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At the edge of mortality there is a place where the seriously ill
or dying wait - a place where they may often feel vulnerable or
alone. For over forty years, bioethicist cum philosopher Richard
Zaner has been at the side of many of those people offering his
incalculable gift of listening, and helping to lighten their
burdens - not only with his considerable skills, but with his
humanity as well. The narratives Richard Zaner shares in
Conversations on the Edge are informed by his depth of knowledge in
medicine and bioethics, but are never "clinical." A genuine and
caring heart beats underneath his compassionate words. Zaner has
written several books in which he tells poignant stories of
patients and families he has encountered; there is no question that
this is his finest. In Conversations on the Edge, Zaner reveals an
authentic empathy that never borders on the sentimental. Among
others, he discusses Tom, a dialysis patient who finally reveals
that his inability to work - encouraged by his overprotective
mother - is the source of his hostility to treatment; Jim and Sue,
young parents who must face the nightmare of letting go of their
premature twins, one after the other; Mrs Oland, whose family
refuses to recognize her calm acceptance of her own death; and, in
the final chapter, the author's mother, whose slow demise continues
to haunt Zaner's professional and personal life. These stories are
filled with pain and joy, loneliness and hope. They are about life
and death, about what happens in hospital rooms - and that place at
the edge - when we confront mortality. It is the rarest of glimpses
into the world of patients, their families, healers, and those who
struggle, like Zaner, to understand.
This book is a critical examination of certain basic issues and
themes crucial to understanding how ethics currently interfaces
with health care and biomedical research. Beginning with an
overview of the field, it proceeds through a delineation of such
key notions as trust and uncertainty, dialogue involving talk and
listening, the vulnerability of the patient against the asymmetric
power of the health professional, along with professional and
individual responsibility. It emphasizes several themes fundamental
to ethics and health care:Â (1) the work of ethics requires
strict focus on the specific situational understanding of each
involved person. (2) Moral issues, at least those intrinsic to each
clinical encounter, are presented solely within the contexts of
their actual occurrence; therefore, ethics must not only be
practical but empirical in its approach. (3) Each particular
situation is in its own way imprecise and uncertain and the
different types and dimensions of imprecision and uncertainty are
critical for everyone involved. (4) Finally, medicine and health
care more broadly are governed by the effort to make sense of the
healer’s experiences with the patient, whose own experiences and
interpretations are ingredient to what the healer seeks to
understand and eventually treat. In addition to providing a way to
develop ethical considerations in clinical life and research
projects, the book proposes that narratives provide the finest way
to state and grapple with these themes and issues, whether in
classrooms or real-life situations. It concludes with a prospective
analysis of newly emerging issues presented by and within the new
genetics, which, together within a focus on the phenomenon of
birth, leads to an clearer understanding of human life.
This book is a critical examination of certain basic issues and
themes crucial to understanding how ethics currently interfaces
with health care and biomedical research. Beginning with an
overview of the field, it proceeds through a delineation of such
key notions as trust and uncertainty, dialogue involving talk and
listening, the vulnerability of the patient against the asymmetric
power of the health professional, along with professional and
individual responsibility. It emphasizes several themes fundamental
to ethics and health care: (1) the work of ethics requires strict
focus on the specific situational understanding of each involved
person. (2) Moral issues, at least those intrinsic to each clinical
encounter, are presented solely within the contexts of their actual
occurrence; therefore, ethics must not only be practical but
empirical in its approach. (3) Each particular situation is in its
own way imprecise and uncertain and the different types and
dimensions of imprecision and uncertainty are critical for everyone
involved. (4) Finally, medicine and health care more broadly are
governed by the effort to make sense of the healer's experiences
with the patient, whose own experiences and interpretations are
ingredient to what the healer seeks to understand and eventually
treat. In addition to providing a way to develop ethical
considerations in clinical life and research projects, the book
proposes that narratives provide the finest way to state and
grapple with these themes and issues, whether in classrooms or
real-life situations. It concludes with a prospective analysis of
newly emerging issues presented by and within the new genetics,
which, together within a focus on the phenomenon of birth, leads to
an clearer understanding of human life.
