This document is part of the Festschrift in Honor of Charles Speel, edited by Thomas J. Sienkewicz and James E. Betts and published by Monmouth College in Monmouth, Illinois in 1997. The Table of Contents for this volume can be accessed here. If you have any questions, you may contact Tom Sienkewicz at

Humanistic Problem Solving: The Case of Mr. T1

William J. Winslade, MC' 63


Pragmatism, the distinctly American philosophy associated with Charles Pierce, John Dewey, William James, and others, stresses the importance of linking theory with practice. Theories are valued more for their instrumental than their intrinsic value. Theories provide means to achieve human ends. Abstract theories may be interesting for their own sake, but their value is enhanced if they facilitate solutions to human problems. Moral theory, for instance, should help us discover not only what is right or good, but also how to achieve these ends in concrete situations. Legal theories express ideals of justice but also should guide us in resolving real disputes. Psychological theories explain human motivation in general, but also should illuminate particular instances of human interactions. Alfred North Whitehead (1962:4) captures the spirit of pragmatic humanism in a trenchant aphorism: "The function of reason is to promote the art of life."

Despite their impatience with empty abstractions and bloodless categories, pragmatists do not denigrate the value of ideas, principles, and theories. Mathematics, for example, must be grasped in theory before it can be used effectively. Still, if numbers were used only for calculating or counting other numbers or only worshiped for their purity, their potential instrumental value would be wasted. Similarly, the meanings of moral principles and the functions of law must be understood before they can be used effectively. The potential value of principles of bioethics such as autonomy, respect for persons, or beneficence becomes actualized when they help resolve problems. The law serves as a human instrument when actual disputes are settled in a courtroom at the negotiating table.

As a philosopher inspired by pragmatism, I seek ways to bring philosophy to bear on problems of living. Although many philosophers often find comfort in analytical detachment, some are also drawn to action and feelings. I often find myself among the latter, eager to understand for the sake of integrating thought, feelings, and action. Yet sufficient intellectual detachment is necessary to understand and appreciate what is going on and how one might best respond. As a lawyer and a psychoanalyst, I am intrigued by the details and nuances of particular cases which call not only for reflection and introspection, but also decision and action. For nearly twenty years I have provided consultation, negotiation, and mediation in hospitals and other health care settings. To integrate thought and action one must be willing sometimes to straddle, if not revise, academic, and professional boundaries. I see myself as a humanist engaged in the practice of problem solving.

The following case provides an example of pragmatic humanism incorporated into a legal process. The case begins with Mr. T, an elderly gentlemen, who resisted and refused numerous efforts to persuade him to have his gangrenous foot amputated. His family was intimidated by him; his physicians were exasperated; his attorney and the attorney for the government were bemused. I was appointed by a court asked to assess his situation to be an independent legal and bioethics adviser to the court. My role went beyond what is currently called ethics consultation (See Winslade 1994). I was also authorized to be a participant in the proceedings­to investigate, to examine witnesses at the hearing, and to report and make recommendations to the court. I accepted the invitation to explore the human problems­psychological, ethical, and legal­and to propose practical ways of solving them.

Although in my official capacity I was appointed as an independent counsel to a court, my unspecified role allowed me the latitude to use collaborative rather than adversarial methods. I sought to create an open-ended dialogue among parties - Mr. T., his family, the physicians, and the attorneys - who seemed to be at an impasse. After I became involved, I organized and orchestrated at Mr. T's home an important meeting during which conversations occurred in an informal setting with most of the essential parties participating. Two important court hearings­about a month apart­produced both an initial court order for an amputation and a judicial demand for continuity of medical care. In this case the judge was more than an impartial arbiter; he also became a passionate participant who sought assurance that his initial judicial order resulted in beneficial consequences. The judge also encouraged a bioethical and psychosocial dimension to be brought into the usual adversary process, thereby affecting the preparation of the case, the hearing, and subsequent related events.

