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Psychiatry's contribution to medical ethics education.

Two recent trends in medical education, the growth of interest in biomedical ethics and the examination of psychiatry's status in medicine, have important implications for psychiatry. Educators are needed to bring a clinical perspective to bear on ethics instruction, yet psychiatrists risk missing this opportunity. Psychiatrists are uniquely suited to contribute because of their expertise in three areas: an understanding of the affective, nonrational components in ethical thought and behavior, a developmental perspective regarding personal morality, and an appreciation of the rootedness of ethics in the social ethos. Problems with contemporary ethical models of informed consent illustrate the value of psychiatry's contribution.

Affect↗

A model for ethical problem solving in medicine, with practical applications.

Despite the dramatic increase over recent years in the research and teaching of medical ethics, there exists no theoretical framework within which to conceptualize ethical problems in medicine, to say nothing of solutions to these problems. The model proposed here attempts to fill this void by developing a conceptual understanding of the nature of moral dilemmas that can be applied to both theoretical and practical problems in medicine. Practical applications are demonstrated in three areas: personal ethical problem solving, hospital ethics committees, and the teaching of medical ethics. Suggestions are offered for the extension of these and other applications of the model, a model proposed as a foundation to be built upon through further research and daily experiences in a world of conflicting values.

Bioethical Issues↗

Why a feminist approach to bioethics?

Many have asked how and why feminist theory makes a distinctive contribution to bioethics. In this essay, I outline two ways in which feminist reflection can enrich bioethical studies. First, feminist theory may expose certain themes of androcentric reasoning that can affect, in sometimes crude but often subtle ways, the substantive analysis of topics in bioethics; second, it can unearth the gendered nature of certain basic philosohical concepts that form the working tools of ethical theory.

Clinical Trials as Topic↗

Underdetermination and incommensurability in contemporary epidemiology.

In the shadowy world between philosophy of science and ethics lie the paired concepts of underdetermination and incommensurability. Typically, scientific evidence underdetermines the hypotheses tested in research studies, providing neither proof nor disproof. As a result, scientists must judge the weight of the evidence, and in doing so, bring scientific and extrascientific values to bear in their approaches to assessing and interpreting the evidence. When different scientists employ very different values, their views are said to be incommensurable. Less prominent differences represent partial incommensurabilities. The definitions and analyses provided by McMullin and by Veatch and Stempsey lay the foundation for the description of partial incommensurabilities in the current practice of assessing and interpreting epidemiologic evidence. This practice is called "causal inference" and is undertaken for the purpose of making causal conclusions and public health recommendations from population-based studies of exposures and diseases. Following the work of Bayley and Longino, several suggestions are examined for dealing with the partial incommensurabilities found in the general practice of causal inference in contemporary epidemiology. Two specific examples illustrate these ideas: studies on the relationship between induced abortion and breast cancer and those on the relationship between moderate alcohol consumption and breast cancer.

Abortion, Induced↗

The failure of theories of personhood.

The belief persists in philosophy, religion, science, and popular culture that some special cognitive property of persons like self-consciousness confers a unique moral standing. However, no set of cognitive properties confers moral standing, and metaphysical personhood is not sufficient for either moral personhood or moral standing. Cognitive theories all fail to capture the depth of commitments embedded in using the language of "person." It is more assumed than demonstrated in these theories that nonhuman animals lack a relevant form of self-consciousness or its functional equivalent. Although nonhuman animals are not plausible candidates for moral personhood, humans too fail to qualify as moral persons if they lack one or more of the conditions of moral personhood. If moral personhood were the sole basis of moral rights, then these humans would lack rights -- and precisely for the reasons that nonhuman animals would.

Animal Rights↗

The crisis of medicine: philosophy and the social construction of medicine.

During the past decade there has been a debate about the field of philosophy of medicine. The debate has focused on fundamental questions about whether the field exists and the nature of the field. This article explores the debate and argues that it has paid insufficient attention to the social dimensions of both philosophy and medicine. The article goes on to argue that by exploring this debate one can better understand some of the difficult questions facing contemporary medicine and health care.

Bioethical Issues↗

Consistency, common morality, and reflective equilibrium.

Biomedical ethicists often assume that common morality constitutes a largely consistent normative system. This premise is not taken for granted in general normative ethics. This paper entertains the possibility of inconsistency within common morality and explores methodological implications. Assuming common morality to be inconsistent casts new light on the debate between principlists and descriptivists. One can view the two approaches as complementary attempts to evade or transcend that inconsistency. If common morality proves to be inconsistent, then principlists might have reason to prefer a less pluralist theory, thereby moving closer to descriptivism. Descriptivists, by contrast, might want to qualify their claim to accommodate all of people's basic moral convictions. Finally, both camps might wish to adopt a more revisionist posture, accepting that an adequate ethical theory occasionally will contradict some of people's deepest moral convictions. Proper application of the method of reflective equilibrium, to which both descriptivists and principlists claim allegiance, may entail greater openness to revisionism than either camp admits.

Bioethics↗

A defense of the common morality.

Phenomena of moral conflict and disagreement have led writers in ethics to two antithetical conclusions: Either valid moral distinctions hold universally or they hold relative to a particular and contingent moral framework, and so cannot be applied with universal validly. Responding to three articles in this issue of the Journal that criticize his previously published views on the common morality, the author maintains that one can consistently deny universality to some justified moral norms and claim universality for others. Universality is located on the common morality and nonuniversality in other parts of the moral life, called "particular moralities." The existence of universal moral standards is defended in terms of: (1) a theory of the objectives of morality, (2) an account of the norms that achieve those objectives, and (3) an account of normative justification (both pragmatic and coherentist).

Bioethics↗

Common morality, coherence, and the principles of biomedical ethics.

The fifth edition of Beauchamp and Childress's Principles of Biomedical Ethics is distinguished by its emphatic embrace of common morality as the ultimate source of moral norms. This essay critically evaluates the fifth edition's discussion of common morality and, to a lesser extent, its treatment of coherence (both the model of ethical justification and the associated concept). It is argued that the book is overly accommodating of existing moral beliefs. The paper concludes with three suggestions for improving this leading text.

Beneficence↗

Zones of consensus and zones of conflict: questioning the "common morality" presumption in bioethics.

Many bioethicists assume that morality is in a state of wide reflective equilibrium. According to this model of moral deliberation, public policymaking can build upon a core common morality that is pretheoretical and provides a basis for practical reasoning. Proponents of the common morality approach to moral deliberation make three assumptions that deserve to be viewed with skepticism. First, they commonly assume that there is a universal, transhistorical common morality that can serve as a normative baseline for judging various actions and practices. Second, advocates of the common morality approach assume that the common morality is in a state of relatively stable, ordered, wide reflective equilibrium. Third, casuists, principlists, and other proponents of common morality approaches assume that the common morality can serve as a basis for the specification of particular policies and practical recommendations. These three claims fail to recognize the plural moral traditions that are found in multicultural, multiethnic, multifaith societies such as the United States and Canada. A more realistic recognition of multiple moral traditions in pluralist societies would be considerable more skeptical about the contributions that common morality approaches in bioethics can make to resolving contentious moral issues.

Bioethics↗