Elements of Moral Experience in Clinical Ethics Training and

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Contents

Acknowledgments ix

Introduction 1
Elements of Clinical Ethics Practice 3
Keep Us in Song: Clinical Ethics, Phenomenology, and Sharing Stories
with Strangers 5

PART I
Elements of Discovery 7
1 Seminar in Strangeness 9
Observations I: Seminar in Clinical Philosophy, October 2003 9
Stairwell Stories I: Vanderbilt University Medical Center, Main
Hospital Lobby 10
Observations II: Seminar in Clinical Philosophy, October 2009 11
The Clinical Part of Clinical Ethics or, Strangeness in the Seminar in
Clinical Philosophy 13
Encountering the Stranger with Alfred Schutz 15
The Strange Life of Alfred Schutz 15
Schutz’s Stranger as a Model 15
Mapping the Unfamiliar World 17
The Stranger’s Discipline and Elements of Responsibility in Clinical Ethics 20
What’s So Strange About a Seminar? 22
2 Clinical Attention as Surrender-and-Catch 25
Mr. Jones and Me 25
Never Quite Easy Again: The Surrender of Attention, the Surrender-To of
Paying Attention 28
Disruption and Attention in Clinical Contexts 28
Mr. Jones and the Experience of Surrender 29
Intellectualizing the Disruption Away 30
Encountering Kurt Wolff’s Surrender-and-Catch 31
Elements of Wolff’s Surrender 32
vi Contents

Elements of Wolff’s Surrender-to 33

Clinical Ethics Rounds and the Discipline of Surrender-To 33
Total Involvement 35
Suspension of Received Notions 35
Pertinence of Everything 36
Identification 38
The Risk of Harm 40
Surrender-to as Responsibility for Attention 40
The Particular Matters for Responsible Practice 42
Practicing Surrender-to: An Invitation to Reflective Clinical Ethics 43
Interlude I: Methods for Unknowing: Disruption and Attention45
The Orientation of the Stranger 45
The Problematic of Disruption ­46
From the Stranger’s Strategies to the Surrender-to 47
Surrender as Method: A Not Entirely Benign Procedure 49

PART II
Elements of Learning  53
3 Self-Reflection and Self-Education in Clinical Ethics 55
Unexpected Invitations in the Neonatal ICU 55
Not a Solo-Sport: Clinical Self-Reflections and Self-Education with Others 56
Reflecting on NICU Journals and the Practice of Self-Reflection 57
Strangers, Surrenderers, and Self-Reflective Dancers 58
After a Moment: Recollecting and Reflecting on Meanings and
Motivations 58
Andrea Frolic’s Mindful Embodiment 59
Too Serious for Trial and Error 62
The Occasion for Practice Emerged 63
I Could Write a Book … 65
Reflecting on NICU Journals and the Practice of Self-Education 66
Harald Ofstad and Self-Education in Moral Development 67
So, What Can I Figure Out from These? 68
Isn’t That What Normally Happens? 69
Always More or Less Dissatisfied: Ofstad’s 10th Characteristic of the
Moral Agent 70
Will I Miss Understanding If I Don’t Ask? 70
Shared Self-Reflection and Communal Self-Education in Clinical
Ethics Practice 71
4 Affiliation and Attunement and Extra-Ordinary Discourse 74
Pivotal and Grounding Orientations: Attunement, Understanding,
and What Is Meant by “Ethics” 74
Texts on Attunement 75
 Contents vii

