Abstract
One of the most important problems of contemporary life is how to bring ethics to bear on the development and applications of technology. This problem is nowhere more acute than in the biomedical sphere. The ethical guidance of biomedical research and medical practice depends on adequately clear sound ethical standards, but it also depends on the internalization of these standards in both research and therapeutic practice. This paper focuses on the problem of determining adequate ethical standards and proposes a wide-ranging pluralistic theory for approaching moral questions. It does this in broad outline, but also with an eye to the applicability of ethical standards to concrete biomedical decisions, including clinical decisions and determination of research programs, especially those involving genetic engineering and fetal tissue use.
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Notes
- 1.
This section and the next draw heavily on, though they also refine and somewhat revise, points made I have made in (2007a), especially Chap. 1.
- 2.
The notions of treating persons as ends and of treating them merely as means can be clarified even independently of Kant’s ethical writings. For an indication of how and references to literature on Kantian ethics see chapter 3 of my (2004).
- 3.
I have discussed a number of questions concerning this issue in (1996).
- 4.
Mill’s quoted formulation is less clear than the formulation I have given in the preceding text; that represents a major kind of utilitarianism–though not the only kind found in Mill – as a sort of ethics by cost-benefit analysis: for each of our options, such as giving a donation to A vs. giving it to B, we assign probabilities of relevant outcomes and, for each of those outcomes we assign values; we multiply the probabilities by the positive or negative numbers representing the good and bad outcomes respectively; and we then rank our options accordingly. Right acts are those that maximize the good. What makes this ethics rather than a kind of economics is that it makes goodness, not profit, the standard of conduct.
- 5.
Joseph DesJardins, e.g., in his work, says, “Utilitarianism is typically identified with the policy of ‘maximizing the overall good’ or, in a slightly different version, of producing ‘the greatest good for the greatest number’” (2005, 30). He does not discuss the difference (which is far from slight), and he discusses utilitarianism in relation to both characterizations. Bentham may be the main source of the greatest number formulation. His Introductory View of the Rationale of Evidence has, “Of legislation the proper end may, it is hoped, be stated as being–not but that there are those who will deny it–in every community, the creation and preservation of the greatest happiness of the greatest number.” (1843, 6) He does not, however, present this as equivalent to his principle of utility: “that principle which approves or disapproves of every action whatsoever, according to the tendency which it appears to have to augment or diminish the happiness of the party whose interest is in question.” (1996, 12).
- 6.
This assumes that the narrow distribution of libraries would not create a degree of resentment that would cause suffering so great as to outweigh the benefits of favoring the educated. Utilitarians always seek to consider the total effect of a possible action; the point here is that inequality of distribution is not automatically or in itself to be avoided. The overall good is the sole standard of conduct.
- 7.
- 8.
For a detailed account of Ross’s intuitionism and a defense of a more comprehensive view that incorporates major elements of it, see my (2004), especially chapters 2 and 3.
- 9.
This contrast is not sharp (and deserves analysis not possible here). Even supposing Kant’s formulations of the Categorical Imperative are all equivalent, he appeals (in its intrinsic end formulation) to a plurality of moral considerations, e.g. an obligation to avoid treating people merely as means and an obligation (not entailed by that) to treat them as ends. For Mill, too there is at least the plurality that comes from taking value to have both negative and positive dimensions.
- 10.
The interpretation of justice, freedom, and happiness (and especially the first two) is treated in detail in my (2004, ch. 5), which also introduces duties of manner as a distinct category. These are obligations concerning how we should do what we ought to do, e.g. respectfully or generously as opposed to resentfully. The entire set of “Rossian” common-sense obligations may also be integrated under an interpretation of Kant’s Categorical Imperative; this Kantian intuitionism, as I call it, is not as easily explained as the pluralist universalism formulated in the text, but below I will describe it in some detail.
- 11.
I speak of optimizing rather than maximizing happiness because, for one thing, a maximization standard, even with the limitations the principle expresses, may be too demanding. I also agree with Mill (and Aristotle as I read him) that the quality as well as quantity of happiness is relevant, which makes talk of maximizing it at best misleading. I have dealt with this kind of demandingness problem in ethics in, e.g., (2004, ch. 4). See my (2004, ch. 5) for rationale for taking freedom to be morally important independently of the other Rossian obligations.
- 12.
The problem of deciding just how much one ought to do for others is difficult on any plausible ethical view, and especially for utilitarianism, which makes maximization of the good the central obligation. I have discussed in detail how this problem may be dealt with in my (2004, chs. 3 & 4).
- 13.
Detailed discussion of Ross’s principles, together with a rationale for my two added ones, is provided in my (2004, ch. 5).
- 14.
For a fine-grained and illuminating theory of equality, see Temkin (1993).
- 15.
Detailed discussion of what constitutes a manner of action and how it is morally important is provided in my (2016).
- 16.
No disrespect for Kant is implied by taking his formula to have force that is independent of his own interpretation of it. His greatness surely consists partly in his using universally applicable categories with meaning that transcends even his own interpretation of the formula. His interpretation is not represented even by him as complete, and (as the literature of Kantian ethics shows) he had views, such as some of the rigoristic ones, that are at best difficult to square with the best interpretation of the Humanity Formula. See, e.g., (Wood 2008).
- 17.
- 18.
- 19.
For recent discussion of the distinction between the therapeutic and non-therapeutic, as well as exploration of other aspects of biomedical enhancement research, see Buchanan (2011).
- 20.
There is even an ambiguity in the formula that, unnoticed (as is common) affects its application. Are we to give priority to maximizing aggregate good and then seek (if there remain options) to distribute it as widely as we can, or are we to prioritize wide distribution, doing some good for the maximum number of people our options permit us to help and only then seek to maximize the aggregate good we produce? These aggregative vs. distribute readings make a vast difference in policy. Detailed discussion of this famous formula is provided in my (2007b).
- 21.
- 22.
- 23.
For valuable discussion of many of the topics in this paper I thank Marta Soniewicka and Adriana Warmbier.
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Audi, R. (2018). Chapter 1 Ethical Theory and Moral Intuitions in Biomedical Decision-Making. In: Soniewicka, M. (eds) The Ethics of Reproductive Genetics. Philosophy and Medicine, vol 128. Springer, Cham. https://doi.org/10.1007/978-3-319-60684-2_1
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