Transcript Patterns of Practice - Journal of Ethics in Mental Health > Journal of

Conference on Ethics in Mental Health,
Toronto 26-27 May 2006
Patterns of Practice:
Do they help in clinical ethics?
Dr Julian C Hughes
Psychiatry of Old Age Service,
North Tyneside General Hospital and
Institute for Ageing and Health,
University of Newcastle
UK
Aim
• Patterns of practice might be a useful way
to think about ethical decision making
Objectives
• To suggest the various ways in which our lives,
including our professional lives, are patterned
• To raise the possibility that, at root, our clinical
decisions are justified by particular patterns of
practice, either good or bad
• To consider how a particular pattern of practice
may or may not be justified from the ethical
perspective
For starters
• “The moral world has its being in, it rests
upon, what we do and how we act. It is in
our actions and the way we treat one
another that values come into being and are
preserved in being.”
(Luntley, M. 1995. Reason, Truth and Self: the Postmodern
Reconsidered. London and New York: Routledge, p. 218)
The place of patterns in our lives
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Patterns of behaviour (eating and sleeping)
Social patterns (manners and driving)
Cultural patterns (football and music)
Patterns of worship
Patterns of thought (adverts and politics)
Linguistic patterns of expression
Professional patterns
• Learned patterns of practice – education
• Professional ethics – the Bolam principle
• A story: to hydrate or not to hydrate?
The discontinuity problem
Clinical practice
Ethical theory
PoP Solution
Clinical practice
Patterns of Practice
Ethical theory
Linguistic practice
• We understand the meaning when we
understand the use (Wittgenstein)
• Meaning and normativity
• Normativity and practice
• Patterns of linguistic practice as the
prerequisite for meaning
Justification and practice
• The justification for saying that I
understand: I have grasped a use
• ‘To understand a language means to be
master of a technique’ (Wittgenstein, PI §199)
• ‘If I have exhausted the justifications I have
reached bedrock, and my spade is turned.
Then I am inclined to say: “This is simply
what I do”.’ (Wittgenstein, PI §217)
Hence:
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Is a pattern of practice a justification?
A ridiculous suggestion (Dr Shipman)!
But I know what a pint of beer is!
‘What people accept as a justification – is
shewn by how they think and live’
(Wittgenstein, PI §325)
The justification of clinical decisions
• This is simply what I do (hydrate) – is this
all that we can say as a justification?
• The shared nature of patterns of practice
• What makes a particular pattern of practice
right or wrong?
– what constitutes a particular pattern of practice?
– how are patterns of practice acquired?
Acquisition
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Education and training
Informed practice
Open to correction
Shared, public nature
Clinical factors
Education and training
Experience
Religious or
spiritual factors
Moral factors
Patterns of Practice
Social factors
Cultural factors
Political factors
Legal factors
Ethical decisions as ordinary
Clinical practice
Patterns of Practice
Ethical theory
Justification
• Coherence of patterns of practice
– from within
– from without
• E.g. Artificial nutrition and hydration
• Concrete circumstances
In sum, PoP:
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Ethical decisions as ordinary
Engagement with concrete circumstances
Reflect embedding culture
Fixity from essential public and shareable nature
Stem from education, training and experience
Reflect dispositions
Need to be genuinely informed and open to
correction
• Require coherence
Summary
• I’ve suggested various ways in which our lives,
including our professional lives, are patterned
• I’ve raised the possibility that, at root, our clinical
decisions are justified by particular patterns of
practice, either good or bad
• I’ve considered how a particular pattern of
practice may or may not be justified from the
ethical perspective
In conclusion
• “The moral world has its being in, it rests
upon, what we do and how we act. It is in
our actions and the way we treat one
another that values come into being and are
preserved in being.”
(Luntley, M. 1995. Reason, Truth and Self: the Postmodern
Reconsidered. London and New York: Routledge, p. 218)