Bioethics became applied ethics when it was assimilated to moral philosophy. Because deduction is the rationality of moral philosophy, subsuming facts under moral principles to deduce conclusions about what ought to be done became the prescribed reasoning of bioethics, and bioethics became a theory comprised of moral principles. Bioethicists now realize that applied ethics is too abstract and spare to apprehend the specificity, particularity, complexity and contingency of real moral issues. Empirical ethics and contextual ethics are needed to incorporate these (...) features into morality, not just bioethics. The relevant facts and features of problems have to be identified, investigated and framed coherently, and potential resolutions have to be constructed and assessed. Moreover, these tasks are pursued and melded within manifold contexts, for example, families, work and health care systems, as well as societal, economic, legal and political backgrounds and encompassing worldviews. This naturalist orientation and both empirical ethics and contextual ethics require judgment, but how can judgment be rational? Rationality, fortunately, is more expansive than deductive reasoning. Judgment is rational when it emanates from a rational process of deliberation, and a process of deliberation is rational when it uses the resources of non-formal reason: observation, creative construction, formal and informal reasoning methods and systematic critical assessment. Empirical ethics and contextual ethics recognize that finite, fallible human beings live in complex, dynamic, contingent worlds, and they foster creative, critical deliberation and employ non-formal reason to make rational moral judgments. (shrink)

Analytic moral philosophy's strong divide between empirical and normative restricts facts to providing information for the application of norms and does not allow them to confront or challenge norms. So any genuine attempt to incorporate experience and empirical research into bioethics – to give the empirical more than the status of mere 'descriptive ethics'– must make a sharp break with the kind of analytic moral philosophy that has dominated contemporary bioethics. Examples from bioethics and science are used to illustrate the (...) problems with the method of application that philosophically prevails in both domains and with the conception of rationality that underlies this method. Cues from how these problems can be handled in science then introduce summaries of richer, more productive naturalist and constructivist accounts of reason and normative knowledge. Liberated by a naturalist approach to ethics and an enlarged conception of rationality, empirical work can be recognized not just as essential to bioethics but also as contributing to normative knowledge. (shrink)

Vulnerability does not mean much for our contemporary morality. It is antithetical to our emphasis on individualism and rationality; it requires that we attend to the body and to our feelings. Yet only by recognizing the depth and breadth of our vulnerability can we affirm our humanity.

Compromise is a pervasive fact of life. It occurs when obligations conflict and repudiating one obligation entirely to satisfy another entirely is unacceptable—for example, when a single parent cannot both raise a child satisfactorily and earn the income that living together demands. Compromise is unsettling, but properly negotiating difficult circumstances develops moral and emotional maturity. Yet compromise has no place in moral philosophy, where it is logically anathematized and deemed to violate integrity. This paper defends compromise with more expansive accounts (...) of reason and integrity that comport with our finite moral agency and infuse our moral lives. (shrink)

Applied ethics is at a watershed. In all its domains a gulf between the theory of applied ethics and the practice of applied ethics is now being recognized. In medical ethics, for example, it has been observed that “practicing clinicians often feel let down by bioethics.” The disappointment of clinicians is attributed in part to their own unrealistic expectations but is also said to be a function ofthe extent to which bioethics as a discipline doesn't seem to be in possession (...) of the realities of practice. Bioethicists tend to leave the “facts” of clinical medicine to the doctors; their task is then to apply elegant and compelling arguments drawn from first principles of ethics … to these undisputed and indisputable facts. Unfortunately, when the relationship between clinical medicine and bioethics is conceived … [in this way], the result is a very sterile discourse. (shrink)

The third edition of Health Care Ethics in Canada builds on the commitment to Canadian content established in earlier editions without sacrificing breadth or rigor.

Vulnerability does not mean much for our contemporary morality. It is antithetical to our emphasis on individualism and rationality; it requires that we attend to the body and to our feelings. Yet only by recognizing the depth and breadth of our vulnerability can we affirm our humanity.

