for each question answer with 2 to 3 sentences max 1. What is the difference between ‘descriptive’ versus ‘normative’ claims? 2. What are the key features of moral claims or norms, according to Vaughn
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for each question answer with 2 to 3 sentences max
1. What is the difference between ‘descriptive’ versus ‘normative’ claims?
2. What are the key features of moral claims or norms, according to Vaughn? Do you agree?
3. What are the key ethical principles? Does this cover everything that matters, morally?
4. What do you think about ethical relativism?
5. What the are strengths and weaknesses of Utilitarianism and Kantian ethics?
for each question answer with 2 to 3 sentences max 1. What is the difference between ‘descriptive’ versus ‘normative’ claims? 2. What are the key features of moral claims or norms, according to Vaughn
34 CHAPTER 2 Bioethics and Moral Theories As we have seen, the moral life is dynamic, complex, and inescapable. In it we wrestle with momentous questions of moral value and moral rightness. We assert, challenge, accept, and reject moral statements. We make moral judgments about the rightness of actions, the goodness of persons or their character, and the moral quality and worth of our lives. Through general moral norms or principles, we direct our actions and inform our choices. We formulate and critique moral arguments, thereby testing what we know or think we know about moral realities. We do all this and one thing more: We naturally and unavoidably venture into the realm of moral theory, trying to see the larger moral meaning behind particular situations and precepts. In this chapter, we explore this realm and try to discern how it fits into the moral life in general and into bioethics in particular. the nature of moral theories In science, theories help us understand the em- pirical world by explaining the causes of events, why things are the way they are. The germ theory of disease explains how particular diseases arise and spread in a human population. The helio – centric (sun-centered) theory of planetary motion explains why the planets in our solar system behave the way they do. In ethics, moral theories have a similar explanatory role. A moral theory explains not why one event causes another but why an action is right or wrong or why a person or a person’s character is good or bad. A moral theory tells us what it is about an action that makes it right , or what it is about a person that makes him or her good . The divine command theory of morality, for example, says that right actions are those commanded or willed by God. Traditional utilitarianism says that right actions are those that produce the greatest happiness for all concerned. These and other moral theories are attempts to define rightness or goodness. In this way, they are both more general and more basic than moral principles or other general norms. Moral theorizing— that is, making, using, or assessing moral theories or parts of theories— is normal and pervasive in the moral life, though it is often done without much recognition that theory is playing a part in the deliberations. Whenever we try to understand what a moral property such as rightness or goodness means, or justify a moral principle or other norm, or re – solve a conflict between two credible principles, or explain why a particular action or practice is right or wrong, or evaluate the plausibility of specific moral intuitions or assumptions, we do moral theorizing. In fact, we must theorize if we are to make headway in such investigations. We must stand back from the situation at hand and try to grasp the larger pattern that only theory can reveal. Moral theories that concentrate on right and wrong actions are known as theories of obliga – tion (or duty) or simply as theories of right action. The divine command theory and utilitarianism are theories of right action. Philosophers often distinguish these from moral theories that focus on good and bad persons or character— so-called virtue-based theories . Virtue ethics (covered later in this chapter) is a prime example. How do moral theories fit into our everyday moral reasoning? In answering that, let’s focus on theories of right action, probably the most 02-Vaughn-Chap02.indd 34 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 35 There is also the testimony of the particular, the evidence of individual moral judgments. Our moral deliberations, then, involve both the general and the particular. Suppose we embrace a moral theory that seems to offer us a plausible explanation of what makes an action right or wrong. When we must decide which action is morally right in a particular situation, we look to our theory for general guidance. From our theory we may glean a set of moral principles that seem to apply to the case at hand. If the principles lead us to conflicting choices, we look again to the theory for insight in resolving the conflict. But we also must take into account our considered judgments about the case. (We may also formulate considered judgments about the relevant principles or rules.) If our considered judgments and the deliverances of our theory are consistent with one another, we have additional assurance that our decision in the case is correct. If our judgments clash with our theory or principles, we must decide which to revise or discard— for critical reasoning demands that our beliefs be coherent, that they do not harbor contradictions. If we believe our judgments to be more credible than the implications of our theory (or principles), we may modif y the theory accordingly (or, rarely, regard the theory as irrepa – rable and give it up). But if the theory seems more credible in this case, we may conclude that our judgment is untrustworthy and set it aside. So a moral theory can show us what is im – portant and reasonable in morality, guiding our judgments through overarching insights that may help us with specific cases and issues, some – times correcting erring judgments along the way. Our considered judgments are fallible indi – cators of moral common sense and are checks against way ward theory or f lawed principle. In bioethics, both of these moral resources are highly respected and widely used. influential moral theories Several moral theories have played major roles in bioethics, and they continue to influence how people think about bioethical issues. Theories of influential type in bioethics. First, moral theo – ries can figure directly in our moral arguments. As we saw earlier, moral arguments contain both moral and nonmoral premises. A moral premise can consist of a moral principle, a moral rule (a less general norm derived from or based on a principle), or a claim expressing a central tenet of a moral theory. Using such a tenet, someone might argue, for example, that stem- cell research should be fully funded rather than halted altogether because such a step would eventually lead to a greater benefit for more people, and right actions (according to utilitari – anism) are those that result in the greatest over – all benefit for the greatest number. Thus the fundamental moral standard of utilitarianism becomes a premise in an argument for a specific action in a particular case. Second, theories can have an indirect impact on moral arguments because principles ap – pealed to are often supported in turn by a moral theory. The principles can be either derived from or supported by the theory’s account of right and wrong action. Consider the prohibi – tion against murder, the basic precept that it is wrong to take the life of an innocent person. This principle can be drawn from theories built around the fundamental notion of respect for persons. As one such theory would have it, murder is wrong because it treats people not as persons with inherent worth but as mere things to be used or dispensed with as one wishes. Some people are tempted to deduce from all this that moral theories are the dominant force in moral reasoning as well as in the moral life. This view would be an oversimplification. By design, moral theories are certainly more gen – eral in scope than moral principles, rules, or judgments. But from this fact it does not follow that theories alone are the ultimate authority in moral deliberations. For one thing, to be truly useful, moral theories must be filled out with details about how to apply them in real life and the kinds of cases to which they are relevant. For another, there is more to morality than what can be captured in the general norms of a theory. 02-Vaughn-Chap02.indd 35 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 36 PART 1: PRINCIPLES AND THEORIES right action (in contrast to virtue-based theories) have dominated the field, each usually based on one of two broad views about the essential char – acter of right actions. Consequentialist moral theories insist that the rightness of actions depends solely on their consequences or results. The key question is what or how much good the actions produce, however good is defined. Deontological (or nonconsequentialist ) theories say that the rightness of actions is determined not solely by their consequences but partly or entirely by their intrinsic nature. For some or all actions, rightness depends on the kind of actions they are, not on how much good they produce. A consequentialist theory, then, may say that stealing is wrong because it causes more harm than good. But a deontological theory may con – tend that stealing is inherently wrong regardless of its consequences, good or bad. Utilitarianism The leading consequentialist theory is utilitari – anism , the view that right actions are those that result in the most beneficial balance of good over bad consequences for everyone involved. It says we should maximize the nonmoral good (t he utility ) of everyone affected, regardless of the contrary urgings of moral rules or unbending moral principles. Various forms of utilitarianism differ in how they define utility, with some equat – ing it with happiness or pleasure (the hedonistic view), others with satisfaction of preferences or desires or some other intrinsically valuable things or states such as knowledge or perfection. In applying the utilitarian moral standard (the greatest good, everyone considered), some moral philosophers concentrate on specific acts and some on rules covering kinds of acts. The former approach is called act-utilitarianism , the idea that the rightness of actions depends solely on the relative good produced by individual actions . An act is right if in a particular situation it pro – duces a greater balance of good over bad than any alternative acts; determining rightness is a matter of weighing the effects of each possible act. The latter approach, known as rule-utilitarianism , avoids judging rightness by specific acts and focuses instead on rules governing categories of acts . It says a right action is one that conforms to a rule that, if followed consistently, would create for everyone involved the most beneficial balance of good over bad. We are to adhere to the rules because they maximize the good for everyone considered— even though a given act may pro – duce bad effects in a particular situation. The classic version of utilitarianism was de – vised by English philosopher Jeremy Bentham (1748– 1832) and given more detail and plausibil – ity by another English philosopher, John Stuart Mill (1806– 1873). Classic utilitarianism is he – donistic in that the utility to be maximized is pleasure, broadly termed happiness, the only intrinsic good. A right action produces more net happiness (amounts of happiness minus unhap – piness) than any alternative action, everyone considered. As Mill put it, [Actions] are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. By “happiness” is intended pleasure, and the absence of pain; by “unhappiness,” pain and the privation of pleasure. 1 Bentham and Mill, however, had different ideas about what happiness entailed, as do many philosophers today. Bentham thinks that happi – ness is one-dimensional: It is pleasure, pure and simple, something that varies only in the amount that an agent can experience. On this scheme, it seems that the moral ideal would be to experi – ence maximum amounts of pleasure, as does the glutton or the debauchee. But Mill thinks that pleasures can vary in quality as well as quantity. For him, there are lower and higher pleasures— the lower and inferior ones indulged in by the glutton and his ilk and the higher and more satisfying ones found in such experiences as the search for knowledge and the appreciation of art and music. Mill famously sums up this contrast by saying, “It is better to be a human being dis – satisfied than a pig satisfied; better to be Socrates dissatisfied than a fool satisfied.” 2 02-Vaughn-Chap02.indd 36 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 37 cause enormous unhappiness— Johnny’s own physical agony, the unimaginable misery of the distraught parents, the anxiety of other family members and friends, and the distress and frus – tration of the physician and nurses who can do little more than stand by as Johnny withers away. On the other hand, administering the lethal injection would immediately end Johnny’s pain and prevent future suffering. The parents would grieve for Johnny but would at least find some relief— and perhaps peace— in knowing that his torture was over. The medical staff would prob – ably also be relieved for the same reason. There would, of course, also be possible negative con – sequences to take into account. In administer – ing the lethal injection, the physician would be risking both professional censure and criminal prosecution. If her actions were to become public, people might begin to mistrust physicians who treat severely impaired children, undermining the whole medical profession. Perhaps the phy – sician’s action would lead to a general devaluing of the lives of disabled or elderly people every – where. These dire consequences, however, would probably not be very likely if the physician acted discreetly. On balance, the act-utilitarian might say, greater net happiness (the least unhappiness) would result from the mercy killing, which would therefore be the morally permissible course. A rule-utilitarian might judge the situation differently. The key question would be which rule if consistently followed would produce the greatest net happiness. Let us say that there are only two rules to consider. One says “Do not kill seriously impaired children, regardless of their suffering or the wishes of their parents.” The other one is “Killing seriously impaired children is permissible if they are suffering severely and improvement is hopeless.” The rule-utilitarian might reason that consistently following the second rule would have terrible consequences. It would cause widespread suspicion about the actions and motives of physicians who treat se – riously impaired and disabled children. People would come to distrust physicians, which in turn would damage the entire health care system. Like all forms of utilitarianism, the classic formulation demands a strong sense of impar – tiality. When promoting happiness, we must not only take into account the happiness of every – one affected but also give everyone’s needs or interests equal weight. Mill explains: [The] happiness which forms the utilitarian stan – dard of what is right conduct, is not the agent’s own happiness, but that of all concerned. As be – tween his own happiness and that of others, util – itarianism requires him to be as strictly impartial as a disinterested and benevolent spec tator. 