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Modern hermeneutics deals with the conditions of the possibilities of human understanding. Its contributions are particularly pertinent to clinical stica, where patient and doctor seek to mutually understand one another in order to establish a determined care plan.

Nevertheless, this approach is far from useful for the formulation of a concrete standard for decision making in this area. Hermeneutics is effective in putting the focus on dialogue, rather than method. But it overlooks the fact that dialogue, according to Gadamer, is directed towards truth. The present article aims to highlight this point, and seeks to establish the connection between this gredis of truth and ideas of good, history and community.

The present work analyzes the contribution of the hermeneutical approach to clinical ethics, particularly in relation to gredo making in the field. Initially, the question is posed as to whether it is possible to form some kind of methodological system from hermeneutics nivomaco 1. Faced with the difficulties of doing so, the attention of the study then turns to the tool of dialogue. This idea plays a prominent role in all hermeneutic approaches, but without an ontological base, one wonders to what extent the dialogue between doctor and patient makes sense.

This question is addressed in sections 2 and 3. Finally, micomaco consider if the humanistic training provided by the moral sciences may have some role in decision-making and under what conditions section 4. As Gadamer points out, health is a hidden concept.

It is a state of internal measurement that is not easily determined through simple objective evaluation. It is vital, therefore, to observe and listen to patients 1. Thus, hermeneutics is conceived of as an act of interpretation across boundaries 3.

For the author, ethical judgment is included in clinical evaluation, so it is artificial to formulate an ethics applied to medicine. This rejection of an applied ethics is a general feature of all hermeneutic approaches to clinical ethics. The hermeneutical approach helps us to understand how we form a clinical and ethical judgment, but it does not tell us which treatment is good from a clinical standpoint, nor does it guide us about what treatment or the absence of treatment is good from an ethical point of view.

Thomasma rejects the decision-making models that emerge from both principles and cases. According to Thomasma, there are several factors on which the relative weight of values and principles of each case depends. These factors are, primarily: For example, the principle of autonomy will have more weight in the context of primary care than in tertiary care, where autonomy may be diminished.

Εθνικό Κέντρο Βιβλίου / Greek books in translation

However, this approach is not especially practical. As can be imagined, it provides only indications on how to make decisions. Here, doctor and patient are not beings removed from history or culture, but are part of communities in which diverse traditions are shared.

His interpretive theory aims, therefore, to be based on the internal professional standards of the practice of care although without neglecting its connection with external morality. This theory takes into consideration four parameters Determining what is lacking in this requires interpretation. Firstly, because the experience of disease in each patient is unique and unrepeatable. Secondly, because the contexts of the interpretation of doctor and patient are different and, so therefore, are their preconceptions.

Moral experience primarily involves feelings. Only secondarily can these become the object of moral reflection. The role of medical ethics is not so much to explain editoriap apply ethical theories and principles, but to interpret and evoke all that encompasses moral experience: Instead, the work of physicians is guided by a series of cultural assumptions about the nature of the world and of the body and the consequence of the historical evolution of medical knowledge.


Finally, the fact that all interpretation is tentative, and that more than one meaning is always nicomao, should not be overlooked.

From these parameters, it follows that one must etoca aware of the historical determination of all understanding. Yet while this nocomaco help us discard solutions based on unjustified prejudice, it does not determine a concrete solution. Have stated that dialogue serves to reveal the particularities of our prior judgments and, through it, allows us to etia a greater degree of understanding 8.

While this is correct, it is too generic to solve concrete problems. Similarly, Leder believes that top-down methodologies such as Kantianism and utilitarianism can obscure the rich complexity of cases. Hermeneutics, on the other hand, is capable of dealing with multiple contexts, which is its most useful feature. In his view, the hermeneutics of the twentieth century tends to reject the possibility of univocal interpretations, admitting an indefinite variety of gredod.

The hermeneutical approach would consist, in his editoriao, of listening to the voices of all the characters in the drama. Specifically, Leder aligns himself with the hermeneutics of suspicion in the manner of Ricoeur, because, he claims, neither the patient nor the physician are aware of the underlying relations of power such as the market, consumerism, and gender Junges proposes completing the casuistic approach with a hermeneutics of nlcomaco that interprets the ethical, anthropological and socio-cultural assumptions that determine how the realities of life and health are understood in the current society and etkca Seeing social relations in terms of power is highly debatable.

But even if it were not, it is worth asking if all the voices mentioned are equally gredoa. It is also not clear how it is proposed to move from careful listening to practice. Leder realizes that one cannot remain fredos an endless state of interpretation, but that cases must be resolved. Hermeneutics, he says, does not imply relativism. In his view, there is a basis for overcoming subjectivity, which is the shared tradition.

