Chapter Synopses

Foreword by Alphonso Lingis

The philosopher Alphonso Lingis reflects on the singularity of the experience of illness, on medicine and doctors, on witnessing, and on microethics.

The Practice of Ethics: A Manifesto

This chapter reviews the nature of ethical problems in medicine and outlines the basic features of the approach adopted in this book. It argues that ethical issues abound in everyday life, and that ethics has to be regarded as a special kind of thinking that is different from scientific thought and spans many disciplines and perspectives.

Epilogue

When we engage another person in almost any interchange, we embark on a process of discovery that may lead into uncharted, unknown territory. Our lives intersect and become intertwined. At the end of the process we are both changed irrevocably. One does not have to go to exotic places or seek out extreme circumstances to encounter the edges of meaning. We live closer to these limits than we imagine—in our relationships, in ordinary experiences, in the grey, commonplace continuum of our everyday lives.

Chapter 1: Medicine and the Ethical Conditions of Modernity

This chapter discusses how modern ways of looking at ethics and morality developed under the influence of science and European Enlightenment thought. It argues that there is a need to move away from conventional frameworks of ethical debate towards an approach based on process and communication about values rather than outcomes or intentions.

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Chapter 2: From Bioethics to Microethics: The Need to Return Ethical Debate to the Clinic

This chapter reflects critically on the nature and influence of the discipline of bioethics and explains the concept of ‘microethics’. It shows how ethics is not concerned merely with abstract principles but with everyday issues arising in the continuous flux of personal and social life, often through small, intimate experiences or interactions that may not even be recognised as of ethical significance.

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Chapter 3: Between Nature and Culture: The Ethics and Politics of Animal Experimentation

This essay examines the philosophical, social and cultural roots of the contemporary opposition to the use of animals in science and considers the question of the cultural construction of ‘nature’ and what is ‘natural’. It asks why there is so little communication between the two sides in the debate when their philosophical starting points are very similar.

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Chapter 4: Sexuality and Ethics in the Medical Encounter

In the official discourses of medicine sexuality is usually discussed only in relation to a narrow range of issues and behaviours. This chapter argues that all clinical practice inherently concerns sexuality because it deals with intimate bodily experiences, the meanings associated with these experiences, and the changes caused by illness and pain.

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Chapter 5: The Medicalisation of Everyday Life and the Moral Space of the Menopausal Woman

The understanding of ageing that emerges from clinical medicine is much more complex than is commonly supposed. This essay addresses this problem by developing the concept of the ‘moral spaces’ we inhabit in our everyday lives and showing how these can evolve and change with time. It illustrates these ideas by focusing specifically on menopause and how it has been taken over and distorted by medicine, the drug industry and the popular culture.

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Chapter 6: The Many Faces of the Clinic

This essay is about Rebecca, a woman who was born in Poland during the Second World War where she suffered terrible outrages that deeply affected the later course of her life. As Rebecca tells her story she moves seamlessly between different kinds of language: the language of science, symptoms and causes, experiential descriptions of their impact, psychological reflections, philosophical meditations, and sexual conflicts and challenges. In recounting her story she establishes a powerful bond with her doctor that is irresistible and irrevocable, but also intractable and illimitable.

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Chapter 7: The Experience of Evil

A major task within the classical philosophical tradition was to elaborate an underlying imperative to do good or to act morally. This chapter traces the microexperience of evil in specific examples and argues that while there is no evidence to support the existence of such an imperative there is nonetheless a basic consciousness of ‘evil’ or injustice that allows us to make decisions and to act.

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Chapter 8: Death Sentence

This chapter relates the story of Maria, a young woman with cancer who tried hard to find her own way of responding to illness and the threat of death. This story describes what someone goes through when she is dying and how to care for her ethically it is necessary to enter into her world, to examine deep questions about health and illness, life and death, hope and despair, to follow the trajectory of her life—with its problems and paradoxes, its accidental occurrences, its heroic and not so heroic decisions—right to the end.

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Chapter 9: Time, Ethics and the Archive

This chapter considers the different ways in which we experience time. It recounts the story of Elizabeth, who left home with her mother when she was a small child and never saw her father again. In the long and tragic life that followed she returned to this and other experiences, with uncertainty, with regret, and with wistful imagination. This story discusses how the doctor’s task is to read the bodily texts and to help organise the mutated experiences of the patient and to serve as a custodian of meanings and memories.

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Chapter 10: At the Gates of the Labyrinth

What is the experience of suffering? How do we make sense of it? Why are we so fascinated by the suffering of others? What effect does it have on us to witness someone in its midst? This is the story of Kakima Oqil and her children. Kakima married young and emigrated to Australia in her early twenties. At first, everything seemed to be going well, but then her husband died tragically in an accident at work ... Sixty years later she is dying from cancer. Although she herself is resolved to her fate her children refuse to accept it. A bitter struggle ensues which cannot have a happy outcome.

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Chapter 11: How to End a Life

Mr K is a man in his early fifties with severe heart failure. He is admitted to hospital for insertion of an artificial heart prior to heart transplantation. Everything goes well at first and Mr K, his family and the doctors are confident and hopeful. But then disaster strikes...

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Chapter 12: Fardels of the Heart

Discussions about the health effects of obesity have largely omitted the voices of the people living with obesity themselves. This chapter recounts the story of Jo, a woman with a young family who battled—courageously and ultimately tragically—both with her weight and the often cruel and unsympathetic responses to it she encountered from others. This is a story of a body that was ravaged, abused and, until the end, uncared for.

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Chapter 13: The Case of Miss T

This is an edited transcript of a discussion at a conference on the theory and practice of ethics. The participants include doctors, nurses, social workers and philosophers. Their discussions and disagreements illustrate how finely balanced and how unpredictable the clinical relationship can be and, no matter how much care is taken, how clinical decisions can lead to unexpected and unwanted outcomes.

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