Page 54 - Contribution To Phenomenology

PHENOMENOLOGY AND THE CLINICAL EVENT 47

To work as a clinician (whether physician or ethics consultant) is thus
to be something like a detective: deliberately probing into the multiple
ways in which the situational participants interrelate, variously experience
and interpret one another and, within that relationship, the relationship
itself—as Kierkegaard would have appreciated [15]. The involvement of
the ethicist is thus a work of circumstantial understanding (both under-
standing, and being-understanding); reflection on this and other cases is
a matter of phenomenological explication [34].
The ethicist's work is principally a matter of enablement or empower-
ment ([39], pp. 175-216; [43], pp. 248-250, 285), and in that sense is
designed as therapeutic. The aim is to help the participants identify what
is at issue for each person; to help each become reflectively alert to and
consider their respective moral frameworks;' to help delineate, weigh, and
imaginatively probe the available options that are most reasonable and
fitting within those respective moral fi*ameworks; and to help each attain
clarity about the "stakes" so as to enable them to live with the outcomes
or aftermaths of needed decisions.
Reflection also suggests that to enter into any ongoing clinical situation
is inevitably to find oneself as also a participant—hence, to be enmeshed
in the different "stakes" and decisions ingredient to and helping to define
the situation. As therapeutic (enabling or empowering), the clinical ethics
consultant must therefore be quite as accountable (and held accountable)
as any physician or other provider ([43], pp. 27-28, 36-41). To be sure,
this accountability must be appropriate: for what is and is not said and
done, and to those whose situation it is most immediately. The idea of
responsibility is thus central to ethical involvement in clinical situations:
to be responsible for what is and is not said and done, and responsive to
those persons whom one seeks to enable or empower.

V. Illness Meanings and Narratives

Toward the end of his Formal and Transcendental Logic [12], Husserl
rejects the idea that there is any direct, immediate access to "the truth"
([12], p. 277). Whatever else may be said about that august topic, much
less about what sorts of evidence might back up claims about truth, it is
necessary to recognize that "truth" and "evidence" are inherently

' That is, to consider, as thoroughly as circumstances permit, what is
''worthwhile."