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Ethics and Society: A Philosophical Disease: Bioethics, Culture, and Identity

Ethics and Society: A Philosophical Disease: Bioethics, Culture, and Identity What remains to be said about ethical problems in medicine, asks Carl Elliott, if we dispense with moral theory? The answer, it turns out, is a great deal. Some of the most vexing ethical problems in medicine today are explored in this book, including the limits of drug treatment for depression, surgery for newborns with ambiguous genitalia, culpability of those with personality disorders, and depression and the capacity to consent to research. In his rich exploration of these topics, Elliott draws upon a broad range of sources: Wittgenstein's philosophy, Walker Percy's novels, Ross McElwee's films, and even the lyrics of Talking Heads. The author casts a broad net but purposefully so. Morality does not derive from theory; rather, it is inextricably intertwined with the daily life that each of us leads: [E]thics does not stand apart. It is one thread in the fabric of a society, and it is intertwined with others. Ethical concepts are tied to a society's customs, manners, traditions, institutions—all of the concepts that structure and inform the ways that a member of that society deals with the world. Thus, Elliott's use of moral sources complements and underscores his view of the complex origins of ethics in a "form of life." The predominant moral theory in bioethics—some say it isn't a theory at all—is principlism. It holds that moral problems in medicine are illuminated by appeal to one or more of four core principles: autonomy, beneficence, nonmaleficence, and justice. While this view of ethics has become familiar in clinical practice, the real action in bioethics in recent years has been "at the margins." Principlism's critics have offered up a number of constructive alternatives. Casuistry holds that moral decisions are made analogically, by appeal to paradigmatic cases. Virtue theory focuses on the characteristics of the moral agent herself, as well as the goodness of the actions performed. Feminism illuminates the systematic oppression of groups by hierarchical social structures. But how, Elliott asks, do we choose the right moral theory? Choosing among theories requires a set of criteria by which one would make the choice. Such criteria, though, either presuppose a metatheory of ethics or do not exist. Equally problematic is the gulf between theory and intuition. The purpose of a moral theory is to guide action, even if our intuition is to act differently. At times, though, a particular moral theory may suggest a repugnant course of action, for example, giving a last scrap of food to a pet rather than a newborn child; here, intuition plays an important role in leading us to reject the theory. However, when does theory count against intuition and vice versa? Elliott rightly observes: Our problem is understanding this practical check on ethical theory. For clearly, if we do in fact have moral disagreement on a given problem, then any theory that does its job will be counter-intuitive for someone by yielding a judgment that runs squarely against that person's sincerely held moral beliefs. Despite the title of the book's last chapter, "A General Antitheory of Bioethics," Elliott's stance is not purely antitheoretical. He acknowledges the usefulness of moral theory in deliberations about ethical problems. A theoretical approach, such as principlism, does allow us to simplify a complex case into more manageable bits, eg, "this case involves a conflict between autonomy and beneficence." This may provide a very useful summary of one's intuitions toward the case. Bioethicists, in their more honest moments at least, will admit that theory offers a powerful rhetorical device when trying to convince others of the right course of action. Thus, Elliott, rather than rejecting theory altogether, urges us to recognize the limits of theory; cautioning that "we go wrong . . . when we begin to expect more from a moral theory than it can provide." It sounds good to say one is a "bioethical antitheorist," but I wonder how sustainable is this stance. For instance, what is the difference between being an antitheorist, at least in the sense articulated above, and moral eclecticism? Rather little, it seems to me. On a deeper level, an antitheoretical stance places a great deal of weight on the distinction between explanation and description—perhaps inevitably more weight than the distinction can bear. Elliott does say a great deal in general about the origins of morality. At some point, a rich description inevitably becomes a vague theory. I suspect, though, that Elliott recognizes this point, for what is a "general antitheory" if not, paradoxically enough, a type of moral theory? This book is one of the finest—and freshest—works of bioethics criticism I have had the pleasure to read. It will challenge philosophers of medicine and reflective clinicians alike. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Ethics and Society: A Philosophical Disease: Bioethics, Culture, and Identity

