Abstract
What has been the contribution of philosophy to the emerging interdisciplinary field of bioethics? Although the news might come as a shock to philosophers accustomed to their lowly and marginal status within American intellectual life, a growing chorus of skeptical casuists, feminists, social scientists, and narrativists have come to the conclusion that philosophy’s role in bioethics has been both dominant and disconcerting. We hear that philosophy, especially in the guise of its Anglo-American analytic wing, has largely dominated the field for the past thirty years, bequeathing to it a distinctive language, method, and agenda. Although some of this criticism has the distinct appearance and flavor of “sour grapes” (“Hey, what about us!”), the charge that philosophy has played a dominant role in the formation of contemporary bioethics seems descriptively correct and well nigh undeniable. Ever since the emergence of the mantra of “autonomy, beneficence, and justice” from the primeval soup of rival moral theologies in the 1970s, the language of bioethics has been largely that of contemporary moral philosophy (1).
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Notes and References
The language of law has had an equal, if not greater, impact on the field of bioethics. Indeed, I think it fair to say that philosophers have often played the role of conceptual custodians, sweeping out and tidying up the results of the day’s court decisions.
See, for e.g., Renée C. Fox and Judith P. Swazey. (1984) Medical Morality Is Not Bioethics: Medical Ethics in China and the United States. Perspect. Biol. Med. 27(3): 336–360; and
John H. Evans. (2002) Playing God: Human Genetic Engineering and the Rationalization of Public Bioethical Debate. Chicago, University of Chicago Press, IL.
Martha Nussbaum. Why practice needs ethical theory: particularism, principle, and bad behavior, in Moral Particularism. (Brad Hooker and Margaret Little, eds.) Oxford, Clarendon Press, pp. 233–234. Nussbaum’ s own definition of ethical theory does not insist that reasons and arguments be derived from a small number of fundamental principles. I have added this element to her account because I believe it captures an important feature of the kinds of traditional moral theories often invoked within bioethics.
President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. (1983). Deciding to Forego Life-Sustaining Treatment. Washington, DC, US.
See, e.g., Mark Kuczewski. (1997) Bioethics’ consensus on method: who could ask for anything more? in Stories and Their Limits. (H. L. Nelson, ed.) Routledge, New York, NY.
Alex London. (2001) The Independence of Practical Ethics. Theoretical Medicine and Bioethics 22(2): 87–105.
K. Danner Clouser and Bernard Gert. (1990) A Critique of Principlism. J. Med. Philos. 15: 219–236.
Albert Jonsen. (1991) Of Balloons and Bicycles, or The Relationship Between Ethical Theory and Practical Judgment. Hastings Center Report 21(5): 14–16.
See generally Albert Jonsen and Stephen Toulmin. (1988) The Abuse of Casuistry. University of California Press, Berkeley.
Cass R. Sunstein. (1996) Legal Reasoning and Political Conflict. Oxford University Press, New York, NY, 35 ff.
Stephen Toulmin . (1981) The Tyranny of Principles. Hastings Center Report 11 (6): 31–39.
See the selection of articles in Hilda L. Nelson. Stories and Their Limits.
Will Kymlicka. (1996) Moral philosophy and public policy, in Philosophical Perspectives on Bioethics. (L.W. Sumner and Joseph Boyle, eds.) University of Toronto Press, Toronto, pp. 244–270.
Ibid., p. 250.
Ibid., p. 252.
See London. The Independence of Practical Ethics.
1 follow Rawls and Daniels in defining a “considered judgment” as a judgment made under conditions conducive to avoiding errors of judgment (e.g., while not under the sway of violent passion, on the basis of adequate information, etc.). See Norman Daniels. (1979) Wide Reflective Equilibrium and Theory Acceptance in Ethics. Journal of Philosophy 76: p. 258.
Derek Parfit. (1984) Reasons and Persons. Oxford University Press, Oxford.
Ronald Dworkin. (1997) In Praise of Theory. Arizona State Law Journal 29: pp. 353–376.
A good example of this sort of evasion can be found in National Institutes of Health, Report of the Human Embryo Research Panel (September, 1994).
Ronald Dworkin. In Praise of Theory. p. 356.
Ibid., p. 358.
