Medicine, Health Care and Philosophy

, Volume 14, Issue 1, pp 91–100 | Cite as

Anti-theory in action? Planning for pandemics, triage and ICU or: how not to bite a bullet

  • Nathan EmmerichEmail author
Scientific Contribution


Anti-theory is a multi-faceted critique of moral theory which, it appears, is undergoing something of reassessment. In a recent paper Hämäläinen discusses the relevance of an anti-theoretical perspective for the activity of applied ethics. This paper explores her view of anti-theory. In particular I examine its relevance for understanding the formal guidance on pandemic flu planning issues by the Department of Health (DoH) in the UK and some subsequent discussions around triage and reverse triage decisions which may be considered by both Primary and Secondary Care Trusts (PCTs and SCTs) (On the division between Primary and Secondary Care Trusts in the UK National Health Service see: [Accessed August 2010]). in setting their own policies and which may face clinicians in the eventuality of a pandemic. Following Hämäläinen in contrasting reflective equilibrium with her anti-theory inspired suggestion of an instrumental approach to moral theory in practice I demonstrate how this understanding complements the diversity of our intuitive moral judgements. Consequentially I suggest that this anti-theoretical instrumental approach is in greater accord with the conditions under which such policy planning and decision making is, or will be, made. Furthermore, on the grounds of keeping open the ethical dimensions of medical practice in conditions of uncertainty, i.e. during a pandemic, I suggest that the anti-theoretical instrumental perspective is, ethically, the preferable approach to producing such policies and guidelines.


Ethics Anti-theory Pandemic flu planning Triage 



I would like to express my thanks to the ESPMH for awarding me the 2010 Young Scholar Essay Prize for this essay and for the helpful comments from the judges and reviewer. Similarly for the anonymous JME reviewers of a much earlier version of this essay. I would also like to thank Prof. Ian Young for his ongoing support during the gestation of this essay and Prof Wheeler for the same, although not just in regards this essay.


