Page 62 - Contribution To Phenomenology

PHENOMENOLOGY AND THE CLINICAL EVENT 55

Maclntyre argues that it is only "in the course of trying to achieve
those standards of excellence which are appropriate to, and partially
definitive of, that form of activity" that one can understand and make
judgments about its internal "goods" or *\drtues" ([19], p. 177). The type
of internal understanding gained through actual practice requires that I
"subject my own attitudes, choices, preferences and tastes to the
standards which currently and partially define the practice" ([19], p. 177).
Thus, one could say, the evidence for making informed judgments
about clinical practice lies within that practice.^^ For Maclntyre, the
"goods internal" to a practice are ^Virtues"—acquired human qualities the
possession and exercise of which ''tends to enable us to achieve those
goods which are internal to practices and the lack of which effectively
prevents us from achieving any such goods'' ([19], p. 178). It seems to me
that this is equivalent to Husserl's emphasis on "immersing oneself in"
the ongoing striving and doing characteristic of science by "freely varying"
relevant examples in order to identify and explicate its common themes.

VIIL AfTiliation

Clinical encounters characteristically present a range of emotional,
volitional, and valuational components, and are thus textured by
uncertainties and ambiguities. Impairment typically breaks into the fabric
of a person's daily life. The relation with providers is not only asym-
metrical but most often between strangers. All these give the phenomena
of clinical encounters their characteristically charged atmosphere.
In the case mentioned, the couple's anger, anxieties, frustration, and
the like obviously textured their experiences and understanding, as was
equally clear regarding the physicians. On what did the one physician
base his judgment that "they are angry at us"? What is the evidence for

^^ This is surely true for the practice of clinical ethics. It should be
emphasized that since this discipline is novel, attaining a sense of its clinical
standards has unique difficulties. In part, as noted in the text, this requires a keen
appreciation of the physician's clinical work ("being in the trenches"); but it also
demands the rigorous appreciation of the experience of illness and impairment, the
clinical standards of other providers, and practical experience working within the
institutional contexts of that set of practices and experiences. It goes without saying
that there is currently little by way of common understanding of the standards
appertaining to clinical ethics; there is thus a pressing need to discover these and
make them integral to "ethics consultations," for instance.