This article begins with some preliminary remarks about the general features and basic varieties of reflective equilibrium in moral reflection. It then considers a couple of preliminary doubts about this method. One of these doubts claims that the most plausible interpretation of RE is so comprehensive that it risks paralyzing our thinking, while the other claims that this same version of RE is insufficiently determinate in practical contexts and will thus fail to be sufficiently action-guiding. The article then explicates the (...) sense in which RE qualifies as a coherence theory of justification, and considers several objections to RE that flow from its reliance on the putative connection between coherence and moral justification. (shrink)

Book reviewed in this article: The Abuse of Casuistry: A History of Moral Reasoning. By Albert R. Jonsen and Stephen Toulmin.

Principlism : the Borg of bioethics -- A common morality for hedgehogs : Bernard Gert -- Getting down to cases : the revival of casuistry in bioethics -- Nice story but so what : narrative and justification in ethics -- Dewey and Rorty's pragmatism and bioethics -- Freestanding pragmatism in bioethics and law -- A method in search of a purpose : the internal morality of medicine -- Method to rule them all? Reflective equilibrium in bioethics -- Concluding reflections : (...) method in bioethics : the very idea. (shrink)

This volume brings together original essays by many of the best and most prominent figures in the emerging field of biomedical ethics and presents them in a dialogue that significantly updates their earlier work. Focusing on the moral dilemmas that recent medical advances have created at both ends of the life course, the contributors discuss such issues as patient autonomy, hospital policies of risk-management, new developments in the abortion debate, genetic counseling and perinatal care, euthanasia and physician-assisted suicide, testing and (...) treatment policies for HIV infection, and fairness in allocating health care and donated organs. (shrink)

I begin this commentary with an expanded typology of theories that endorse an internal morality of medicine. I then subject these theories to a philosophical critique. I argue that the more robust claims for an internal morality fail to establish a stand-alone method for bioethics because they ignore crucial non-medical values, violate norms of justice and fail to establish the normativity of medical values. I then argue that weaker versions of internalism avoid such problems, but at the cost of failing (...) to provide a clear sense in which their moral norms are internal or can ground a comprehensive approach to moral problems. Finally, I explore various functions that an internal morality might serve, concluding with the observation that, while there may be a core of good sense to the notion of an internal morality of medicine, our expectations for it must be drastically lowered. (shrink)

There are many good reasons for a merger between bioethics and human rights. First, though, significant philosophical groundwork must be done to clarify what a human right to health would be and—if we accept that it exists—exactly how it might influence the practical decisions we face about who gets what in very different contexts.

This paper represents the first installment of alarger project devoted to the relevance of pragmatism forbioethics. One self-consciously pragmatist move would be toreturn to the classical pragmatist canon of Peirce, James andDewey in search of substantive doctrines or methodologicalapproaches that might be applied to current bioethicalcontroversies. Another pragmatist (or neopragmatist) move wouldbe to subject the regnant principlist paradigm to Richard Rorty'ssubversive assaults on foundationalism in epistemology andethics. A third pragmatist method, dubbed ``freestandingpragmatism'' by its proponents, embraces a ``pragmatist'' approachto practical (...) reasoning without discernable moorings either to theclassical canon or to Rorty's neopragmatism. This thirdpragmatist approach to method in practical ethics is the subjectof this article. I begin with an examination of freestandingpragmatism in the theory of judicial decision making. I arguethat this version of legal pragmatism – so described on account ofits commitments to contextualism, instrumentalism, eclecticism,and freedom from grand theory – bears a striking resemblance tomuch self-described pragmatist work in bioethics today. Ifurther argue that if this is what we mean by ``pragmatism,'' thenin a certain sense ``we are all pragmatists now.''. (shrink)

In this commentary, I critically discuss the respective views of Gert and Beauchamp–Childress on the nature of so-called common morality and its promise for enriching ethical reflection within the field of bioethics. Although I endorse Beauchamp and Childress’ shift from an emphasis on ethical theory as the source of moral norms to an emphasis on common morality, I question whether rouging up common morality to make it look like some sort of ultimate and universal foundation for morality, untouched by the (...) dialectics of time and reflective equilibrium, was an equally good move. As for Gert’s magisterial conception of common morality, I conclude that certain elements of his system are controversial at best and woefully inadequate at worst. He has a tendency to find in common morality what he himself put there, and his highly restricted conception of duties of assistance strikes this reader as ad hoc, inadequately defended, and unworthy of a project whose goal is to lessen the amount of misery in the world. (shrink)

A textbook for undergraduates. Some 70 selections (more than half are new to this edition) follow an introductory essay. Current controversies (surrogacy, genetic engineering, proxy consent) are thoroughly covered. Annotation copyrighted by Book News, Inc., Portland, OR.

Participants in AIDS research may justify noncompliance with protocols by a “coercion defense.” While this defense may not be philosophically successful, a prudent social policy can enhance compliance by encouraging community participation and providing greater access to non‐validated therapies.