Instead of being only a participant observer, I was a participant interpreter. Participant observers seek mainly to study and understand their subjects, though their presence as an observer inevitably affects to some degree the context and conduct of those within the situation. But, at least in theory, participant observers avoid direct intervention in the normal course of the conduct under observation. Participant "interpreters," as I use the term, may intervene to help clarify issues, identify options, facilitate courses of conduct, and participate in the decision making process. For example, I sought not only to understand the situation of Mr. T, but also to help change it for the better. As a result of the change in dynamics among the participants, in particular toward collaborative efforts rather than adversarial posturing, eventually effective solutions were found to various problems, including but not limited to Mr. T's amputation. I think, in retrospect, that what the probate judge enabled me and others to do was not merely to apply bioethics to a legal case;but also to concentrate on seeking broader solutions to human problems. Legal procedures did not, as they so often do, dominate the preparation or the hearing. The law served as a human instrument rather than a bureaucratic obstacle. The interactions among the participants not only changed the life of Mr. T, but also altered our own perceptions. We were able to think, see, and feel differently about Mr. T as well as about the legal process. Perhaps in other cases the introduction of such a court appointed participant interpreter might contribute in a similarly significant way, by drawing more attention to the problems of living rather than legal technicalities.2

Mr. T and his Problems3

Mr. T was a 73 year old retired taxi driver from the Isle of Man. He was charming, witty, and stubborn. He and his wife of 51 years, Kathleen, lived in a bungalow in a California beach community. In the late 1960's, Mr. T ended his long career of heavy drinking after his alcoholism left him bedridden and severely depressed. Following ten weeks at an alcohol rehabilitation program, he returned sober, but still depressed and withdrawn. In mid-1979, he got an infection in his left toe which did not heal. After about two months, Kathleen called a doctor to the house, but Mr. T adamantly refused to permit the physician to touch or otherwise examine his toe. Kathleen and his daughter (who lived nearby) could not convince Mr. T to seek medical attention for his foot despite his considerable pain. He remained virtually immobilized on the living room couch.

A few weeks later, a fire erupted in Mr. T's living room when he feel asleep on the couch while smoking a cigarette. A neighbor called the fire department; firefighters arrived in time prevent any serious injury or damage. Kathleen and her daughter were told by a fireman that it might be possible to hospitalize Mr. T on the grounds that he was gravely disabled (unable to provide food, clothing and shelter) as a result of a mental disorder. The police were called to his dilapidated bungalow after the fire department left. Although Mr. T refused to enter the hospital voluntarily, the police instructed the paramedics to take him in as an involuntary psychiatric patient who was dangerous to himself and gravely disabled. He was treated for a few weeks for his psychiatric problems­depression, withdrawal, etc. He was also informed that his infected toe had become gangrenous. Physicians agreed that an amputation, while not yet an emergency, was medically indicated to prevent a life-threatening infection. Mr. T vacillated between consenting to and refusing the amputation.

During his hospitalization Mr. T did permit his infected toe to be debrided and cleaned and to have dressings applied. He also received pain medication which helped make him comfortable. Eventually he was released from involuntary commitment with his gangrenous toes beginning to slough off. He resumed his role as autocrat of the living room from his semi-reclining position on the couch. At this point, his wife and daughter, literally and figuratively unable to move Mr. T, contacted the public guardian's office of Los Angeles County to determine whether (1) a personal conservator could be appointed and (2) whether a court would order that an amputation be performed. The probate court appointed an attorney for Mr. T, the public guardian's office was represented by county counsel, and I was appointed by the court on its own motion as counsel for the court with the authority to conduct an independent investigation and to participate in the court hearing. I was chosen for this role because, at that time, I was chairman of the Los Angeles County Bar Association Bioethics Committee.

As I began my independent investigation, it seemed sensible to try to work collaboratively with the other attorneys. The county counsel (correctly) perceived the case as a conundrum; Mr. T's attorney felt obligated to advocate for Mr. T's preference not to have a conservator or an amputation. However, both attorneys agreed to hold a meeting in Mr. T's living room to observe my chosen psychiatric expert (who was also an attorney) interview Mr. T. Previously, a family physician, a psychiatrist, and an orthopedist had interviewed Mr. T. The family physician had judged him to be competent to refuse the amputation, but believed his decision was irrational; the psychiatrist believed that his competence was somewhat impaired by depression, denial, and possible suicidal desires, but that he was nonetheless mentally competent; the orthopedist was confident that he was incompetent and that the surgery should be mandated.

