Robyn Bluhm

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition.

Joshua Greene and his colleagues have proposed a dual-process theory of moral decision-making to account for the effects of emotional responses on our judgments about moral dilemmas that ask us to contemplate causing direct personal harm. Early formulations of the theory contrast emotional and cognitive decision-making, saying that each is the product of a separable neural system. Later formulations emphasize that emotions are also involved in cognitive processing. I argue that, given the acknowledgement that emotions inform cognitive decision-making, a single-process theory can explain all of the data that have been cited as evidence for Greene’s theory. The emotional response to the thought of causing harm may differ in degree, but not in kind, from other emotions influencing moral decision-making.