in a clinical moral conflict, the procedure I outline is both necessary and sufficient for full moral justification of the resulting decision. If the committee followed this procedure, their decision is the morally correct one for them to make given the resources available to them—it was the best decision they could have made at the time. An appropriate consensus defines the morally correct decision. Merely arguing for our preferred ethical theory is not enough; some sort of truly shared decision-making is needed.

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