Casuistry and Improvement in Clinical Ethics

Abstract: One might cautiously assume that the clinical ethicist becomes better at their job with experience. It is an interesting and important question why, exactly, this would be the case. What precisely is the mechanism or phenomenon by which the clinical ethicist improves over time?
One natural answer to this question refers to casuistry, or case-by-case reasoning. The idea would be that over time, the clinical ethicist builds up their repertoire of past cases on which to draw in grappling with the case before them. With more past cases at their disposal, the clinical ethicist is that much better equipped to reason analogically about the case at hand.
But casuistry has come under fire, and there are reasons to be skeptical of it as a method of bioethics. My paper attempts to make sense of the possibility that the clinical ethicist improves with experience, without assuming that casuistry is the clinical ethicist’s chosen form of moral reasoning. This involves three tasks: to clarify what constitutes improvement in clinical ethics, to examine criticisms of casuistry, and to explore what might facilitate the improvement of the clinical ethicist’s moral reasoning over time. I invoke the concept of mastery as its discussed outside of bioethics and propose that practice with reflective equilibrium could be responsible for such improvement.

Keywords: clinical ethics, moral reasoning, casuistry