3 In classic utilitarianism, the emphasis is on maximizing the total quantity of net happiness, not ensuring that it is rationed in any particular amounts among the people involved. This means that an action resulting in 1,000 units of happi – ness for 10 people is better than an action yield – ing only 900 units of happiness for those same 10 people— regardless of how the units of happi – ness are distributed among them. Classic utilitar – ians do want to allocate the total amount of happiness among as many people as possible (thus their motto, “the greatest happiness for the greatest number”). But maximizing total happiness is the fundamental concern whether everyone gets an equal portion or one person gets the lion’s share. How might utilitarianism apply to a bioethical issue? Consider this scenario: Johnny is a 10-year- old boy with cerebral palsy, emaciated and bed- ridden, hooked to feeding tubes and monitors, his body twisted in pain that is almost impossible to control, his days measured out by one agoniz – ing surgical operation after another, locked in the mental life of an infant and acknowledged by all the experts to be without hope. His anguished parents, wanting desperately to end his suffering, beg the physician to give Johnny a lethal injec – tion. What should the physician do? Suppose in this case there are only two options: indefinitely maintaining Johnny in his present condition or carrying out the parents’ wishes. An act-utilitarian might reason like this. Allowing the current situation to continue would 02-Vaughn-Chap02.indd 37 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 38 PART 1: PRINCIPLES AND THEORIES Society might begin to devalue the lives of dis – abled people generally as well as the elderly and other vulnerable populations. The rule would also appear to entail a blatant violation of the cardinal principle of medical practice— do no harm. Adhering to it might therefore cause an erosion of all ethical codes and professional stan – dards in medicine. But following the first rule would have no such consequences. It would permit the suffering of some impaired children, but this consequence seems not to be as catastrophic as those produced by consistently conforming to the second rule. For the rule-utilitarian, then, the morally right action would be not to administer the lethal injection, despite the parents’ pleas. Kantian Ethics From the great German philosopher Immanuel Kant (1724– 1804) comes what is widely regarded as probably the most sophisticated and influ – ential deontological theory ever devised. It is the very antithesis of utilitarianism, holding that right actions do not depend in the least on consequences, the maximization of utility, the production of happiness, or the desires and needs of human beings. For Kant, the core of morality consists of following a rational and universally applicable moral rule and doing so solely out of a sense of duty. An action is right only if it con – forms to such a rule, and we are morally praise – worthy only if we perform it for duty’s sake alone. In Kant’s system, all our moral duties are ex – pressed in the form of categorical imperatives . An imperative is a command to do something; it is categorical if it applies without exception and without regard for particular needs or pur – poses. A categorical imperative says, “Do this— regardless.” In contrast, a hypothetical imperative is a command to do something if we want to achieve particular aims, as in “If you want good pay, work hard.” The moral law, then, rests on absolute directives that do not depend on the contingencies of desire or utility. Kant says that through reason and reflection we can derive our duties from a single moral principle, what he calls the categorical impera- tive. He formulates it in different ways, the first one being “Act only on that maxim through IN DEPTH UTILITARIANISM AND THE GOLDEN RULE Probably much to the dismay of his religious critics, John Stuart Mill defended his radical doctrine of utilitarianism by arguing that it was entirely consis – tent with a fundamental Christian teaching: In the golden rule of Jesus of Nazareth, we read the complete spirit of the ethics of utility. To do as one would be done by, and to love one’s neighbour as oneself, constitute the ideal perfection of utilitarian morality. As the means of making the nearest approach to this ideal, utility would enjoin, first, that laws and social arrangements should place the happiness, or (as speaking practically it may be called) the interest, of every individual, as nearly as possible in harmony with the interest of the whole; and secondly, that education and opinion, which have so vast a power over human character, should so use that power as to establish in the mind of every individual an indissoluble association between his own happiness and the good of the whole; especially between his own happiness and the practice of such modes of conduct, negative and positive, as regard for the universal happiness prescribes: so that not only he may be unable to conceive the possibility of happiness to himself, consis – tently with conduct opposed to the general good, but also that a direct impulse to promote the general good may be in every individual one of the habitual motives of action, and the sentiments connected therewith may fill a large and prominent place in every human being’s sentient existence. 4 02-Vaughn-Chap02.indd 38 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 39 are particularly relevant to bioethics. Notably he argues that there is an absolute moral prohi- bition against killing the innocent, lying, com – mitting suicide, and failing to help others when feasible. Perhaps the most renowned formulation of the categorical imperative is the principle of re – spect for persons (a formulation distinct from the first one, though Kant thought them equiva – lent). As he puts it, “Act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means, but always at the same time as an end .” 6 People must never be treated as if they were mere instruments for achieving some fur – ther end, for people are ends in themselves, possessors of ultimate inherent worth. People have ultimate value because they are the ultimate source of value for other things. They bestow value; they do not have it bestowed upon them. So we should treat both ourselves and other persons with the respect that all inherently valuable beings deserve. According to Kant, the inherent worth of persons derives from their nature as free, ratio – nal beings capable of directing their own lives, determining their own ends, and decreeing their own rules by which to live. Thus, the inher – ent value of persons does not depend in any way on their social status, wealth, talent, race, or cul – ture. Moreover, inherent value is something that all persons possess equally. Each person de – serves the same measure of respect as any other. Kant explains that we treat people merely as a means instead of an end-in-themselves if we dis – regard these characteristics of personhood—if we thwart people’s freely chosen actions by coercing them, undermine their rational decision-making by lying to them, or discount their equality by discriminating against them. In bioethics, clear- cut cases of not respecting persons in Kant’s sense would normally include experimenting on people without their knowledge and consent, lying to them about their medical condition and prognosis, and forcing patients to receive treat – ment against their will. which you can at the same time will that it should become a universal law.” 5 For Kant, our actions have logical implications— they imply general rules, or maxims, of conduct. If you tell a lie for financial gain, you are in effect acting according to a maxim like “It’s okay to lie to someone when doing so benefits you financially.” The question is whether the maxim correspond – ing to an action is a legitimate moral law. To find out, we must ask if we could consistently will that the maxim become a universal law applicable to everyone— that is, if everyone could consistently act on the maxim and we would be willing to have them do so. If we could do this, then the action described by the maxim is morally permissible; if not, it is prohibited. Thus moral laws embody two characteristics thought to be essential to morality itself: universality and impartiality. To show us how to apply this formulation of the categorical imperative to a specific situation, Kant uses the example of a lying promise. Sup – pose you need to borrow money from a friend, but you know you could never pay her back. So to get the loan, you decide to lie, falsely promising to repay the money. To find out if such a lying promise is morally permissible, Kant would have you ask if you could consistently will the maxim of your action to become a universal law, to ask, in effect, “What would happen if everyone did this?” The maxim is “Whenever you need to borrow money you cannot pay back, make a lying promise to repay.” So what would happen if ev- eryone in need of a loan acted in accordance with this maxim? People would make lying promises to obtain loans, but everyone would also know that such promises were worthless, and the custom of loaning money on promises would disappear. So willing the maxim to be a universal law involves a contradiction: If everyone made lying promises, promise-making itself would be no more; you cannot consistently will the maxim to become a universal law. Therefore, your duty is clear: Making a lying promise to borrow money is morally wrong. Kant’s first formulation of the categorical im – perative yields several other duties, some of which 02-Vaughn-Chap02.indd 39 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 40 PART 1: PRINCIPLES AND THEORIES Notice that this formulation of the categori – cal imperative does not actually prohibit treating a person as a means but forbids treating a per – son simply , or merely , as a means— as nothing but a means. Kant recognizes that in daily life we often must use people to achieve our various ends. To buy milk, we use the cashier; to find books, we use the librarian; to get well, we use the doctor. But because their actions are freely chosen and we do not undermine their status as persons, we do not use them solely as instruments of our will. Medical researchers use their human subjects as a means to an end— but not merely as a means to an end if the subjects give their informed consent to participate in the research. Natural Law Theory From ancient times to the present day, many people have thought that the outlines of the moral law are plain to see because they are written large and true in nature itself. This basic notion has been developed over the centuries into what is known as natural law theory , the view that right actions are those that conform to moral standards discerned in nature through human reason. Undergirding this doctrine is the belief that all of nature (including humankind) is teleological, that it is somehow directed toward particular goals or ends, and that humans achieve their highest good when they follow their true, natural inclinations leading to these goals or ends. There is, in other words, a way things are— natural pro – cesses and functions that accord with the natural law— and how things are shows how things should be . The prime duty of humans, then, is to guide their lives toward these natural ends, acting in accordance with the requirements of natural law. Implicit in all this is the element of rational – ity. According to natural law theory, humans are rational beings empowered by reason to perceive the workings of nature, determine the natural inclinations of humans, and recognize the impli – cations therein for morally permissible actions. That is, reason enables human beings to ascertain the moral law implicit in nature and to apply that objective, universal standard to their lives. Though natural law theory has both religious and nonreligious forms, the theistic formulation of theologian-philosopher Thomas Aquinas (1225– 1274) has been the theory’s dominant version. It is not only the official moral outlook of the Roman Catholic Church, but it has also been the intellectual starting point for many contemporary variations of the theory, secular and otherwise. For Aquinas, God is the author of the natural law who gave humans the gift of reason to discern the law for themselves and live accordingly. Aquinas argues that human beings naturally tend toward— and therefore have a duty of— preserving human life and health (and so must not kill the innocent), producing and raising children, seek – ing knowledge (including knowledge of God), and cultivating cooperative social relationships. In all this, Aquinas says, the overarching aim is to do and promote good and avoid evil. Natural law theory does not provide a relevant moral rule covering every situation, but it does offer guidance through general moral principles, some of which are thought to apply universally and absolutely (admitting no exceptions). Among these principles are absolutist prohibitions against directly killing the innocent, lying, and using contraceptives. In his list of acts considered wrong no matter what, Aquinas includes adul – tery, blasphemy, and sodomy. Of course, moral principles or rules often conflict, demanding that we fulfill two or more incompatible duties. We may be forced, for ex – ample, to either tell a lie and save people’s lives or tell the truth and cause their death— but we cannot do both. Some moral theories address these problems by saying that all duties are prima facie: When duties conflict, we must decide which ones override the others. Theories that posit ab – solute duties— natural law theory being a prime example— often do not have this option. How does the natural law tradition resolve such dilemmas? Among other resources, it uses the doctrine of double effect . This principle, a cornerstone of Roman Catholic ethics, affirms that performing a bad action to bring about a good effect is never 02-Vaughn-Chap02.indd 40 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 41 effects, the action of taking a life is in itself immoral, a violation of the cardinal duty to preserve innocent life. 2. Ending the woman’s life to save her from terrible suffering is an instance of causing a bad effect (the woman’s death) as a means of achieving a good effect (cessation of pain)— a failure of test 2. 