Abstract

Physicians and nurses are confronted daily with the task of making clinical and ethical decisions about a case. Historically the guidance for clinicians' ethical deliberations has come from applied normative ethics which focuses on the theories of deontology and teleology, and the principles of autonomy, beneficence, non-maleficence, and justice. However, clinicians and ethicists increasingly find this approach inadequate. This dissertation examines an alternative approach to clinical ethics--modern casuistry--and offers a critical analysis of its usefulness for clinical ethical decision making. ;Modern casuistry's primary apologist, Albert Jonsen, has argued that casuistry is a more fitting approach to clinical ethical reflection than the traditional deductive approach and that clinicians should use it. However, the development and application of this method has been done without adequate consideration of how clinicians do make clinical ethical decisions. To provide greater insight into how clinicians do make clinical and ethical decisions, the research of six scholars, Carlton, Bosk, Zussman, Benner, Self, and Schon is presented and discussed in light of Jonsen's description of how clinicians should make their decision using the casuistic method. In addition, a small cross cultural exploratory study of how clinicians make clinical and ethical decisions was conducted and the findings are examined in relationship to Jonsen's application of casuistry to clinical ethics. ;Finally, criticisms of casuistry as a method for clinical ethics are presented: Arras, Wildes, and Zaner. These are followed by a critique of casuistry as a method for clinical ethics which is grounded in the findings of the research of the six scholars, the findings of the cross cultural study and the criticisms of Arras, Wildes, and Zaner. ;The conclusion of this dissertation is that casuistry can serve as a useful, though incomplete, case-based method for clinical ethical analysis for both clinical ethicists and clinicians. The method does not adequately address the complexity of the decision making process, the contribution of the artistry of practice to ethical reflection, nor the moral agendas that both clinician and casuist bring to the development of paradigm cases in the application of this method to clinical ethics.