Efficient Causation and Principalism: A Bishopian Analysis of Medical School Bioethics
Benjamin Frush, MA, UNC School of Medicine
In his 2011 book The Anticipatory Corpse, Jeffrey Bishop argues compellingly that contemporary medicine suffers a clear inability to define the ends of its practice, the primary consequence of which is an impoverished and at times absurd treatment of dying patients. Drawing on Aristotelian metaphysical categories, Bishop diagnoses a “metaphysics of efficient causation” as the source of this a-teleological approach to the human body and, as a consequence, practices directed towards dying bodies.
While Bishop’s discussion of how this plays out vis-à-vis dying patients is cogently argued, he himself notes that the inculcation of this metaphysics of efficient causation begins far before it manifests in the experiences of dying patients. Bishop utilizes a Foucaultian “archaeological” methodology to note how the contemporary medical school has come to assume this metaphysics as normative, providing critical historical information to better understand our current state.
While Bishop succeeds in both tracing the development of this metaphysics of efficient causation and how it informs end-of-life practices, there is room to explore further the intermediary steps that occur between the history we have collectively inherited, and the decisions that manifest on the part of practicing clinicians, such as those involved in end-of-life care.
Perhaps the most critical part of this “in-between time” is the formation that occurs in medical school, when students begin to assume the efficient metaphysics as normative but before they are autonomous practitioners.
The goal of this paper will be to describe how the medical student comes to internalize this metaphysics of efficient causation, specifically in the course of their pre-clinical medical ethics training. Specifically, I will argue how the regnant principle-based approach to bioethics as initially described by Beauchamp and Childress both produces and reifies the idea that medical ethics primarily serves the purpose of ensuring efficient resolution of problems which could hamper the medical treatment process described by Bishop.
I will describe how this principles-based approach is taught, and argue that the four-principle framework by its very nature fails to provide any insight on the telos of medicine, and thus is destined simply to provide mere band-aids to medical problems that demand a more robust definition of ends. Moreover, I will argue that such a principle-based approach causes the medical student to view her role as one of participating in this metaphysics of efficient causation, rather than entertaining a teleological understanding of her profession and how it relates to the patients she serves.
Depending on space, I will seek to argue that only way for the medical student to discern and orient herself towards the telos of her work is through the lens of tradition, as defined by Alasdair MacIntyre in Three Rival Versions of Moral Enquiry.
While this piece will likely be more critical than constructive, the hope is that unmasking how a principle-based ethic inevitably consigns the medical student to a metaphysics of efficient causation means she should recognize the necessity of tradition to provide hope for a more robust understanding of the end of her profession.
In his 2011 book The Anticipatory Corpse, Jeffrey Bishop argues compellingly that contemporary medicine suffers a clear inability to define the ends of its practice, the primary consequence of which is an impoverished and at times absurd treatment of dying patients. Drawing on Aristotelian metaphysical categories, Bishop diagnoses a “metaphysics of efficient causation” as the source of this a-teleological approach to the human body and, as a consequence, practices directed towards dying bodies.
While Bishop’s discussion of how this plays out vis-à-vis dying patients is cogently argued, he himself notes that the inculcation of this metaphysics of efficient causation begins far before it manifests in the experiences of dying patients. Bishop utilizes a Foucaultian “archaeological” methodology to note how the contemporary medical school has come to assume this metaphysics as normative, providing critical historical information to better understand our current state.
While Bishop succeeds in both tracing the development of this metaphysics of efficient causation and how it informs end-of-life practices, there is room to explore further the intermediary steps that occur between the history we have collectively inherited, and the decisions that manifest on the part of practicing clinicians, such as those involved in end-of-life care.
Perhaps the most critical part of this “in-between time” is the formation that occurs in medical school, when students begin to assume the efficient metaphysics as normative but before they are autonomous practitioners.
The goal of this paper will be to describe how the medical student comes to internalize this metaphysics of efficient causation, specifically in the course of their pre-clinical medical ethics training. Specifically, I will argue how the regnant principle-based approach to bioethics as initially described by Beauchamp and Childress both produces and reifies the idea that medical ethics primarily serves the purpose of ensuring efficient resolution of problems which could hamper the medical treatment process described by Bishop.
I will describe how this principles-based approach is taught, and argue that the four-principle framework by its very nature fails to provide any insight on the telos of medicine, and thus is destined simply to provide mere band-aids to medical problems that demand a more robust definition of ends. Moreover, I will argue that such a principle-based approach causes the medical student to view her role as one of participating in this metaphysics of efficient causation, rather than entertaining a teleological understanding of her profession and how it relates to the patients she serves.
Depending on space, I will seek to argue that only way for the medical student to discern and orient herself towards the telos of her work is through the lens of tradition, as defined by Alasdair MacIntyre in Three Rival Versions of Moral Enquiry.
While this piece will likely be more critical than constructive, the hope is that unmasking how a principle-based ethic inevitably consigns the medical student to a metaphysics of efficient causation means she should recognize the necessity of tradition to provide hope for a more robust understanding of the end of her profession.