Caenepeel Didier, Jobin Guy
U. de Montreal, Canada.
J Int Bioethique. 2005 Sep-Dec;16(3-4):107-33, 174-5.
Clinical ethics, as instituted in committees, aims to solve ethical problems by means of interdisciplinary deliberation. Elucidation and deliberation are used a s pragmatic means whose finality is decision-making. This being so, it may be wondered if clinical ethics has not been pruned of its more global critical potential. Narrative approaches open some ways of thinking of this critical function, but they seem to us to be nevertheless still insufficient for the task. We propose to explore the heuristic and practical fertility of the concepts of discursiveness--more inclusive than narrativity--, and co-authority--that we will have to situate and relate to notions of power, expertise and normativity--, in order to give fresh thought to the role and functions of a clinical ethics committee in a health care institution, and consequently the possible contribution of clinical ethics both as deliberation process and critical reflection of practices. To achieve this result, we propose the following approach. First of all, we will identify the limits of current narrative proposals. Secondly, we will present the concept of discursiveness based on work that follows on from the ethics of discussion. Thirdly, we will expose our definition of the concept of co-authority in a discursive space which includes both the actors of the clinical situation and the actors of the deliberation. Fourthly and finally, we will draw the consequences for a critical theory of the role and functions of a clinical ethics committee.
临床伦理委员会所践行的临床伦理学,旨在通过跨学科审议来解决伦理问题。阐释与审议被用作务实手段,其最终目的是做出决策。既然如此,人们可能会问,临床伦理学是否已被削弱了其更具全局性的批判潜力。叙事方法为思考这一批判功能开辟了一些途径,但在我们看来,它们对于这项任务而言仍显不足。我们提议探讨话语性(比叙事性更具包容性)和共同权威这两个概念的启发性及实际效用——我们必须将其置于权力、专业知识和规范性概念之中并与之关联——以便重新思考临床伦理委员会在医疗机构中的角色和功能,进而思考临床伦理学作为审议过程和对实践的批判性反思可能做出的贡献。为实现这一目标,我们提议采用以下方法。首先,我们将确定当前叙事提议的局限性。其次,我们将基于源自讨论伦理学的研究成果来阐述话语性概念。第三,我们将在一个既包括临床情境中的行为者又包括审议中的行为者的话语空间中揭示我们对共同权威概念的定义。第四也是最后一点,我们将得出对临床伦理委员会角色和功能批判理论的影响。