臨床倫理の方法論としての討議倫理と物語倫理

抄録

This paper analyzes how discourse ethics and narrative ethics contribute to resolve ethical questions in the context of clinical ethics. Jonsen et al. present a practical approach to ethics case analysis in medicine. Their approach has universal value, but at the same time has some defaults: culture-specific aspect to USA, lacking perspectives of time/process, prospective guide, and communicational aspects. Habermas' discourse ethics supplies some of the deficiencies, but will hardly handle cases in which (A) the patient is lacking competence to participate in the discourse, and, (B) the patient has the ability to participate in the discourse, but at an insufficient level to perform fully rational discussion. Narrative ethics, on the other hand will sophisticate clinical ethics by supplying norms such as "Take into account the process of formation of individual's values and that of norms in a group of people," and "Compare cases and stories." It will enable clinical ethics to handle the case of patients lacking the ability to make rational discussion. Although incompetent patients cannot be handled with that meta-ethical sophistication, the question can be reset as follows: "Can we determine the story of an incompetent agent via discourse in which the agent does not participate?" By resetting this way, narrative ethics may open new horizons to consider this sort of question in the light of normative argument.