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At least 19 recordsLinked to original sources

PubMed1991

Getting down to cases: the revival of casuistry in bioethics.

This article examines the emergence of casuistical case analysis as a methodological alternative to more theory-driven approaches in bioethics research and education. Focusing on The Abuse of Casuistry by A. Jonsen and S. Toulmin, the article articulates the most characteristic features of this modern-day casuistry (e.g., the priority allotted to case interpretation and analogical reasoning over abstract theory, the resemblance of casuistry to common law traditions, the 'open texture' of its principles, etc.) and discusses some problems with casuistry as an 'anti-theoretical' method. It is argued that casuistry so defined is 'theory modest' rather than 'theory free' and that ethical theory can still play a significant role in casuistical analysis; that casuistical analyses will encounter conflicting 'deep' interpretations of our social practices and institutions, and are therefore unlikely sources of increased social consensus on controversial bioethical questions; that its conventionalism raises questions about casuistry's ability to criticize norms embedded in the societal consensus; and that casuistry's emphasis upon analogical reasoning may tend to reinforce the individualistic nature of much bioethical writing. It is concluded that, not-withstanding these problems, casuistry represents a promising alternative to the regnant model of 'applied ethics' (i.e., to the ritualistic invocation of the so-called 'principles of bioethics'). The pedagogical implications of casuistry are addressed throughout the paper and include the following recommendations: (1) use real cases, (2) make them long, richly detailed and comprehensive, (3) present complex sequences of cases, (4) stress the problem of 'moral diagnosis', and (5) be ever mindful of the limits of casuistical analysis.

Bioethical Issues↗

PubMed1993

The priesthood of bioethics and the return of casuistry.

Several recent attempts to develop models of moral reasoning have attempted to use some form of casuistry as a way to resolve the moral controversies of clinical ethics. One of the best known models of casuistry is that of Jonsen and Toulmin who attempt to transpose a particular model of casuistry, that of Roman Catholic confessional practice, to contemporary moral disputes. This attempt is flawed in that it fails to understand both the history of the model it seeks to transpose and the morally pluralistic context of secular, postmodern society. The practice of casuistry which Jonsen and Toulmin wish to revive is a practice set in the context of a community with a shared set of moral values and structures of moral authority. Without a set of common moral values and rankings, and a moral authority to interpret cases the casuistry of the postmodern age will be pluralistic, that is, there will be many casuistries not just one.

Bioethics↗

PubMed2000

On the intersection of casuistry and particularism.

A comparison of casuistry with the strain of particularism developed by John McDowell and David Wiggins suggest that casuistry is susceptible to two very different mistakes. First, as sometimes developed, casuistry tends toward an implausible rigidity and systematization of moral knowledge. Particularism offers a corrective to this error. Second, however, casuistry tends sometimes to present moral knowledge as insufficiently systematized: It often appears to hold that moral deliberation is merely a kind of perception. Such a perceptual model of deliberation cannot offer a convincing account of the possibility of moral progress. This second problem is one to which particularism is itself prone. To redress it, other aspects of casuistry must be exploited: Casuistry contains an account of presumptive generalizations that explains how moral deliberation might be structured by rules while also depending at critical junctures on perception.

Bioethics↗

PubMed2003

[Something about the history and future use of casuistry].

Already Aristotle was aware of that an act ethically could not be judged alone by its effect, but circumstances should also be considered. This point of view was later taken over by Christianity in the form of the so called casuistry. The use of circumstances in the judgment of an act as regards the moral permissibility was, however, to some extent misused, especially by the Jesuites in the 16th and the first half of the 17th century. In defence of the "Jansenites" Blaise Pascal launched a direct attack on the Jesuites' use of casuistry in spiritual advice of the sinners. His elegant and vitty satire destroyed any talk of using casuistry for a long time, at least in the protestantic Northern Europe. Casuistry was regarded as synonym with sophistry. In 1988 Jonsen and Toulmin has argued that it is only the misuse of casuistry that is to blame. Used in a proper way it still has a future resolving moral problems especially in medical ethics. The present author is of the opinion that some degree of casuistical reasonning unconsciously is used in the present ethical debate, but more awareness hereof may be an advantage in the debate.

Casuistry↗

PubMed1994

How Jonsen really views casuistry: a note on the abuse of Father Wildes.

Kevin Wildes has recently argued in the Journal that Albert Jonsen's model of casuistry is ill-suited to a secular world context, because this model is rooted in a particular history and because of the moral pluralism of contemporary society in which a content-specific method of moral reasoning cannot readily be deployed. Contra Wildes, two arguments are offered. First, casuistry is not tied exclusively to Roman Catholic theology; casuistry also has deep roots in Classical thought, roots that Jonsen and Toulmin underscore. Second, the context of Roman Catholic theology can be distinguished from the method of casuistry, permitting that method to be deployed successfully in morally pluralistic contexts.

