Abstract
The problem of developing a moral philosophy of medicine is explored in this essay. Among the challenges posed to this development are the general mistrust of moral philosophy and philosophy in general created by post-modernist philosophical and even anti-philosophical thinking. This reaction to philosophical systematization is usually called antifoundationalism. I distinguish different forms of antifoundationalism, showing that not all forms of their opposites, foundationalism, are alike, especially with regards to claims made about the certitude of moral thought. I conclude that we are correct to mistrust absolutist principles in a moral philosophy of medicine, but can find some center within the practice of medicine itself for a moral foundation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Veatch RM. The Hippocratic ethic is dead. The New Physician Sept. 1984: 41–42, 48.
Gray P. Gagging the doctors. Time Magazine January 8, 1996: 50.
Pellegrino ED. The metamorphosis of medical ethics: a 30-year retrospective. Journal of the American Medical Association March 1993; 269(9): 1158–1163.
Pellegrino ED. What philosophy of medicine is. Unpublished manuscript.
The two of us plan to develop a book on the moral philosophy of medicine as the next step in our continuing work in the field of philosophy of medicine. Hence the ideas contained in this essay will be further developed in our later, joint work.
See Pellegrino ED, Thomasma DC. A Philosophical Basis of Medical Practice. New York: Oxford University Press, 1981: 27–30.
Kilner JF, de S. Cameron NM, Schiedermayer DL, eds. Bioethics and the Future: A Christian Appraisal. Grand Rapids, MI: Eerdmans Publishing Co., 1995. Also see Thomasma DC, Loewy EH. Exploring the role of religion in medical ethics 5(2): 257–268. Cambridge Quarterly of Healthcare Ethics 1996; 6, Engelhardt HT, Wildes K, eds. Christian Bioethics 1995; 1: entire volume.
This enterprise is part of the development of a comprehensive philosophy of medicine and medical ethics that has occupied us in different ways in each of the preceding five volumes we have authored together. We are acutely aware that this is an ambitious and even presumptuous enterprise. We are swimming against powerful currents in contemporary bioethics, currents such as antifoundationalism, multiculturalism, contextualism, narration, etc.
Toulmin S. The primacy of practice. William Bennett Bean Symposium on Philosophy and Medicine. Galveston, Texas: February 15 & 16, 1995. Vol. 50. Dordecht, Netherlands: Kluwer Academic Publishers (in press).
Rockmore T. Introduction. In Rockmore T, Singer BJ, eds. Antifoundationalism Old and New. Philadelphia: Temple University Press, 1992: 2.
Toulmin: 1.
Toulmin: 2.
Toulmin: 4.
Rockmore, Antifoundationalism Old and New: 3.
Chisholm RM. The Foundations of Knowing. Minneapolis: University of Minnesota Press, 1982.
Habermas J. Nachmetaphysisches Denken: Philosophische Aufsätze. Frankfurt a/M: Suhrkamp, 1988.
Tollefsen O. In Tollefsen J, ed. Foundationalism Defended: Essays on Epistemology, Ethics and Aesthetics. Bethesda, MD: Cambridge Press, 1995.
MacIntyre A. Why is the search for the foundation of ethics is so frustrating? Hastings Center Report 1979; 9(4): 16–22.
MacIntyre A. Three Rival Versions of Moral Enquiry. Notre Dame, IN: University of Notre Dame Press, 1990.
MacIntyre A. After Virtue. 2nd Edition. Notre Dame, IN: University of Notre Dame Press, 1985.
MacLean A. The Elimination of Morality: Reflections on Utilitarianism and Bioethics. London and New York: Routledge, 1993: 5.
Ibid: 35.
Waller BN. Noncognitive moral realism. Philosophia 1994; 24(1–2): 59.
Harris J. The elimination of morality [review]. Journal of Medical Ethics 1995; 21: 220–224.
Cornford FM. Microcosmographia Academica: Being a Guide for the Young Academic Politician. Fifth edition. Cambridge: Bowes & Bowes, 1953: 10.
MacLean, Elimination of Morality: 114.
Telfer E. The elimination of morality [review]. Philosophical Books 1995; 36(3): 204–206.
MacIntyre A. Patients as agents. In Spicker SF, Engelhardt HT, Jr., eds. Philosophy and Medicine: Philosophical Medical Ethics: Its Nature and Significance Volume 3. Boston, MA: D. Reidel Publishing Co., 1977; quote: 210.
Thomasma DC. Clinical ethics as hermeneutics. Theoretical Medicine 1994; 15(2): 93–111.
Rockmore, Antifoundationalism Old and New: 6–7.
Wartofsky, MW. What can the epistemologists learn from the endocrinologists? William Bennett Bean Symposium on Philosophy and Medicine. Galveston, TX: February 15&16, 1995.Volume 50. Dordecht, Netherlands: KluwerAcademic Publishers (in press).
Aquinas, St. Thomas. Summa Theologiae, I, Iae, Q. 23, art. 7, obj. 3: “... bonum in operibus naturae invenitur ut in pluribus, defectus autem, et malum, ut in paucioribus.” Aquinas was here arguing about whether one could predict the number of predestined persons. He held one could not, and this objection to his view argued that one could predict a majority of “elect.” He responds to this objection in ad. 3, by arguing that the natural order of things does indeed seem to respect a tilt toward the majority being good, with only a minority of defects and/or evil, but in the supererogatory order, the rule seems rather to be that only a minority of persons achieve real note, and the majority are found wanting. Applying this concept to moral certitude, however, one could argue that Aquinas held that ethics can only be “generally, for the most part true,” since the order of nature is not capable of producing absolute certitude. This conviction, for example, led MacIntyre and Gorovitz, in the first issue of Journal of Medicine and Philosophy to argue for “necessary fallibility” in medicine: MacIntyre A, Gorovitz S. Toward a theory of medical fallibility. Journal of Medicine and Philosophy 1976; 1(1): 51–71.
Husserl E. Vom Ursprung der Geometrie. In his: Krisis der Europäischen Wissenschaften und die Transzendentale Phaänomenologie. Den Haag: M. Nijhoff, 1962: 365–381. See especially: 365.
Dewey J. Experience and Nature. New York: Dover Publications, 1958.
Toulmin S. How medicine saved the life of ethics. Perspectives in Biology and Medicine 1982; 25: 736–750.
Toulmin, The primacy of practice: 12.
Putnam H. Meaning and the Moral Sciences. Boston/London: Henley, 1978.
Feyerabend P. On the critique of scientific reason. In Howson C, ed. Method and Appraisal. Cambridge: Cambridge University Press, 1976: 309–339. Quote: 310.
Pellegrino Ed and Thomasma DC. The Virtues in Medical Practice. New York: Oxford University Press, 1994.
Nagel T. The Possibility of Altruism. Oxford: Oxford University Press, 1970: 79–146.
Tollefsen, Foundationalism Defended: 117.
Nagel, The Possibility of Altruism: 144–145.
Pellegrino ED and Thomasma DC. For the Patient's Good: The Restoration of Beneficence in Healthcare. New York: Oxford University Press, 1988.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Thomasma, D.C. ANTIFOUNDATIONALISM AND THE POSSIBILITY OF A MORAL PHILOSOPHY OF MEDICINE. Theor Med Bioeth 18, 127–143 (1997). https://doi.org/10.1023/A:1005726024062
Issue Date:
DOI: https://doi.org/10.1023/A:1005726024062