The French version of this book, Theorie du champ de la conscience
(1957), appeared under the auspices of the International
Phenomenological Society. This present version appears through the
collaboration of the staff of the Duquesne Studies, Psychological
Series. In writing this book, I wanted to make it a
phenomenological study, not a book about phenomenology. The
intention was to advance c- tain phenomenological problems rather
than to present a survey of or a report on phenomenology. My point
of view is that of the pheno- nologist at work, not of an observer
of a methodology from without. While it appeared desirable to
expound in a detailed manner some of Husserl's notions and theories
which have importance for phenomen- ogy as a whole, I have con?ned
my treatment to those which have direct and immediate reference to
the problems treated in this study. The manuscript of this book was
completed in 1953 before the appe- ance of several volumes of
Husserliana among which vol. VI, Die Krisis der Europaischen
Wissenschaften und die transzendentale Phanomenologie (1954), and
vol. IX, Phanomenologische Psychologie (1962), have particular
bearing upon the problems dealt with in this book. Also the most
recent presentation of Gestalt theory by W. Metzger, Psychologie
(1st ed. 1940, 2nd ed. 1954) did not come to my attention before
the completion of the manuscript."
Under the title of "Phenomenology: Continuation and Crit icism,"
the group of essays in this volume are presented in honor of Dorion
Cairns on his 70th birthday. The contributors comprise friends,
colleagues and former students of Dorion Cairns who, each in his
own way, share the interest of Dorion Cairns in Husserlian
phenomenology. That interest itself may be best defined by these
words of Edmund Husserl: "Philosophy - wis dom (sagesse) - is the
philosopher's quite personal affair. It must arise as his wisdom,
as his self-acquired knowledge tending toward universality, a
knowledge for which he can answer from the beginning . . . " 1 It
is our belief that only in the light of these words can
phenomenology and phenomenological philosophy be continued, but
always reflexively, critically. For over forty years Dorion Cairns
has, through his teaching and writing, selflessly worked to bring
the idea expressed by Husserl's words into self conscious exercise.
In so doing he has, to the benefit of those who share his interest,
confirmed Husserl's judgement of him that he is "among the rare
ones who have penetrated into the deepest sense of my
phenomenology, . . . who had the energy and persist ence not to
desist until he had arrived at real understanding."
Early in the first volume of his Ideen zu einer reinen Phiinomeno
logie und phiinomenologischen Philosophie, Edmund Husserl stated
concisely the significance and scope of the problem with which this
present study is concerned. When we reflect on how it is that
consciousness, which is itself absolute in relation to the world,
can yet take on the character of transcendence, how it can become
mundanized, We see straightaway that it can do that only by means
of a certain participation in transcendence in the first, originary
sense, which is manifestly the transcendence of material Nature.
Only by means of the experiential relation to the animate organism
does consciousness become really human and animal (tierischen), and
only thereby does it achieve a place in the space and in the time
of Nature. l Consciousness can become "worldly" only by being
embodied within the world as part of it. In so far as the world is
material Nature, consciousness must partake of the transcendence of
material Nature. That is to say, its transcendence is manifestly an
embodiment in a material, corporeal body. Consciousness, thus,
takes on the characteristic of being "here and now" (ecceity) by
means of experiential (or, more accurately, its intentive) relation
to that corporeal being which embodies it. Accordingly, that there
is a world for consciousness is a conse quence in the first
instance of its embodiment by 2 that corporeal body which is for it
its own animate organism."
From the tone of the report by the President's Commission for the
Study of Ethical Problems in Medicine and Biomedical and Behavioral
Re search, one might conclude that the whole-brain-oriented
definition of death is now firmly established as an enduring
element of public policy. In that report, Defining Death: Medical,
Legal and Ethical Issues in the Determination of Death, the
President's Commission forwarded a uni form determination of death
act, which laid heavy accent on the signifi cance of the brain stem
in determining whether an individual is alive or dead: An
individual who has sustained either (1) irreversible cessation of
circulatory and respiratory functions, or (2) irreversible
cessation of all functions of the entire brain, including the brain
stem, is dead. A determination of death must be made in accordance
with accepted medical standards ( 1], p. 2). The plausibility of
these criteria is undermined as soon as one confronts the question
of the level of treatment that ought to be provided to human bodies
that have permanently lost consciousness but whose brain stems are
still functioning."
