Does Ethical Theory Have a Future in Bioethics?

See Fullinwider R. K. , “Against Theory, or. Applied Philosophy-A Cautionary Tale,” Metaphilosophy 20 (1989), 222–34.

For works published during the period, see National Commission for the Protection of Human Subjects, The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research (DHEW Publication No. (OS) 78–0012, 1978); Brady J. V. Jonsen A. R. , “The Evolution of Regulatory Influences on Research with Human Subjects,” in Greenwald R. eds., Human Subjects Research (New York: Plenum Press, 1982): 3–18; Levine R. J. , Ethics and Regulation of Clinical Research, 1st edn. (Baltimore: Urban & Schwarzenberg, 1981); Pellegrino E. D. Thomasma D. C. , A Philosophical Basis of Medical Practice (New York: Oxford University Press, 1981); and O'Connor F. W. Deviance and Decency: The Ethics of Research With Human Subjects (London: Sage Publications 1979). For later studies or accounts of the period, see Moreno J. D. , Deciding Together: Bioethics and Consensus (New York: Oxford University Press, 1995); Advisory Committee on Human Radiation Experiments, Final Report of the Advisory Committee on Human Radiation Experiments (New York: Oxford University Press, 1996); DeGrazia D. , “Moving Forward in Bioethical Theory: Theories, Cases, and Specified Principlism,” Journal of Medicine and Philosophy 17 (1992), 511–39; Arras J. , “Principles and Particularity: The Role of Cases in Bioethics,” Indiana Law Journal 69 (1994): 983–1014; and Veatch R. M. , “From Nuremberg through the 1990s: The Priority of Autonomy,” in Vanderpool H. Y. , ed. The Ethics of Research Involving Human Subjects: Facing the 21st Century (Frederick, MD: University Publishing Group 1996): 45–58.

Clouser K. D. Gert B. , “A Critique of Principlism,” The Journal of Medicine and Philosophy 15 (1990), 219–36. Jonsen A. Toulmin S. , The Abuse of Casuistry (Berkeley: University of California Press, 1988).

Christakis N. A. , “Ethics are Local: Engaging Cross-Cultural Variation in the Ethics for Clinical Research,” Social Science and Medicine 35 (1992): 1079–91, quotation from 1079, 1089.

Id., 1088.

Turner L. , “Zones of Consensus and Zones of Conflict: Questioning the ‘Common Morality’ Presumption in Bioethics,” Kennedy Institute of Ethics Journal 13 (2003); 193–218, esp. 196.

Christakis , supra note 4, 1088.

Macklin R. , Against Relativism: Cultural Diversity and the Search for Ethical Universals in Medicine (New York: Oxford University Press, 1999).

Sulmasy D. P. , “Review of Against Relativism,” The National Catholic Bioethics Quarterly 1 (2001): 467–69, esp. 468–9. See, however, Macklin's explicit statement in her “Preface” (p. v.) of the way she limits her theoretical goals.

For an example of the sorts of arguments of the opposition in publications in bioethics that need to be addressed, see the essays in Cross-Cultural Perspectives on the (Impossibility of Global Bioethics, ed. Po-Wah Julia Tao Lai (Dordrecht: Kluwer, 2002).

For nuanced accounts of the use of moral philosophy to defend both relativism and anti-relativism, see Harman G. Thomson J. J. , Moral Relativism and Moral Objectivity (Cambridge, MA: Blackwell Publishers, 1996). Thomson mounts a compelling philosophical defense of “objectivity.” A very different and engaging approach, more concrete but not appropriately described as practical ethics, is Nussbaum M. C. , Women and Human Development: The Capabilities Approach (Cambridge: Cambridge University Press, 2000), especially chapter 1, “In Defense of Universal Values.”

Daniels N. , Justice and Justification: Reflective Equilibrium in Theory and Practice (Cambridge: Cambridge University Press, 1996); Daniels N. , “Wide Reflective Equilibrium in Practice,” in Sumner L. W. Boyle J. , eds., Philosophical Perspectives on Bioethics (Toronto: University of Toronto Press, 1996), 96–114; Daniels N. , “Wide Reflective Equilibrium and Theory Acceptance in Ethics,” Journal of Philosophy 76 (1979), 256–82; and, with Buchanan A. Brock D. W. Wikler D. , From Chance to Choice: Genetics and Justice (Cambridge: Cambridge University Press, 2000), esp. 371ff.

Rawls J. , A Theory of Justice (Cambridge, MA: Harvard University Press, 1971; revised edition, 1999).

Daniels , supra note 12, 1.

Daniels N. , “Wide Reflective Equilibrium in Practice” provides the most accessible material on methodology in bioethics, but the claim to have used the method in practice is boldest and most interesting in From Chance to Choice: Genetics and Justice, p. 371; and 22–23, 308–9.