  1. Anscombe, G.E.M. 1958. Modern moral philosophy. Philosophy 33: 1–19.CrossRefGoogle Scholar
  2. Bauman, Z. 1993. Postmodern ethics. Oxford: Wiley-Blackwell.Google Scholar
  3. Benjamin, M. 1990. Philosophical integrity and policy development in bioethics. Journal of Medicine and Philosophy 15: 375.PubMedGoogle Scholar
  4. Boden, R., D. Epstein, and J. Latimer. 2009. Accounting for ethos or programmes for conduct? The brave new world of research ethics committees. Sociological Review 57: 727–749.CrossRefGoogle Scholar
  5. Bourdieu, P. 1977. Outline of a theory of practice. Cambridge: Cambridge University Press.Google Scholar
  6. Caplan, A.L. 1980. Ethical engineers need not apply: The state of applied ethics today. Science, Technology, & Human Values 6: 24–32.CrossRefGoogle Scholar
  7. Chipman, M., B.E. Hackley, and T.S. Spencer. 1980. Triage of mass casualties: Concepts for coping with mixed battlefield injuries. Military Medicine 145: 99–100.PubMedGoogle Scholar
  8. Christian, M.D., et al. 2006. Development of a triage protocol for critical care during an influenza pandemic. Canadian Medical Association Journal 175: 1377–1381.CrossRefPubMedGoogle Scholar
  9. Clarke, S.G. 1987. Anti-theory in ethics. American Philosophical Quarterly 24: 237–244.Google Scholar
  10. Clarke, S.G., and E. Simpson. 1989. Anti-theory in ethics and moral conservatism. Albany: SUNY Press.Google Scholar
  11. Daniels, N. 1979. Wide reflective equilibrium and theory acceptance in ethics. The Journal of Philosophy 76: 256–282.CrossRefGoogle Scholar
  12. Department of Health, London. April 2009. Pandemic flu: Managing demand and capacity in health care organisations (Surge). Accessed 3 Nov 2009.
  13. Dickenson, D. 2006. Gender and ethics committees: Where’s the ‘different voice? Bioethics 20: 115–124.CrossRefPubMedGoogle Scholar
  14. Edwards, J.C. 1989. Ethics without philosophy: Wittgenstein and the moral life. Tampa: University Press of Florida.Google Scholar
  15. Gordon, S.M. 2009. Update on 2009 pandemic influenza A (H1N1) virus. Cleveland Clinic Journal of Medicine 76(10): 577–582.CrossRefPubMedGoogle Scholar
  16. Hämäläinen, N. 2009. Is moral theory harmful in practice?—Relocating anti-theory in contemporary ethics. Ethical Theory and Moral Practice 12: 539–553.CrossRefGoogle Scholar
  17. Hedgecoe, A. 2008. Research ethics review and the sociological research relationship. Sociology 42: 873–886.CrossRefGoogle Scholar
  18. Hester, D.M. (ed.). 2008. Ethics by committee. Maryland: Rowman & Littlefield.Google Scholar
  19. Jonsen, A., and S. Toulmin. 1988. The abuse of casuistry: A history of moral reasoning. Berkeley, CA: University of California Press. First Published: 1988.Google Scholar
  20. Kelen, G.D., et al. 2006. Inpatient disposition classification for the creation of hospital surge capacity: A multiphase study. The Lancet 368: 1984–1990.CrossRefGoogle Scholar
  21. Kraus, C.K., F. Levy, and G.D. Kelen. 2007. Lifeboat ethics: Considerations in the discharge of inpatients for the creation of hospital surge capacity. Disaster medicine and public health preparedness 1: 51–56.CrossRefPubMedGoogle Scholar
  22. Maclean, A. 1993. The elimination of morality: Reflections on utilitarianism and bioethics. London: Routledge.Google Scholar
  23. McD Taylor, D. 2006. Reverse triage: Useful for day-to-day access block? The Lancet 368: 1940–1941.CrossRefGoogle Scholar
  24. Melnychuk, R.M., and N.P. Kenny. 2006. Pandemic triage: The ethical challenge. Canadian Medical Association Journal 175: 1393–1394.CrossRefPubMedGoogle Scholar
  25. Momeyer, R.W. 1990. Philosophers and the public policy process: Inside, outside, or nowhere at all? Journal of Medicine and Philosophy 15: 391–409.PubMedGoogle Scholar
  26. Momeyer, R.W. 2002. What conception of moral truth works in bioethics? Journal of Medicine and Philosophy 27: 403–416.CrossRefPubMedGoogle Scholar
  27. Murdoch, I. 1997. Existentialists and mystics: Writings on philosophy and literature. London: Chatto & Windus.Google Scholar
  28. O’Donnell, C. 2008. Correspondence regarding: Pandemic planning articles. Journal of the Intensive Care Society 9: 191–192.Google Scholar
  29. Rawls, J. 1971. A theory of justice. Cambridge: Belknap Press.Google Scholar
  30. Richter, D.J. 1999. Ethics after anscombe: Post ‘modern moral philosophy’. Netherlands: Kluwer Academic Publishers.Google Scholar
  31. Smith, L.F., and J.R. Morrissy. 1994. Ethical dilemmas for general practitioners under the UK new contract. Journal of Medical Ethics 20: 175–180.CrossRefPubMedGoogle Scholar
  32. Sorell, T. 1999. Moral theory and anomaly. Oxford: Wiley-Blackwell.Google Scholar
  33. Toulmin, S.E. 1950. An examination of the place of reason in ethics. Cambridge: Cambridge University Press.Google Scholar
  34. Toulmin, S.E. 1981. The tyranny of principles. The Hastings Centre Report 11: 31–39.CrossRefGoogle Scholar
  35. Weil, M.H., and W.C. Shoemaker. 2004. Pioneering contributions of Peter Safar to intensive care and the founding of the Society of Critical Care Medicine. Critical Care Medicine 32(Suppl 2): S8–S10.CrossRefPubMedGoogle Scholar
  36. Williams, B. 1973. Morality and the Emotions. In Problems of the Self, ed. B. Williams, 207–229. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
  37. Williams, B. 2006. Ethics and the limits of philosophy. Abingdon: Routledge. First Published 1985.Google Scholar
  38. Wittgenstein, L. 2009. Philosophical Investigations, 4th ed. Oxford: Wiley-Blackwell. First Published: 1953.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.School of Sociology, Social Policy and Social WorkQueen’s University BelfastBelfastNorthern Ireland,UK

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