The French version of this book, Theorie du champ de la conscience
(1957), appeared under the auspices of the International
Phenomenological Society. This present version appears through the
collaboration of the staff of the Duquesne Studies, Psychological
Series. In writing this book, I wanted to make it a
phenomenological study, not a book about phenomenology. The
intention was to advance c- tain phenomenological problems rather
than to present a survey of or a report on phenomenology. My point
of view is that of the pheno- nologist at work, not of an observer
of a methodology from without. While it appeared desirable to
expound in a detailed manner some of Husserl's notions and theories
which have importance for phenomen- ogy as a whole, I have con?ned
my treatment to those which have direct and immediate reference to
the problems treated in this study. The manuscript of this book was
completed in 1953 before the appe- ance of several volumes of
Husserliana among which vol. VI, Die Krisis der Europaischen
Wissenschaften und die transzendentale Phanomenologie (1954), and
vol. IX, Phanomenologische Psychologie (1962), have particular
bearing upon the problems dealt with in this book. Also the most
recent presentation of Gestalt theory by W. Metzger, Psychologie
(1st ed. 1940, 2nd ed. 1954) did not come to my attention before
the completion of the manuscript."
In the following essays discussing clinical ethics consultation,
three sorts of reflective writing are presented. The first is a
description of a clinical ethics consultation, more generously
detailed than most that have been published, yet obviously limited
as a documentation of the experiences at its source. It is followed
by three examples of a second kind in the probing commentaries by
highly regarded figures in biomedical and clinical ethics -
Francois Baylis, Tom Tomlinson, and Barry Hoffmaster. Finally,
these are followed by a third variety of reflection in the form of
responses to those three commentaries, by Bilton and Stuart G.
Finder, and my Afterword - a further reflection on some of the
issues and questions intrinsic to clinical ethics consultation and
to these various essays. The consultation itself was conducted by
Bliton; but Finder not only assisted at one point (he is the
colleague' mentioned in Bliton's manuscript) but frequently
participated in the discussions that are invariably part of our
clinical ethics consultative practice in our Center for Clinical
and Research Ethics at Vanderbilt University Medical Center. It was
thus natural for Finder to participate in the response. Each of
these essays is fascinating and important on its own; together,
however, they constitute a truly unusual and, we believe, very
significant contribution that will hopefully figure prominently in
subsequent discussions, and in shaping and deepening an endeavor -
clinical ethics - still in much-needed search of its own
discipline, method rationale and place in the domain of clinical
practice more generally. This group of essays is also quite unique,
addressing as it does the coherence of a form of practice - and, it
must be emphasized, several forms of writing about as well as
theoretical proposals for understanding that practice - whose
current and future character remains very much in contention. That
a situation such as the one discussed here often provokes strong
and passionate responses will be no surprise &endash; whether
because of its relative novelty, its risky nature, the high stakes
involved, or something else. It is in any event a striking feature
of ethics consultations that the people directly or even indirectly
involved tend at times to feel rather passionately about what is
said (and not said), what is done (and not done), and what is then
reported (or, it may be, left out). Even so, such energetic
feelings, much less the candor of my colleague's response to such
passion, are rarely if ever apparent from published reports. For
this reason alone, a considerable debt of gratitude is surely owed
to our commentators &endash; reflective and deliberative, yet
passionate and forceful as each of them are."
From the tone of the report by the President's Commission for the
Study of Ethical Problems in Medicine and Biomedical and Behavioral
Re search, one might conclude that the whole-brain-oriented
definition of death is now firmly established as an enduring
element of public policy. In that report, Defining Death: Medical,
Legal and Ethical Issues in the Determination of Death, the
President's Commission forwarded a uni form determination of death
act, which laid heavy accent on the signifi cance of the brain stem
in determining whether an individual is alive or dead: An
individual who has sustained either (1) irreversible cessation of
circulatory and respiratory functions, or (2) irreversible
cessation of all functions of the entire brain, including the brain
stem, is dead. A determination of death must be made in accordance
with accepted medical standards ( 1], p. 2). The plausibility of
these criteria is undermined as soon as one confronts the question
of the level of treatment that ought to be provided to human bodies
that have permanently lost consciousness but whose brain stems are
still functioning."