See, e.g., Susan Wolf. (1995) Feminism and Bioethics. Oxford University Press, New York, NY; and
Martha Nussbaum. (2000) Women and Human Development. Cambridge University Press, New York, NY.
In this regard, see Susan Muller Oki’s critique of Michael Walzer’ s communitarianism (1989), in Justice, Gender and the Family. Basic Books, New York NY, pp. 41–73.
John Rawls. (1971) A Theory of Justice. Harvard University Press, Cambridge, pp. 20–22, 46–53.
1 shall bracket here the philosophical difficulties involved in equating coherence with justification. For an interesting and well-balanced discussion of this controversy, see Michael DePaul. (1993) Balance and Refinement: Beyond Coherence Methods of Moral Inquiry. Routledge, London/New York.
See also Joseph Raz. (1994) The relevance of coherence, in Joseph Raz, Ethics in the Public Domain. Clarendon Press, Oxford, pp. 277–319.
These various uses of reflective equilibrium—e.g., for justifying moral theories as well as practical judgments bearing on individual acts and policies—are well explored in Wibren Van Der Burg and Theo Van Willigenburg. (1998) Relective Equilibrium. Kluwer, Dordrecht.
Tom Beauchamp and James Childress. (2001) Principles of Biomedical Ethics, 5th ed. Oxford University Press, New York, NY, pp. 397–401; and
Dan Brock. (1996) Public moral discourse, in Philosophical Perspectives on Bioethics. (L. W. Sumner and Joseph Boyle, eds.) University of Toronto Press, Toronto, pp. 271–296.
David DeGrazia. (1996) Taking Animals Seriously: Mental Life and Moral Status. Cambridge University Press, New York; and
Baruch Brody. (1998) Life and Death Decision Making. Oxford University Press, New York, NY, Chapter 1.
See, e.g., Tom Beauchamp. On Eliminating the Distinction Between Applied Ethics and Ethical Theory. The Monist 67(4): pp. 514– 531; and Brock. Public Moral Discourse.
For additional critiques in the same vein, see Robert L. Holmes. (1990) The Limited Relevance of Analytical Ethics to the Problems of Bioethics. J. Med. Philos. 15: 143–159: and
Barry Hoffmaster. (1989) Philosophical ethics and practical ethics: never the twain shall meet, in Clinical Ethics: Theory and Practice. (Barry Hoffmaster, Benjamin Freedman, and Gwen Fraser, eds.) Humana Press, Totowa, NJ, pp. 201–230.
Allen Buchanan, Dan Brock, Norman Daniels, and Daniel Wikler. (2000) From Chance to Choice: Genetics and Justice. Cambridge University Press, New York, NY, Chapter 5.
Martha Nussbaum. Why Practice Needs Ethical Theory: Particularism, Principle, and Bad Behavior. p. 250. I give some concrete examples of such bad philosophy in the bioethics context below, at p. 25ff.
Annette Baier. (1994)What do women want in a moral theory? in Moral Prejudices. Harvard University Press, Cambridge, pp. 2,3.
Benjamin Freedman. (1987) Equipoise and the Ethics of Clinical Research. New England Journal of Medicine 317: pp. 141–145.
National Bioethics Advisory Commission. (2001) Ethical and Policy Issues in Research Involving Human Participants. Bethesda, MD, Chapter 4.
36 Later iterations of Freedman’ s project are shedding much needed light on current controversies over the ethics of international research trials. See, e.g., Alex John London. (2001) Equipoise and International Human—Subjects Research.Bioethics 15(4): pp. 312–332.
Allen Buchanan and Dan Brock. (1986) Deciding for Others. Milbank Quarterly 64(2): pp. 67–80.
Buchanan and Brock argue that competency determinations are “all or nothing” in the sense that they either allow or disallow a patient to make a given decision.
Bruce Miller. (1981) Autonomy and the Refusal of Lifesaving Treatment. Hastings Center Report (11)4: pp. 22–28.
For the sake of brevity, I shall only mention in passing here a fourth example of important conceptual analysis for bioethics—namely, the analysis of such ubiquitous, yet little understood, concepts as “coercion” and “exploitation.” Especially in the contexts of reproductive and research ethics, these concepts have lately been thoroughly debased to the status of all-purpose negative epithets. For two extremely helpful conceptual–ethical remedies, see Alan Wertheimer. (1987) Coercion. Princeton University Press, Princeton; and
Alan Wertheimer. (1996) Exploitation. Princeton University Press, Princeton.