When the meeting was held at Mr. T's home, the participants included Mr. T, the three attorneys, Mr. T's wife, daughter, and son-in-law, a home care nurse, and the forensic psychiatrist. Mr. T held forth from his couch with his bandaged foot prominently elevated on the coffee table. During the interview with the forensic psychiatrist, Mr. T displayed a good long term memory, a sense of humor, and an ability to respond appropriately in conversation; the forensic psychiatrist believed that his short term memory deficits were indicative of organic brain syndrome resulting from alcoholism, aging, or both. A few minutes after Mr. T had correctly answered a question, he could not recall that it had been asked. He denied that he had gangrene or that anyone had told him he had gangrene. Although he admitted that his toe had been sore, he insisted that it was getting better. He correctly pointed out that the nurse cleaned and dressed his foot and that the pain was gone. "Why, a few walks in the ocean," he claimed, "and I will dance all night." Mr. T added, pointing upward, that God would take care of him. Even when his own attorney told him that several physicians had told him he had gangrene and that his foot needed to be amputated, Mr. T denied having heard this before. The nurse told him in our presence that his foot was getting worse, not better, but Mr. T dismissed her with a wave of his hand. Convinced by the putrid odor emitted when the nurse removed the dressing, everyone except Mr. T believed her.

During my forty-minute interview with Mr. T, he was cooperative and willing to answer my questions. After listening to the other interview, it occurred to me that a key question has not been raised. I then asked him a hypothetical question: If you had gangrene, or believed that you had gangrene, and a doctor said amputation was needed to save your life, what would you say? He quickly replied that he would say "amputate." However, when asked if he believed that he currently had gangrene, he denied it completely. He denied that any doctor has told him that he had gangrene.

He did not, for example, indicate that he knew he had gangrene, but he still did not want amputation. He did not say that he did not believe what the doctors told him; he did not recall talking to any doctors. Apparently he sincerely believed that he did not have a serious condition. As a result, he did not understand or appreciate that he was suffering from a life-threatening illness. He did not grasp that he had gangrene and that amputation was indicated. Because he did not acknowledge the risks of his condition, he could not evaluate what course of action is appropriate. He did not take in, much less assess, the relevant facts and opinions. He denied, forgot, or refused to hear what was said. I concluded that Mr. T lacked the capacity to refuse medical treatment necessary to save his life.

About a week after the meeting at Mr. T's house, a hearing was conducted at the Probate Court in downtown Los Angeles. Mr. T, his wife, his daughter, and three physicians testified at the hearing. All three attorneys, as well as the judge, participated in the questioning. The transcript of the hearing reveals many of the same ambiguities and uncertainties described previously, with some additional nuances.

Mr. T was the first person to testify. He was cooperative to the extent that his memory and psychological state allowed. When asked whether he had been told or believed that he had a gangrene which posed a threat to his life, he denied both. He acknowledged that his foot was bandaged, but insisted that it was getting better. "It's a good foot," he said. He trusted that God would take care of him. He made it clear that he desired to retain his foot. When confronted with the same hypothetical question which I had posed during the interview at his house, he sometimes replied that he would agree to an amputation and sometimes that it was a very difficult question. His memory­even during the hearing­was fragmented. He could remember little about conversations concerning his foot. But in other respects his testimony was relevant, coherent, and appropriate­evening charming and humorous. For example, I reminded him that he had complained during my interview at his home that my questions gave him a headache. His response was "Yes, sir. It cost me $10 in aspirins."

Although Mr. T made intelligible responses to each individual question at the time it was asked, his responses were inconsistent with each other. At times he seemed wholly unwilling to consider an amputation, at other times he agreed to it (if it was necessary to save his life), and at other times he was indecisive. He showed little recollection of previous conversations, hospitalizations, and treatments. The overriding impression one gets from the transcript is that Mr. T still did not believe that his foot was seriously infected. If he did believe that it was a life-threatening condition, he would be ambivalent about whether or not to consent to an amputation, but his denial and his memory deficits made it difficult to assess the extent to which he understood and appreciated the situation.

The physicians who testified reflected a similar inconclusiveness in their professional opinions. The opinions ranged along a spectrum of opinion about Mr. T: that he was competent and irrational; that he was depressed and possibly suicidal, but not demented or incompetent; or that he suffered from organic brain syndrome and was incompetent. Each physician cited some evidence in support of his or her position because Mr. T responded in a variety of different ways.

To complicate matters further, his wife and daughter reported that, although Mr. T had been lethargic and deeply depressed before being forcibly taken to the hospital, he was now much more lively., but that, as his vitality had improved, so had his stubbornness. They were both frustrated and yet unwilling to impose their will on Mr. T. It was clear that they loved him and wanted the amputation to be ordered, but did not desire the authority to make the decision for him. They wanted the judge to decide.

