A Question of Choice
Bioethical Reflections on a Spiritual Response to the Technological Imperative
First published in 1997, this book contributes to our understanding of the way our society responds to issues of death and dying. The trans-disciplinary research which informs this discussion is situated in the disciplines of bioethics and palliative care. Postmodern notions of discourse and power are used to explore the organizational approach of one hospice (Karuna Hospice Service) to working with the dying. In modern, Western technological societies, biomedicine is the dominant discourse which underpins our care of the terminally ill. Bioethics has recently emerged as a discipline concerned with resolving the many ethical dilemmas arising from such a physiological, technologized approach to death. Rather than add to such studies, this research looks into the direction of alternative ways of responding to the dying in our community. KHS was chosen for this research as it presented the possibility of a holistic and spiritual alternative to the positivist, reductionist hegemony of scientific medicine. The research focus is on establishing and describing this difference, and exploring how such an organization could maintain resistance to mainstream medicine. The research findings are shared with the intent of using the material and insights gained to explore important issues presently arising in bioethics and palliative care, for example the recent critique of Principalism in bioethics and the methodological difficulties restricting research into spirituality for palliative care.
Table of Contents
1. Introduction. 2. The Postmodern Lens. 3. Engaging in the Research. 4. Setting the Stage by Stating the Difference. 5. Buddhism: The Difference Within the Difference. 6. Connecting the Discourses: Spirituality. 7. A Changing Discourse: Death and Dying. 8. Silencing the ‘Technological Imperative’. 9. Coming into Existence: The Threats. 10. Coming into Existence: Success. 11. Maintaining Existence. 12. Spirituality: Making the Difference. 13. Bioethical Reflections. 14. A Concluding Statement.
’This book makes an original and important contribution to that trans-disciplinary endeavour which is bioethics. Its respectful use of the insights of life within a hospice assists our understandings of death, dying, palliative care, and their associated discourses. Perhaps most importantly, in examining the richness of death and dying via a bioethical lens, it helps to show spiritual dimensions of life, too long neglected in secular bioethics. This is a study on the cutting edge of bioethics, with insights for members of all the health care professions.’ Christopher Newell, Senior Lecturer in Medical Ethics, University of Tasmania and Vice President, Australian Bioethics Association ’...a refreshing and timely challenge to the predominance of the medical model in care of the dying in our Westernized society...the book should be read by professionals caring for the dying in hospitals or nursing homes, for whom it should present a special challenge.’ Journal of Medical Ethics ’...The author anticipates, acknowledges and responds...her challenge has been to move from a secular, modernist, scientific understanding of end-of-life issues towards the yet-to-be fully explored postmodern approach’ Medicine, Health Care and Philosophy ’...some insights are fascinating...focuses on the unresolved tensions and problems of the research. This is a thought-provoking book that clarifies a Buddhist understanding of spiritualist...has important implications for the research question, the findings, and the conclusions drawn’ Review of Politics