Me and the MOMS: ***Tuesday*** 76

Uncanny Circumstances Require Extraordinary Attention 82
Me and the MOMS: *** Tuesday, Late Afternoon*** 82
Richard M. Zaner: Attention to the Actual Circumstances at Hand 86
Moral Factors and Situational Definitions 86
Acts of Affiliation 87
Me and the MOMS: ***Wednesday Morning*** 88
Pierre Bourdieu: Communication with the Other and Shared
Meaning-Making 89
Responsibility for Collaborative Construction 90
Me and the MOMS: ***Thursday*** 94
Mark J. Bliton: Self-Reflexivity and the Trembling of Attunement 95
Unspeakable Responsibility 96
What, Then, Is Left? 97
Me and the MOMS: ***Thursday Afternoon*** 98
The Conditions for Extra-Ordinary Discourse 100
Afterwards/After Words 101
Interlude II: Methods for Learning with Others: Vulnerability
and Sharing Stories  104
From Attunement to Vulnerability 104
Learning about Our Own Practice Requires Help from Others 105
Engaging with the Zadeh Project: Peer Review as Peer Learning 105
Interpersonal and Individual Vulnerability: Reflections on the Zadeh Project
and Sharing Stories with Strangers 106

PART III
Elements of Experience  109
5 Constituent Vulnerability, Constituent Responsibility  111
“We Are Power” 111
Afterwards/After Words 115
Vulnerability and Responsibility in Clinical Ethics: Connections and Reflections
with Hoffmaster, Spiegelberg, and Zaner 116
The Dance of Vulnerability and Responsibility 117
Barry Hoffmaster and the Meaning of Vulnerability 117
Clinical Ethics Consultant’s Responsibility to Vulnerability 119
Herbert Spiegelberg’s Ethics for Fellow Existers 120
The Undeserved Unfairness of Happenstance in Clinical Encounters 123
Richard M. Zaner’s Meditation on Vulnerability 125
Responsibility En Masse 128
Stories Are Responsibilities 130
viii Contents

6 Clinical Storytelling and Fragments of Experiences  133

Part I: Acknowledgement: It Is Impossible to Speak … and Monstrous
Not to Mention 133
Later That Same Day: The “Cameron Story” 133
Part II: Resolution: Lessons Learned in Sharing Stories 135
My Story – Clinical Ethics Consultation Service Case Review 137
Part III: Pursuance: Reflectively Unphilosophical Fragments or, 10 Things for
Readers to Know 139
First: This Is the Hardest Story I’ve Ever Written 139
Second: Meaning-Making in Clinical Encounters Is Not an Epistemic
Project – It Is a Moral Activity Requiring Preparation and Practice 140
Third: The Arc of This Chapter Is Learning to Tell My Own Story – As a
Clinically and Philosophically Relevant Aspect of Practice 140
Fourth: Storytelling Carries Obligations. So Does Listening 142
Fifth: I’m Struck by the Multiple Activities at Work in Listening-
and-Telling Stories 143
Sixth: Clinical Storytelling Is Transformative of Story, of Teller, of
Listener 143
Seventh: The Work of Stories Is Shared Over Time 144
Eighth: Stories We Share Are Also NOT SAFE 145
Ninth: The Storytelling Reveals that We Can’t Always Account for What We
Do and Why 146
Tenth: Storytelling Is Intersubjective and Rigorous Is Ways We May Not
Appreciate 148
Part IV: Psalm: Invitation to Fragmentation 149
Sharing Stories with Strangers: Continuing When There Is No Ending 153
Notes on Storytelling – Clinical and Otherwise 153
Continuing Because There Is No Ending 155