The judge from time to time would enter into the questioning of Mr. T and the other witnesses. The judge was particularly concerned about the consequences of amputation and the nature of the follow-up care which would be offered. It was apparent that he, too, found the situation perplexing. The judge was respectful of Mr. T's asserted faith in God, but troubled by the gaps in Mr. T's memory and rigidity of his beliefs. Testimony from Mr. T and others brought out that he wanted to live, enjoyed life, and could, with proper medical and physical therapy, have his life saved and its quality preserved. The judge ordered that a temporary conservator be appointed with the authority to consent to the amputation. The judge was noticeably moved as he issued the order. He went on to explain carefully why he believed that Mr. T did not have the specific competence necessary to decide about an amputation. The judge then abruptly left the bench and went to his chambers.

Struck by his obvious emotion, I visited the judge in his chambers. I learned that his father as well as his son-in-law had experienced amputation as a result of war injuries. The judge was well aware of the critical importance of post-operative care and counselling. He described some of the complex psychological consequences­anger, loss, mourning, etc.­which he had seen with his relatives who had suffered amputations.

A week after the court hearing, Mr. T's gangrenous foot was amputated. He recovered well physically, but was unwilling to engage in physical therapy. No psychiatric care was ordered by the surgeons. For about a month, Mr. T languished in the hospital; he became more depressed and uncooperative. However, his appointed attorney and the public guardian assigned as his temporary conservator sought to have Mr. T placed in a rehabilitation hospital. The surgeons and the hospital bureaucrats balked because of delays about Medicare funding. Meanwhile, Mr. T had become a problem patient.

A month after the first hearing, a second hearing was held to determine whether a permanent guardian should be appointed. At the hearing, the only witnesses were the public guardian and the surgeon who performed the amputation. The public guardian described the bureaucratic difficulties and the surgeon described Mr. T's uncooperativeness. The judge was visibly angry with both reports. He reprimanded the surgeon for his failure to follow through with adequate post-operative care, psychiatric counseling, placement, or rehabilitation. The judge was irritated with the surgeon's lack of familiarity with the specifics of Mr. T's care and with the bureaucratic obstacles which the public guardian had failed to surmount. It was made quite clear that the judge would not tolerate further delays in providing for Mr. T's specific medical, psychological, social, and personal needs. The judge ordered a transcript of the first hearing to help make it clear to the surgeon and public guardian that appropriate follow-up care was critical to restore Mr. T's functioning. Eventually, Mr. T was discharged from the hospital to his bungalow near the beach.

A month later Mr. T's daughter called his attorney to report another fire at Mr. T's house caused by a cigarette. She informed the attorney that no further follow-up had been provided for Mr. T, that his medical and psychological status was questionable, and that he had deteriorated. After a series of phone calls, another meeting was held at Mr. T's house. This time the public guardian was strongly encouraged, if not pressured, to find a suitable residential placement for Mr. T and his wife, who was no longer able to cope with the burdens of daily caretaking.

With the help of a reluctant but capable new public guardian, Mr. T and his wife were placed in a pleasant residential nursing home. Relieved of the burdensome caretaking responsibilities, she continued her close companionship with her

husband. However, she also had some freedom to run errands or visit relatives while knowing that Mr. T had adequate care and supervision. The Medicare obstacles were removed and the financial matters were resolved without further complications.

About one year later, I visited Mr. T and his wife at the nursing home. Mr. T was lively, lucid, and charming. He had steadfastly refused physical therapy, but he was quite comfortable in his wheelchair. The staff told me that he regularly entertained the other residents with his wit and stories. His wife seemed relaxed and happy. I asked Mr. T if he remembered going to court a year earlier. "Oh, yes," he replied, "that is when we went to court to get permission to have my foot amputated"! Mr. T's revisionist memory served him well. Despite his limited mobility, he had regained his ability to enjoy his life. The judge's order had been finally fulfilled.


In this section, I offer some thoughts about this case to call attention to a few of the connections among law, ethics, and psychodynamics as aspects of humanistic problem solving. My aim is to raise issues and to point the way toward further exploration, not to provide a comprehensive analysis.