It has often been remarked that bioethics is a quintessentially American phenomenon. Broadly speaking, bioethics as a field has tended to enshrine the value of autonomy, it places individual rights above communal well-being, and it has adopted a largely permissive and optimistic view of emerging biotechnologies. In contrast to much European thinking at the intersection of ethics and medicine, American-style bioethics has been resolutely middlebrow, eschewing grand philosophical schemes in favor of pragmatic policy-making and democratic consensus. It was, then, perhaps (...) only a matter of time before various theorists began proposing a marriage between bioethics and pragmatism, which is the homegrown American philosophy. (shrink)

Book reviewed in this article: The Abuse of Casuistry: A History of Moral Reasoning. By Albert R. Jonsen and Stephen Toulmin.

There are many good reasons for a merger between bioethics and human rights. First, though, significant philosophical groundwork must be done to clarify what a human right to health would be and—if we accept that it exists—exactly how it might influence the practical decisions we face about who gets what in very different contexts.

In spite of the routine acknowledgement of Richard Rorty's ubiquitous influence, those who have invoked his name en route to advancing their case for a pragmatist bioethics have not given us a very clear picture of exactly how Rorty's work might actually contribute to methodological discussion in this field. I try to provide such an account here. Given the impressive depth and scope of Rorty's work during the past two decades, I make no pretense of presenting either a comprehensive or (...) novel interpretation of his project. My primary aim here is simply to sketch what I take to be the implications of Rorty's neopragmatism for our methodological debates within bioethics. I conclude that the yield of Rorty's pragmatism for current methodological debates in bioethics is primarily negative, knocking the props out from under any pretensions to foundations and universal principles of right and wrong. His "professorial pragmatism" and philosophical trash disposal efforts would clearly sweep away some approaches based upon appeals to nature or universal human dignity, and his deflationary nominalist view of principles would threaten the foundations of some influential principlist approaches to bioethics. (shrink)

The Routledge Companion to Bioethics is a comprehensive reference guide to a wide range of contemporary concerns in bioethics. The volume orients the reader in a changing landscape shaped by globalization, health disparities, and rapidly advancing technologies. Bioethics has begun a turn toward a systematic concern with social justice, population health, and public policy. While also covering more traditional topics, this volume fully captures this recent shift and foreshadows the resulting developments in bioethics. It highlights emerging issues such as climate (...) change, transgender, and medical tourism, and re-examines enduring topics, such as autonomy, end-of-life care, and resource allocation. (shrink)

This chapter contains sections titled: Top‐down vs Bottom‐up Core Elements of Casuistical Analysis Advantages of a Casuistical Approach Objections and Replies Conclusion References Further reading.

This chapter contains sections titled: Reproductive Liberty Strong Libertarianism Reproductive Liberty in the Balance Conclusion.

The notion of virtue in general, and courage in particular, has had a hard time integrating itself into the everyday lexicon of bioethics. Following the lead of enlightenment moral philosophy, which concentrates on the theory of right action as opposed to the ancient Greeks' emphasis on the development of good character, bioethics, with some notable exceptions, has tended to relegate consideration of the virtues to the sidelines of moral argument. Recently, however, there have been calls for the necessity of “moral (...) courage” in the context of clinical ethics. As nurses, physicians, and other health care professionals confront a variety of moral contexts in which the virtue of courage is invoked to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions, they are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. For example, a nurse's hesitation to approach a physician to request increased sedation for an agitated patient out of fear of retaliation is represented in one article as a lack of courage.In this paper we offer a critical assessment of such invocations of courage. While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice. As we shall argue, a call to virtuousness is not always virtuous. (shrink)

The call has been made for global bioethics. In an age of pandemics, international drug trials, and genetic technology, health has gone global, and bioethics must follow suit. George Annas is one among a number of thinkers to recommend that bioethics expand beyond its traditional domain of patient–physician interactions to encompass a broader range of health-related matters. Medicine, Annas argues, must “develop a global language and a global strategy that can help to improve the health of all of the world's (...) citizens.” Individual countries cannot address global health issues, and culturally specific principles are inadequate for addressing global bioethics concerns. We will need a language and moral framework grounded in a foundation of universally shared, transcultural judgments about humankind that will also recognize moral pluralism. The claim has been made that such a foundation already exists in human rights, and that human rights should, therefore, be the new lingua franca of bioethics. (shrink)

It is clear from George Annas's response to our arguments that he has misunderstood and misrepresented our positions on several key points. We suspect that this may be due in part to significant differences between our respective agendas and points of view, so we begin this exchange with an exploration of these differences.

Book reviewed in this article: Rockefeller Medicine Men: Medicine and Capitalism in America. By E. Richard Brown.

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

After a detailed analysis of just what radical theology means, as a concept and in its relationship to traditional theology, this volume offers a selection of essays written for both academic and wider audiences which show aim at catching radical theology in action, in the church and in the culture at large.