Perhaps no philosopher has so fully explored the nature and
conditions of historical understanding as Wilhelm Dilthey. His
work, conceived overall as a Critique of Historical Reason and
developed through his well-known theory of the human studies,
provides concepts and methods still fruitful for those concerned
with analyzing the human condition. Despite the increasing
recognition of Dilthey's contributions, relati vely few of his
writings have as yet appeared in English translation. It is
therefore both timely and useful to have available here two works
drawn from different phases in the development of his philosophy.
The "Ideas Concerning a Descriptive and Analytic Psychology"
(1894), now translated into English for the first time, sets forth
Dilthey's programma tic and methodological viewpoints through a
descriptive psychology, while "The Understanding of Other Persons
and Their Expressions of Life" (ca. 1910) is representative of his
later hermeneutic approach to historical understanding. DESCRIPTIVE
PSYCHOLOGY AND THE HUMAN STUDIES Dilthey presented the first mature
statement of his theory of the human studies in volume one of his
Einleitung in die Geisteswissenschaften (Introduction to the Human
Studies), published in 1883. He argued there that for the proper
study of man and history we must eschew the metaphysical
speculation of the absolute idealists while at the same time
avoiding the scientistic reduction of positivism.
Historically, philosophy has been the point of origin of the
various sciences. However, once developed, the sciences have
increasingly become autonomous, although often taking some paradigm
from leading philosophies of the era. As aresult, in recent times
the relationship of philosophy to the sciences has been more by way
of dialogue and critique than a matter of spawning new sciences.
This volume of the Selected Studies brings together a series of
essays which develop that dialogue and critique with special
reference to the insights of phenomenological philosophy.
Phenomenology in its own way has been interfaced with the sciences
from its outset. Perhaps the most widely noted relation, due in
part to Edmund Husserl's characterization of the beginning steps of
phenomenology as a "descriptive psychology," has been with the
various psychologies. It is weIl known that the early Gestaltists
were influenced by Husserl and, later, the Existential psychologies
acknowledged the impact of Martin Heidegger and Jean-Paul Sartre,
to mention but two philosophers. And, of course, Husserl's lifetime
concern for the foundations of logic and mathe maties, especially
as these (the former in particular) were developed into a
foundational "theory of science," has figured prominently in these
dialogues. 2 INTRODUCTION Less directly but more currently, the
impact of phenomenology upon the disciplines has begun to be feIt
in a whole range of the sciences."
Phenomenology in the United States is in a state of ferment and
change. Not all the changes are happy ones, however, for some of
the most prominent philosophers of the first generation of
phenomenologists have died: in 1959 Alfred Schutz, and within the
past two years John \Vild, Dorion Cairns, and Aron Gur witsch.
These thinkers, though often confronting a hostile intel lectual
climate, were nevertheless persistent and profoundly
influential-through their own works, and through their students.
The two sources associated with their names, The Graduate Faculty
of The New School for Social Research, and the circle around John
Wild first at Harvard and later at Northwestern and Yale, produced
a sizable portion of the now second gener ation American
phenomenological philosophers. In a way, it was the very hostility
of the American philo sophical milieu which became an important
factor in the ferment now taking place. Although the older, first
generation phenome nologists were deeply conversant with other
philosophical move ments here and abroad, their efforts at
meaningful dialogue were largely ignored. Determined not to remain
isolated from the dominant currents of Anglo-American philosophy in
par ticular, the second generation opened the way to a dialogue
with analytic philosophers, especially through the efforts of the
Society for Phenomenology and Existential Philosophy, led by 2
INTRODUCTION such men as James M. Edie and Hubert Dreyfus and, in
other respects, Herbert Spiegelberg and Maurice Natanson."
Under the title of "Phenomenology: Continuation and Crit icism,"
the group of essays in this volume are presented in honor of Dorion
Cairns on his 70th birthday. The contributors comprise friends,
colleagues and former students of Dorion Cairns who, each in his
own way, share the interest of Dorion Cairns in Husserlian
phenomenology. That interest itself may be best defined by these
words of Edmund Husserl: "Philosophy - wis dom (sagesse) - is the
philosopher's quite personal affair. It must arise as his wisdom,
as his self-acquired knowledge tending toward universality, a
knowledge for which he can answer from the beginning . . . " 1 It
is our belief that only in the light of these words can
phenomenology and phenomenological philosophy be continued, but
always reflexively, critically. For over forty years Dorion Cairns
has, through his teaching and writing, selflessly worked to bring
the idea expressed by Husserl's words into self conscious exercise.