In Justice and Justification: Reflective Equilibrium in Theory and Practice, Daniels discusses reflective equilibrium, especially wide reflective equilibrium, in the first part of the book-the “Theory” part-but not in the second. Chapters 1–8 in the first part all deal with the theory of reflective equilibrium. In the second part (chapters 9–16)–the “Practice” part-reflective equilibrium is mentioned only in the title of chapter 16, and never developed. In chapter 9, the first of the practice chapters, Daniels points to some general implications of his account, but also notes-appropriately-“the many difficulties that face drawing implications from ideal theory for nonideal settings” (199). As I read Daniels, he is a persuasive spokesperson for the defense and extension of Rawls' theory of justice, but he does little to implement the method of reflective equilibrium or to show its implications for practical ethics.

Daniels N , From Chance to Choice: Genetics and Justice, supra note 12, 371.

The book Reflective Equilibrium, ed. van der Burg Webren van Willigenburg Theo (Dordrecht: Kluwer Academic Publishers, 1998), is comprised of nineteen essays on the subject. It supposedly discusses how the idea of reflective equilibrium offers a model for practical moral problems. While there is philosophical discussion of the practical implications of the model, I cannot find actual examples of the use of the method to address practical problems.

Gert B. , Morality: A New Justification of the Moral Rules. This theory is brought to bear on various problems in bioethics in Gert B. Culver C. M. Clouser K. D. , Bioethics: A Return to Fundamentals (New York: Oxford University Press, 1997).

MacIntyre A. , After Virtue, 2nd edn. (Notre Dame: University of Notre Dame Press, 1984), 17, 175, 187, 190–203. See also MacIntyre A. , “Does Applied Ethics Rest on A Mistake?” Monist 67 (1984), 498–513.

Brody H. Miller F. G. , “The Internal Morality of Medicine: Explication and Application to Managed Care,” Journal of Medicine and Philosophy 23 (1998), 384–410, especially 386.

Brody Miller , supra note 21, 393–97; italics added.

Brody Miller , supra note 21, 397.

Miller F. G. Brody H. , “Professional Integrity and Physician-Assisted Death,” Hastings Center Report (1995), 8–17, especially 12–16.

Brody Miller , supra note 21, 393–94, 397; italics added.

Moreno J. , “Ethics by Committee: The Moral Authority of Consensus,” The Journal of Medicine and Philosophy 13 (1988), p. 413.

Dennett D. , “Conditions of Personhood,” in The Identities of Persons , ed. Rorty A. O. (Berkeley: University of California Press, 1976), 175–96; Feinberg J. Baum Levenbook B. , “Abortion,” in Matters of Life and Death: New Introductory Essays in Moral Philosophy , 3d edn., ed. Regan T. (New York: Random House, 1993); Warren M. A. , “Abortion,” in Singer Peter , ed. A Companion to Ethics (Cambridge, MA: Blackwell Reference, 1991); 303–14; Warren M.A. , Moral Status: Obligations to Persons and Other Living Things (New York: Oxford University Press, 1997); Kennedy Institute of Ethics Journal 9 (December 1999), Special Issue on Persons, ed. Becker Gerhold K.

Dworkin G. , The Theory and Practice of Autonomy (New York: Cambridge University Press, 1988). The most interesting book in bioethics on autonomy, in my judgment, is O'Neill O. , Autonomy and Trust in Bioethics (Cambridge University Press, 2002); however, this book does not present a theory or conceptual analysis of autonomy.

Dworkin , supra note 28, 20.

No such work has as yet been put forward in bioethics, but some beginnings are available in ethical theory. See Frankfurt H. G. , “Freedom of the Will and the Concept of a Person,” Journal of Philosophy 68 (1971): 5–20, as reprinted in The Importance of What We Care About (Cambridge: Cambridge University Press, 1988): 11–25; and Christman J. , “Autonomy and Personal History,” Canadian Journal of Philosophy 21 (1991): 1–24, esp. 10ff. Christman's account is a nuanced version of the theory of nonrepudiated acceptance (using the language of nonresistance). Although it is far from clear that Frankfurt has a theory of autonomy, see his uses of the language of “autonomy” in his Necessity, Volition, and Love (Cambridge: Cambridge University Press, 1999), chaps. 9, 11. Frankfurt's early work was on persons and freedom of the will. In his later work, he seems to regard the earlier work as providing an account of autonomy, which is a reasonable estimate even if it involves some creative reconstruction.

The articles closest to this ideal are: Bernat J. L. Gert B. Mogielnicki R. P. , “Patient Refusal of Hydration and Nutrition: An Alternative to Physician-Assisted Suicide or Voluntary Active Euthanasia,” Archives of Internal Medicine 153 (December 27, 1993): 2723–28; Brock D. W. , Life and Death: Philosophical Essays in Biomedical Ethics (New York: Cambridge University Press, 1993); Beauchamp T. L. , “The Justification of Physician-Assisted Suicide,” Indiana Law Review 29 (1996): 1173–1200; and McMahan J. , “Killing, Letting Die, and Withdrawing Aid,” Ethics 103 (1993): 250–279.