Critiques of casuistry and why they are mistaken

Casuistic methods of reasoning in medical ethics have been criticized by a number of authors. At least five main objections to casuistry have been put forward: (1) it requires a uniformity of views that is not present in cont emporary pluralistic society; (2) it cannot achieve consensus on controvers ial issues; (3) it is unable to examine critically intuitions about cases; (4) it yields different conclusions about cases when alternative paradigms are chosen; and (5) it cannot articulate the grounds of its conclusions. Tw o main versions of casuistry have been put forward, and the responses to th ese objections depend in part on which version one is defending. Jonsen has advocated a version modeled on the approach to casuistry used by moral the ologians in the 15th and 16th century, involving comparison of the case at hand with a single paradigm and a "lineup" of cases. The present author has advocated another version, drawn from experience with cases in clinical et hics, which involves comparing the case at hand with two or more paradigms. Four of the five objections are unsuccessful when directed against Jonsen' s approach, and all of them are unsuccessful when directed against the appr oach involving comparison with two or more paradigms.