Theoretical accounts of the nature and purposes of clinical ethics consultation are disappointingly superficial and diffuse. Attempts to illuminate the goals, the forms, the substance, and the criteria for the success of ethics consultations need to focus on detailed reports of cases and the contexts in which they occur. The uncommonly rich description of the consultation surrounding Mrs. Roses plight provides a splendid opportunity to explore such matters. The ethics consultant pursues a number of ventures providing and clarifying information, improving (...) communication, educating and counseling, and being a friend with variable degrees of success. What the ethics consultant can do and how well he can do it are in large part constrained by three features of the hospital context in which this consultation unfolds: pervasive, perhaps ineliminable, uncertainty; communication failures; and firmly entrenched power. A fundamental issue for an ethics consultant is whether structural and institutional constraints should be accepted or challenged. Should an ethics consultant be a peacemaker or a reformer? (shrink)

A commentary on a special report, titled Narrative Ethics: The Role of Stories in Bioethics, that appeared with the January‐February 2014 issue.

The branch of clinical medicine most likely to qualify as a social science is family medicine. Whether family medicine is a social science is addressed in four steps. First, the nature of family medicine is outlined. Second, the extent to which social science knowledge is used in family practice is discussed. Third, the extent to which family medicine can qualify as a social science is considered with respect to an orthodox model of the social sciences, that is, one that emphasizes (...) affinities between the natural and social sciences. Finally, the same question is addressed with respect to an unorthodox model of the social sciences, that is, one that stresses the evaluative nature of the social sciences. CiteULike Connotea Del.icio.us What's this? (shrink)

The notion that the family is the unit of care for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine (...) — treating the patient in the family and treating the family in the patient — and defend both as appropriate foci for care by family doctors. The practical problem that arises when the family is introduced into health care is deciding when to concentrate on the family system. The moral problems that arise concern how extensively doctors may become involved in the personal lives of their patients and families. The patient-centered clinical method provides a strategy for handling both problems. Thus, making the family a focus of care in family medicine can be justified on theoretical, practical, and moral grounds. (shrink)

The ethical theories employed in health care today assume, in the main, a modern Western philosophical framework. Yet the diversity of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggest that a cross-cultural study of health care ethics is needed. A Cross-Cultural Dialogue on Health Care Ethics provides this study. It shows that ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each (...) value, and identifying common values found within all traditions, It encourages the development of global awareness and sensitivity to and respect for the diversity of peoples and their values and will advance understanding as well as help to foster a greater balance and a fuller truth in consideration of the human condition and what makes for health and wholeness. (shrink)

Read together, historian Alexandra Minna Stern's Telling Genes: The Story of Genetic Counseling in America and bioethicist Michael Parker's Ethical Problems and Genetics Practice convey a rich understanding of genetic practices and their implicit moralities. The books are methodologically similar in that both authors examine genetics practices empirically, and the resulting perspectives are complementary, Stern's from outside genetics practices and Parker's from inside.

There is more rationality in our lives than there is in our philosophy. There is more morality in our lives than there is in our philosophy. Those claims undoubtedly are startling, perhaps even incomprehensible, given that the Western philosophical tradition from Plato on is devoted to rationality, in morality and everywhere else. The narrowly circumscribed account of rationality in that philosophical tradition—formal reason—is, however, the source of both claims. The formal reason of philosophy is rule-governed reasoning, the kind of inferential (...) reasoning used in logic and mathematics. This view percolates through ordinary understandings of rationality as well, exemplified by the familiar use of the expression .. (shrink)

The main aim of this paper is to clarify the dispute over judicial discretion by distinguishing the different senses in which claims about judicial discretion can be understood and by examining the arguments for these various interpretations. Three different levels of dispute need to be recognized. The first concerns whether judges actually do exercise discretion, the second involves whether judges are entitled to exercise discretion, and the third is about the proper institutional role of judges. In this context, the views (...) of Dworkin, Raz, Perry, Greenawalt, and Sartorius are examined. Finally, it is suggested that a resolution of the judicial discretion controversy requires a satisfactory theory of the justification of judicial decisions. (shrink)