Index  158
Acknowledgments

For the patients, families, and clinical colleagues too numerous to name, I am grateful beyond
measure for your openness and vulnerability, your insights and questions, and the stories you
shared with me of your experiences as we shared the experiences in the moral moments of clinical
ethics encounters. You have taught me how many ways there are to care for other human beings
and to be cared for in return. I daresay most are unaware of how profoundly they have shaped my
practice and my professional and personal growth, but I hope that in our moments together they felt
heard and felt that they and their stories mattered.
For my predecessors, professional colleagues and peers, I am grateful for the questions and
insights, the support and the stories you’ve shared through conversation, conferencing, and
correspondence, in person, by video calls through the pandemic, through your writings both
personal and professional. I give special thanks to Dr. Ken Leeds and Dr. Andy Kondrat, my
colleagues at Cedars-Sinai for unwavering support, encouragement, and helping me be clear as
I can; to Dr. Mindy McGarrah-Sharp, who has offered professional and personal support from
graduate school to the present day; and to Dr. Laura Webster, for her professional insights, and
caring friendship. I am grateful to Dr. Richard M. Zaner, my teachers’ teacher, whose work has
so profoundly shaped the field and my own practice, through his creativity and clarity and his
deep insistence that stories are at the core of clinical ethics work. And I am grateful to Dr. Leon
Morgenstern, of blessed memory, who founded the Bioethics Program at Cedars-Sinai Medical
Center, which became the Center for Healthcare Ethics. Leon’s deep care for patients and their
care providers, and his insistence that I should write every day have inspired me and carried me
through the many challenges and iterations of this work. I am grateful to the writers and poets
and artists who have infused my life with meaning and wonder through stunning convergences
and constellations of discovery. Special thanks to Ms. Dar Williams for permission to quote her
beautiful song, “You’re Aging Well.” Special thanks, also, to Mr. Duy Huynh for allowing me
to use his beautiful painting, “Transformative Chapter” as the cover for these transformative
chapters.
For my teachers-colleagues-friends, Mark J. Bliton and Stuart G. Finder: thank you. For wel-
coming my questions and stories, showing me how to pay attention, and demonstrating how to live
in and through my own vulnerability in moments of disruption inherent in this work – and in the
tricky business of being human. Thank you for showing me what it means to be supported and to
support each other – personally and professionally. Thank you for helping me learn to listen hard
to what all matters in moments of connection with other humans, and thank you for helping me
find my voice, especially in the writing of this book. I am grateful for all the stories we share and
am looking forward to all those yet to unfold, yet to be told.
x Acknowledgments

For my family – endless thanks to my parents and siblings who have supported me in all I do,
and with whom I share stories that shape how I understand and find meaning in the world. My
gratitude to my children is boundless as well: they are incandescent beings who make the world
shine brighter, and they have taught me how to listen, especially when it’s hard, and how to pay
attention to both the mundane and the extraordinary. They have made me a better clinician than I
could have imagined, and I hope they realize my clinical work has made me a better parent than I
would have been otherwise. Sophia, Ellison, and Latham, along with their father, Shane Bartlett,
supported this project since it first emerged, even among shifting storylines in our family and our
world. All three, along with William and Henry, my bonus children, continue to teach me how to
elicit and articulate what matters, how to be flexible and responsive, and how to keep going in the
midst of uncertainty, appreciating and loving each other along the way. Finally, I am grateful for
the love and support of my partner, Preston Robinson, for the wild serendipity that reconnected us,
the deep, old stories that ground us, and for whatever is next as our story together, the story of our
family, continues and grows …
Introduction

“The ‘what to do’ issue seems the author’s and thus is a straw man: Consult. See the parents.”
– Reviewer # 2, 2012