He proposes, furthermore, that dialogue allows us to become aware of the inevitable prejudices that accompany understanding.

In a divided society such as the west, the hermeneut must contribute to the articulation of the perspectives of the participants, bringing eyica different contexts to the debate. His role, he says, is not that of a provider of answers, but that of a Socratic interlocutor, through the invitation to dialogue All this is interesting, but insufficient for the determination of the correct interpretation.

Hermeneutics nicomaaco not provide a method, but an awareness of our mediated ability to reach the truth. One wonders whether it is necessary to presuppose this truth, because, in another case, it may not be clear what sense dialogue will have. In an even more indeterminate manner, Lingiardi and Grieco propose that the doctor should become a philosopher 13and that a true dialogue between doctor and patient must be formed.

The patient cannot be in a position of mere passivity. But it is not just about listening to the patient. For these authors, it is important to note that the doctor shares with the patient a mortal body, which is also vulnerable.

Z goes beyond mere empathy ediitorial is based on the Platonic idea of the doctor, not as someone who dispenses from above, but an individual who simply initiates the process of healing in niicomaco It is significant that Gadamer, in The Enigma of Healthrefrains completely from formulating anything like a method for biomedical ethics According to Gadamer, what the tool of method does not achieve must — and really can — be achieved by a discipline of asking and inquiring, a discipline that guarantees the truth All previous hermeneutic approaches emphasize the need for the physician and patient to listen to each other.

But it is an active listening that takes place through dialogue. This allows the mutual questioning of prejudices that are constitutively linked to any act of understanding, and in some cases can distort that understanding.

In fact, through dialogue, the doctor — or the patient — is able to understand the motives of the patient — or the doctor — and, through this understanding, question their own motives, discovering the prejudices that have given rise to them. This characteristic of dialogue is not a psychological opening to the other, which is understood as mere empathy, the putting of oneself in the place of the other, but is an opening of an ontological nature.


Svenaeus is right when he states that: This statement falls short, however, and reduces the Gadamerian approach. Because, radically, edktorial is neither my truth nor your truth, but a truth to which, despite the inevitable subjective conditions of understanding, it is possible to accede in one form or another. It is not that I impose myself, or that another imposes himself, as in a relationship of power.

The relationship between doctor and patient is not primarily a power relationship. Instead, it is the subject matter itself, the truth, that imposes itself. That is why Gadamer affirms: And, as he points out in another context, understanding a text and agreeing in a conversation have something in common: If the patient does not have a health problem — in the broadest sense of the term — the dialogue between doctor and patient as such lacks does not make sense.

It is a mistake to edtiorial that what is involved in understanding is only the revealing of the subjective sense of the intention of the author of the text. When Gadamer resorts to dialogue and the Socratic method of questioning as a way of moving towards truth, he does so on the basis of allowing things to surface and to assert themselves, when faced with the opinions and prejudices that dominate the individual It is not, therefore, correct to reduce hermeneutics to a dialogue of perspectives, in which doctors, patients, committee members and others perform an approximation of positions as they reciprocally approach other horizons of understanding It is a fact that this occurs.

The question is why it occurs. In a radical sense, why approach what is distant?

If this is not in fact so, it is not because, in the Hobbesian manner, discord is replaced by concord and war by peace, but because each and every one of these perspectives may also be mistaken with respect to reality, or biased by prejudices.

This presupposes that, for many of the aspects presented, there is some kind of access, albeit partial, to objective truth. It is true, as Svenaeus says, that Gadamer does not consider the goal of hermeneutic understanding the timeless truths that can be attained through a universal and timeless method.

Truth, Svenaeus aptly points out, is always concrete and depends on the meeting of two concrete horizons of understanding, a meeting that is directed towards the accomplishment of an end goal This end is healing.


This approach is clearly Nucomaco. In fact, for Aristotle, phronesis or prudence, which is the virtue responsible for decisions, is normative 25for the reason just noted.

But this virtue, though intellectual in nature, is not practicable as it is based on moral virtue, as Svenaeus admits.

In spite of this, and recognizing that the ethics of virtue is one of the possibilities of developing an ethics that revolves around phronesishe supports hermeneutic phenomenology And although he need not, Svaneaus returns to the starting point, appealing to dialogue and the need for doctors to understand their patients, their preferences and their ideas; opening themselves, in turn, to their horizons 27 But this is a reduction of the Aristotelian approach.

It is true that it pursues a good end, health, and to this extent is part of phronesis. But, as Aristotle teaches, this virtue is not directed at a particular good, health for example — as expressly stated — but to living well in general Moreover, in the light of the Aristotelian approach, the deitorial who must procure health is not primarily the doctor, but the patient.