What about events leading to the implementation of a zero-tolerance policy for bringing "weapons" to school? What about events that spark disputes over the way in which prayer and other religious expression ought (not) to enter the school, including proposals to post the Ten Commandments in the classroom? What about events that lead to questioning the moral appropriateness of hiring a(n openly) homosexual teacher or to the problematic influence of corporate sponsorship of individual schools (euphemistically called "adoption")? What about instances of hazing, plagiarism, bullying, or disruptive classroom behavior that plague schools?

These kinds of events come to mind as I reflect on Howard Radest’s observation in From Clinic to Classroom that many real moral problems with tremendous potential for moral education are generally ignored in the classroom once the teacher "gets down to business". Radest suggests that current classroom moral education is inadequate but could possibly be improved if we were to learn how to turn stories about events of the sort mentioned above into moral cases. We could then arguably teach by "thinking with cases".

What has prompted Radest to make such a suggestion? Radest, now retired, was the director of the Ethical Culture Fieldston School (New York City) and dean of The Humanist Institute. He has taught biomedical ethics to a variety of clinicians and non-clinicians. He has also spent much time in the clinical setting working with diverse professionals. For example, he has helped to initiate, nurture, and serve on Hospital Ethics Committees in the two hospitals in his community. In the clinic he has been learning and examining how bioethics approaches cases. So, both his classroom experience and clinical experience as a bioethicist have inspired Radest to wonder if biomedical ethics, as a morally educational activity in the clinic (primarily the hospital), might fruitfully serve as a model for moral education in the classroom, from kindergarten through graduate school.

To help the reader appreciate the intriguing promise of bioethics as such a model, Radest dedicates most of the book to bringing the reader as directly as possible into the clinic, especially to look at what bioethics is doing there. The theme intended to tie the material together is how stories become cases. He finds that patients tell the stories of the lived experience of their illnesses, of the events that have led them to seek medical help. As I understand him, a particular story becomes a case for the healthcare practitioner as some of the idiosyncrasies drop out and patterns emerge, thereby allowing this story-becoming-a-case to connect with other cases. The virtue of cases is that they can be linked to each other to help the physician, for example, make a diagnosis, offer treatment, and make a prognosis. Further, cases lead into what Radest calls the practice community – the history, tradition, culture, and practice of healthcare that support and inform the individual physicians as they treat individual patients. A particular case, though, remains linked to its story. It must if the motivation for practitioners to work with cases – wanting urgently to help the patient with the "pain of disease" – is to be kept alive.

Radest is uncertain, though, whether or not moral education in the classroom can be taught by "thinking with cases". After all, despite appearances, our educational system does not have a real practice community and, as suggested already, does not routinely use its compelling stories to teach moral understanding and decision-making in the classroom. It would seem that in the classroom there is no motivator of equivalent force to that operative in the clinic. Radest worries that thinking with cases in the classroom might be difficult if not impossible to do. The reader is left to work this out for her or himself.

Who are the intended readers? Most directly they would seem to be fellow educators. His challenge, as well as the book’s focus on what happens in the clinic, appears designed to educate educators who have little if any experience in and of hospitals. Also, insofar as a person wants to play a role in reshaping our school systems so that they provide better moral education, that person would also be a likely reader.

Yet, the predominant writing and thinking style of the book will not appeal to everyone. Radest is after all a philosopher; he relishes the complexities of ideas, savors their nuances and possibilities in a way that will not suit everyone’s taste. Much of the time, the reader will have to work. One will encounter some explanations that do not clarify so much as call the reader into spaces for exploration between the words, between the lines. The reader will come across intriguing metaphors with an almost poetic density that tempts her or him to reader to linger, to dig into the deeper meanings. While this can be creative and stimulating for some readers, for others it will probably be frustrating, even confusing. Unless the reader adapts well or is accustomed to such a style of writing and thinking, s/he may lose sight of the overall project of the book for all the at times dense detail.

If the reader is willing to do the work, however, there is much of delight and worth to discover and ponder. Often and with rich psychological insight, Radest puts the reader as if in the mind of the physician, patient, or even himself. This lets the reader almost live the clinical experience. For the clinically experienced reader, this is a wonderful and intriguing journey. Happily, as suggested earlier, clinical familiarity is not needed in order to get a sense of the clinic and develop some appreciation for what in particular bioethics tries to do there. This is the facet of the book that I enjoyed the most. Certain passages invite return journeys. In fact, the book can be read multiple times with new paths of thought and feeling taken each time as the landscape become clearer, more familiar. I look forward to more re-readings.

Linda A. Rankin, Ph.D., is a Clinical Ethicist and a Clinical Assistant Professor of Medicine in the Department of Medicine, University of Tennessee Medical Center at Knoxville, Knoxville, TN. She is also Adjunct Assistant Professor of Philosophy in the Department of Philosophy at the University of Tennessee at Knoxville. She has been a faculty member in the Department of Philosophy’s Inter-Campus Graduate Program in Medical Ethics for the past six and one half years. Most recently she turned her attention to bioethical issues in mental health. She redesigned, expanded, and supervised the Medical Ethics Program’s master’s level Clinical Practicum in Mental Health Ethics and its corresponding academic course.

Categories: Philosophical