Sage Journals: Discover world-class research

Abstract

Accepted standards of parental decisional autonomy and child best interests do not address adequately the complex moral problems involved in the care of critically ill children. A growing body of moral discourse is calling for the recognition of `tragedy' in selected human problems. A tragic dilemma is an irresolvable dilemma with forced terrible alternatives, where even the virtuous agent inescapably emerges with `dirty hands'. The shift in moral framework described here recognizes that the form of conduct called for by tragic dilemmas is the practice of phronesis. The phronetic agent has acquired a capacity to discern good agency in tragic circumstances. This discernment is practiced through the artful creation of moral narratives: stories that convey that which is morally meaningful in a particular situation; that is, stories that are `meaning making'. The phronetic agent addresses tragic dilemmas involving children as a narrator of contextualized temporal embodied human (counter)stories.

Keywords

bioethics children critical care pediatrics phronesis tragedy

Get full access to this article

View all access options for this article.

References

Beauchamp TL , Childress JF Principles of biomedical ethics, fifth edition. New York: Oxford University Press , 2001.

Carnevale FA Ethical care of the critically ill child: a conception of a `thick' bioethics. Nurs Ethics 2005; 12: 239-52.

Buchanan AE , Brock DW Deciding for others: the ethics of surrogate decision making. Cambridge: Cambridge University Press, 1990.

American Academy of Pediatrics. Guidelines on forgoing life-sustaining medical treatment. Pediatrics 1994; 93: 532-36.

Canadian Pediatric Society. Treatment decisions regarding infants, children and adolescents. Pediatr Child Health 2004; 9: 99-103.

Nussbaum MC The costs of tragedy: some moral limits of cost-benefit analysis. J Legal Stud 2000; 29: 1005-36.

Barbour JD Tragedy as a critique of virtue: the novel and ethical reflection. Chico, CA: Scholars Press, 1984: 165-89.

Duhamel A. Le tragique comme catégorie d'analyse éthique. In: Lacroix A , Malherbe J-F eds. L'éthique à l'ère du soupçon: la question du fondement anthropologique de l'éthique appliquée. Montreal: Liber, 2003: 115-30.

Nietzsche F. The birth of tragedy: out of the spirit of music. ( Tanner M ed.; Whiteside S trans.) Londo n: Penguin, 1993. (First published 1872.)

10.

Taylor C. Sources of the self: the making of the modern identity. Cambridge, MA: Harvard University Press, 1989.

11.

Taylor C. The ethics of authenticity. Cambridge, MA: Harvard University Press, 1991.

12.

Nelson HL Damaged identities, narrative repair. Ithaca, NY: Cornell University Press, 2001: 1-35.

13.

Sophocles. Antigone. In: The Oedipus plays of Sophocles. (Roche P trans.) London: Plume Books, 2004: 187-252.

14.

Nussbaum MC The vulnerability of the good human life: activity and disaster. In: Nussbaum MC. The fragility of goodness. Luck and ethics in Greek tragedy and philosophy. Cambridge: Cambridge University Press, 2001: 312-42.

15.

Sophocles. Oedipus the King. In: The Oedipus plays of Sophocles. (Roche P trans.) London: Plume Books, 2004:1-81.

16.

Hursthouse R. On virtue ethics. Oxford : Oxford University Press, 1999: 65-87.

17.

Wall J. Phronesis , poetics, and moral creativity. Ethical Theory Moral Pract 2003; 6: 317-41.

18.

Ricoeur P. Oneself as another. (Blamey K trans.) Chicago, IL: University of Chicago Press, 1992. (French original 1990.)

19.

Gadamer H-G. Truth and method. (Barden B, Cumming J trans.). New York : Crossroad, 1975.

20.

Taylor C. Interpretation and the sciences of man. In: Rabinow P , Sullivan WM eds. Interpretive social science: a second look. Berkeley, CA: University of California Press, 1987: 33-81.

21.

Benner P. , Hooper-Kyriakidis P. , Stannard D. Clinical wisdom and interventions in critical care: a thinking-in-action approach . Philadelphia, PA: Saunders, 1999.

22.

Dreyfus H. , Dreyfus S. A five-stage model of the mental activities involved in directed skill acquisition. (Operations Research Center Report.) Berkeley, CA: University of California at Berkeley, 1980.

23.

Schön DA The reflective practitioner: how professionals think in action. New York, NY: Basic Books, 1983.

The Birth of Tragedy in Pediatrics: a Phronetic Conception of Bioethics

Abstract

Keywords

Get full access to this article

References