Once upon a time, early in my career, I wrote about a clinical ethics encounter from the Neonatal
Intensive Care Unit. This writing became a paper which explored the consultant’s experience of
responsibility. My aim was to describe, in an accessible way, what it is like trying to decide what
to do among the multiple options available in what are assumed to be the mundane choices and
actions that unfold in a clinical consult. The paper was well received at the Annual Meeting for the
American Society of Bioethics and Humanities, and so I thought, “Hmmm …, I should turn this
into a manuscript.” Which I did. The manuscript wasn’t accepted (which, of course, is something
that happens). More germane to this book was the epiphany gained from reading the reviewer’s
comments. I was stunned, at least at first, baffled, and then ultimately grateful for the response en-
capsulated in Reviewer #2’s comment above. Why? Although Reviewer #2 gets a bad rap for being
the nitpicky pendant, focused on their taken-for-granted method or favorite disciplinary view, the
comment made me pay attention to something I had taken for granted – in my clinical practice and
my writing: Of course the “what to do” issue was the author’s/consultant’s! It is always the ques-
tion for the clinical ethics consultant, isn’t it? Isn’t it?
It turns out not, and so Reviewer #2’s comment over a decade ago clarified what has become
a set of questions, threaded together at the core of my own practice: What is it like to actually
do clinical ethics work? How do we practice responsibly as individuals? And how do we do this
work together as part of a community, a field? These questions shape my daily practice and have
informed much of my scholarship. Over time, they became the motivating concerns for writing
this book, which answers each question with its subtitle: Sharing Stories with Strangers. What is
it like to actually do clinical ethics work? A lot like sharing stories with strangers. How do we do
this work responsibly as individuals? We can answer that question only if we are responsible in
sharing stories with strangers. And how do we do this work together as part of a community and
field? You guessed it! Through sharing stories with strangers. And exploring the depths and lay-
ers, the variations and nuances in what it means to share stories with strangers gets to the heart of
clinical ethics work.
Clinical ethics consultation includes an array of communicative practices oriented and organized
by careful inquiry into the moral and ethical concerns that arise in healthcare settings, and therefore
involves having conversations with the people whose concerns these actually are, including pa-
tients, families, and clinicians. As clinical ethics consultants, we elicit and listen to and learn from
the stories that patients, family members, and clinicians share in consultation conversations. The
focus is on the specificity of this encounter, with these people facing questions and uncertainties

DOI: 10.4324/9781003354864-1
2 Introduction

in their own particular circumstances. We often retell those encounters in case reports, conference
papers, or publications, as part of our professional engagement and development, sharing others’
stories as examples of themes or concerns that, while unique to them, are also common or familiar
across other healthcare contexts and practice settings. The communicative nature of clinical eth-
ics work spans the specificity and depth of conversations in consultation encounters to the scope
and reach of discussions about themes, issues, and topics that generate requests for clinical ethics
consultation.
And yet, as individuals and a field, we are less likely to communicate and share stories about
our experiences as clinical ethics consultants. In the legitimating forums of presentation and pub-
lication, an ethics consultants’ stories about their own experiences often are disregarded as too
individual and idiosyncratic, as not contributing to what are claimed as the real ethics issues.
Given the increasingly prominent models in this field that make claims for authoritative expertise,
standardized procedural approaches, and exam-certified legitimacy, clinical ethics encounters –
the moral moments we experience – are expected to get neutralized and anonymized, tamed and
flattened into “case studies” or “examples” for “kinds” of consults.1 The consultants’ experiences
are excluded and excised from the tale, seemingly unwelcome. Not only does this exclusion serve
to create doubt that our personal experiences and insights are somehow considered as legitimate
sources of understanding, it serves to alienate diverse forms of moral practice across different com-
munal contexts.
The guide for this book, the invitation to you, dear reader, is that stories do not have to be gen-
eralized and they can serve a different purpose in our practices. Stories are personal. Interpersonal.
Intersubjective. Stories convey values and moral insight in those ways we embody and model
our responsibilities when telling them – and when listening to and receiving them. Stories shared
among clinical ethics consultants can create communities of understanding about this work, con-
nected by pathways through provinces of meaning. Even when we discover meanings that don’t
always fit into predetermined frameworks in one or another view about “ethics,” our stories can
illuminate elements of actual practice and invite reflection on what may be common among our
unique experiences.
After all, stories of particular consultants’ practices do emerge and they circulate in conversa-
tion, shared within our communities of practice. Our stories come out in the conversations after
presentations at a conference; in discussions around the coffee station or across the bar or over the
dinner table with peers from other institutions; colleagues and friends from other places and times.
These are the stories that make people wince with remembrance of their own moments; or nod
slowly, listening carefully to the strange newness; or bust out an awkward guffaw of recognition
and fellow feeling from the absurdities that pepper clinical experience. These are the stories we tell
each other and ourselves, about the work we do and how and why.
In my tradition, practice as a clinical ethics consultant means taking seriously the moral dimen-
sions unfolding in a particular encounter, and part of developing a responsible practice is engage-
ment with the specifics of one’s particular practice, as well as with insights from the broader field
and how colleagues and peers engage with their practice. Like all stories, our clinical experiences
require tellings-and-listenings for their meanings to emerge in the spaces among speakers and
audience, or writers and readers. Stories shape our practices, and our understandings of this work
we do together.
So, inspired both by the clinical ethics encounters that stay with me as stories and by com-
ments like the one that stuck with me from Reviewer #2, much of my professional engagement
has explored the question of “what to do” or “what we do” as a live and lively concern, rather than
as already answered. Specifically, over the years I’ve wound up writing my experiences as stories
as a way of trying to get clear about what just happened and what all mattered in each encounter
 Introduction 3