3. The death of the woman is intended; it is not merely a tragic side effect of the attempt solely to ease her pain. So the action fails test 3. 4. Causing the death of an innocent person is a great evil that cannot be counter balanced by the good of pain relief. So the action does not pass test 4. The verdict in such a case would be different, however, if the patient’s death were not inten – tionally caused but unintentionally brought about. Suppose, for example, that the physician sees that the woman is in agony and so gives her a large injection of morphine to minimize her suffering— knowing full well that the dose will also probably speed her death. In this scenario, the act of easing the woman’s pain is itself mor – ally permissible (test 1). Her death is not a means to achieve some greater good; the goal is to ease her suffering (test 2). Her death is not intended; the intention is to alleviate her pain, though the unintended (but foreseen) side effect is her has – tened death (test 3). Finally, the good effect of an easier death seems more or less equivalent in importance to the bad effect of a hastened death. Therefore, unintentionally but knowingly bringing about the woman’s death in this way is morally permissible. We get similar results if we apply the double- effect principle in the traditional way to abor – tion. We find that as the intentional destruction of an innocent human life (so-called direct), abortion is always immoral (test 1). Moreover, it is wrong even (or especially) if it is performed to bring about some good result, such as saving the mother’s life or preventing serious harm to her (tests 2 and 3). On the other hand, actions morally acceptable but that performing a good action may sometimes be acceptable even if it produces a bad effect. More precisely, the prin – ciple says it is always wrong to intentionally per – form a bad action to produce a good effect, but doing a good action that results in a bad effect may be permissible if the bad effect is not in – tended although foreseen. In the former case, a bad thing is said to be directly intended; in the latter, a bad thing is not directly intended. These requirements have been detailed in four “tests” that an action must pass to be judged morally permissible. We can express a tradi – tional version of these tests like this: 1. The action itself must be morally permissible. 2. Causing a bad effect must not be used to obtain a good effect (the end does not justif y the means). 3. Whatever the outcome of an action, the intention must be to cause only a good effect (the bad effect can be foreseen but never intended). 4. The bad effect of an action must not be greater in importance than the good effect. Consider the application of these tests to eu – thanasia. Suppose an 80-year-old hopelessly ill patient is in continuous, unbearable pain and begs to be put out of her misery. Is it morally permissible to grant her request (either by giving a lethal injection or ending all ordinary life- sustaining measures)? If we apply the doctrine of double effect as just outlined, we must conclude that the answer is no : Euthanasia— either active or passive— is not a morally permissible option here. (In the Roman Catholic view, all forms of euthanasia are wrong, although it is permissible not to treat a hopelessly ill person for whom ordinary life-sustaining treatments are useless.) Failing even one of the tests would render an action impermissible, but in this case let us run through all four as a natural law theorist might: 1. Taking steps to terminate someone’s life is a clear violation of test 1. Whatever its 02-Vaughn-Chap02.indd 41 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 42 PART 1: PRINCIPLES AND THEORIES leading unintentionally to the death of a fetus (so-called indirect abortion) may be permissible in rare cases. Say a pregnant woman has an in – fectious disease that will kill her unless she gets injections of a powerful drug. But the drug will abort the fetus. According to the doctrine of double effect, receiving the injections may be morally permissible if the action itself is morally permissible, which it is (test 1); if the death of the fetus is not used to rescue the woman (test 2); if the injections are given with the intention of curing the woman’s disease, not of inducing an abortion (test 3); and if the death of the fetus is balanced by the life of the woman (test 4). Rawls’ Contract Theory In its broadest sense, contractarianism refers to moral theories based on the idea of a social contract, or agreement, among individuals for mutual advantage. The most influential contem – porary form of contractarianism is that of phi – losopher John Rawls (1921– 2002), who uses the notion of a social contract to generate and defend moral principles governing how members of a society should treat one another. He asks, in effect, by what principles should a just society structure itself to ensure a fair distribution of rights, duties, and advantages of social cooperation? His answer is that the required principles— essentially principles of justice— are those that people would agree to under hypothetical con – ditions that ensure fair and unbiased choices. He believes that if the starting point for the social contract is fair— if the initial conditions and bargaining process for producing the prin – ciples are fair— then the principles themselves will be just and will define the essential makeup of a just society. As Rawls says, [The] guiding idea is that the principles of justice for the basic structure of society are the object of the original agreement. They are the principles that free and rational persons concerned to further their own interests would accept in an initial position of equality as defining the fundamental terms of their association. These principles are to regulate all further agreements; they specify the kinds of social cooperation that can be entered into and the forms of government that can be established. 7 At the hypothetical starting point— what Rawls calls the “original position”— a group of normal, self-interested, rational individuals come together to choose the principles that will determine their basic rights and duties and their share of society’s benefits and burdens. But to ensure that their decisions are as fair and impar – tial as possible, they must meet behind a meta – phorical “veil of ignorance.” Behind the veil, no one knows his own social or economic status, class, race, sex, abilities, talents, level of intelli – gence, or psychological makeup. Since the par – ticipants are rational and self-interested but ignorant of their situation in society, they will not agree to principles that will put any particu – lar group at a disadvantage because they might very well be members of that group. They will choose principles that are unbiased and nondis – criminatory. The assumption is that since the negotiating conditions in the original position are fair, the agreements reached will also be fair— the principles will be just. Rawls contends that given the original posi – tion, the participants would agree to arrange their social relationships according to these fun – damental principles: 1. Each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberty for all. 2. Social and economic inequalities are to be arranged so that they are both: (a) to the greatest benefit of the least advantaged . . . and ( b) attached to offices and positions open to all under conditions of fair equality of opportunity. 8 The first principle— the equal liberty principle— says that everyone is entitled to the most freedom possible in exercising basic rights 02-Vaughn-Chap02.indd 42 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 43 entitled to adequate health care, which includes all appropriate measures for eliminating or compensating for the disadvantages of disease and impairment. 10 In such a system, there would be universal access to a basic level of health care, while more elaborate or elective services would be available to anyone who could afford them. Another implication: Suppose that to provide a basic level of health care to everyone (and meet the equality-of-opportunity requirement), soci – ety would have to spend 90 percent of its health care resources. But say that in the current system, 50 percent of the resources are being spent on acute care for the elderly— that is, ex- pensive measures to extend the lives of people who have already lived a long time. According to Rawlsian principles, is the current system of health care unjust? Virtue Ethics Most moral theories— including all those just discussed— are theories of obligation. They em – phasize the rightness of actions and the duties of moral agents. Their main concern is knowing and doing what’s right, and their chief guide to these aims is moral principles or directives. Virtue ethics , however, is a radically different kind of moral theory: It focuses on the develop – ment of virtuous character. According to virtue ethics, character is the key to the moral life, for it is from a virtuous character that moral con – duct and values naturally arise. Virtues are in – grained dispositions to act by standards of excellence, so having the proper virtues leads as a matter of course to right actions properly mo – tivated. The central task in morality, then, is not knowing and applying principles but being and becoming a good person, someone possessing the virtues that define moral excellence. In virtue ethics, someone determines right action not by consulting rules but by asking what a truly virtuous person would do or whether an action would accord with the relevant virtues. Aristotle (384– 322 b.c.e. ) is the primary in – spiration for contemporary versions of virtue ethics. For him, as for many modern virtue and duties (for example, the right to vote and hold office and freedom of speech, assembly, and thought). Each person should get a maximum degree of basic liberties but no more than anyone else. This principle takes precedence over all other considerations (including the second prin – ciple) so that basic liberties cannot be reduced or canceled just to improve economic well-being. The second principle concerns social and economic goods such as income, wealth, oppor – tunities, and positions of authority. Part (b) says that everyone is entitled to an equal chance to try to acquire these basic goods. No one is guar – anteed an equal share of them, but opportunities to obtain these benefits must be open to all, re – gardless of social standing. Rawls knows that social and economic in – equalities will naturally arise in society. But as he asserts in part (a), they are not unjust if they work to everyone’s benefit, especially to the benefit of the least well off in society. “[There] is no injus – tice,” he says, “in the greater benefits earned by a few provided that the situation of persons not so fortunate is thereby improved.” 9 For Rawls, such a policy is far more just than one in which some people are made to suffer for the greater good of others: “[I]t is not just that some should have less in order that others may prosper.” In Rawls’ scheme, the demands of the first principle must be satisfied before satisfying the second, and the requirements of part (b) must be met before those of part (a). In any just distri – bution of benefits and burdens, then, the first priority is to ensure equal basic liberties for all concerned, then equality of opportunity, then the arrangement of any inequalities to the benefit of the least advantaged. As a theory of distributive justice, Rawls’ con – tractarianism seems to have significant implica – tions for the allocation of society’s health care resources. For example, one prominent line of argument goes like this: As Rawls claims, every – one is entitled to fair equality of opportunity, and adequate (basic) health care enables fair equality of opportunity (by ensuring “normal species functioning”). Therefore, everyone is 02-Vaughn-Chap02.indd 43 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 44 PART 1: PRINCIPLES AND THEORIES people’s character and actions. The friend we saved from drowning would probably be appalled if we declared that we saved her out of duty even though we did not really care whether she lived or died. Many moral philosophers agree that mo – tivations are indeed important considerations in moral judgments, and they have incorporated virtues into their theories of obligation. Virtue ethics fits well with the emphasis on virtues that has always been part of the healing arts. Physicians and nurses are expected to pos – sess particular virtues, including compassion, trustworthiness, justice, and honesty. They are expected to be more than just technically skilled and knowledgeable and to do more than merely follow the rules of conduct or procedure. They are obliged to do right by their patients, and this obligation is most likely met through the culti – vation and possession of virtues. The virtue ethics approach to bioethical issues is distinctive. On abortion, for example, the virtue ethicist might argue that a woman’s deci – sion to have an abortion should be judged by the virtues (or lack thereof ) that she draws on in deciding what to do. If she decides to have an abortion just because she is afraid of the respon – sibilities of parenthood, she shows cowardice. If she wants to go through with an abortion merely because pregnancy would disrupt her vacation plans, she shows self-centeredness and callous – ness. In neither case is the virtue ethicist likely to call the woman’s decision virtuous. 