Abstract

In order to evaluate the three levels structure analysis, a clinical ethics group conducted a literature review in an effort to clarify the relational structure among them. By following debates on methodologies in clinical ethics, the group focused on a comparison of the top-down vs bottom-up approaches, which would appear on the surface to be in contrast. A methodology called clinical pragmatism has been proposed to consolidate the two approaches. From the viewpoint of clinical pragmatism, respect for the patient‘s autonomy, for example, would mean that, while maintaining the central importance of the patient‘s value judgment, the patient shares the context specific to his or her case with family and medical professionals. The principle is embodied in the process of creating the narrative together in that shared environment