The approach that we advocate here largely compliments Komesaroff's microethics, but there is an additional element: it places a greater emphasis on dialogue. Dialogue plays a central role in most every aspect of medical practice.
Or so it would seem. The following discussion sets out the basic elements of a dialogic approach to ethics.
Dialogic ethics is organized around an extended notion of collegiality. It presupposes that all credentialed health care professionals are indispensable co-participants in a relationship of exchange. Participants are accorded equal opportunity to freely express their beliefs, values, traditions and perspectives. We maintain that professionals of all stripes stand to gain from engaging the perspectives and ideas of rival conceptions rather than being driven by the logic of their own particular category of professional moral knowledge. It may produce new, possibly hybrid, systems of ethical thought and moral standards that are appropriate to today's multidisciplinary health care environments.
We know that incompatible values and conflicting expectations of the 'right thing to do' can be found at most every juncture of the treatment process. Ideals, moral concerns, evaluative standards and experiential perspectives 'outside' established patterns of judgement and understanding that strike some as understandable and important may be regarded by others as incompatible with their own values and systems of meaning. Orthodox ethical discourses tend to obscure unspoken diversity and cover over moral conflict with rather bland absolute and universalistic norms.
Traditional approaches stand in open contradiction to dialogic ethics. Although consensus is something which participants may aim in the exchange, dialogic ethics does not stipulate mutual agreement as a necessary precondition for exchange. Rather, it acknowledges and accepts the possibility of conflict between moral discourses and ethical systems within an ongoing process of negotiation. This is not to suggest that dialogic encounters never result in consensual agreement over common standards of evaluation for judging practice, knowledge, beliefs, and conduct. However, consensus is understood as something that is constructed discursively from the bottom up. Universality and particularity may therefore figure in the new vantage point.