11 The Ethics of Care The ethics of care is a distinctive moral perspec – tive that arose out of feminist concerns and grew to challenge core elements of most other moral theories. Generally those theories empha – size abstract principles, general duties, individ – ual rights, impartial judgments, and deliberative reasoning. But the ethics of care shifts the focus to the unique demands of specific situations and to the virtues and feelings that are central to close personal relationships— empathy, compassion, love, sympathy, and fidelity. The heart of the moral life is feeling for and caring for those with ethicists, the highest goal of humanity is the good life, or “human flourishing” (what Aristotle calls eudaimonia , or happiness), and developing virtues is the way to achieve such a rich and satisfying life. Thus virtues are both the traits that make us good persons and the dispositions that enable us to live good lives. The good life is the virtuous life. Unlike many theories of obligation, virtue ethics asks us to do more than just observe min – imal moral rules— it insists that we aspire to moral excellence , that we cultivate the virtues that will make us better persons. In this sense, virtue ethics is goal-directed, not rule-guided. The moral virtues— benevolence, honesty, loyalty, compassion, fairness, and the like— are ideals that we must ever strive to attain. (There are also nonmoral virtues such as patience, prudence, and reasonableness, which need not concern us here.) By the lights of both Aristotle and modern virtue ethicists, character is not static. We can become more virtuous by reflecting on our lives and those of others, practicing virtuous behavior, or imitating moral exemplars such as Gandhi, Buddha, Jesus, Muhammad, and Socrates. We can— and should— be better than we are. To the virtue ethicist, possessing the right virtues means having the proper motivations that naturally accompany those virtues. To act morally, we must act from virtue, and acting from virtue means acting with the appropriate motives. It is not enough to do right; we must do right for the right motivating reasons. If we save a drowning friend, we should do so out of genuine feelings of compassion, kindness, or loyalty— not because of the prodding of moral rules or social expectations. In contrast, some moral theories (notably Kant’s) maintain that acting morally is solely a matter of acting for duty’s sake— performing an action simply be – cause duty requires it. Virtuous motives are irrelevant; we act morally if we do our duty re – gardless of our motivations. But this notion seems to many to offer a barren picture of the moral life. Surely, they say, motivations for acting are often relevant to our evaluations of 02-Vaughn-Chap02.indd 44 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 45 impartiality too far. Recall that impartiality in morality requires us to consider everyone as equal, counting everyone’s interests the same. The principle applies widely, especially in matters of public justice, but less so in personal relationships of love, family, friendship, and the like. We seem to have special obligations (partiality) to close friends, family members, and others we care for, duties that we do not have to strangers or to uni- versal humanity. As some philosophers explain it, The care perspective is especially meaningful for roles such as parent, friend, physician, and nurse, in which contextual response, attentiveness to subtle clues, and deepening special relationships are likely to be more important morally than impartial treatment. 14 May I devote my time and resources to caring for my own friends and family, even if this means ignoring the needs of other people whom I could also help? From an impartial point of view, our duty is to promote the interests of everyone alike. But few of us accept that view. The ethics of care confirms the priority that we naturally give to our family and friends, and so it seems a more plausible moral conception. 15 Most moral theories emphasize duties and downplay the role of emotions, attitudes, and motivations. Kant, for example, would have us do our duty for duty’s sake, whatever our feelings. For him, to be a morally good parent, we need only act from duty. But taking care of our chil – dren as a matter of moral obligation alone seems whom you have a special, intimate connection— an approach that especially resonates with phy – sicians and nurses. Early on, the ethics of care drew inspiration from the notion that men and women have dramatically different styles of moral decision- making, with men seizing on principles, duties, and rights, and women homing in on personal relationships, caring, and empathy. This differ – ence was highlighted in research done by psy – chologist Carol Gilligan and published in her 1982 book In a Different Voice . 13 Typically men recog – nize an ethic of justice and rights, she says, and women are guided by an ethic of compassion and care. In her view the latter is as legitimate as the former, and both have their place in ethics. Other research has suggested that the differ – ences between men and women in styles of moral thinking may not be as great as Gilligan sug – gests. But the credibility of the empirical claim does not affect the larger insight that the research seemed to some writers to suggest: Caring is an essential part of morality, and the most influential theories have not fully taken it into account. These points get support along several lines. First, virtue ethics reminds us that virtues are part of the moral life. If caring is viewed as a virtue— in the form of compassion, empathy, or kindness— then caring too must be an element of morality. A moral theory then would be defi – cient if it made no room for care. Moreover many argue that unlike the ethics of care, most moral theories push the principle of IN DEPTH CAN VIRTUE BE TAUGHT? Aristotle believes that moral virtues are not the sort of thing you can learn by merely studying them, as you would if you wanted to learn calculus. He insists that moral virtues can only be learned through practice, by living the virtues. As he says, [M]oral virtue comes about as a result of habit. . . . From this it is also plain that none of the moral virtues arises in us by nature. . . . [B]ut the virtues we get by first exercising them, as also happens in the case of the arts as well. For the things we have to learn before we can do them, we learn by doing them, e.g., men become builders by building and lyreplayers by playing the lyre; so too we become just by doing just acts, temperate by doing temperate acts, brave by doing brave acts. 12 02-Vaughn-Chap02.indd 45 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 46 PART 1: PRINCIPLES AND THEORIES an empty exercise. Surely being a morally good parent also involves having feelings of love and attitudes of caring. The ethics of care eagerly takes these emotional elements into account. Many philosophers, including several writ – ing from a feminist perspective, have lodged such criticisms against the most influential moral theories while suggesting that a mature morality should accommodate both an ethic of obligation and an ethic of care. Annette Baier, for example, has taken this approach: It is clear, I think, that the best moral theory has to be a cooperative product of women and men, has to harmonize justice and care. The morality it theorizes about is after all for all persons, for men and for women, and will need their com – bined insights. As Gilligan said, what we need now is a “marriage” of the old male and the newly articulated female insights. 16 For many nurses, the ethics of care seems like a fitting, natural approach to morality in nursing practice. After all, caring has always been an es – sential part of what nurses do and how they think about their jobs. When the focus of concern is, say, a very sick patient and her family, traditional moral theories would have those involved attend to relevant moral principles, strive for an im – partial stance, emphasize individual rights, and engage in impassive moral deliberations. But the ethics of care insists that medical care providers pay more attention to the specific needs of the patient and her family, be aware of the special re – lationships they have with each other, understand the attitudes and feelings at work among them, and act with compassion, sympathy, and respect. Feminist Ethics Feminist ethics is an approach to morality aimed at advancing women’s interests and cor – recting injustices inflicted on women through social oppression and inequality. It is defined by a distinctive focus on these issues, rather than by a set of doctrines or common ideology among feminists, many of whom may disagree on the nature of feminist ethics or on particular moral issues. A variety of divergent perspectives have been identified as examples of feminist ethics, including the ethics of care. Feminist ethics generally downplays the role of moral principles and traditional ethical concepts, insisting instead that moral reflection must take into account the social realities— the relevant social practices, relationships, institutions, and power arrangements. Many feminists think that the familiar principles of Western ethics— autonomy, utility, freedom, equality, and so forth— are too broad and abstract to help us make moral judg – ments about specific persons who are enmeshed in concrete social situations. It is not enough, for example, to respect a woman’s decision to have an abortion if she is too poor to have one, or if her culture is so oppressive (or oppressed) as to make abortion impossible to obtain, or if social condi – tioning leads her to believe that she has no choice or that her views don’t count. Theoretical auton – omy does not mean much if it is so thoroughly undermined in reality. Many theorists in feminist ethics also reject the traditional concept of the moral agent. Jan Crosthwaite says that the old notion is that of “abstract individuals as fundamentally autono – mous agents, aware of their own preferences and values, and motivated by rational self-interest (though not nece ssarily selfish).” 17 But, she says, many feminists present a richer conception of persons as histori – cally and culturally located, socially related and essentially embodied. Individuals are located in and formed by specific relationships (chosen and unchosen) and ties of affection and responsibil – ity. . . . Such a conception of socially embedded selves refocuses thinking about autonomy, shifting the emphasis from independent self- determination towards ideals of integrity within relatedness. . . . Respecting autonomy becomes less a matter of protecting individuals from “coercive” influences than one of positive empow – erment, recognizing people’s interdependence and supporting individuals’ development of their own understanding of their situation and options. 18 02-Vaughn-Chap02.indd 46 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 47 Some critics also question the ability of casu- istry to justify a moral decision or the selection of a paradigm case. Casuists hold that justifi – cation comes from a society’s traditions, values, or conventions. But it seems that a solid set of principles or standards would be necessary to counteract the bias, arbitrariness, or vagueness of these influences. Casuistry has made valuable contributions to our understanding and use of moral reasoning. But in its purest form it seems problematic. More recent scholarship, however, has demonstrated ways that casuistry can take into account some moral principles or norms. criteria for judging moral theories As you can see, as explanations of what makes actions right or character good, moral theories can differ dramatically in both content and quality. In their own fashion, they try to identify the true determinants of rightness or goodness, and they vary in how close they seem to get to the mark. Most moral philosophers would read – ily agree: Some moral theories are better than others, and a vital task in ethics is to try to tell which is which. Moral theories can be useful and valuable to us only if there are criteria for judging their worth— and fortunately there are such standards. In several ways, moral theories are analogous to scientific theories. Scientists devise theories to explain the causes of events. The germ theory is offered to explain the cause and spread of infectious diseases. The Big Bang theory is used to explain the structure and expansion of the universe. The “greenhouse effect” is put forth to explain climate change. For each phenomenon to be explained, scientists usually have several possible theories to consider, and the challenge is to determine which one is best (and is there – fore most likely to be correct). The superior theory is the one that fares best when judged by gener – ally accepted yardsticks known as the scientific criteria of adequacy . One criterion often invoked Though all adherents of feminist ethics sup – port liberation and equality for women, they dis – agree on how these values apply to specific moral issues. Most support unimpeded access to abor – tion, but some do not. As later chapters show, opinions among feminists also diverge on sur – rogacy and reproductive technologies such as in vitro fertilization. Casuistry Casuistry is a method of moral reasoning that emphasizes cases and analogy rather than uni – versal principles and theories from which moral judgments are supposed to be deduced. Casuists say reasonable moral judgments are arrived at not by applying theories, rights, and rules, but by paying careful attention to spe – cific cases and circumstances. In casuistry, judgments about new cases are made by anal – ogy with similar or paradigm cases; as in law, casuistry operates by consulting precedent. Casuists point out that problems in moral rea – soning are especially likely when theories or principles are strictly applied without regard to the relevant details of cases. They also note that we are often far more confident of specific moral judgments than we are of decisions based on general principles. Moral philosophers, however, have voiced several concerns about the method. For one thing, it seems that casuistry is dependent on rules or principles just as moral theories are. Consider this criticism: Casuists sometimes write as if paradigm cases speak for themselves or inform moral judgment by their facts alone, an implausible thesis. For the casuist to move constructively from case to case, a recognized and morally relevant norm must connect the cases. The norm is not part of the facts or narrative of the cases involved; it is a way of interpreting, evaluating, and linking cases. All analogical reasoning in casuistry requires a connecting norm to indicate that one sequence of events is morally like or unlike another sequence in relevant respects. 