Defense Date

4-7-2026

Graduation Date

Spring 5-8-2026

Availability

Immediate Access

Submission Type

dissertation

Degree Name

PhD

Department

Health Care Ethics

School

McAnulty College and Graduate School of Liberal Arts

Committee Chair

Joris Gielen

Committee Member

Gerard Magill

Committee Member

Peter Osuji

Keywords

Values-based clinical ethics, Clinical ethics consultation, Bernard Lonergan, Deaths of Despair, Principlism, Suicidality and psychache, Medical aid in dying, Continuous deep sedation, Palliative psychiatry, Severe persistent mental illness

Abstract

This dissertation argues that contemporary clinical ethics is inadequately equipped to support patients suffering in extremis because it relies on an insufficiently discriminating account of health and a constrained model of moral reasoning. Drawing on Bernard Lonergan, it reconceives health as an emergent, multi-layered, heuristic notion shaped by biological, psychological, social, and existential goods. On that basis, it critiques principlism’s global applicability thesis and the undergirding claim that its principles form part of the common morality, arguing that this justificatory structure is philosophically insufficient and practically limited for clinical ethics in cases marked by profound suffering, moral plurality, and normative uncertainty.

In response, the dissertation develops Values-Based Clinical Ethics (VBCE) as a patient-centered framework for consultation. VBCE treats values, narrative, and first-person experience as clinically relevant data, guides deliberation through phronesis, and uses heuristic tools to locate breakdown across different levels of human flourishing. The framework is then tested in three domains: despair and suicidality, Medical Aid in Dying (MAID), and continuous deep sedation (CDS). Across these cases, the dissertation shows that suffering in extremis often concerns meaning, identity, connectedness, and future possibility as much as pathology or conflict among principles.

The dissertation concludes that VBCE offers a more adequate clinical ethics for such cases by protecting morally vulnerable stakeholders, resisting premature closure, subjecting established norms to case-specific scrutiny, and directing recommendations toward goods disclosed in the patient’s values and narrative rather than toward what is most readily defensible in policy or principle. It further argues that severe persistent mental illness (SPMI) does not meet the terminality ordinarily required for MAID and that futility judgments in psychiatry remain unjustified under current medical uncertainty. Instead, it advances palliative psychiatry as the more humane alternative.

Taken together, the dissertation reorients clinical ethics toward a more discriminating account of health, a more person-responsive model of consultation, and a more humane response to suffering in extremis. Clinical ethics must understand the person, discern the goods at stake, and remain committed to care that relieves suffering without abandonment.

Language

English

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