Clinical decision-making: the case against the new casuistry

Area of Science:

• Bioethics
• Medical Ethics
• Philosophy of Medicine

Background:

• Albert Jonsen and Stephen Toulmin proposed casuistry as a method for resolving complex medical ethical issues.
• Casuistry emphasizes case details to determine appropriate actions in clinical settings.
• This approach has faced significant criticism regarding its practical application and theoretical underpinnings.

Purpose of the Study:

• To evaluate Carson Strong's recent attempt to defend and salvage the Jonsen-Toulmin version of casuistry.
• To determine if Strong's arguments effectively address the major criticisms leveled against casuistry.
• To assess the suitability of casuistry as a framework for complex clinical decision-making.

Main Methods:

• Critical analysis of Carson Strong's arguments defending casuistry.
• Examination of the major criticisms previously directed at Jonsen and Toulmin's casuistry.
• Evaluation of the logical coherence and practical implications of Strong's defense.

Main Results:

• Carson Strong's efforts to defend casuistry were found to be unsuccessful.
• The major criticisms against casuistry were not adequately deflected by Strong's arguments.
• The analysis indicates that casuistry remains vulnerable to significant objections.

Conclusions:

• Jonsen and Toulmin's version of casuistry, even as defended by Strong, is not a suitable framework for resolving complex issues in clinical practice.
• The foundational weaknesses of casuistry persist, limiting its utility in medical decision-making.
• Further development or alternative approaches may be necessary for effective clinical ethical reasoning.