CASUISTRY IN MEDICAL ETHICS: REHABILITATED, OR REPEAT OFFENDER? TOM TOMLINSON Centerfor Ethics and Humanities, C-208 East Fee Hall, Michigan Stare University, East Lansing, M148824, USA ABSTRACT. For a number of reasons, casuistry has come into vogue in medical ethics. Despite the frequency with which it is avowed, the application of casuistry to issues in medical ethics has been given virtually no systematic defense in the ethics literature. That may be for good reason, since a close examination reveals that casuistry delivers rauch less than its advocates suppose, and that it shares some of the säme weaknesses as the principle-based methods it would hope to supplant. Key words: casuistry, ethical method, medical ethics 1. INTRODUCTION In recent years, and especially since the publication of The Abuse of Casußtry, by Albert R. Jonsen and Stephen Toulmin[1], many persons working in medical ethics have advocated the revival of the medieval art of casuistry as a method of moral thinking especially suited to addressing ethical problems in medicine, Given the frequency with which writers in medical ethics declare themselves casuists, there are surprisingly few published attempts at any sustained, in-depth defense of the application of casuistical methods to specific problems in medicaI ethics. I will argue that there is a very good reason for that shortage: the appeal of casuistry is a superficial one, that promises rauch more than it delivers. Before beginning my critical assessment, it will be useful to ger some understanding of why casuistry atträcts such eager adherents from medical ethics. Understood vaguely as a method of moral reasoning rooted in judgments about cases räther than in commitrnents to abstract principles, casuistry's appeäl has two sources - reactions against principle-based approaches to ethical problems; and the practical and pedagogical centrality of the "case" in medicäl ethics. Theoretical Medicine 15: 5-20, 1994. © 1994 Kluwer Academic Publishers. Printed in the Netherlands.