19 02-Vaughn-Chap02.indd 47 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 48 PART 1: PRINCIPLES AND THEORIES is fruitfulness — whether the theory makes suc – cessful predictions of previously unknown phe – nomena. All things being equal, a theory that makes successful predictions of novel phenomena is more likely to be true than one that does not. Another important criterion is conservatism — how well a theory fits with established facts, with what scientists already know. All things being equal, a theory that conflicts with what scientists already have good reasons to believe is less likely to be true than a theory that has no such conflicts. Of course, an unconservative theory can turn out to be correct, and a conser – vative theory wrong, but the odds are against this outcome. Analogously, moral theories are meant to explain what makes an action right or a person good, and to try to determine which moral theory is most likely correct, we apply conceptual yardsticks— the moral criteria of adequacy . Any plausible moral theory must mea – sure up to these critical standards. An important criterion of adequacy for moral theories is Criterion I: consistency with our con – sidered moral judgments . Any plausible scien- tific theory must be consistent with the data that the theory is supposed to explain; there should be no conflicts between the theory and the rele – vant facts. A theory put forth to explain plane – tary motion, for example, must account for the relevant data— scientific observations of the movements of the planets and related objects. Likewise, a moral theory must also be consistent with the data it is supposed to explain: our con – sidered moral judgments, what some call our moral common sense. We arrive at these judg – ments after careful deliberation that is as free of bias, self-interest, and other distorting influences as possible. Moral philosophers grant these judg – ments considerable respect and try to take them into account in their moral theorizing. As we have seen, these judgments are fallible, and they are often revised under pressure from trustworthy principles or theories. But we are entitled to trust them unless we have good reason to doubt them. Therefore, any moral theory that is seriously in – consistent with our considered judgments must be regarded as badly flawed, perhaps fatally so, and in need of radical revision. Our considered judgments, for example, tell us that slavery, murder, rape, and genocide are wrong. A moral theory that implies otherwise fails this criterion and is a candidate for rejection. In applying this standard, we must keep in mind that in both science and ethics, there is tension between theory and data. A good theory explains the data, which in turn influence the shape of the theory. Particularly strong data can compel scientists to alter a theory to account for the information, but a good theory can also give scientists reasons to question or reject particular data. In the same way, there is a kind of give and take between a moral theory and the relevant data. Our considered moral judgments may give us good reasons for altering or even rejecting our moral theory. But if our moral theory is co – herent and well supported, it may oblige us to rethink or reject our considered judgments. In both science and ethics, the goal is to ensure that the fit between theory and data is as tight as possible. The fit is acceptably close when no further changes in the theory or the data are necessary— when there is a kind of balance be – tween the two that moral philosophers call “reflective equilibrium.” Another test of adequacy is Criterion II : con – sistency with the facts of the moral life . In sci- ence, good theories are consistent with scientific background knowledge, with what scientists already have good reasons to believe. They are, as mentioned earlier, conservative. This back – ground knowledge includes other well-founded theories, highly reliable findings, and scientific (natural) laws. Moral theories should also be consistent with background knowledge— the moral background knowledge, the basic, ines – capable experiences of the moral life. These ex – periences include making moral judgments, disagreeing with others on moral issues, being mistaken in our moral beliefs, and giving rea – sons for accepting moral beliefs. That we do in fact experience these things from time to time is a matter of moral common sense— seemingly 02-Vaughn-Chap02.indd 48 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 49 as we judge a theory’s worth. But the criteria do help us make broad judgments on rational grounds about a theory’s strengths and weak- nesses. We must use them as guides, relying on our best judgment in applying them, just as sci – entists must use their own educated judgment in wielding their kind of criteria of adequacy. In neither case is there a neat algorithm for theory assessment, but nonetheless in both arenas the process is objective, reasonable, and essential. We should also remember that no moral theory is perfect, and none is likely to get the highest marks on every test. But there is much to learn even from flawed theories. If we look closely, we can see that each of the most influential theories of past centuries, even with its faults apparent, seems to have grasped at least a modest, gleam – ing piece of the truth about the moral life. Utilitarianism For simplicity’s sake, let us try to apply the criteria to classic act-utilitarianism, the view that right actions are those that result in the greatest overall happiness for everyone involved. First, note that the theory seems to pass the test suggested by Cri – terion II (consistency with the facts of the moral life). Utilitarianism assumes that we can indeed make moral judgments, have moral disagree – ments, be mistaken in our moral beliefs, and pro – vide supporting reasons for our moral judgments. The theory, however, has been accused of a lack of usefulness— failing Criterion III (resourceful – ness in moral problem-solving). The usual charge is that utilitarianism is a poor guide to the moral life because the theory demands too much of us and blurs the distinction between obligatory and supererogatory actions. Utilitarianism says that obvious facts of the moral life. Thus, any moral theory that is inconsistent with these aspects of the moral life is deeply problematic. It is possible that we are deluded about the moral life— that we, for example, merely think we are disagreeing with others on moral issues but are actually just venting our feelings. But our expe – rience gives us good grounds for taking the commonsense view until we are given good rea – sons to believe otherwise. Finally, we have Criterion III: resourcefulness in moral problem-solving . If a scientific theory helps scientists answer questions, solve problems, and control facets of the natural world, it dem – onstrates both its plausibility and usefulness. All things being equal, such a resourceful theory is better than one that has none of these advan – tages. Much the same is true for moral theories. A resourceful moral theory helps us solve moral problems. It can help us identify morally relevant aspects of conduct, judge the rightness of actions, resolve conflicts among moral principles and judgments, test and correct our moral intuitions, and understand the underlying point of morality itself. Any moral theory that lacks problem-solving resourcefulness is neither useful nor credible. applying the criteria In this section, we apply the three moral criteria of adequacy to two theories we discussed earlier (one consequentialist, the other deontological). As we do, keep in mind that evaluating moral theories using these yardsticks is not a rote pro – cess. There is no standard procedure for applying the criteria to a theory and no set of instructions for assigning conceptual weight to each criterion REVIEW: Evaluating Moral Theories: Criteria of Adequacy Criterion I: consistency with our considered moral judgments Criterion II: consistency with the facts of the moral life Criterion III: resourcefulness in moral problem-solving 02-Vaughn-Chap02.indd 49 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 50 PART 1: PRINCIPLES AND THEORIES we should always try to maximize happiness for everyone considered, to do our utmost to in – crease overall utility. But some say this require – ment would lead us to extreme beneficence— to, for example, give away most of our possessions, spend most of our time in charity work, and deem mandatory many acts that we would nor – mally consider above and beyond the call of duty. Some defenders of the theory have sug – gested that it can be modified easily to ease the demands that it places on us. A few utilitarians have insisted that, contrary to the popular view, the commonsense distinction between obliga – tory and supererogatory acts is mistaken and that morality does demand the kind of sacrifice that utilitarianism implies. The most serious accusation against classic utilitarianism is that it flies in the face of our considered moral judgments (Criterion I), espe – cially concerning issues of justice and rights. Consider the case of a medical researcher trying to develop a cure for Alzheimer’s disease. To devise this cure that would save countless lives, she needs only to conduct a single, secret experiment in which she gives a lethal drug to 10 early-stage Alzheimer’s patients (without their knowledge) and does a postmortem examination on their brains. By increasing the unhappiness of 10 people (and depriving them of all possible happiness in the future), she can maximize happiness for thousands. Should she conduct the experiment? According to classic utilitarianism, if her actions would go undetected and have no additional un – happy effects, the answer is yes. The experiment would be justified by the enormous amount of net happiness it would generate. But the utili – tarian verdict seems to conflict strongly with our considered judgments about justice. Taking the lives of a few people to benefit many others appears unjust, regardless of the good conse – quences that would flow from the deed. Critics claim that cases like this show that utilitarianism is a seriously inadequate theory. Now consider the case of a competent patient with a serious illness who refuses medical treat – ment on religious grounds. He knows that he would suffer much less pain and have a longer and happier life if he were treated, but he still objects. But his physician wants to maximize the happiness and well-being of all her patients, so she surreptitiously treats the patient anyway without his consent. (Let us assume that no ad – ditional legal, professional, or psychological con – sequences ensue.) Does the physician do right? The utilitarian seems obliged to say yes. But our commonsense judgment would likely be that the physician violated her patient’s autonomy— specifically, his right of self-determination. Some utilitarians have replied to such Crite – rion I criticisms by saying that scenarios like those just presented are unrealistic and misleading. In the real world, they say, actions that seem to conflict with our moral intuitions almost always produce such bad consequences that the actions cannot be justified even on utilitarian grounds. Once all the possible consequences are taken into account, it becomes clear that the proposed actions do not maximize happiness and that commonsense morality and utilitarianism co – incide. In real life, for example, the deeds of the researcher and the physician would almost cer – tainly be exposed, resulting in a great deal of un – happiness for all concerned. Critics respond to the utilitarian by admitting that many times the judgments of commonsense morality and utili – tarianism do in fact coincide when all the facts are known— but not always. Even the utilitarian must admit that there could be cases in which actions that maximize utility do clash with our considered moral judgments, and this possibility raises doubts about the utilitarian standard. Kant’s Theory Like utilitarianism, Kant’s theory seems gener – ally consistent with the basic facts of the moral life (Criterion II), but many philosophers argue that it is not consistent with moral common sense (Criterion I). A major cause of the problem, they say, is Kant’s insistence that we have absolute (or “perfect”) duties— obligations that must be hon – ored without exception. Thus in Kantian ethics, we have an absolute duty not to lie or to break a promise or to kill the innocent, come what may. Imagine that a band of killers wants to murder 02-Vaughn-Chap02.indd 50 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 51 objective. But if it is subjective in the way just described, its helpfulness as a guide for living morally is dubious. Defenders of Kant’s theory, however, believe there are remedies for this dif- ficulty. Some argue, for example, that the prob – lem disappears if the second formulation is viewed as a supplement to the first, rather than as two independent principles. key terms act-utilitarianism consequentialist theory contractarianism deontological (or nonconsequentialist) theory doctrine of double effect moral theory natural law theory rule-utilitarianism utilitarianism virtue ethics summary A moral theory explains why an action is right or wrong or why a person or a person’s character is good or bad. Making, using, or assessing moral theories is a normal, pervasive feature of the moral life. Consequentialist moral theories assume that the rightness of actions depends on their conse – quences or results. Deontological theories say that the rightness of actions is determined partly or wholly by their intrinsic nature. The leading consequentialist theory is utilitarianism, the view that right actions are those that result in the most beneficial balance of good over bad consequences for everyone involved. The theory comes in two main types. Act-utilitarianism is the idea that the rightness of actions depends on the relative good produced by individual ac – tions. Rule-utilitarianism says a right action is one that conforms to a rule that, if followed con – sistently, would create for everyone involved the most beneficial balance of good over bad. Kan – tian ethics is opposed to consequentialist theo – ries, holding that morality consists of following a rational and universally applicable moral rule an innocent man who has taken refuge in your house, and the killers come to your door and ask you point blank if he is in your house. To say no is to lie; to answer truthfully is to guarantee the man’s death. What should you do? In a case like this, says Kant, you must do your duty — you must tell the truth though murder is the result and a lie would save a life. But in this case such devotion to moral absolutes seems completely askew, for saving an innocent life seems far more important morally than blindly obeying a rule. Our considered judgments suggest that sometimes the consequences of our actions do matter more than adherence to the letter of the law, even if the law is generally worthy of our respect and obedience. Some have thought that Kant’s theory can yield implausible results for another reason. Recall that the first formulation of the categori – cal imperative says that an action is permissi – ble if persons could consistently act on the relevant maxim, and we would be willing to have them do so. This requirement seems to make sense if the maxim in question is some – thing like “Do not kill the innocent” or “Treat equals equally.” But what if the maxim is “En – slave all Christians” or “Kill all Ethiopians”? We could— without contradiction— will either one of these precepts to become a universal law. And if we were so inclined, we could be willing for everyone to act accordingly, even if we ourselves were Christians or Ethiopians. So by Kantian lights, these actions could very well be morally permissible, and their permissibil – ity would depend on whether someone was willing to have them apply universally. Critics conclude that because the