I realized then, as I do now, how difficult it sometimes is to assess a particular person's competence. Even when one attempts to determine a person's specific competence to perform a given task­here to refuse the amputation, numerous variables are relevant. Mr. T's desire to keep his foot to maintain his physical integrity was understandable. So was his belief in God; many people turn to personal faith for support in times of crisis. His ambivalence and indecisiveness are likewise not a surprise. But Mr. T's failure, inability, or refusal to believe that he had gangrene distinguishes his case from others who have competently refused amputation (In re Ouackenbush, 383 A. 2d 785 [1968]). And his response (on some occasions) to the hypothetical question "What would you say if you did believe you had gangrene?" suggested both general competence and specific incompetence. Without doubt Mr. T's competence was impaired, but what degree of impairment is sufficient to override his autonomy and to order him to undergo the amputation? Furthermore, Mr. T's memory, ambivalence, and indecisiveness fluctuated; thus different physicians perceived him differently at different times. Even during the hearing he responded differently to similar questions posed by different people.

In the end, Mr. T seemed more responsive, for whatever reason, to the judge than to the physicians. A moment before the judge issued his order for Mr. T's amputation, he seemed to mutter something to himself. I asked Mr. T if he wanted to say something. "I just said," he replied in a firm voice, "that I think the judge is a honorable gentleman." Was this because he sensed that the judge was about to make a decision that Mr. T wanted but could not make himself? Was it because of the kind and caring manner in which the judge conducted the hearing? Was it because Mr. T was in awe of judicial but not medical authority? I do not know and I am not sure Mr. T could have answered these questions if they had been asked. But I believe he meant what he said. And it is consistent with Mr. T's revised memory of the purpose of the hearing. Perhaps he could not articulate for himself that he wanted the judge to order the amputation until after it had occurred. His conscious desire to keep his foot, which motivated his denial of his condition and his refusal to consent to an amputation, may have been in conflict with an unconscious desire to submit to an amputation to preserve his life. Perhaps a powerful, but inarticulate, life instinct, as well as a conscious desire to live, were in conflict with his explicit desire to maintain physical integrity. Mr. T may, after all, have gotten what he really wanted.

That the probate judge appointed me as a counsel to the court, not merely a consulting expert, represented a novel intervention which significantly altered the usual adversary process. Mr. T's attorney still concentrated her attention on protecting her client's rights and the county counsel represented the public's interest, but each attorney also cooperated with me as the court's counsel. The trio of lawyers performed in a different register than the usual adversarial duet. For one thing, my presence and assigned authority allowed me to formulate the legal agenda as a problem to be solved jointly rather than merely a conflict between the rights of Mr. T and the state. My role prior to the hearing, like that of the judge during the hearing, was to go beyond technical legal issues to the substance of the human problems.

We discovered that attorneys, clients, families, doctors, bureaucrats, and judges could eventually work together rather than in opposition to solve a perplexing set of problems. Although not all cases can be successfully mediated or negotiated, many conflicts can be defused or managed better if adversarial attitudes are minimized. The use of alternative dispute resolution strategies early on may decrease the likelihood that a case will end up in court. Of course sometimes, as in the case of Mr. T, the courtroom becomes an unavoidable part of a larger process.

The judge's special interest in this case, based on his personal experience, no doubt motivated him to play an active role in the case, which he approached in an imaginative way. He did not simply impose his prejudices; he did not even publicly reveal his personal knowledge. Instead he reshaped the process to make it more likely that key issues would emerge. Only at the second hearing, when he chastised the surgeon and the public guardian's office for their failure to follow through, did his passion publicly erupt. Even then it took further collective effort by others to find a suitable solution to Mr. T's problems in living. The judge catalyzed, but did not dominate, the process which eventually resulted in a satisfactory solution to the living arrangements for Mr. T and his wife.

This case reminds us that medical problems are often inextricably linked to a web of psychological, personal, familial, legal, ethical, religious, and social issues. It is sometimes possible to find solutions to legal and medical problems which do justice, not only to the legalities, but also to the nuances of the human condition. To reach such solutions, however, it may be necessary to blur or even to defy usual professional practices or academic boundaries. One may also be required to develop new strategies which alter standard procedures. Insights from the humanities can sometime provide clues about how best to proceed in unfamiliar situations. A close reading of cases like that of Mr. T may also benefit humanists. Problems such as those posed by the case of Mr. T engage our attention, imagination, and emotions. We not only learn something about Mr. T, we learn something about ourselves.