or experience. As the collection of recollections has grown, I’ve realized that all of them illustrate
what I have grown to think of as elements of or facets of responsibility in doing clinical ethics
work, which together form what Richard M. Zaner called “a general method.”2 Over time, through
writing these stories and reflections on my experience as the clinical ethics consultant, I have en-
gaged what other thinkers in the field have thought about these elements of practice, and explored
other, additional resources – philosophical, literary, creative arts – seeking perspectives that might
help me think about these elements of clinical ethics.
With what I have learned is the not insignificant amount of time required to coax these things
into view, those efforts were likewise shaped into this book, The Elements of Moral Experience in
Clinical Ethics Training and Practice: Sharing Stories with Strangers, a bricolage structured to
invite reflection on the stories we share and the elements of practice they reveal. Each chapter in-
cludes one or more stories of a clinical ethics encounter that illustrate a specific element of practice,
followed by reflections to draw from an array of resources, seeking from a cacophony of voices.
Drawn from stories and songs as well as philosophy, sociology, anthropology, and clinical ethics
literature, these voices offer insights and explanations that help to find ways to understand meaning
in clinical encounters. The aim in this structure is to enable the reader to engage in ways that best
suit their needs: each story can be read on its own, as can the reflections. Or each chapter can be
engaged as a whole, or each of the three parts – with two chapters each – could be read to focus
on specific elements: Discovery, Learning, or Experience. Or the reader could read from start to
finish, following the arc of the book, though with the caveat that everything circles back around to
the questions with which we began: What is it like to actually do clinical ethics work? How do we
practice responsibly as individuals? And how do we do this work together as part of a community,
a field? The brief outline that follows might serve as a guide for the perplexed.

Elements of Clinical Ethics Practice

Part I: Elements of Discovery focuses on the experience of unknowing in clinical ethics work,
experiences elicited through disruption and strangeness. These are worked through by the careful
focusing of attention and the experiences of surrender-and-catch, which can be engaged and en-
acted as part of practice and method in clinical ethics work.
Chapter 1, “Seminar in Strangeness” introduces the unavoidable, inherent disruption and
strangeness of clinical ethics work. “Observations I,” “Stairwell Stories I,” and “Observations II”
illustrate the disconcerting experiences of discovering that clinical ethics – and clinical philoso-
phy – was different than imagined: more interpersonal, reflective, and requiring vulnerability for
communication and understanding. Chapter 1 uses Alfred Schutz’s 1944 essay “The Stranger”3 to
explore the experiences of disruption, uncertainty, and navigating meaning-making constituent of
clinical ethics work – and models the focus, reflection, and careful attention that became a method
of doing clinical philosophy outside the classroom.
Chapter 2, “Clinical Attention as Surrender-and-Catch,” explores attention as an element in
clinical ethics work: the attention that is deliberately directed and the attention that is elicited by
disruptive occasions or encounters. After the story, “Mr. Jones and Me,” the chapter alternates be-
tween journal excerpts from my first clinical rotations in the Medical Intensive Care Unit (MICU),
and reflection on sociologist Kurt Wolff’s generative and wondrously peculiar book, Surrender and
Catch: Experience and Inquiry Today.4 These reflections provide clinical and practical frames for
understanding – particularly the unexpected surrender-and-catch, and more deliberate process of
surrender-to: both ever-present possibilities in clinical ethics work.
Part I ends with an “Interlude I: Methods of Unknowing: Disruption and Attention” to explore
disruption/strangeness and surrender-and-catch together as a kind of method of unknowing and
4 Introduction