first formulation of the categorical imperative seems to sanction such obviously immoral acts, the theory is deeply flawed. Defenders of Kant’s theory, on the other hand, view the problems as repair – able and have proposed revisions. This apparent arbitrariness in the first for – mulation can significantly lessen the theory’s usefulness (Criterion III). The categorical im – perative is supposed to help us discern moral directives that are rational, universal, and 02-Vaughn-Chap02.indd 51 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 52 PART 1: PRINCIPLES AND THEORIES and doing so solely out of a sense of duty. An action is right only if it conforms to such a rule, and we are morally praiseworthy only if we per – form it for duty’s sake alone. Natural law theory is a centuries-old view of ethics that maintains that right actions are those conforming to moral standards discerned in nature through human reason. Rawls’ theory is a form of contractarian – ism, which means it is based on the idea of a social contract, or agreement, among individu – als for mutual advantage. He argues for a set of moral principles that he believes would be ar – rived at through a fair, but hypothetical, bar – gaining process. Virtue ethics focuses on the development of virtuous character. The central task in morality is not knowing and applying principles but being and becoming a good person, someone possessing the virtues that define moral excellence. The ethics of care em – phasizes the virtues and feelings that are central to close personal relationships. The worth of moral theories can be assessed through the application of the moral criteria of adequacy. Criterion I is consistency with our considered moral judgments; Criterion II, con – sistency with the facts of the moral life; and Criterion III, resourcefulness in moral problem- solving. further reading Thomas Aquinas, Summa Theologica, in Basic Writings of St. Thomas Aquinas , trans. A. C. Pegis (New York: Random House, 1945), volume II, 3–46. Jeremy Bentham, “Of the Principle of Utility,” in An In – troduction to the Principles of Morals and Legislation (Oxford: Clarendon Press, 1879), 1– 7. Baruch A. Brody, Moral Theory and Moral Judgments in Medical Ethics (Dordrecht: Kluwer, 1988). Curtis Brown, “Ethical Theories Compared,” http:// w w w.trinity.edu/cbrown/intro/ethical_theories.html (19 October 2015). Stephen Buckle, “Natural Law,” in A Companion to Ethics , ed. Peter Singer (Cambridge, UK: Blackwell, 1993), 161– 74 . Steven M. Cahn and Joram G. Haber, Twentieth Century Ethical Theory (Upper Saddle River, NJ: Prentice-Hall, 19 95). Robert Cavalier, Online Guide to Ethics and Moral Philosophy , http://caae.phil.cmu.edu/Cavalier/80130/ part2/sect9.html (19 October 2015). Fred Feldman, “Act Utilitarianism: Pro and Con,” in Introductory Ethics (Englewood Cliffs, NJ: Prentice- Hall, 1978), 30–60. John Finnis, Natural Law and Natural Rights ( N e w Yo r k : Oxford University Press, 1980). William K. Frankena, Ethics , 2nd ed. (Englewood Cliffs, NJ: Prentice-Hall, 1973). C. E. Harris, Applying Moral Theories (Belmont, CA: Wadsworth, 1997). Dale Jamieson, “Method and Moral Theory,” in A Com – panion to Ethics , ed. Peter Singer (Cambridge, UK: Blackwell, 1993), 476– 87. Rob Lawlor, “Moral Theories in Teaching Applied Ethics,” Journal of Medical Ethics , June 2007, vol. 33, no. 6, http://w w w.ncbi.nlm.nih.gov/pmc/articles/ PMC2598269/ (19 October 2015). Mark Murphy, “The Natural Law Tradition in Ethics,” in The Stanford Encyclopedia of Philosophy (Winter 2002 ed.), ed. Edward N. Zalta, http://plato.stanford .edu/archives/win2002/entries/natural-law-ethics/. Kai Nielsen, “A Defense of Utilitarianism,” Ethics 82 (1972): 113– 24. Kai Nielsen, Ethics Without God (Buffalo, NY: Prometheus, 1973). Robert Nozick, “The Experience Machine,” in Anarchy, State and Utopia (New York: Basic Books, 1974). Onora O’Neill, “Kantian Ethics,” in A Companion to Ethics , ed. Peter Singer, (Cambridge, UK: Blackwell, 1993), 175– 85. Louis P. Pojman and Lewis Vaughn, eds., The Moral Life , 3rd ed. (New York: Oxford University Press, 2007). James Rachels, The Elements of Moral Philosophy , 4th ed. (New York: McGraw-Hill, 2003). James Rachels, ed., Ethical Theory 2: Theories About How We Should Live (Oxford: Oxford University Press, 1998). John Rawls, “Some Remarks About Moral Theory,” in A Theory of Justice (Cambridge, MA: Harvard Univer – sity Press, 1999), 40– 46. J. J. C. Smart, “Extreme and Restricted Utilitarianism,” in Essays Metaphysical and Moral (Oxford: Blackwell, 1987). Bonnie Steinbock, ed., The Oxford Handbook of Bio – ethics (Oxford: Oxford University Press, 2007). Paul Taylor, Principles of Ethics (Encino, CA: Dickenson, 197 5). Lewis Vaughn, Doing Ethics: Moral Reasoning and Con – temporary Issues (New York: W.W. Norton, 2008). 02-Vaughn-Chap02.indd 52 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 53 11. Examples from Rosalind Hursthouse, Beginning Lives (Oxford: Blackwell, 1987), cited in Justin Oakley, “A Virtue Ethics Approach,” in A Companion to Bioethics (Oxford: Blackwell, 2001), 86– 97. 12. Aristotle, Nicomachean Ethics, trans. W. D. Ross, re vised by J. L. Ackrill and J. O. Urmson (Oxford: Oxford University Press, 1925, 1980), book II, chap. 1. 13. Carol Gilligan, In a Different Voice: Psychological Theory and Women’s Development (Cambridge, MA: Harvard University Press, 1982). 14 . Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 5th ed. (New York: Oxford University Press, 2001), 372. 15. James Rachels, The Elements of Moral Philosophy (New York: McGraw-Hill, 2003), 168. 16 . Annette C. Baier, “The Need for More Than Ju s t ic e ,” Canadian Journal of Philosophy, suppl. vol. 13 (1988):56. 17. Jan Crosthwaite, “Gender and Bioethics,” in A Companion to Bioethics, ed. Helga Kuhse and Peter Singer (Malden, MA: Blackwell, 2001), 32– 40. 18 . Ibid., 3 7. 19. Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics (New York: Oxford University Press, 2013), 401. Bernard Williams, “A Critique of Utilitarianism,” in Utilitarianism: For and Against , ed. J. J. C. Smart and Bernard Williams (New York: Cambridge Uni – versity Press, 1973), 82–117. Scott D. Wilson, “Ethics,” The Internet Encyclopedia of Philosophy , http://www.iep.utm.edu/ (19 October 2 015). notes 1. John Stuart Mill, “What Utilitarianism Is,” in Util i- tarianism , 7th ed. (London: Longmans, Green, and Co., 1879), chap. 2 . 2. Ibid. 3. Ibid. 4. Mill, Utilitarianism, chap. II. 5. Immanuel Kant, Groundwork of the Metaphysics of Morals, trans. H. J. Paton (New York: Harper & Row, 1964), 88. 6. Ibid., 96. 7. John Rawls, A Theory of Justice, rev. ed. (Cambridge, MA: Harvard University Press, 1999), 10. 8. Ibid., 266. 9. Ibid., 13. 10. Norman Daniels, Just Health Care (New York: Cam bridge University Press, 1985), 34– 58. From Utilitarianism, 7th ed. (London: Longmans, Green, and Co., 1879). Utilitarianism JOHN STUART MILL English philosopher John Stuart Mill argues for his view of ethics in Utilitarianism (1861), from which this excerpt is taken. He explains that utilitarians judge the morality of conduct by a single standard, the principle of utility : Right actions are those that result in greater overall well-being (or utility ) for the people involved than any other possible actions. We are duty bound to maximize the utility of everyone affected, regardless of the contrary urgings of moral rules or unbending moral principles. READINGS . . . The creed which accepts as the foundation of morals, Utility, or the Greatest Happiness Principle, holds that actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. By happiness is intended pleasure, and the absence of pain; by un – happiness, pain, and the privation of pleasure. To give a clear view of the moral standard set up by the theory, much more requires to be said; in particular, what things it includes in the ideas of pain and pleasure; and to what extent this is left an open 02-Vaughn-Chap02.indd 53 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 54 PART 1: PRINCIPLES AND THEORIES question. But these supplementary explanations do not affect the theory of life on which this theory of morality is grounded—namely, that pleasure, and freedom from pain, are the only things desirable as ends; and that all desirable things (which are as numerous in the utilitarian as in any other scheme) are desirable either for the pleasure inherent in themselves, or as means to the promotion of plea – sure and the prevention of pain. Now, such a theory of life excites in many minds, and among them in some of the most estimable in feeling and purpose, inveterate dislike. To suppose that life has (as they express it) no higher end than pleasure—no better and nobler object of desire and pursuit—they designate as utterly mean and grovel – ing; as a doctrine worthy only of swine, to whom the followers of Epicurus were, at a very early period, contemptuously likened; and modern holders of the doctrine are occasionally made the subject of equally polite comparisons by its German, French, and English assailants. When thus attacked, the Epicureans have always answered, that it is not they, but their accusers, who represent human nature in a degrading light; since the accusation supposes human beings to be capable of no pleasures except those of which swine are ca – pable. If this supposition were true, the charge could not be gainsaid, but would then be no longer an imputation; for if the sources of pleasure were pre – cisely the same to human beings and to swine, the rule of life which is good enough for the one would be good enough for the other. The comparison of the Epicurean life to that of beasts is felt as degrading, precisely because a beast’s pleasures do not satisfy a human being’s conceptions of happiness. Human beings have faculties more elevated than the animal appetites, and when once made conscious of them, do not regard anything as happiness which does not include their gratification. I do not, indeed, consider the Epicureans to have been by any means faultless in drawing out their scheme of consequences from the utilitarian principle. To do this in any sufficient manner, many Stoic, as well as Christian elements re – quire to be included. But there is no known Epicurean theory of life which does not assign to the pleasures of the intellect; of the feelings and imagination, and of the moral sentiments, a much higher value as pleasures than to those of mere sensation. It must be admitted, however, that utilitarian writers in general have placed the superiority of mental over bodily pleasures chiefly in the greater permanency, safety, uncostliness, &c., of the former—that is, in their cir – cumstantial advantages rather than in their intrinsic nature. And on all these points utilitarians have fully proved their case; but they might have taken the other, and, as it may be called, higher ground, with entire consistency. It is quite compatible with the principle of utility to recognise the fact, that some kinds of pleasure are more desirable and more valu – able than others. It would be absurd that while, in estimating all other things, quality is considered as well as quantity, the estimation of pleasures should be supposed to depend on quantity alone. If I am asked, what I mean by difference of qual – ity in pleasures, or what makes one pleasure more valuable that another, merely as a pleasure, except its being greater in amount, there is but one possible answer. Of two pleasures, if there be one to which all or almost all who have experience of both give a decided preference, irrespective of any feeling of moral obligation to prefer it, that is the more desir – able pleasure. If one of the two is, by those who are competently acquainted with both, placed so far above the other that they prefer it, even though knowing it to be attended with a greater amount of discontent, and would not resign it for any quantity of the other pleasure which their nature is capable of, we are justified in ascribing to the pre – ferred enjoyment a superiority in quality, so far out – weighing quantity as to render it, in comparison, of small account. Now it is an unquestionable fact that those who are equally acquainted with, and equally capable of appreciating and enjoying, both, do give a most marked preference to the manner of existence which employs their higher faculties. Few human creatures would consent to be changed into any of the lower animals, for a promise of the fullest allowance of a beast’s pleasures; no intelligent human being would consent to be a fool, no instructed person would be an ignoramus, no person of feeling and conscience would be selfish and base, even though they should be persuaded that the fool, the dunce, or the rascal is better satisfied with his lot than they are with 02-Vaughn-Chap02.indd 54 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 55 the pig, is of a different opinion, it is because they only know their own side of the question. The other party to the comparison knows both sides. It may be objected, that many who are capable of the higher pleasures, occasionally, under the influ – ence of temptation, postpone them to the lower. But this is quite compatible with a full appreciation of the intrinsic superiority of the higher. Men often, from infirmity of character, make their election for the nearer good, though they know it to be the less valu – able; and this no less when the choice is between two bodily pleasures, than when it is between bodily and mental. They pursue sensual indulgences to the injury of health, though perfectly aware that health is the greater good. It may be further objected, that many who begin with youthful enthusiasm for ev – erything noble, as they advance in years sink into indolence and selfishness. But I do not believe that those who undergo this very common change, vol – untarily choose the lower description of pleasures in preference to the higher. I believe that before they devote themselves exclusively to the one, they have already become incapable of the other. Capacity for the nobler feelings is in most natures a very tender plant, easily killed, not only by hostile influences, but by mere want of sustenance; and in the majority of young persons it speedily dies away if the occupa – tions to which their position in life has devoted them, and the society into which it has thrown them, are not favourable to keeping that higher capacity in ex – ercise. Men lose their high aspirations as they lose their intellectual tastes, because they have not time or opportunity indulging them; and they addict themselves to inferior pleasures, not because they de – liberately prefer them, but because they are either the only ones to which they have access, or the only ones which they are any longer capable of enjoying. It may be questioned whether any one who has remained equally susceptible to both classes of pleasures, ever knowingly and calmly preferred