Doing the right thing? values and pragmatism in contemporary Australian general practice

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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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