In so doing he has, to the benefit of those who share his interest,
confirmed Husserl's judgement of him that he is "among the rare
ones who have penetrated into the deepest sense of my
phenomenology, . . . who had the energy and persist ence not to
desist until he had arrived at real understanding."
In the following essays discussing clinical ethics consultation,
three sorts of reflective writing are presented. The first is a
description of a clinical ethics consultation, more generously
detailed than most that have been published, yet obviously limited
as a documentation of the experiences at its source. It is followed
by three examples of a second kind in the probing commentaries by
highly regarded figures in biomedical and clinical ethics -
Francois Baylis, Tom Tomlinson, and Barry Hoffmaster. Finally,
these are followed by a third variety of reflection in the form of
responses to those three commentaries, by Bilton and Stuart G.
Finder, and my Afterword - a further reflection on some of the
issues and questions intrinsic to clinical ethics consultation and
to these various essays. The consultation itself was conducted by
Bliton; but Finder not only assisted at one point (he is the
colleague' mentioned in Bliton's manuscript) but frequently
participated in the discussions that are invariably part of our
clinical ethics consultative practice in our Center for Clinical
and Research Ethics at Vanderbilt University Medical Center. It was
thus natural for Finder to participate in the response. Each of
these essays is fascinating and important on its own; together,
however, they constitute a truly unusual and, we believe, very
significant contribution that will hopefully figure prominently in
subsequent discussions, and in shaping and deepening an endeavor -
clinical ethics - still in much-needed search of its own
discipline, method rationale and place in the domain of clinical
practice more generally. This group of essays is also quite unique,
addressing as it does the coherence of a form of practice - and, it
must be emphasized, several forms of writing about as well as
theoretical proposals for understanding that practice - whose
current and future character remains very much in contention. That
a situation such as the one discussed here often provokes strong
and passionate responses will be no surprise &endash; whether
because of its relative novelty, its risky nature, the high stakes
involved, or something else. It is in any event a striking feature
of ethics consultations that the people directly or even indirectly
involved tend at times to feel rather passionately about what is
said (and not said), what is done (and not done), and what is then
reported (or, it may be, left out). Even so, such energetic
feelings, much less the candor of my colleague's response to such
passion, are rarely if ever apparent from published reports. For
this reason alone, a considerable debt of gratitude is surely owed
to our commentators &endash; reflective and deliberative, yet
passionate and forceful as each of them are."
Ethics and the Clinical Encounter explores the moral dimensions of
clinical medicine and the phenomenon of illness, to determine what
ethics must be in order to be fully responsive to clinical
encounters. Written in a lively and conversational style with
minimal technical terminology, and enhanced by actual experience or
real clinical situations, this volume lays out a clinical ethics
methodology both in practical and theoretical terms.Here's what the
experts had to say: Professor Zaner has provided us with a
remarkably lucid and trenchant discussion of the interface of
philosophy and the field of medicine. He brings into play an
extraordinary range of historial knowledge, extensive observations
based on firsthand experience with medical practices, and an acute
sense of philosophical argumentation. This is a work that will be
an exemplary and indispensable text in the philosophy of medicine
for years to come. -- Calvin Schrag... it is a highly original
contribution usable in a number of fields.... It really has no
competition.... The genius of Zaner's approach is to ground ethics
from the 'bottom up' and to direct us to the concrete particulars
of therapeutic encounters wherein lie moral and ethical matters ...
meaty, challenging, and ultimately rewarding.... -- Paul R.
DokeckiRichard M. Zaner founded the Center for Clinical and
Research Ethics at Vanderbilt University Medical Center. Having
established Vanderbilt's first Hospital Ethics Committee (1985), he
served as co-chair of VUMC's Ethics Committee since its inception
in 1990. Zaner has published five original books, edited ten, and
translated four more, and has published more than 100 sections of
books and professional journals.
"The Structures of the Life-World "is the final focus of
twenty-seven years of Alfred Schutz's labor, encompassing the
fruits of his work between 1932 and his death in 1959. This book
represents Schutz's seminal attempt to achieve a comprehensive
grasp of the nature of social reality. Here he integrates his
theory of relevance with his analysis of social structures. Thomas
Luckmann, a former student of Schutz's, completed the manuscript
for publication after Schutz's untimely death.
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