‘Despite Circumstance’: The Principles of Medical Ethics and the Role of Hope

Abstract

In this paper, I will examine how the role of hope can inform our interpretation of the classical principles of medical ethics. Defining hope as a future-oriented expectation for the good, I will look at how it can shape our understanding of justice, beneficence, respect for autonomy and non-maleficence. I will suggest that ethically engaging with these principles in medical practice requires placing value on the patient–practitioner relation as a mode of hope. Engaging the writings of Emmanuel Lévinas and Søren Kierkegaard, I will show how hope reveals itself through responsible and expectant relationship, even in the midst of suffering.

KEYWORDS:

• Bioethics
• medical ethics
• principles
• hope
• embodiment

Acknowledgements

The author would like to thank Sophie Rider and Carolyn Westin for their insights.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Anna Westin has lectured and completed her PhD in existential phenomenology and addiction at St. Mary's University, and has also lectured at Richmond, the American University in London and LST. Her current research interests and publications explore ethics, healing, mental illness and pain. She has published in a number of academic journals and is involved in community initiatives on creativity and justice.

Notes

1 Macklin cites the ‘yuck’ factor as one example of this (2015, p. 75).

2 He develops this further through his phenomenology of ‘saying’ and the ‘said’, found in Otherwise than Being (1998b).

3 Lévinas cites the doctor–patient relation as an example of this responsible relationship that permits an ‘exit’ in Useless Suffering (1988).

4 Where respect for autonomy develops through the three conditions of intentionality, understanding and noncontrol (Beauchamp and Childress 2013, p. 104).

5 This phenomenon is, for instance, expressed in standing ‘by oneself in leading one’s life, and not giving in to despair’ (Grøn 2013, p. 290).

6 See, for instance, instances of healing in Pullinger (2001) and Larmer (2014).

7 Christen et al. suggest that the core feature of principlism is to ‘locate moral principles pertaining to a particular moral situation and to use specific, balancing and (deductive) application to create a bridge between the moral situation and the relevant principles’ (2014, p. 2). Boyd suggests that this theory requires application through the unique hermeneutic encounter of the patient–practitioner relation (2005, p. 481).

8 Or, undergoing the passivity of suffering, to use the phenomenological language of Ricoeur (1995, p. 250).

9 I have clarified the distinction between exiting from the ‘total harm’ of death, and the possibility of dealing with other harms in the midst of this. Therefore, even in light of death, the practitioner may remain hopeful of preventing or removing other harms, such as discomfort or loneliness (as seen, for example, in the principle of non-maleficence).

10 Using the terminology of Boyd (2005, p. 481).

11 Lévinas writes that ‘[c]ategorisation is not an act of justice’ (1969, p. 67). This justice extends beyond understanding the other through her diagnosis. It requires the unfolding relationship that the principles suggest.