hence openness to discovery. The inevitable unknowing and the humbling acceptance that neither
the Stranger’s careful approach nor the deliberate attention of the surrender-to may be sufficient
for understanding and action serve as an access point to deliberate inquiry, and ongoing learning,
as part of responsible practice.
Part II: Elements of Learning focuses on practices of self-reflection and self-education, as these
occur with others, through practices of affiliation and attunement. Chapter 3, “Self-Reflection and
Self-Education in Clinical Ethics” explores the need to recognize rigor in self-reflection as a cru-
cial component of method in clinical ethics work, illustrated through a clinical encounter from my
training in the Neonatal Intensive Care Unit (NICU).5 The story, “Unexpected Invitations,” unfolds
through journal excerpts from my months in the NICU and is framed by anthropologist and clinical
ethicist Andrea Frolic’s call for embodied self-reflection in clinical ethics work6 and philosopher
Harald Ofstad’s reminder – from over 40 years ago – that self-reflection, as a necessary part of
moral education, is not a merely solitary activity.7
Chapter 4, “Affiliation and Attunement: Extra-ordinary Discourse” is the longest and most central
chapter for the book. This chapter dives into the details of such interpersonal connection in clinical
ethics by explicating two key elements: attunement and affiliation. These elements are illustrated by
“Me and the MOMS,” a story of an encounter with a pregnant woman and her partner considering
experimental prenatal surgery for their fetus with spina bifida. The interpersonal and moral features
are examined through the sociological and clinical-philosophical lenses of Pierre Bourdieu, Richard
M. Zaner, and Mark J. Bliton.8 The encounter – and the philosophical reflections that followed – serve
as a pivot point and key recognition of clinical ethics as a moral activity and extraordinary discourse.
Part II: Elements of Learning ends with “Interlude II: Learning with Others: Vulnerability and
Sharing Stories,” which reviews how elements of self-reflection and self-education, along with
affiliation and attunement are constituent and necessary for responsible clinical ethics practice.
Drawing from the example of Peer Review, Peer Education, and Modeling in the Practice of
Clinical Ethics Consultation: The Zadeh Project, Stuart Finder and Mark Bliton’s edited volume
on peer learning,9 Interlude II helps frame the questions that shape the final third of the book: how
do we talk about or share, find meaning in, and give accounts of our own moral moments and en-
counters with others? What do we do if we recognize the vulnerability of such moments, and how
do we respond when the encounter exposes our own affiliations, commitments, or unacknowledged
biases? When our experiences put us into question?
Part III: Elements of Experience thus considers experiences of clinical ethics work through the
ethics consultant’s vulnerability – and through the practice of telling our own stories of our own
experiences. Chapter 5, “Constituent Vulnerability, Constituent Responsibility” explores vulnera-
bility as an unavoidable, inherent element of responsibility in clinical ethics practice. It begins with
“We Are Power” and “Afterwards/After Words,” stories of a wrenching clinical encounter with
struggling clinicians and a grieving family that illustrate the multiple forms of and expressions of
vulnerability that clinical ethics consultants experience. This chapter draws philosophical insights
from Barry Hoffmaster’s reflections in “What Does Vulnerability Mean?”10; Herbert Spiegelberg
about responsibility in “Ethics for Fellows in the Fate of Existence”11; and from Richard M. Zaner’s
“Power and Hope in the Clinical Encounter: a Meditation on Vulnerability.”12
Finally, Chapter 6, “Clinical Storytelling and Fragments of Experience” wrestles with the chal-
lenge of clinical ethics consultants sharing our own moral experiences and exploring their mean-
ings with others. This element in clinical ethics practice emerges in “Later That Same Day: The
“Cameron Story”” the story of a moment where I nearly fainted mid-consult, in the room with a
patient requesting a legally prescribed lethal medication to end her life via medical aid-in-dying.
The reflections explore the rigors of telling and making sense of that disruption, exposure, shame,
and uncertainty that shuddered and rippled like shockwaves out from that moment. The reflections on
 Introduction 5

