Conference on Ethics in Mental Health, Toronto 2627 May 2006 Patterns of Practice: Do they help in c

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Conference on Ethics in Mental Health, Toronto
26-27 May 2006Patterns of PracticeDo 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

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Aim

• Patterns of practice might be a useful way to
  think about ethical decision making

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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

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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)

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The place of patterns in our lives

• 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

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Professional patterns

• Learned patterns of practice education
• Professional ethics the Bolam principle
• A story to hydrate or not to hydrate?

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The discontinuity problem
Clinical practice
Ethical theory
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PoP Solution
Clinical practice
Patterns of Practice
Ethical theory
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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

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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)

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Hence

• 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)

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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?

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Acquisition

• Education and training
• Informed practice
• Open to correction
• Shared, public nature

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Clinical factors
Experience
Education and training
Religious or spiritual factors
Moral factors
Patterns of Practice
Social factors
Political factors
Cultural factors
Legal factors
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Ethical decisions as ordinary
Clinical practice
Patterns of Practice
Ethical theory
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Justification

• Coherence of patterns of practice
• from within
• from without
• E.g. Artificial nutrition and hydration
• Concrete circumstances

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In sum, PoP

• 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

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Summary

• Ive suggested various ways in which our lives,
  including our professional lives, are patterned
• Ive raised the possibility that, at root, our
  clinical decisions are justified by particular
  patterns of practice, either good or bad
• Ive considered how a particular pattern of
  practice may or may not be justified from the
  ethical perspective

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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)