Abstract
Moral decision procedures such as principlism or casuistry require intuition at certain junctures, as when a principle seems indeterminate, or principles conflict, or we wonder which paradigm case is most relevantly similar to the instant case. However, intuitions are widely thought to lack epistemic justification, and many ethicists urge that such decision procedures dispense with intuition in favor of forms of reasoning that provide discursive justification. I argue that discursive justification does not eliminate or minimize the need for intuition, or constrain our intuitions. However, this is not a problem, for intuitions can be justified in easy or obvious cases, and decision procedures should be understood as heuristic devices for reaching judgments about harder cases that approximate the justified intuitions we would have about cases under ideal conditions, where hard cases become easy. Similarly, the forms of reasoning which provide discursive justification help decision procedures perform this heuristic function not by avoiding intuition, but by making such heuristics more accurate. Nonetheless, it is possible to demand too much justification; many clinical ethicists lack the time and philosophical training to reach the more elaborate levels of discursive justification. We should keep moral decision procedures simple and user-friendly so that they will provide what justification can be achieved under clinical conditions, rather than trying to maximize our epistemic justification out of an overstated concern about intuition.
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References
Aristotle. Nicomachean Ethics. Translated by Terence Irwin. 2d ed. Indianapolis: Hackett Publishing Company, 1999.
Audi R. (2004) The Good in the Right. Princeton: Princeton University Press.
Beauchamp T. L. (2000) Reply to Strong on Principlism and Casuistry. The Journal of Medicine and Philosophy 25: 342–347.
Beauchamp T. L., James F. C. (2001) Principles of Biomedical Ethics. 5th ed. Oxford: Oxford University Press.
BonJour L. (1998) In Defense of Pure Reason. Cambridge: Cambridge University Press.
DeGrazia D. (1992) Moving Forward in Bioethical Theory: Theories, Cases, and Specified Principlism. The Journal of Medicine and Philosophy 17: 511–539.
Dworkin G. (2006) Theory, Practice, and Moral Reasoning. In: David C. (eds) The Oxford Handbook of Ethical Theory. (pp 624–644). Oxford: Oxford University Press.
Gert B., Charles M. C., Danner C. K. (2006) Bioethics: A Systematic Approach. 2d. ed. Oxford: Oxford University Press.
Graber G. C., Thomasma D. T. (1989) Theory and Practice in Medical Ethics. New York: The Continuum Publishing Company.
Jonsen A. R. (1995) Casuistry: An Alternative or Complement to Principles? Kennedy Institute of Ethics Journal 5(3): 237–251.
Jonsen A. R., Mark S., Winslade J. W. (2002) Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. 5th ed. New York: McGraw Hill Companies, Inc.
Kaebnick G. (2000) On the Intersection of Casuistry and Particularism. Kennedy Institute of Ethics Journal 10(4): 307–322.
London A. J. (2001) Editor’s Introduction: Theory and Engagement in Bioethics. Theoretical Medicine and Bioethics 22: 65–68.
London A. J. (2001) The Independence of Practical Ethics. Theoretical Medicine and Bioethics 22: 87–105.
Mill J. S. “Utilitarianism” In Ethics: History, Theory, and Contemporary Issues. Edited by S. M. Cahn and P. Markie. 317–351. Oxford: Oxford University Press, 2006
Quante M., Andreas V. (2002) Defending Principlism Well Understood. The Journal of Medicine and Philosophy 27: 621–649.
Rawls J. (1999) Outline of a Decision Procedure for Ethics. In: Samuel F. (eds) Collected Papers. (pp. 1–19). Cambridge: Harvard University Press.
Rawls J. (1971) A Theory of Justice. Cambridge: Harvard University Press.
Richardson H. S. (1997) Practical Reasoning About Final Ends. Cambridge: Cambridge University Press.
Richardson H. S. (2000) Specifying, Balancing, and Interpreting Bioethical Principles. The Journal of Medicine and Philosophy 25(3): 285–307.
Richardson, H. S. Specifying Norms as a Way to Resolve Concrete Ethical Problems. Philosophy and Public Affairs, 19 (Fall, 1990): 279–310.
Ross, W. D. (1988) The Right and the Good. Oxford: Oxford University Press, 1930. Reprint, Indianapolis: Hackett Publishing Company.
Rudnick A. (2001) A Meta-Ethical Critique of Care Ethics. Theoretical Medicine and Bioethics 22: 505–517.
Strong C. (1999) Critiques of Casuistry and Why They are Mistaken. Theoretical Medicine and Bioethics 20: 395–411.
Strong C. (2000) Specified Principlism: What is it, and Does it Really Resolve Cases Better than Casuistry? The Journal of Medicine and Philosophy 25: 323–341.
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I wish to thank Peter Murphy for helpful conversations on several issues raised in this paper.
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Davis, J.K. Intuition and The Junctures of Judgment in Decision Procedures for Clinical Ethics. Theor Med Bioeth 28, 1–30 (2007). https://doi.org/10.1007/s11017-007-9027-z
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DOI: https://doi.org/10.1007/s11017-007-9027-z