Post-Secular Medical Education: (Pre-)Ethics, Homo Liturgicus, and Hidden Curricula
D. Brendan Johnson, TMC Fellow, Duke University
Western ethical theory is in a moment of deep transition. As the modern and postmodern intersect, even descriptive systems dividing religious from secular and public from private are challenged.
In medicine, while clinical bioethics may largely continue upon a flat utilitarian ethics, medical education presents a modernist vision of ethics as a variety of ethical systems: utilitarianism, deontology, casuistry, virtue ethics, and most notably, principalism. Not only does this schema fail by presenting dehistoricized systems as mere philosophical options for a rational agent’s choosing, it lacks a notion of normative ethical direction. In combination, these weaknesses risk medical ethics losing its positive voice – reducing it to the lowest common denominator or, worse, the pragmatics of corporate risk-management. This approach fails to engage medicine’s deep existential commitments to its work, such as the commitment to patient and community beyond the medical encounter’s transaction, looking towards the root causes of disease, and potentially even engagement that takes personal risks. This project attempts to reframe a more helpful approach to ethics as in some sense pre-ethical and existential, rooted instead in what John D. Caputo calls ‘obligation’ and thereby offering a new way forward in the formation of medical professionals.
First, John D. Caputo’s work will critique current ethical formulations and illuminate a more helpful (non)ground of ethics; his "Against Ethics" (1993) serves as a key text which will serve to humble ethics as an attempt to bracket our experience and calculate moments of decision – procedures which mistakenly try to make our ethical lives ‘safe’. Through Against Ethics we will move towards a pre-ethical stance of obligation. Secondly, through Caputo’s "On Religion" (2001) we will reframe and ultimately find that the Enlightenment division between sacred and secular is wanting. We are constrained, even in our contemporary ‘secular’ world, to exist as always ‘religious’ actors whose hearts are always oriented towards something. Third, we will think with James K.A. Smith’s "Desiring the Kingdom" (2009) which reformulates education away from intellectualized information and instead to whole-person formation. Recapitulating a pre-modern Augustine, education is the formation of Smith's 'homo liturgicus': “embodied, practicing creatures whose love/desire is aimed at something ultimate”. Finally, this approach allows us to theorize and face the ‘hidden curriculum’ of medical education as the formation program it truly is, and to move towards a more helpful post-modern reformulation of medical ethics education as the formation of whole persons deeply engaged in the medical care of those suffering.
Smith, J. (2009). Desiring the Kingdom: Worship, Worldview, and Cultural Formation. Grand Rapids, MI: Baker Academic.
In medicine, while clinical bioethics may largely continue upon a flat utilitarian ethics, medical education presents a modernist vision of ethics as a variety of ethical systems: utilitarianism, deontology, casuistry, virtue ethics, and most notably, principalism. Not only does this schema fail by presenting dehistoricized systems as mere philosophical options for a rational agent’s choosing, it lacks a notion of normative ethical direction. In combination, these weaknesses risk medical ethics losing its positive voice – reducing it to the lowest common denominator or, worse, the pragmatics of corporate risk-management. This approach fails to engage medicine’s deep existential commitments to its work, such as the commitment to patient and community beyond the medical encounter’s transaction, looking towards the root causes of disease, and potentially even engagement that takes personal risks. This project attempts to reframe a more helpful approach to ethics as in some sense pre-ethical and existential, rooted instead in what John D. Caputo calls ‘obligation’ and thereby offering a new way forward in the formation of medical professionals.
First, John D. Caputo’s work will critique current ethical formulations and illuminate a more helpful (non)ground of ethics; his "Against Ethics" (1993) serves as a key text which will serve to humble ethics as an attempt to bracket our experience and calculate moments of decision – procedures which mistakenly try to make our ethical lives ‘safe’. Through Against Ethics we will move towards a pre-ethical stance of obligation. Secondly, through Caputo’s "On Religion" (2001) we will reframe and ultimately find that the Enlightenment division between sacred and secular is wanting. We are constrained, even in our contemporary ‘secular’ world, to exist as always ‘religious’ actors whose hearts are always oriented towards something. Third, we will think with James K.A. Smith’s "Desiring the Kingdom" (2009) which reformulates education away from intellectualized information and instead to whole-person formation. Recapitulating a pre-modern Augustine, education is the formation of Smith's 'homo liturgicus': “embodied, practicing creatures whose love/desire is aimed at something ultimate”. Finally, this approach allows us to theorize and face the ‘hidden curriculum’ of medical education as the formation program it truly is, and to move towards a more helpful post-modern reformulation of medical ethics education as the formation of whole persons deeply engaged in the medical care of those suffering.
Smith, J. (2009). Desiring the Kingdom: Worship, Worldview, and Cultural Formation. Grand Rapids, MI: Baker Academic.