Tools for Dialogue: A Pragmatist Approach to Clinical Ethics Support

In a pluralistic environment, the lack of common moral foundations on which to ground the practice of clinical ethics support (CES), the coexistence of different theoretical approaches and the diversity of stakeholders and disciplines involved presents challenges for CES. On a practical level, health care professionals need to consider the diverse and often conflicting values, perspectives and backgrounds of various stakeholders, while supporting them in making practical and morally motivated decisions on how to act. On a theoretical level, CES has to prevent slipping into relativism, while at the same time taking into account the inherent diversity of healthcare practice. In a different time and era, at the beginning of the twentieth century, the pioneers of American pragmatism, Charles Sanders Peirce, William James and John Dewey, addressed a similar challenge, and tried to answer the question of how to withstand the risk of scepticism while acknowledging the fallibility of principles and theories. CES in a pluralistic society and American pragmatism are concerned with the same issue: what is the status of philosophical and ethical thinking in a context in which we cannot count on fixed principles or metaphysical truths? The goal of this thesis is to investigate whether classic American pragmatist philosophy can provide a useful theoretical framework which can enable CES to face pluralism in our contemporary societies. In particular, this thesis adds to the existing literature by focusing on the relevance of a pragmatist approach for: a) supporting professionals and other stakeholders in dealing with ethical dilemmas in health care, b) defining the nature of ethics expertise and integrating CES within health care organizations, and c) providing ethics education for health care professionals and researchers.