Rather than defining and using a single concept of intuition—philosophical, practical, or neuroscientific—Braude here examines intuition as it occurs at different levels and in different contexts of clinical reasoning. He argues that not only does intuition provide the bridge between medical reasoning and moral reasoning, but that it also links the epistemological, ontological, and ethical foundations of clinical decision making. In presenting his case, Braude takes readers on a journey through Aristotle’s Ethics—highlighting the significance of practical reasoning in relation to theoretical reasoning and the potential bridge between them—then through current debates between regulators and clinicians on evidence-based medicine, and finally applies the philosophical perspectives of Reichenbach, Popper, and Peirce to analyze the intuitive support for clinical equipoise, a key concept in research ethics. Through his phenomenological study of intuition Braude aims to demonstrate that ethical responsibility for the other lies at the heart of clinical judgment.

 

Braude’s original approach advances medical ethics by using philosophical rigor and history to analyze the tacit underpinnings of clinical reasoning and to introduce clear conceptual distinctions that simultaneously affirm and exacerbate the tension between ethical theory and practice. His study will be welcomed not only by philosophers but also by clinicians eager to justify how they use moral intuitions, and anyone interested in medical decision making.

Listening to the Whispers gives voice to scholars in philosophy, medical anthropology, physical therapy, and nursing, helping readers re-think ethics across the disciplines in the context of today's healthcare system. Diverse voices, often unheard, challenge readers to enlarge the circle of their ethical concerns and look for hidden pathways toward new understandings of ethics. Essays range from a focus on the context of corporatization and managed care environments to a call for questioning the fundamental values of society as these values silently affect many others in healthcare. Each chapter is followed by a brief essay that highlights issues useful for scholarly research and classroom discussion. The conversations of interpretive research in healthcare contained in this volume encourage readers to re-think ethics in ways that will help to create an ethical healthcare system with a future of new possibilities.

Outstanding Academic Title, Choice Magazine

How the politics of “medical necessity” complicates American health care

The definition of medical necessity has morphed over the years, from a singular physician’s determination to a complex and dynamic political contest involving patients, medical companies, insurance companies, and government agencies. In this book, Daniel Skinner constructs a comprehensive understanding of the politics of defining this concept, arguing that sustained political engagement with medical necessity is essential to developing a health care system that meets basic public health objectives.

From medical marijuana to mental health to reproductive politics, the concept of medical necessity underscores many of the most divisive and contentious debates in American health care. Skinner’s close reading of medical necessity’s production illuminates the divides between perceptions of medical need as well as how the gatekeeper concept of medical necessity tends to frame medical objectives. He questions the wisdom of continuing to use medical necessity when thinking critically about vexing health care challenges, exploring the possibility that contracts, rights, and technology may resolve the contentious politics of medical necessity.

Skinner ultimately contends that a major shift is needed, one in which health care administrators, doctors, and patients admit that medical necessity is, at its base, a contestable political concept.