Elements of Moral Experience in Clinical Ethics Training and Practice Sharing Stories with Strangers

Introduction

Elements of Clinical Ethics Practice

Keep Us in Song: Clinical Ethics, Phenomenology, and Sharing Stories with Strangers

Elements of Discovery

1 Seminar in Strangeness

Observations I: Seminar in Clinical Philosophy, October 2003

Stairwell Stories I: Vanderbilt University Medical Center, Main Hospital Lobby

Observations II: Seminar in Clinical Philosophy, October 2009

The Clinical Part of Clinical Ethics or, Strangeness in the Seminar in Clinical Philosophy

Encountering the Stranger with Alfred Schutz

The Stranger’s Discipline and Elements of Responsibility in Clinical Ethics

What’s So Strange About a Seminar?

2 Clinical Attention as Surrender-and-Catch

Mr. Jones and Me

Never Quite Easy Again: The Surrender of Attention, the Surrender-To of Paying Attention

Disruption and Attention in Clinical Contexts

Mr. Jones and the Experience of Surrender

Intellectualizing the Disruption Away

Encountering Kurt Wolff’s Surrender-and-Catch

Elements of Wolff’s Surrender

Elements of Wolff’s Surrender-to

Clinical Ethics Rounds and the Discipline of Surrender-To

Surrender-to as Responsibility for Attention

The Particular Matters for Responsible Practice

Practicing Surrender-to: An Invitation to Reflective Clinical Ethics

Interlude I: Methods for Unknowing: Disruption and Attention

The Orientation of the Stranger

The Problematic of Disruption

From the Stranger’s Strategies to the Surrender-to

Surrender as Method: A Not Entirely Benign Procedure

Elements of Learning

3 Self-Reflection and Self-Education in Clinical Ethics

Unexpected Invitations in the Neonatal ICU

Not a Solo-Sport: Clinical Self-Reflections and Self-Education with Others

Reflecting on NICU Journals and the Practice of Self-Reflection

Strangers, Surrenderers, and Self-Reflective Dancers

Andrea Frolic’s Mindful Embodiment

Reflecting on NICU Journals and the Practice of Self-Education

Harald Ofstad and Self-Education in Moral Development

Always More or Less Dissatisfied: Ofstad’s 10th Characteristic of the Moral Agent

Shared Self-Reflection and Communal Self-Education in Clinical Ethics Practice

4 Affiliation and Attunement and Extra-Ordinary Discourse

Pivotal and Grounding Orientations: Attunement, Understanding, and What Is Meant by “Ethics”

Texts on Attunement

Me and the MOMS: ***Tuesday***

Uncanny Circumstances Require Extraordinary Attention

Me and the MOMS: *** Tuesday, Late Afternoon***

Richard M. Zaner: Attention to the Actual Circumstances at Hand

Me and the MOMS: ***Wednesday Morning***

Pierre Bourdieu: Communication with the Other and Shared Meaning-Making

Me and the MOMS: ***Thursday***

Mark J. Bliton: Self-Reflexivity and the Trembling of Attunement

Me and the MOMS: ***Thursday Afternoon***

The Conditions for Extra-Ordinary Discourse

Afterwards/After Words

Interlude II: Methods for Learning with Others: Vulnerability and Sharing Stories

From Attunement to Vulnerability

Learning about Our Own Practice Requires Help from Others

Engaging with the Zadeh Project: Peer Review as Peer Learning

Interpersonal and Individual Vulnerability: Reflections on the Zadeh Project and Sharing Stories with Strangers

Elements of Experience

5 Constituent Vulnerability, Constituent Responsibility

“We Are Power”

Afterwards/After Words

Vulnerability and Responsibility in Clinical Ethics: Connections and Reflections with Hoffmaster, Spiegelberg, and Zaner

