Ethics Unit of the Bern University Hospital in Switzerland.
Bioethics. 2011 Sep;25(7):354-60. doi: 10.1111/j.1467-8519.2011.01911.x.
In this paper we introduce narrative and hermeneutical perspectives to clinical ethics support services (CESS). We propose a threefold consideration of 'theory' and show how it is interwoven with 'practice' as we go along. First, we look at theory in its foundational role: in our case 'narrative ethics' and 'philosophical hermeneutics' provide a theoretical base for clinical ethics by focusing on human identities entangled in stories and on moral understanding as a dialogical process. Second, we consider the role of theoretical notions in helping practitioners to understand their situation in clinical ethics practice, by using notions like 'story', 'responsibility', or 'vulnerability' to make explicit and explain their practical experience. Such theoretical notions help us to interpret clinical situations from an ethical perspective and to foster moral awareness of practitioners. And, thirdly, we examine how new theoretical concepts are developed by interpreting practice, using practice to form and improve our ethical theory. In this paper, we discuss this threefold use of theory in clinical ethics support services by reflecting on our own theoretical assumptions, methodological steps and practical experiences as ethicists, and by providing examples from our daily work. In doing so, we illustrate that theory and practice are interwoven, as theoretical understanding is dependent upon practical experience, and vice-versa.
在本文中，我们将叙事和解释学视角引入临床伦理支持服务（CESS）。我们提出了对“理论”的三重考虑，并展示了在实践中如何将其与实践交织在一起。首先，我们从基础作用的角度来看待理论：在我们的案例中，“叙事伦理学”和“哲学解释学”通过关注纠缠在故事中的人类身份以及作为对话过程的道德理解，为临床伦理学提供了理论基础。其次，我们考虑了理论概念在帮助从业者理解临床伦理实践中的作用，通过使用“故事”、“责任”或“脆弱性”等概念来明确和解释他们的实际经验。这些理论概念有助于我们从伦理角度解释临床情况，并培养从业者的道德意识。第三，我们通过解释实践来研究如何通过实践来发展新的理论概念，使用实践来形成和改进我们的伦理理论。在本文中，我们通过反思我们作为伦理学家的理论假设、方法步骤和实践经验，并提供我们日常工作中的例子，讨论了临床伦理支持服务中这种三重理论用法。通过这样做，我们说明了理论和实践是交织在一起的，因为理论理解依赖于实践经验，反之亦然。