Casuistry↗

PubMed1994

Casuistry and its communitarian critics.

Communitarian critics have derided case-based reasoning for ignoring the need to arrive at a shared hierarchy of goods prior to case resolution. They claim that such a failure means that casuistry depends on either a naive metaphysical realism or an ethical conventionalism. Casuistry does embrace a certain unobjectionable moral realism and can require appeals to narrative histories, but despite this dependence on the surrounding culture, casuists possess a way to remain critical of society through the concept of practical wisdom and the use of a moral taxonomy. Therefore, casuistry's viability depends upon the existence and employment of this Aristotelian virtue. Furthermore, the casuistry that emerges is a sophisticated type of communitarianism rather than a free-standing method.

Altruism↗

PubMed2001

Casuistry as bioethical method: an empirical perspective.

This paper examines the role that casuistry, a model of bioethical reasoning revived by Jonsen and Toulmin, plays in ordinary moral reasoning. I address the question: 'What is the evidence for contemporary casuistry's claim that everyday moral reasoning is casuistic in nature?' The paper begins with a description of the casuistic method, and then reviews the empirical arguments Jonsen and Toulmin offer to show that every-day moral decision-making is casuistic. Finally, I present the results of qualitative research conducted with 15 general practitioners (GPs) in South Australia, focusing on the ways in which these GP participants used stories and anecdotes in their own moral reasoning. This research found that the GPs interviewed did use a form of casuistry when talking about ethical dilemmas. However, the GPs' homespun casuistry often lacked one central element of casuistic reasoning--clear paradigm cases on which to base comparisons. I conclude that casuistic reasoning does appear to play a role in every-day moral decision-making, but that it is a more subdued role than perhaps casuists would like.

Adult↗

PubMed1991

Casuistry as methodology in clinical ethics.

This essay focuses on how casuistry can become a useful technique of practical reasoning for the clinical ethicist or ethics consultant. Casuistry is defined, its relationship to rhetorical reasoning and its interpretation of cases, by employing three terms that, while they are not employed by the classical rhetoricians and casuists, conform, in a general way, to the features of their work. Those terms are (1) morphology, (2) taxonomy, (3) kinetics. The morphology of a case reveals the invariant structure of the particular case whatever its contingent features, and also the invariant forms of argument relevant to any case of the same sort: these invariant features can be called topics. Taxonomy situates the instant case in a series of similar cases, allowing the similarities and differences between an instant case and a paradigm case to dictate the moral judgment about the instant case. This judgment is based, not merely on application of an ethical theory or principle, but upon the way in which circumstances and maxims appear in the morphology of the case itself and in comparison with other cases. Kinetics is an understanding of the way in which one case imparts a kind of moral movement to other cases, that is, different and sometimes unprecedented circumstances may move certain marginal or exceptional cases to the level of paradigm cases. In conclusion, casuistry is the exercise of prudential or practical reasoning in recognition of the relationship between maxims, circumstances and topics, as well as the relationship of paradigms to analogous cases.

Bioethical Issues↗

PubMed1994

Casuistry in medical ethics: rehabilitated, or repeat offender?

For a number of reasons, casuistry has come into vogue in medical ethics. Despite the frequency with which it is avowed, the application of casuistry to issues in medical ethics has been given virtually no systematic defense in the ethics literature. That may be for good reason, since a close examination reveals that casuistry delivers much less than its advocates suppose, and that it shares some of the same weaknesses as the principle-based methods it would hope to supplant.

Bioethical Issues↗

PubMed1999

Critiques of casuistry and why they are mistaken.

Casuistic methods of reasoning in medical ethics have been criticized by a number of authors. At least five main objections to casuistry have been put forward: (1) it requires a uniformity of views that is not present in contemporary pluralistic society; (2) it cannot achieve consensus on controversial issues; (3) it is unable to examine critically intuitions about cases; (4) it yields different conclusions about cases when alternative paradigms are chosen; and (5) it cannot articulate the grounds of its conclusions. Two main versions of casuistry have been put forward, and the responses to these objections depend in part on which version one is defending. Jonsen has advocated a version modeled on the approach to casuistry used by moral theologians in the 15th and 16th century, involving comparison of the case at hand with a single paradigm and a "lineup" of cases. The present author has advocated another version, drawn from experience with cases in clinical ethics, which involves comparing the case at hand with two or more paradigms. Four of the five objections are unsuccessful when directed against Jonsen's approach, and all of them are unsuccessful when directed against the approach involving comparison with two or more paradigms.

Attitude to Health↗

PubMed2006

Balancing in ethical deliberation: superior to specification and casuistry.

Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals.

Bioethics↗

PubMed1994

Respondeo: method and content in casuistry.