The Dance of Vulnerability and Responsibility

Barry Hoffmaster and the Meaning of Vulnerability

Herbert Spiegelberg’s Ethics for Fellow Existers

Richard M. Zaner’s Meditation on Vulnerability

Stories Are Responsibilities

6 Clinical Storytelling and Fragments of Experiences

Part I: Acknowledgement: It Is Impossible to Speak… and Monstrous Not to Mention 133

Later That Same Day: The “Cameron Story”

Part II: Resolution: Lessons Learned in Sharing Stories

My Story – Clinical Ethics Consultation Service Case Review

Part III: Pursuance: Reflectively Unphilosophical Fragments or, 10 Things for Readers to Know

First: This Is the Hardest Story I’ve Ever Written

Second: Meaning-Making in Clinical Encounters Is Not an Epistemic Project – It Is a Moral Activity Requiring Preparation and Practice

Third: The Arc of This Chapter Is Learning to Tell My Own Story – As a Clinically and Philosophically Relevant Aspect of Practice

Fourth: Storytelling Carries Obligations. So Does Listening

Fifth: I’m Struck by the Multiple Activities at Work in Listening-and-Telling Stories

Sixth: Clinical Storytelling Is Transformative of Story, of Teller, of Listener

Seventh: The Work of Stories Is Shared Over Time

Eighth: Stories We Share Are Also NOT SAFE

Ninth: The Storytelling Reveals that We Can’t Always Account for What We Do and Why

Tenth: Storytelling Is Intersubjective and Rigorous Is Ways We May Not Appreciate

Part IV: Psalm: Invitation to Fragmentation

Sharing Stories with Strangers: Continuing When There Is No Ending

Notes on Storytelling – Clinical and Otherwise

Continuing Because There Is No Ending

Index

Biography

Virginia L. Bartlett is an assistant professor of biomedical sciences and assistant director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles, CA. She is a past chair of the Clinical Ethics Consultation Affairs committee for the American Society for Bioethics and Humanities.

Elements of Moral Experience in Clinical Ethics Training and Practice: Sharing Stories with Strangers will be a significant and important contribution to the practice of clinical ethics consultation. Rather than merely tell readers what is relevant, Virginia Bartlett has invited them to engage with both the common and unique in clinical experiences. Professor Bartlett’s tolerance for the discomforts of taking a clear-eyed look creates this accessibility. With that careful eye and a generous voice, she provides opportunities for a reader to make their own assessment about the ways these stories match up with real life experiences in health care. Not only will the reader learn about the evident and the more subtle ways that a person working as an ethics consultant encounters people, questions, standpoints, even values, and so on, they will also learn about what actually happens in our very human experience of health care.

- Mark J. Bliton, PhD, Director of Medical Bioethics at Kaiser Permanente Los Angeles Medical Center in Los Angeles, CA. He is Editor, with Stuart G. Finder, PhD, of Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project, Springer 2018.

"In this highly engaging and original work, Bartlett uses herself as an example to offer a deeply personal and realistic sense of what it actually is like to do ethics consultation, including the intellectual, emotional, and even physical experiences involved.  In so doing, she exquisitely illuminates how clinical ethics practice is itself a kind of moral undergoing – one that entails far more than mastering and applying knowledge or rote skills."

- Stuart G. Finder, Ph.D., Director, Center for Healthcare Ethics, Cedars-Sinai

"In Elements of Moral Experience in Clinical Ethics Training and Practice, Dr. Bartlett shows practitioners of clinical ethics – and practitioners of being human - how to acknowledge their responsibility through the collective recollection of stories that help make sense of what it means to care for one another."

- Joseph B. Fanning, Ph.D., Associate Professor of Medicine, Associate Director, Center for Biomedical Ethics and Society, Vanderbilt University

"This book offers a unique, genre-bending text that would be useful to trainees, graduate students, instructors, and preceptors. There is a deficit of clinical ethics literature focused on the experience, to use the author’s own words, of “doing ethics.” The author’s use of stories from her training and career intermingled with reflection and theory is an innovative way to help students and trainees early in their career better understand the work of clinical ethics."

Stephanie Larson, Lecturer in the Department of English at Case Western University