This article describes and rejects three standard views of reason in secular clinical ethics. The first, instrumental reason view, affirms that reason may be used to draw conceptual distinctions, map moral geography, and identify invalid forms of argumentation, but prohibits recommendations because reason cannot justify any content-full moral or metaphysical commitments. The second, public reason view, affirms instrumental reason, and claims ethicists may make recommendations grounded in the moral and metaphysical commitments of bioethical consensus. The third, comprehensive reason view, also affirms instrumental reason, but encourages ethicists to make recommendations grounded in the moral and metaphysical commitments of their private worldviews. A compatibilist view of public reason is then defended, which holds that each standard view captures an important role for reason in different aspects of secular clinical ethics. The article ends by identifying three implications for enduring theoretical debates in clinical ethics.
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Elsewhere, I have elaborated on various critiques of Engelhardt's view in greater depth (Brummett 2021b).
See: (American Society for Bioethics and Humanities 2011, 2015, 2017; Appelbaum 2007; Beauchamp and Childress 2013; Berlinger et al. 2013; Diekema et al. 2011; Dubler and Liebman 2011; Fletcher et al. 2005; Ford and Dudzinski 2008; Hester and Schonfeld 2012; Jonsen et al. 2006; Kon et al. 2016; Lo 2009).
Bioethical consensus contains moral and metaphysical commitments. The presence of moral content in bioethical consensus is clear (as consensus positions are grounded in the values of respect for autonomy, beneficence, non-maleficence, and justice) whereas the metaphysical content has been less emphasized in the literature. One way to recognize these metaphysical claims is to understand that once it is determined what moral principles have weight, it must subsequently be determined to whom those principles apply (Veatch and Guidry-Grimes 2019, 37). Identifying persons with moral standing is a distinctly metaphysical task. Elsewhere it is argued that the metaphysical commitments of secular clinical ethics extend beyond claims of personhood to claims of the ultimate nature of reality. For example, prohibiting a Jehovah’s Witness parent from refusing a life-saving blood transfusion for their child rejects the idea that the child’s eternal salvation is threatened by receiving blood (Brummett 2019, Brummett 2021a).
On this point, Charles Camosy writes, “Consider that secular utilitarian traditions are defined by their authoritative, faith-based and transcendent answers to the following kinds of questions. What is that about which we should be ultimately concerned? Maximizing good consequences. How are we to determine what counts as good consequences? Some will say ‘pleasure over pain;’ others will talk about preferences satisfied over preferences ‘thwarted;’ still others ‘happiness over unhappiness.’ How do we aggregate consequences? ‘One counts as one and none more than one.’ But who counts as one? Do future or potential persons count? […] Answers to these (and many other) big questions are derived from the authoritative, transcendental, faith-based, first principles of traditions like hedonistic and preference utilitarianism” (Camosy 2012, 14).
A moral judgment counts as “considered” if it is screened for obvious sources of error and bias, held with a high degree of confidence, and stable (Nichols 2012). Additionally, although I focus on moral claims here, recall that bioethical consensus involves moral and metaphysical claims, which is acknowledged in the method of wide reflective equilibrium that involves bringing moral claims in coherence with non-moral (read scientific, social, metaphysical) claims (Nichols 2012; Räikkä 2009; Daniels 1996).
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Brummett, A. What is the appropriate role of reason in secular clinical ethics? An argument for a compatibilist view of public reason. Med Health Care and Philos (2021). https://doi.org/10.1007/s11019-021-10004-9
- Clinical ethics
- Ethics expertise