Doing the right thing? values and pragmatism in contemporary Australian general practice
- Publication Type:
- Thesis
- Issue Date:
- 2005
Closed Access
Filename | Description | Size | |||
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01Front.pdf | contents and abstract | 742.12 kB | |||
02Whole.pdf | thesis | 14.07 MB |
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NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- There is no universally accepted foundational theory of moral philosophy or any
comprehensively tested method of bioethics which can accommodate the uncertainties
and complexities of both the macroethical issues and the microethical processes of
General Practice in a practical and reproducible fashion.
A philosophy of medicine and an ethics for its practice must accommodate the
differences in roles, responsibilities and relationships of its parts. In as much as the roles
of various medical specialties and the type of relationships formed with patients differ,
so will the criteria for the measurement of the ethical probity of those professional
specialties take on nuanced differences. This thesis is an analysis of the irreducible
features of contemporary Australian General Practice which discloses the need for a
distinctive ethic in that practice. It presents the case that this ethic can be provided most
usefully by the use of a principled pragmatist process.
Pragmatic processes reject epistemological assumptions about objectivity and
rationality, and respect the pluralistic, participatory and provisional nature of medical
practice. They are particularly suited to CAGP and the longitudinal therapeutic narrative
which characterizes the dominant form of relationships with patients therein.
Contemporary Australian General Practice is an inherently pragmatic project which has
evolved over time in ways which have maximized the probability of it effecting
reasonable outcomes in the face of much technical uncertainty, of balancing a complex
pattern of responsibilities, and of sustaining a complex set of interrelated values and
relationships. It achieves this while attending to the needs of unreferred patients often
with unclear agendas which do not always fit well into a biomedical model of illness. It
can be regarded constructively as a complex non linear system.
The defining characteristics of contemporary Australian General Practice (CAGP)
imply a set of core values for that practice. This relationship between defining
characteristics and core values is significant in two respects. First, that the basic
structure of General Practice can be appreciated as constituted by the mutually
supportive interdependence of these two factors, and that certain values are basic to the
very identity of CAGP. Second, that the existence of basic values internal to CAGP has
important implications for the framework of an ethic appropriate to it.
The defining characteristics and derived core values of General Practice will and must
change with the times in response to developments in technology, to variations in
resources and to changes in community values. In addition, at any one time not all GPs
will agree as to what they value most within their professional activity. The relevant
consideration, however, is that if GPs are able to identify and justify their values they
can use them to ground considerations of the probity of their practices.
A protocol using pragmatist principles to guide such considerations is developed and
presented.
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