Our 4th approach to ethics is
something called casuistry.
So this is saying that cases are the way to
think about how to approach ethical dilemmas.
It is searched that the priority of our
practice and our experience trump the theories.
So, over the span of our career, you know, a
physician, a nurse will see many patients,
many cases, and that practice of
taking care of each individual patient
we sort of learn by doing
of how to approach a case.
And that is what casuistry is all about.
So it's reasoning by analogy.
So it's taking that previous
case, how we handled it,
how others might have
handled it, and saying
"Well, is this an analogous situation to what I'm
confronting now in taking care of the patient performing?"
It's similar to a case law. So in case
law, a judge will render an opinion
based on president cases to look how
past judges have made decisions
and say how does the case before them
compare or contrast to that previous case
and can they use president to then make a decision.
Now there are caveats to that.
You know, you don't want to take a case
from 100 years ago and how it was decided
and knowing that there might have been biases and
prejudice and how those decisions were reached
and then trying to apply it
to your current situation.
So, again, it's a comparison and
contrasting to those past cases.
It's not saying that those past cases are always
going to be the way to handle a situation.
And so for each specific
case that you're looking at,
you're wanting to see what are the relevant
parallels and are there, you know,
comparisons that can be made
or contrasting viewpoints
that can be shown from the previous case,
say "Can we reach consensus in this case?"
So take for example that middle-aged woman with the
anoxic brain injury is in a persistent vegetative state.
There are famous cases of women in persistent
vegetative state like in the United States.
In the Evolution of Bioethics, there
was Karen Ann Quinlan, Nancy Cruzan,
Terry Schiavo, these women had conditions that
put them in a persistent vegetative state
and their family members need to make
decisions about how to handle those.
So you could take those similar cases
and say "Okay, here's the condition.
This is what our current patient is dealing with
and her family members need to make decisions.
How are they similar or dissimilar could we
figure out what to do in this particular case.
And there may be general principles that are developed
over time as you would handle more and more cases.
So, these use as guidelines
per se of "Can we, you know,
reason by analogy to them develop
these general approaches to a case?"
But it also recognizes that
principles are never final.
You have to look at the particular case, avoid any biases
or prejudices in rendering an opinion about this case,
and use casuistry to sort of
figure out a course of action.
So that's our 4th approach to
medical ethics, casuistry.
The idea in all of these approaches
is to sort of combine all of them.
Hopefully, you strive
to be virtuous.
You strive to adhere to the core
principles and principalism.
You pay attention and focus
the lens on the ethic of care
and you use the cases that you've taken care of in
the past to help guide you for the future cases.
All of those hopefully can be combined
into one as you approach medical ethics.