Philosophical introduction: Case analysis in clinical ethics

Medical ethics has had a rich and complex history over the past 40 years. It has been transformed from a rather clear and straightforward set of rules and attitudes, shaped largely by the medical profession itself, into a major field of academic and social inquiry. Contemporary work in medical ethics can be divided into three parts: ethical analysis and arguments of large-scale issues in science, practice and policy (such as consideration of the ethical issues concerning cloning or resource allocation); theoretical inquiry into the foundations of medical ethics; and practical analysis of particular dilemmas in clinical practice. This last area in medical ethics is normally referred to as clinical ethics, and is in many respects the most important and vibrant part of medical ethics today. It lives through its intimate connection with clinical practice and medical and healthcare education, the ways in which suggestions made by practitioners of clinical ethics are rapidly tested in clinical reality, and the growth of a practical field of work in which ‘ethicists’ support patients, professionals and ethics committees in making good decisions in difficult circumstances. For all this vibrant growth, there has been some unease with the way clinical ethics has developed. Healthcare professionals are sometimes baffled by the argumentative curlicues of the philosophers; patients and activists are often suspicious that all this ‘ethics’ is just a way of reinforcing existing professional attitudes and authority, and that ethicists are just as blind to patients' concerns as the medical professionals; and philosophers are generally infuriated by the apparent laziness and lack of rigour of their ‘applied’ colleagues