Born from a conceptually clear and well-argued doctoral dissertation, Jordan Mason's first book speaks prophetically to the professionalizing discipline of clinical ethics at a critical juncture of debate about the heart of the practice itself. In Being Beheld, Mason examines the push toward standardization of process in clinical ethics consultation (CEC), questioning the merits of doing so rather than, as many in the field are currently debating, what the standard process ought to be. While a move toward robust engagement of process is a fruitful result of a historical move away from overreliance on theory and application of rules, what has emerged is a challenging-forth mode of revealing the moral problems, possibilities, and proposals for resolution that ultimately miss "being" in all its dynamism. For Mason, to miss being is to fail to encounter the person(s) before us and by extension, the good(s) we seek to promote through the practice of CEC and the practice of medicine. This sidestepping of being is not due to misapplication of technique but a feature of the use of extractive and universal modes of revealing that qualify as challenging-forth. To illustrate the ways that the standard models on offer lead even well-meaning practitioners into this mode of challenging-forth, Mason walks through five models on their own terms.
For each she points out the ways the model seeks efficiency and repeatability, constrains moral analysis, and prevents encounter between persons beyond the rigid (and somewhat artificial) roles of contemporary healthcare. But Mason warns us not to be lured into thinking that we can ameliorate the practical drawbacks of one method by crafting a hybrid of multiple models: "we are not escaping the enframing that each of these standardized techniques brings once they are begun (17, emphasis original)." While it is certainly helpful to have one's own familiarity with the CEC models included in her analysis, Mason describes each one in turn, presenting them charitably before her critique.
Mason's deft use of Heideggerian philosophy to critique standardized CEC methods is precise without adding extraneous concepts to the flow of the book. Where this text truly shines is in the innovative weaving of Christian metaphysics and liturgical theology into a rich understanding of what CEC can be in the hands of a practitioner truly committed to beholding being. Instead of seeking efficiency and repeatability, Mason outlines that seeing reality for what is and persons for who they are (insofar as we can deeply know others within the limited time they are in our care) is the path toward responsive and responsible CEC. While the purposes and expected activities of CEC should be explainable to stakeholders, especially to those requesting the consultation, each request should be addressed with a flexibility and moral encounter of persons that standardized methods do not permit. In looking to the non-identical repetition that a patient is, next steps are always contingent, circling, and dependent rather than set, linear, and independent. Instead of relying on our own power to enact a specified technique, a liturgical gaze sets the mystery of creation and the good as the ultimate horizons of inquiry. Ethicists are often perceptive individuals, with enough experience in healthcare to give rise to cynical expectations of stakeholders, but such cynicism and overconfidence in our own power of perception can stunt our moral imaginations. There are many takeaways for a practicing ethicist from this book, but chief among them is to always, always, allow oneself to be surprised.
As is custom in bioethics literature, a few well-placed case studies guide the reader to consider the practical application of the theoretical groundwork that Mason has laid out. The last vignette, which is designed to show a liturgical stance, is helpful in showing that simply following a standardized process would not have unearthed the real concerns and goods at stake for the patient. However, it is unclear how the liturgical stance is markedly different than the phenomenological approach associated with Richard Zaner. His preferred interventions of drawing out the narrative of the patient through repeated conversation and looking to the main stakeholders to identify the relevant features of a solution are both present in the actions of the ethicist in the vignette. Perhaps it is simply the case that a liturgical stance truly does have some commonalities with a more purely phenomenological approach, though Mason is persuasive that a liturgical stance is more capable of de-centering the ethicist in a way that Zaner does not achieve.
A focused book, there is little that one is left wanting from Being Beheld. For all the incisive critique of the techne of standardized CEC, Mason does not fully flesh out how such techniques malform their users. It would have been interesting to hear her analysis of what specific effects standardized processes have on the ethicist herself, thus lending more contrast to the discussion of the role of phronesis in a liturgical stance.
In all, Mason both offers a complete critique and positively argues for another way, a liturgically-informed doing of the practical ethics that is CEC. At the same time, Mason will start new conversations as the field begins to grapple with the proffering of a new path amidst the move to professionalization.
JACQUELYN HAROOTUNIAN-CUTTS
ENDNOTES
Thank you to Dylan Manson for proofreading this piece.