In the centre of Fedora, that grey stone metropolis, stands a metal building with a crystal globe in every room. Looking into each globe, you see a blue city, a model of a different Fedora. These are the forms the city could have taken if, for one reason or another, it had not become what we see today. In every age someone, looking at Fedora as it was, imagined a way of making it the ideal city, but while he constructed his miniature model, Fedora was already no longer the same as before, and what had until yesterday a possible future became only a toy in a glass globe.
Much writing and thinking in bioethics takes the form of a kind of Calvinesque speculative architecture. Our aim in this book and in the particular way in which it has been created has been to do something different. We wanted, in particular, to encourage the contributors to engage with one another and with the case to a degree unusual in bioethics practice. Behind this intention is something like a commitment to the idea that moral development, the growth of moral understanding and the emergence of moral practice in medicine (and in bioethics) can be facilitated by encouraging moral philosophers and health professionals to engage with one another in a focused and reasonably structured setting. More broadly it is to argue that conversation is a developmental fundamental of human experience (Parker 1995).
Medical ethics has had a rich and complex history over the past 40 years. It has been transformed from a rather clear and straightforward set of rules and attitudes, shaped largely by the medical profession itself, into a major field of academic and social inquiry. Contemporary work in medical ethics can be divided into three parts: ethical analysis and arguments of large-scale issues in science, practice and policy (such as consideration of the ethical issues concerning cloning or resource allocation); theoretical inquiry into the foundations of medical ethics; and practical analysis of particular dilemmas in clinical practice. This last area in medical ethics is normally referred to as clinical ethics, and is in many respects the most important and vibrant part of medical ethics today. It lives through its intimate connection with clinical practice and medical and healthcare education, the ways in which suggestions made by practitioners of clinical ethics are rapidly tested in clinical reality, and the growth of a practical field of work in which ‘ethicists’ support patients, professionals and ethics committees in making good decisions in difficult circumstances.
For all this vibrant growth, there has been some unease with the way clinical ethics has developed. Healthcare professionals are sometimes baffled by the argumentative curlicues of the philosophers; patients and activists are often suspicious that all this ‘ethics’ is just a way of reinforcing existing professional attitudes and authority, and that ethicists are just as blind to patients' concerns as the medical professionals; and philosophers are generally infuriated by the apparent laziness and lack of rigour of their ‘applied’ colleagues.
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