this encounter emerge as fragments, possibly the most fitting genre for brief reflections on the lim-
its of clinical storytelling and narrative approaches to ethics, and to do this I draw from reflective
resources in literature, song, and creative arts. These diverse genres are intended highlight modes
of imaginative engagement that support sharing and understanding, accounting for the wild seren-
dipity and anarchy of voices in human experiences, especially in clinical encounters.
The work doesn’t end, although the book does, concluding with “Sharing Stories with Strangers:
Continuing When There is No Ending”: exploring ideas regarding un-get-around-able orientations
and core elements necessary for responsible practice in clinical ethics work. They also reflect what
I see as the necessity for stories and shared reflection in clinical ethics work, particularly the need
to recognize these practices of discovering and excavating meaning as necessary to illustrate the
richly layered, iterative, and ongoing experiences that are the work.

Keep Us in Song: Clinical Ethics, Phenomenology, and Sharing Stories

with Strangers
The stories that follow are offered as examples of the everyday, the mundane phenomenon of clini-
cal ethics work – both the experiences of the clinical moments as well as the discernable moral in-
sights gathered by reflecting and learning from them (a process without strict beginning or end, I’ll
note). They offer access to the even stranger phenomenon of attempting to capture these stories on
a page and share them with others – with readers-as-strangers. I offer my stories of my experiences
in clinical ethics work, with the invitation for others to read, to consider, to ask, probe, argue, as a
spur for reflection on their access to and experience with or understandings of the phenomenon of
clinical ethics consultation. These stories of mine are offered humbly and proudly.
Humbly in the knowledge that as a phenomenological work, it is partial and particular and as
a collection of stories or memoir, it struggles in the bounds of the genre, not designed to offer any
steps or advice one might expect in an account of professional development. These stories have
no aphorism at the end, not single moral or meaning – even if they are about moral elements of
clinical ethics practice. People will find much to dispute and challenge and question – and that is
by design.
It is also offered proudly, for many of the same reasons, in keeping with the moral dialogue we
so desperately need. People will find much to consider and question and dispute and chew on –
good! Whether the response is “What nonsense!” or “I had that same experience!” or “That essay
she references is old news” or “I don’t even know who that thinker is …” May your conversations
be fruitful – with yourself and your peers, with your trainees and mentors. May you share your
stories with strangers and accept theirs in return, learning from each other what it is like to do this
work, alone and together.

Notes
1 Rasmussen, Lisa (2018). Standardizing the Case Narrative. In Stuart G. Finder and Mark J. Bliton (eds.),
Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh
Project. Cham, Switzerland: Springer Verlag. pp. 151–160.
2 Zaner, Richard M. (1988) Ethics and the Clinical Encounter. Englewood Cliffs, NJ: Prentice Hall.
3 Schutz, Alfred (1944). The Stranger: An Essay in Social Psychology. American Journal of Sociology 49
(6):499–507.
4 Wolff, Kurt H. (1976). Surrender and Catch: Experience and Inquiry Today. In Boston Studies in the Phi-
losophy and History of Science, vol. 51. Dordrecht: Springer.
5 N.b. This is not the story that Reviewer #2 found unsatisfactory.
6 Frolic, Andrea (2011). Who are we when we are doing what we are doing? The case for mindful embodi-
ment in ethics case consultation. Bioethics 25 (7):370–382.
6 Introduction