Norman Daniels. (1985) Just Health Care. Cambridge University Press, New York.
Ibid., p. 41.
Nor need it be, as some uncharitable critics have alleged, a fraudulent attempt to portray one’s personal political preferences as the conclusions of a “scientifically neutral” moral philosophy. See, e.g., A Holmes. (1985) The Limited Relevance of Analytical Ethics To the Problems of Bioethics; and
Annette Baier. (1985) Doing Without Moral Theory? Postures of the Mind. University of Minnesota Press, Minneapolis, pp. 228–245.
Norman Daniels and James Sabin. (1997) Limits to Health Care: Fair Procedures, Democratic Deliberation, and the Legitimacy Problem for Insurers. Philosophy and Public Affairs 26(4): 303–350. For a more generalized vindication of the claim that ethics and political philosophy must eventually be supplemented by democratic deliberation,
see Amy Gutmann and Dennis Thompson. (1996) Democracy and Disagreement. Harvard University Press, Cambridge.
Joel Feinberg. (1984) Harm to Others. Oxford University Press, New York.
Tom Beauchamp and Ruth Faden. (1986) A History and Theory of Informed Consent. Oxford University Press, New York, NY.
Beauchamp and Childress. Principles of Biomedical Ethics, 5th ed. pp. 293–311.
Gerald Dworkin. (1988) The Theory and Practice of Autonomy. Cambridge University Press, New York, NY.
Allen Buchanan and Dan Brock Deciding for Others.
Some academic bioethicists have much more faith in the dictates of their unconstrained theories than they do in regnant medical and social norms. Thus, although their theorizing is important and interesting as an academic exercise, it largely fails to connect with the social and political world as we know it, and thereby forfeits the ability to influence policy. Good examples of this kind of unconstrained academic theorizing can be found in the works of Peter Singer, an unconstrained utilitarian, and H. Tristram Engelhardt, Jr., an unconstrained libertarian.
For a similar defense of middle-level theory, see Ruth Macklin. (1989) Ethical theory and applied ethics: a reply to the skeptics, in Clinical Ethics: Theory and Practice. (Barry Hoffmaster, Benjamin Freedman, and Gwen Fraser, eds.) Humana Press, Totowa, NJ, pp. 101–124.
Baruch Brody. Life and Death Decision Making. pp. 25,113–115.
Michael Green and Daniel Wilder. (1980) Brain Death and Personal Identity. Philosophy and Public Affairs 9(2): 105–133.
Rebecca Dresser and John Robertson. (1989) Quality of Life and Non-Treatment Decisions for Incompetent Patients. Law, Medicine and Health Care. 17(3): 234–244.
See, e.g., Allen Buchanan. (1988) Advance Directives and the Personal Identity Problem. Philosophy and Public Affairs 17: 277–302.
See Jonsen and Toulmin. The Abuse of Casuistry. p. 330.
See, e.g., David Burrell and Stanley Hauerwas. (1977) From system to story: an alternative pattern for rationality in ethics, in Knowledge, Value and Belief (H.T. Engelhardt, Jr., and Daniel Callahan, eds.) The Hastings Center, Hastings-on-Hudson, NY.
For some ruminations on Dewey’s potential contribution to this debate over the proper role of the philosopher in practical ethics, see John D. Arras. (2002) Pragmatism in Bioethics: Been There, Done That. Social Philosophy and Policy pp. 39–41.
A good example of this problem is the hard won insight that standard theories of justice are ill equipped to help us answer the most basic problems of health care rationing. See Daniels and Sabin. Limits to Health Care: Fair Procedures, Democratic Deliberation, and the Legitimacy Problem for Insurers.
An example of this problem is the failure of political theorists to recognize an issue raised sharply by advocates for the so-called disabilities rights movement—namely, how inclusive of differences should a society’s fundamental institutions be? See Allen Buchanan et al. From chance to choice, in Genetic Intervention and the Morality of Inclusion. Chapter 7.
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Arras, J.D. (2003). The Owl and the Caduceus. In: Miller, F.G., Fletcher, J.C., Humber, J.M. (eds) The Nature and Prospect of Bioethics. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-370-5_1
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