Kieran’s IDG Update #4: End-of-Life Care Practices and Interdisciplinarity
As covered elsewhere on this blog, the Physicians’ Moral Experience project is, at its core, interdisciplinary. As Midori and I went through this interview process, we encountered the caring and thoughtful work that physicians and health professionals undertake, especially with regard to this fraught issue of end-of-life care. As professionals in one field, we came very much to respect and admire the professionals in this other field who took time out from their busy lives to answer our questions. These questions were more particular than is normal for open-ended qualitative research. In our case, we were exploring distinctions that are established in a specific bio-ethics field in philosophy to see what if any relevance they had to medical professionals in the field of end-of-life care. These are ethical and logical distinctions on allowing to die, palliative care, consent, assistance in dying, ethical decision making, the nature of assisting a person to die, and so on. In a sense, we were taking what is either a debate or a focus developed in one specific field – a particular version of philosophical bioethics – and asking if it applies to how physicians approach their own practice. During the interview process, we discovered that some of the philosophical distinctions could be seen as troublesome and even controversial to physicians on the ground. Despite that, all the interviewees gave themselves with goodwill to the interview process and answered the questions as best as they could, even if some questions seemed irrelevant, abstract, academic, and even in some cases offensive, while others seemed challenging, interesting and though-provoking.
Gadamer, the famous hermeneutic philosopher, noted that the fate of the development of knowledge under modern conditions includes increasing specialization.
Specialization is the irreversible tendency of modern science in all its different manifestations. As you know the law of specialization is not confined to the development of modern medical science and medical practice. Scientific research in every discipline finds itself facing the same situation. Each of the different areas of scientific enquiry are methodologically separated off from one another, which makes it imperative that we struggle to forge new, interdisciplinary links between them…. Those areas which are not fully amenable to techniques of methodological verification we term ‘grey zones,’ a term not restricted to things that are simply irrational. (Gadamer, “The Enigma of Health” 1996)
This project if nothing else is an example of the struggle to forge ‘new, interdisciplinary links’ – in this case on the shared focus of end-of-life care. The link was initially established during the interview process. As Midori describes, that discussion is now in the process of being turned into a text. While this interpretive research does not seek to establish empirically verifiable patterns (that is more the focus of quantitative sociology), it does seek to get at the meaning of action in this particular case. It embraces what could easily be called a classic ‘grey zone’ – an area “not fully amenable to techniques of methodological verification.” Still, there are empirical findings that can be developed in relation to what a particular set of medical doctors said in relation to the questions they were asked. Further, these findings can be addressed and examined from a more reflexive analytic perspective to understand their relation to more universal issues involved in end-of-life decisions and care. In turn, this understanding will push forward new and important interdisciplinary understanding of the grey zone of end-of-life care. If modern life can be said to be organized around the denial of death, as the title of a famous book has it, this collaborative research project seeks to rescue the phenomena of death and dying from denial. The researchers intend to bring to contemporary culture a sense of the experience of death, an experience that is central to our past culture as well as to most cultures around the world. I know that I, as one member of this research group, have been given a lot to think about in relation to the ethics of dying. I thank Midori Matthew for her invaluable assistance and I again thank the participants for their time, patience and goodwill.