Ethical Deliberation in Multiprofessional Health Care Teams

Chapter 7. The Cognitional Theory of Bernard Lonergan and the Structure of Ethical Deliberation

Chapter 7 The Cognitional Theory of Bernard Lonergan and the Structure of Ethical Deliberation Kenneth R. Melchin The preceding chapter by James Sauer presents a brief overview and analysis of some of the principal contributors to the theoretical literature in discourse ethics. Sauer identifies two main approaches in this literature , the contextualists and the proceduralists. The focus of the proceduralists (e.g., Habermas, Rawls, Ackerman) is on the structure of ethical discourse and/or the political contracts and institutions that establish procedures for adjudicating conflicting value claims. Their interest is in general structural features that operate in all ethical discourse regardless of context or ethical content. In their view, all participants are rationally bound to accept these norms or obligations whenever they seek to advance their ethical claims through discourse. The focus of the contextualists (e.g., Gadamer, Maclntyre, Sandel) is on the social, cultural, historical traditions and contexts of meaning that inform ethicalclaims, and whichset the frameworkfor adjudicatingamong conflicting claims. Foundational norms or principles for resolving ethical disputes are to be found in the analysis of cultural contexts of ethical meaning, which the parties implicitlydraw upon in advancingtheir claims. The contextualists argue that purely formal or discourse-structure approaches themselves draw upon traditions for their notions of obligation and rationality and that a full grounding of their own theories requires appropriating these traditions. Sauer's chapter draws upon the work of Paul Ricoeur to argue that these two theoretical approaches do not present mutuallyexclusive analyses of ethical discourse. Rather, they highlight two realms ofnormativity operative in ethical discourse that interact to drive the dynamics of discourse in complex dialectical ways. To understand what is going on in discourse requires analyzing both the interpersonal contexts of moral meaning operative in the discourse as well as procedural aspects of the discourse structure. 113 THEORETICAL PERSPECTIVES FROMTHE FIELDS OF ETHICS AND CONFLICT STUDIES While Sauer's analysis does not put an end to the debates in discourse ethics, it does provide grounds for a direction where a synthesis might be found. If these two theoretical approaches do not offer conflicting analyses of the same phenomena but complementary analyses of distinct realms of normativity operative in the ethical discourse, then itwould seem to make sense to analyze discourse in both realms. These two realms would need to be reflected in formulating practical guides for ethical discourse in health care teams. Sauer's argument for the complementarity of these two approaches is based in Ricoeur's analysis of a structured "intentionality" operative in linguistic meaning. Bernard Lonergan has developed a theory ofhuman cognition that offers a comprehensive explanation of "intentionality" as it operates in diverse realms of meaning and patterns of human experience . Because it is based in an empirical analysis of operations ofhuman cognition as they function in all activities of human knowing and valuing , Lonergan's theory suggests itself as a framework for carrying forward the insights of Ricoeur and integrating the contributionsfrom various fields of research in ethics. In addition,Lonergan's work offers grounds for understanding how various individuals' operations of meaning can group together to form structures of sociality that can function quite apart from the planningor explicit understanding of any individuals.1 Consequently , this framework promises insightsthat may help link the respective concerns for the personal and the public realms of value of the contextualists and the proceduralists. The strategy in this chapter will be to set out Lonergan's fourfold structure of cognition as a framework for responding to the concerns of the proceduralists and the contextualists and to explore some implications for ethical discourse in health care teams. THE FOURFOLD STRUCTURE OF COGNITION Lonergan's philosophy is based upon four distinct levels of operations that are involved in human cognition.2 While Lonergan developed his fourfold structure in the study of cognition as operative in scientific See, for example, Kenneth R. Melchin, History, Ethics, and Emergent Probability (Lanham, Md.: University Press of America, 1987); Patrick H. Byrne, "Jane Jacobs and the Common Good," in Ethics in Making a Living, ed. Fred Lawrence (Atlanta: Scholars Press, 1989), 169-189; Philip McShane, Randomness, Statistics and Emergence (Dublin: Gill and Macmillan, 1970). See Bernard Lonergan, Method, chap. 1, for a summary presentation of the four levels of cognitional operations. 114 1 2 THE COGNITIONALTHEORY OFLONERGAN ANDETHICAL DELIBERATION understanding, his own work and that of others has carried this forward into a theory of ethics.3 Lonergan's...