James Tallmon has argued that my criticisms of Jonsen and Toulmin are ill founded. Tallmon argues that Jonsen and Toulmin argue for a method of rhetorical reasoning and not for a particular content. He argues that if one distinguishes the content and method of casuistry the Jonsen-Toulmin model can work. But Tallmon, like Jonsen and Toulmin, cannot escape the need for casuistry to have a content. Tallmon's response evidences that need since he assumes that there is a 'Medical Community' which has a moral vision.

Bioethics↗

PubMed2004

Ethics in nursing homes: experience and casuistry.

The purpose of the study was to further explore the methods that nurses use to solve ethically difficult care situations in nursing homes while the aim of this article was to present a model for nursing practice in such situations. Fourteen nurses from three nursing homes in Norway were observed and interviewed in order to discern the strategies they used to deal with ethically difficult care situations. To analyse this information, we used a constant comparative method until a grounded theory emerged. The nurses' principal strategy was to apply earlier experiences while striving for the best outcome for the elderly patients. This article discusses this strategy and compares it to a theory of ethics called casuistry. We suggest that by using the method of experiences combined with casuistry in a more systematic way, nurses can develop acceptable solutions for difficult care situations in nursing homes.

Adaptation, Psychological↗

PubMed1995

Casuistry: an alternative or complement to principles?

Casuistry is a traditional method of interpreting and resolving moral problems. It focuses on the circumstances of particular cases rather than on the application of ethical theories and principles. After a brief history of casuistry, the method is explained and its relation to theory and principles is discussed.

Bioethics↗

PubMed2004

Casuistry and social category bias.

This research explored cases where people are drawn to make judgments between individuals based on questionable criteria, in particular those individuals' social group memberships. We suggest that individuals engage in casuistry to mask biased decision making, by recruiting more acceptable criteria to justify such decisions. We present 6 studies that demonstrate how casuistry licenses people to judge on the basis of social category information but appear unbiased--to both others and themselves--while doing so. In 2 domains (employment and college admissions decisions), with 2 social categories (gender and race), and with 2 motivations (favoring an in-group or out-group), the present studies explored how participants justify decisions biased by social category information by arbitrarily inflating the relative value of their preferred candidates' qualifications over those of competitors.

Attitude↗

PubMed1994

Case method and casuistry: the problem of bias.

Case methods of reasoning are persuasive, but we need to address problems of bias in order to use them to reach morally justifiable conclusions. A bias is an unwarranted inclination or a special perspective that disposes us to mistaken or one-sided judgments. The potential for bias arises at each stage of a case method of reasoning including in describing, framing, selecting and comparing of cases and paradigms. A problem of bias occurs because to identify the relevant features for such purposes, we must use general views about what is relevant; but some of our general views are biased, both in the sense of being unwarranted inclinations and in the sense that they are one of many viable perspectives. This reliance upon general views to determine relevancy creates additional difficulties for defenders who maintain that case methods of moral reasoning are not only useful, but more basic, reliable or prior to other forms of moral reasoning. If we cannot identify the case's relevant features and issues independently of our general views or biases, we need further explanation about why a case method or casuistry should be viewed as prior to or more basic or reliable than other forms of moral reasoning. Problems of bias also arise for other methods of reasoning. In medical science, case reviews are regarded as an unreliable way to form generalizations, and methods such as clinical trials are used to address bias.

Bioethical Issues↗

PubMed1996

Choosing a framework for ethical analysis in advanced practice settings: the case for casuistry.

The need for advanced practice nurses to incorporate ethical analysis into case management is becoming more apparent -- particularly for the increasingly independent practice settings of psychiatric and mental health nursing. The nursing literature contains many articles dealing with the more abstract treatment of clinical ethics, but for the practitioner there is unfortunately little information available that uses ethical principles in a practical framework, which addresses the concrete reality of daily, difficult clinical decision making. This article applies a model of reasoned analysis to an actual case study using the concepts of casuistry or case-based reasoning. This method offers an alternative to the more popular paradigm of principilism. Complicated by the existence of violence and abuse, the case examines several ethical issues including patient privacy and legitimate breaches of patient confidentiality.

Adolescent↗

PubMed1998

Casuistry and principlism: the convergence of method in biomedical ethics.

Casuistry and principlism are two of the leading contenders to be considered the methodology of bioethics. These methods may be incommensurable since the former emphasizes the examination of cases while the latter focuses on moral principles. Conversely, since both analyze cases in terms of mid-level principles, there is hope that these methods may be reconcilable or complementary. I analyze the role of principles in each and thereby show that these theories are virtually identical when interpreted in a certain light. That is, if the gaps in each method are filled by a concept of judgment or Aristotelian practical wisdom, these methods converge.

Casuistry↗