7 Ofstad, Harald (1974). Education versus growth in moral development. The Monist 58 (4):581–599.
8 Bourdieu, Pierre (1999). Understanding. In Pierre Bourdieu (ed.), The Weight of the World: Social Suf-
fering in Contemporary Society. Cambridge, UK: Polity Press. pp. 607–626. Bliton, Mark J. (2008).
Maternal-Fetal Surgery and the ‘Profoundest Question in Ethics’. In Paul J. Ford and Denise M. Dudzin-
ski (eds.), Complex Ethics Consultations: Cases That Haunt Us. Cambridge, UK: Cambridge University
Press. pp. 36–42. See also fn 2, fn 4 above.
9 Finder, Stuart G. and Bliton, Mark J. (eds.) (2018). Peer Review, Peer Education, and Modeling in the
Practice of Clinical Ethics Consultation: The Zadeh Project. Cham, Switzerland: Springer Verlag.
10 Hoffmaster, Barry (2006). What does vulnerability mean? Hastings Center Report 36(2):38–45.
11 Spiegelberg, H. (1986). Ethics for Fellows in the Fate of Existence. In Steppingstones Toward an Ethics
for Fellow Existers: Essays 1944–1983. Springer. pp. 199–218.
12 Zaner, Richard M. (2000). Power and hope in the clinical encounter: A meditation on vulnerability. Medi-
cine, Health Care and Philosophy 3 (3):263–273.

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Part I

Elements of Discovery
1 Seminar in Strangeness

Observations I: Seminar in Clinical Philosophy, October 2003

The tears erupted silently and fell hot on the page, smudging the ink on the paper where I had
been taking notes. They were tears of frustration, I knew. It wasn’t sadness or even anger, neces-
sarily. More like furious internal recriminations over my inability to say clearly what I wanted
to say, plus an astonishing resentment that simmered toward those four wide open eyes, staring
expectantly from behind two pair of glasses – one professor on either side of the table. Finder
and Bliton didn’t seem to get it, wouldn’t get it, didn’t care how ridiculous I felt in my tongue-
tied distress.
My fellow classmates were a three-part study in awkwardness, a triptych of discomfort.
Kyle’s eyes ping-ponged from me to the professors, Stuart Finder and Mark Bliton; Cherita
carefully examined her pen-tip; Joe – who had taken the Seminar before, looked at me sideways,
down the table, earnest sympathy and a clearly too-optimistic smile of encouragement hover-
ing. My momentary exasperation at their silence – leaving me floundering for words – was now
compounded by the embarrassment of capping my ineffectual engagement with tears. They all
just waited: awkwardly or encouragingly, or simply curiously, in the case of the professors. They
just waited and watched, with their glasses and beards and wide, open eyes: Finder with his head
tilted slightly, like a robin watching the meandering of a pill bug, Bliton tugging absently at the
ends of his Vandyke. I wondered if this was some sort of philosophical hazing – with the two
of them acting the stereotype to match the phenotype. What on earth did they expect me to do
or say now? Why didn’t they have the courtesy to move on, to let me contain myself? To ask
someone else a question or otherwise fill in that dreadful, wretched silence? Not quite silence,
I thought, as I sniffed and cleared my throat, too loudly for the moment. I looked down at my
smudged notes.
“This question – what the author has written here – raises some real, as in actual, real for us – the
readers – questions. As readers, as people, these are real live questions, as William James would
say, that are deeply challenging.”
Thank God, finally, I thought, at last daring to lift my glasses and wipe my eyes, as everyone’s
heads swiveled toward Bliton’s measured voice.
“Virginia, can you help us understand what this raised for you? It was clearly having an effect,
and that seems like it might be helpful to probe a bit and try to understand what is at stake … in
that effect, in your response …”
They weren’t going to let it go. I couldn’t believe it. I glared at Bliton, I blinked once, willing
away the sharp, hot pressure of more tears and I took a breath. My words came out clipped, precise,

DOI: 10.4324/9781003354864-3