Our aim in this casebook is not to write categorical prescriptions for the diagnosis and treatment of ethical problems that have arisen out of the interaction of pharmaceutical influences on clinical practice with human vulnerabilities when making decisions under conditions of uncertainty (Bursztajn et al., 1981/1990). Rather, it is to provide a series of case descriptions and analyses, a series of Wittgenstein’s context-dependent “family resemblances,” that make up a memorable family photograph of a spectrum of clinical and ethical dilemmas and methods of analysis. We are mindful that an action that may be meaningfully ethical in one time or context may be unethical in another
time or context.
We hope readers across all levels of professional experience and ethical sophistication will be reminded of some of these vignettes in the course of their everyday practice, when it comes time to ask first, “Is there an ethical question here?”; next, “How can we talk about it?”; and finally,“What is to be done or not done?” We hope these questions can be asked without doing more harm than good. Self-righteous or overly certain ethical discourse imposed on complex fact patterns can as often lead to harm as ethical tone-deafness or obliviousness (Bursztajn, 1986).
In some instances different fact patterns or different ethical models may yield different answers; in other instances the answers may be the same. Navigating between the Scylla of relativism and the Charybdis of absolutism, these cases and their analyses can be thought of as notes for the ongoing development of an ethical professional practice in an age of pharmaceutical influence on clinical decision making under conditions of uncertainty.