Nearly a decade before I encountered Mr. T, while I was a law student, I studied carefully a seminal book on bioethics (Ramsey 1970). Although I found Ramsey's theological and ethical reflections challenging and his approach to the physician-patient relationship illuminating, his analysis of the principle of respect for persons seemed exceedingly abstract. Ramsey stressed the significance of informed consent, but it was my impression that the idea of informed consent, though theoretically appealing, failed to capture what respect for persons requires in practice. For example, a person can be treated with respect, even if their preferences are overridden and their consent not obtained. Conversely, even if persons are informed, the manner in which they are treated may fail to show respect for them. Thus, the theory of informed consent does not guarantee that respect for persons will be manifested in practice. Something more is required. A pragmatic approach to the principle of respect for persons integrates theory and practice.

One of the things I learned from participating in this process was how important and how difficult it is to understand, really to understand, others from their points of view. Although Mr. T's family, physicians, and attorneys listened to him and took him seriously, they did not completely hear him or fully connect with his feelings and concerns. The judge, however, was able to integrate the facts and Mr. T's medical and psychosocial needs at the moment and over time. The judge displayed greater empathy4 for him. Although Mr. T was informed, he was not competent to take in the information provided. Despite his refusal to consent to the amputation, the judge's careful attention to Mr. T's thoughts and feelings displayed respect for him as a person. Beyond that, he announced his decision and judicial order to Mr. T in a manner evoking Mr. T's surprising response described earlier. Mr. T's reciprocal respect for the judge at the hearing and, perhaps, the revision of his memory, were consequences, I believe, of the empathy and respect shown to Mr. T by the judge. Empathy links the abstract principle of respect for persons with the manifestation of mutual respect in an interpersonal context. The principle of respect for persons, properly put into practice in this case, culminated in real benefits for all concerned.

In conclusion, I want to suggest that the approach to problem solving adopted by the probate judge in this case is limited neither to the courts nor to the medical setting. My role as a participant interpreter and as an agent of the court in this case was enhanced by humanistic and psychological insights, as well as a legal role which permitted innovation. No profession or academic field, however, has a monopoly on the skills needed to perform the task of a participant interpreter. The demands of the role are shaped by the specific problems arising out of the particular circumstances. The participant interpreter brings to the situation the ability to identify issues, to ask questions, to analyze options, to offer guidance, and to help carry out decisions. Humanists can play an important part in creating an intellectual and practical environment in which reason can promote the art of life.

Works Cited

Davis, Dena S. Davis. 1991. "Rich Cases: The Ethics of Thick Description." Hastings Center Report, July - August, 1991, pp. 12-17.

More, Ellen Singer, and Maureen A. Milligan. 1994. The Empathic Practitioner. New Brunswick: Rutgers University Press.

Jonsen, FIRST NAME, FIRST NAME Siegler, and William J. Winslade. 1993. Clinical Ethics, 3d ed. New York: McGraw Hill.

Ramsey, Paul. 1970. The Patient as a Person. New Haven: Yale University Press.

Winslade, William J. 1993. "End-of-Life Medicine, Law, and Ethics: A Twilight Zone" in Emerging Issues in Biomedical Policy: An Annual Review, edited by Robert H. Blank and Andrea L. Bonnicksen. PLACE OF PUBLICATION AND PUBLISHER NEEDED.

__________. 1994. "Ethics Consultation: Cases in Context."Albany Law Review 57:679-691.

Whitehead, Albert Lord. 1962. The Function of Reason. Boston: Beacon Press.


1. An earlier version of this paper was presented at the Hastings Center Fellows Meeting, and at the William Bennett Bean Symposium on the Humanities in Medicine. It will also be published in The Journal of Clinical Ethics in 1997.

2. See Winslade 1993, where I discuss the merits of an independent court appointed conservator in contested cases concerning termination of life-support for hopelessly ill patients. But the help of a participant interpreter might be an even better idea.

3. The case presented is discussed in detail rather than as a vignette. (A brief account of this case is found in Jonsen, Siegler, and Winslade 1993: 48-49. Although brief case excerpts are useful for some purposes, a detailed case report helps to bring out nuances and contextual complexities. Because my approach to - or perhaps I should say prejudice about - bioethics stresses cases in context rather than principles and theories, I prefer case descriptions rich enough to speak for themselves. See Davis 1991.

4. On the concept of empathy in medical practice, see More and Milligan 1994.

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