JAMA , Volume 283 (18) – May 10, 2000
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Publisher
American Medical Association
Copyright
Copyright © 2000 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.283.18.2452-JBK0510-2-1
Publisher site
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Abstract

What remains to be said about ethical problems in medicine, asks Carl Elliott, if we dispense with moral theory? The answer, it turns out, is a great deal. Some of the most vexing ethical problems in medicine today are explored in this book, including the limits of drug treatment for depression, surgery for newborns with ambiguous genitalia, culpability of those with personality disorders, and depression and the capacity to consent to research. In his rich exploration of these topics, Elliott draws upon a broad range of sources: Wittgenstein's philosophy, Walker Percy's novels, Ross McElwee's films, and even the lyrics of Talking Heads. The author casts a broad net but purposefully so. Morality does not derive from theory; rather, it is inextricably intertwined with the daily life that each of us leads: [E]thics does not stand apart. It is one thread in the fabric of a society, and it is intertwined with others. Ethical concepts are tied to a society's customs, manners, traditions, institutions—all of the concepts that structure and inform the ways that a member of that society deals with the world. Thus, Elliott's use of moral sources complements and underscores his view of the complex origins of ethics in a "form of life." The predominant moral theory in bioethics—some say it isn't a theory at all—is principlism. It holds that moral problems in medicine are illuminated by appeal to one or more of four core principles: autonomy, beneficence, nonmaleficence, and justice. While this view of ethics has become familiar in clinical practice, the real action in bioethics in recent years has been "at the margins." Principlism's critics have offered up a number of constructive alternatives. Casuistry holds that moral decisions are made analogically, by appeal to paradigmatic cases. Virtue theory focuses on the characteristics of the moral agent herself, as well as the goodness of the actions performed. Feminism illuminates the systematic oppression of groups by hierarchical social structures. But how, Elliott asks, do we choose the right moral theory? Choosing among theories requires a set of criteria by which one would make the choice. Such criteria, though, either presuppose a metatheory of ethics or do not exist. Equally problematic is the gulf between theory and intuition. The purpose of a moral theory is to guide action, even if our intuition is to act differently. At times, though, a particular moral theory may suggest a repugnant course of action, for example, giving a last scrap of food to a pet rather than a newborn child; here, intuition plays an important role in leading us to reject the theory. However, when does theory count against intuition and vice versa? Elliott rightly observes: Our problem is understanding this practical check on ethical theory. For clearly, if we do in fact have moral disagreement on a given problem, then any theory that does its job will be counter-intuitive for someone by yielding a judgment that runs squarely against that person's sincerely held moral beliefs. Despite the title of the book's last chapter, "A General Antitheory of Bioethics," Elliott's stance is not purely antitheoretical. He acknowledges the usefulness of moral theory in deliberations about ethical problems. A theoretical approach, such as principlism, does allow us to simplify a complex case into more manageable bits, eg, "this case involves a conflict between autonomy and beneficence." This may provide a very useful summary of one's intuitions toward the case. Bioethicists, in their more honest moments at least, will admit that theory offers a powerful rhetorical device when trying to convince others of the right course of action. Thus, Elliott, rather than rejecting theory altogether, urges us to recognize the limits of theory; cautioning that "we go wrong . . . when we begin to expect more from a moral theory than it can provide." It sounds good to say one is a "bioethical antitheorist," but I wonder how sustainable is this stance. For instance, what is the difference between being an antitheorist, at least in the sense articulated above, and moral eclecticism? Rather little, it seems to me. On a deeper level, an antitheoretical stance places a great deal of weight on the distinction between explanation and description—perhaps inevitably more weight than the distinction can bear. Elliott does say a great deal in general about the origins of morality. At some point, a rich description inevitably becomes a vague theory. I suspect, though, that Elliott recognizes this point, for what is a "general antitheory" if not, paradoxically enough, a type of moral theory? This book is one of the finest—and freshest—works of bioethics criticism I have had the pleasure to read. It will challenge philosophers of medicine and reflective clinicians alike.

Journal

JAMA – American Medical Association

Published: May 10, 2000

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