the lower; though many, in all ages, have broken down in an ineffectual attempt to combine both. From this verdict of the only competent judges, I apprehend there can be no appeal. On a question which is the best worth having of two pleasures, or which of two modes of existence is the most grateful to the feelings, apart from its moral attributes and theirs. They would not resign what they possess more than he, for the most complete satisfaction of all the desires which they have in common with him. If they ever fancy they would, it is only in cases of unhappiness so extreme, that to escape from it they would exchange their lot for almost any other, however undesirable in their own eyes. A being of higher faculties requires more to make him happy, is capable probably of more acute suffering, and is certainly accessible to it at more points, than one of an inferior type; but in spite of these liabilities, he can never really wish to sink into what he feels to be a lower grade of existence. We may give what ex – planation we please of this unwillingness; we may attribute it to pride, a name which is given indis – criminately to some of the most and to some of the least estimable feelings of which mankind are ca – pable; we may refer it to the love of liberty and per – sonal independence, an appeal to which was with the Stoics one of the most effective means for the inculcation of it; to the love of power, or to the love of excitement, both of which do really enter into and contribute to it: but its most appropriate appel – lation is a sense of dignity, which all human beings possess in one form or other, and in some, though by no means in exact, proportion to their higher faculties, and which is so essential a part of the hap – piness of those in whom it is strong, that nothing which conflicts with it could be, otherwise than momentarily, an object of desire to them. Whoever supposes that this preference takes place at a sacri – fice of happiness—that the superior being, in any – thing like equal circumstances, is not happier than the inferior—confounds the two very different ideas, of happiness, and content. It is indisputable that the being whose capacities of enjoyment are low, has the greatest chance of having them fully satisfied; and a highly-endowed being will always feel that any happiness which he can look for, as the world is constituted, is imperfect. But he can learn to bear its imperfections, if they are at all bearable; and they will not make him env y the being who is indeed unconcious of the imperfections, but only because he feels not at all the good which those im – perfections qualify. It is better to be a human being dissatisfied than a pig statisfied; better to be Socrates dissatisfied than a fool satisfied. And if the fool, or 02-Vaughn-Chap02.indd 55 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 56 PART 1: PRINCIPLES AND THEORIES from its consequences, the judgment of those who are qualified by knowledge of both, or, if they differ, that of the majority among them, must be admitted as final. And there needs be the less hesitation to accept this judgment respecting the quality of plea – sures, since there is no other tribunal to be referred to even on the question of quantity. What means are there of determining which is the acutest of two pains, or the intensest of two pleasurable sensations, except the general suffrage of those who are familiar with both? Neither pains nor pleasures are homogeneous, and pain is always heterogeneous with pleasure. What is there to decide whether a particular plea – sure is worth purchasing at the cost of a particular pain, except the feelings and judgment of the experi – enced? When, therefore, those feelings and judg – ment declare the pleasures derived from the higher faculties to be preferable in kind, apart from the question of intensity, to those of which the animal nature, disjoined from the higher faculties, is sus – ceptible, they are entitled on this subject to the same regard. . . . Reprinted from The Foundations of the Metaphysic of morals, translated by T. K. Abbott (this translation first published in 1873). The Moral Law IMMANUEL KANT Kant argues that his moral theory is the very antithesis of utilitarianism, holding that right actions do not depend in the least on consequences, the production of happiness, or the desires and needs of human beings. For Kant, the core of morality consists of following a rational and universally applicable moral rule —the Categori – cal Imperative — and doing so solely out of a sense of duty. An action is right only if it conforms to such a rule, and we are morally praiseworthy only if we perform it for duty’s sake alone. Preface As my concern here is with moral philosophy, I limit the question suggested to this: Whether it is not of the utmost necessity to construct a pure moral phi – losophy, perfectly cleared of everything which is only empirical, and which belongs to anthropology? for that such a philosophy must be possible is evident from the common idea of duty and of the moral laws. Everyone must admit that if a law is to have moral force, i.e., to be the basis of an obligation, it must carry with it absolute necessity; that, for ex – ample, the precept, ‘‘Thou shall not lie,’’ is not valid for men alone, as if other rational beings had no need to observe it; and so with all the other moral laws properly so called; that, therefore, the basis of obligation must not be sought in the nature of man, or in the circumstances in the world in which he is placed, but a priori simply in the conception of pure reason; and although any other precept which is founded on principles of mere experience may be in certain respects universal, yet in as far as it rests even in the least degree on an empirical basis, perhaps only as to motive, such a precept, while it may be a practical rule, can never be called a moral law. . . . The Good Will Nothing can possibly be conceived in the world, or even out of it, which can be called good, without qualification, except a Good Will. Intelligence, wit, judgment, and the other talents of the mind, how – ever they may be named, or courage, resolution, perseverance, as qualities of temperament, are un – doubtedly good and desirable in many respects; but these gifts of nature may also become extremely bad and mischievous if the will which is to make use of them, and which, therefore, constitutes what is called c h a ra c t e r, is not good. It is the same with 02-Vaughn-Chap02.indd 56 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 57 can neither add to nor take away anything from this value. It would be, as it were, only the setting to enable us to handle it the more conveniently in common commerce, or to attract to it the attention of those who are not yet connoisseurs, but not to recommend it to true connoisseurs, or to determine its value. . . . The Supreme Principle of Morality: The Categorical Imperative As I have deprived the will of every impulse which could arise to it from obedience to any law, there remains nothing but the universal conformity of its actions to law in general, which alone is to serve the will as principle, i.e., I am never to act otherwise than so that I could also will that my maxim should become a universal law. Here, now, it is the simple conformity to law in general, without assuming any particular law applicable to certain actions, that serves the will as its principle, and must so serve it, if duty is not to be a vain delusion and a chimerical notion. The common reason of men in its practical judgments perfectly coincides with this, and always has in view the principle here suggested. Let the question be, for example: May I when in distress make a promise with the intention not to keep it? I readily distinguish here between the two significa – tions which the question may have: Whether it is prudent, or whether it is right, to make a false promise? The former may undoubtedly often be the case. I see clearly indeed that it is not enough to ex – tricate myself from a present difficulty by means of this subterfuge, but it must be well considered whether there may not hereafter spring from this lie much greater inconvenience than that from which I now free myself, and as, with all my supposed cunning, the consequences cannot be so easily fore – seen but the credit once lost may be much more injurious to me than any mischief which I seek to avoid at present, it should be considered whether it would not be more prudent to act herein according to a universal maxim, and to make it a habit to promise nothing except with the intention of keep – ing it. But it is soon clear to me that such a maxim will still only be based on the fear of consequences. Now it is a wholly different thing to be truthful from duty, and to be so from apprehension of injurious the gifts of fortune . Power, riches, honour, even health, and the general well-being and contentment with one’s conditions which is called happiness , inspire pride, and often presumption, if there is not a good will to correct the influence of these on the mind, and with this also to rectify the whole prin – ciple of acting, and adapt it to its end. The sight of a being who is not adorned with a single feature of a pure and good will, enjoying unbroken prosperity, can never give pleasure to an impartial rational spectator. Thus a good will appears to constitute the indispensable condition even of being worthy of happiness. There are even some qualities which are of service to this good will itself, and may facilitate its action, yet which have no intrinsic unconditional value, but always presuppose a good will, and this qualifies the esteem that we justly have for them, and does not permit us to regard them as absolutely good. Mod – eration in the affections and passions, self-control, and calm deliberation are not only good in many respects, but even seem to constitute part of the in – trinsic worth of the person but they are far from deserving to be called good without qualification, although they have been so unconditionally praised by the ancients. For without the principles of a good will, they may become extremely bad; and the cool – ness of a villain not only makes him far more danger – ous, but also directly makes him more abominable in our eyes than he would have been without it. A good will is good not because of what it per – forms or effects, not by its aptness for the attain – ment of some proposed end, but simply by virtue of the volition, that is, it is good in itself, and consid – ered by itself to be esteemed much higher than all that can be brought about by it in favor of any in – clination, nay, even of the sum-total of all inclina – tions. Even if it should happen that, owing to special disfavor of fortune, or the niggardly provi – sion of a step-motherly nature, this will should wholly lack powder to accomplish its purpose, if with its greatest efforts it should yet achieve nothing, and there should remain only the good will (not, to be sure, a mere wish, but the summoning of all means in our power), then, like a jewel, it would still shine by its own light, as a thing which has its whole value in itself. Its usefulness or fruitlessness 02-Vaughn-Chap02.indd 57 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 58 PART 1: PRINCIPLES AND THEORIES consequences. In the first case, the very notion of the action already implies a law for me; in the second case, I must first look about elsewhere to see what results may be combined with it which would affect myself. For to deviate from the principle of duty is beyond all doubt wicked; but to be unfaith – ful to my maxim of prudence may often be very advantageous to me, although to abide by it is cer – tainly safer. The shortest way, however, and an un – erring one, to discover the answer to this question whether a lying promise is consistent with duty, is to ask myself, Should I be content that my maxim (to extricate myself from difficulty by a false prom – ise) should hold good as a universal law, for myself as well as for others? And should I be able to say to myself, ‘‘Every one may make a deceitful promise when he finds himself in a difficulty from which he cannot otherwise extricate himself ’’? Then I pres – ently become aware that while I can will the lie, I can by no means will that lying should be a uni – versal law. For with such a law there would be no promises at all, since it would be in vain to allege my intention in regard to my future actions to t hose who would not believe this allegation, or if they over-hastily did so, would pay me back in my own coin. Hence my maxim, as soon as it should be made a universal law, would necessarily destroy itself. I do not, therefore, need any far-reaching pene – tration to discern what I have to do in order that my will may be morally good. Inexperienced in the course of the world, incapable of being prepared for all its contingencies, I only ask myself: canst thou also will that thy maxim should be a universal law? It not, then it must be rejected, and that not because of a disadvantage accruing from myself or even to others, but because it cannot enter as a principle into a possible universal legislation, and reason extorts from me immediate respect for such legislation. I do not indeed as yet discern on what this respect is based (this the philosopher may inquire), but at least I understand this, that it is an estimation of the worth which far outweighs all worth of what is rec – ommended by inclination, and that the necessity of acting from pure respect for the practical law is what constitutes duty, to which every other motive must give place, because it is the condition of a will being good in itself, and the worth of such a will is above every thing. Thus, then, without quitting the moral knowledge of common human reason, we have arrived at its principle. And although, no doubt, common men do not conceive it in such an abstract and universal form, yet they always have it really before their eyes, and use it as the standard of their decision. . . . Nor could anything be more fatal to morality than that we should wish to derive it from examples. For every example of it that is set before me must be first itself tested by principles of morality, whether it is worthy to serve as an original example, i.e., as a pattern, but by no means can it authoritatively fur – nish the conception of morality. Even the Holy one of the Gospels must first be compared with our ideal of moral perfection before we can recognize Him as such; and so He says of Himself, ‘‘Why call ye Me [whom you see] good; none is good [the model of good] but God only [whom ye do not see].’’ But whence have we the conception of God as the supreme good? Simply from the idea of moral perfection, which reason frames a priori, and connects inseparably with the notion of a free will. Imitation finds no place at all in morality, and examples serve only for en – couragement, i.e., they put beyond doubt the feasibil – ity of what the law commands, they make visible that which the practical rule expresses more generally, but they can never authorize us to set aside the true original which lies in reason, and to guide ourselves by examples. From what has been said, it is clear that all moral conceptions have their seat and origin completely a priori in the reason, and that, moreover, in the com – monest reason just as truly as in that which is in the highest degree speculative; that they cannot be ob – tained by abstraction from any empirical, and there – fore merely contingent knowledge; that it is just this purity of their origin that makes them worthy to serve as our supreme practical principle, and that just in proportion as we add anything empirical, we detract from their genuine influence, and from the absolute value of actions; that it is not only of the greatest necessity, in a purely speculative point of view, but is also of the greatest practical importance, to derive these notions and laws from pure reason, to present them pure and unmixed, and even to determine the 02-Vaughn-Chap02.indd 58 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 59 thou canst at the same time will that it should become a universal law. Now if all imperatives of duty can be deduced from this one imperative as from their principle, then, although it should remain undecided whether what is called duty is not merely a vain notion, yet at least we shall be able to show what we understand by it and what this notion means. Since the universality of the law according to which effects are produced constitutes what is prop – erly called nature in the most general sense (as to form), that is the existence of things so far as it is determined by general laws, the imperative of duty may be expressed thus: Act as if the maxim of tby action were to become by tby will a universal law of nature. Four Illustrations We will now enumerate a few duties, adopting the usual division of them into duties to ourselves and to others and into perfect and imperfect duties. 1. A man reduced to despair by a series of misfor – tunes feels wearied of life, but is still so far in posses – sion of his reason that he can ask himself whether it would not be contrary to his duty to himself to take his own life. Now he inquires whether the maxim of his action could become a universal law of nature. His maxim is: From self-love I adopt it as a principle to shorten my life when its longer duration is likely to bring more evil than satisfaction. It is asked then simply whether this principle founded on self-love can become a universal law of nature. Now we see at once that a system of nature of which it should be a law to destroy life by means of the very feeling whose special nature it is to impel to the improvement of life would contradict itself, and therefore could not exist as a system of nature, and consequently would be wholly inconsistent with the supreme principle of all duty. 2. Another finds himself forced by necessity to borrow money. He knows that he will not be able to repay it, but sees also that nothing will be lent to him, unless he promises stoutly to repay it in a definite time. He desires to make this promise, but he has still so much conscience as to ask himself: Is it not unlawful and inconsistent with duty to get out of a compass of this practical or pure rational knowledge, i.e. to determine the whole faculty of pure practical reason; and, in doing so, we must not make its prin – ciples dependent on the particular nature of human reason, though in speculative philosophy this may be permitted, or may even at times be necessary; but since moral laws ought to hold good for every ratio – nal creature, we must derive them from the general concept of a rational being. In this way, although for its application to man morality has need of anthro – pology, yet, in the first instance, we must treat it in – dependently as pure philosophy, i.e., as metaphysic, complete in itself (a thing which in such distinct branches of science is easily done); knowing well that unless we are in possession of this, it would not only be vain to determine the moral element of duty in right actions for purposes of speculative criticism, but it would be impossible to base morals on their genuine principles, even for common practical purposes, es – pecially of moral instruction, so as to produce pure moral dispositions, and to engraft them on men’s minds to the promotion of the greatest possible good in the world. . . . First Formulation of the Categorical Imperative: Universal Law In this problem we will first inquire whether the mere conception of a categorical imperative may not perhaps supply us also with the formula of it, containing the proposition which alone can be a categorical imperative; for even if we know the tenor of such an absolute command, yet how it is possible will require further special and laborious study, which we postpone to the last section. When I conceive a hypothetical imperative, in general I do not know beforehand what it will contain until I am given the condition. But when I conceive a categorical imperative, I know at once what it con – tains. For as the imperative contains besides the law only the necessity that the maxims shall conform to this law, while the law contains no conditions re – stricting it, there remains nothing but the general statement that the maxim of the action should con – form to a universal law, and it is this conformity alone that the imperative properly represents as necessary. There is therefore but one categorical impera – tive, namely, this: Act only in that maxim whereby 02-Vaughn-Chap02.indd 59 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 60 PART 1: PRINCIPLES AND THEORIES difficulty in this way? Suppose, however, that he re – solves to do so, then the maxim of his action would be expressed thus: When I think myself in want of money, I will borrow money and promise to repay it, although I know that I never can do so. Now this principle of self-love or of one’s own advantage may perhaps be consistent with my whole future welfare; but the question is, Is it right? I change then the sug – gestion of self-love into a universal law, and state the question thus: How would it be if my maxim were a universal law? Then I see at once that it could never hold as a universal law of nature, but would necessar – ily contradict itself. For supposing it to be a universal law that everyone when he thinks himself in a diffi – culty should be able to promise whatever he pleases, with the purpose of not keeping his promise, the promise itself would become impossible, as well as the end that one might have in view in it, since no one would consider that anything was promised to him, but would consider that anything was promised to him, but would ridicule all such statements as vain pretenses. 3. A third finds in himself a talent which with the help of some culture might make him a useful man in many respects. But he finds himself in comfort – able circumstances, and prefers to indulge in pleasure rather than to take pains in enlarging and improv – ing his happy natural capacities. He asks, however, whether his maxim of neglect of his natural gifts, besides agreeing with his inclination to indulgence, agrees also with what is called duty. He sees then that a system of nature could indeed subsist with such a universal law although men (like the South Sea islanders) should let their talents rest, and re – solve to devote their lives merely to idleness, amuse – ment, and propagation of their species— in a word, to enjoyment; but he cannot possibly will that this should be a universal law of nature, or be implanted in us as such by a natural instinct. For, as a rational being, he necessarily wills that his faculties be de – veloped, since they serve him, and have been given him, for all sorts of possible purposes. 4. A fourth, who is in prosperity, while he sees that others have to contend with great wretchedness and that he could help them, thinks: What concern is it of mine? Let everyone be as happy as Heaven Pleases, or as he can make himself; I will take nothing from him nor even env y him, only I do not wish to contribute anything to his welfare or to his assis – tance in distress! Now no doubt if such a mode of thinking were a universal law, the human race might very well subsist, and doubtless even better than in a state in which everyone talks of sympathy and good- will, or even takes care occasionally to put it into practice, but, on the other side, also cheats when he can, betrays the right of men, or otherwise violates them. But although it is possible that a universal law of nature might exist in accordance with that maxim, it is impossible to will that such a principle should have the universal validity of a law of nature. For a will which resolved this would contradict itself, inasmuch as many cases might occur in which one would have need of the love and sympathy of others, and in which, by such a law of nature, sprung from his own will, he would deprive himself of all hope of the aid he desires. These are a few of the many actual duties, or at least what we regard as such, which obviously fall into two classes on the one principle that we have laid down. We must be able to will that a maxim of our action should be a universal law. This is the canon of the moral appreciation of the action generally. Some actions are of such a character that their maxim cannot without contradiction be even conceived as a universal law of nature, far from it being possible that we should will that it should be so. In others this intrinsic impossibility is not found, but still it is im – possible to will that their maxim should be raised to the universality of a law of nature, since such a will would contradict itself. It is easily seen that the former violate strict or rigorous (inflexible) duty; the latter only laxer (meritorious) duty. Thus it has been completely shown by these examples how all duties depend as regards the nature of the obligation (not the object of the action) on the same principle. Second Formulation of the Categorical Imperative: Humanity as an End in Itself . . . Now I say: man and generally any rational being exists as an end in himself, not merely as a means to be arbitrarily used by this or that will, but in all 02-Vaughn-Chap02.indd 60 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 61 principle is: rational nature exists as an end in itself. Man necessarily conceives his own existence as being so; so far then this is a subjective principle of human actions. But every other rational being regards its existence similarly, just on the same rational prin – ciple that holds for me: so that it is at the same time an objective principle, from which as a supreme practical law all laws of the will must be capable of being deduced. Accordingly the practical imperative will be as follows. So act as to treat humanity, whether in thine own person or in that of any other, in every case as an end withal, never as means only. . . . . . . Looking back now on all previous attempts to discover the principle of morality, we need not wonder why they all failed. It was seen that man was bound to laws by duty, but it was not observed that the laws to which he is subject are only those of his own giving , though at the same time they are universal , and that he is only bound to act in con – formity with his own will; a will, however, which is designed by nature to give universal laws. For when one has conceived man only as subject to a law (no matter what), then this law required some interest, either by way of attraction or constraint, since it did not originate as a law from his own will, but his will was according to a law obliged by something else to act in a certain manner. Now by this necessary consequence all the labour spent in finding a su – preme principle of duty was irrevocably lost. For men never elicited duty , but only a necessity of acting from a certain interest. Whether this interest was private or otherwise, in any case the imperative must be conditional, and could not by any means be capable of being a moral command. I will there – fore call this the principle of Autonomy of the will, in contrast with every other which I accordingly reckon as Heteronomy . his actions, whether they concern himself or other rational beings, must be always regarded at the same time as an end. All objects of the inclinations have only a conditional worth; for if the inclina – tions and the wants founded on them did not exist, then their object would be without value. But the inclinations themselves being sources of want are so far from having an absolute worth for which they should be desired, that on the contrary, it must be the universal wish of every rational being to be wholly free from them. Thus the worth of any object which is to be acquired by our action is always con – ditional. Beings whose existence depends not on our will but on nature’s, have nevertheless, if they are nonrational beings, only a relative value as means, and are therefore called things ; rational beings, on the contrary, are called persons , because their very nature points them out as ends in themselves, that is as something which must not be used merely as means, and so far therefore restricts freedom of action (and is an object of respect). These, therefore, are not merely subjective ends whose existence has a worth for us as an effect of our action, but objective ends, that is things whose existence is an end in itself: an end moreover for which no other can be substi – tuted, which they should subserve merely as means, for otherwise nothing whatever would possess absolute worth; but if all worth were conditioned and therefore contingent, then there wouldbe no supreme practical principle of reason whatever. If then there is a supreme practical principle or, in respect of the human will, categorical impera – tive, it must be one which, being drawn from the conception of that which is necessarily an end for everyone because it is an end in itself, constitutes an objective principle of will, and can therefore serve as a universal practical law. The foundation of this 02-Vaughn-Chap02.indd 61 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 62 PART 1: PRINCIPLES AND THEORIES for Kant, fulfilling an obligation; again it is a qual – ity of character, or, rather, a whole range of quali – ties of character, some of which may actually be defects, such as tactlessness, boastfulness, and so on—a point which can be brought out, in terms of principles, only with the greatest complexity and artificiality, but quite simply and naturally in terms of character. If we wish to enquire about Aristotle’s moral views, it is no use looking for a set of principles. Of course we can find some principles to which he must have subscribed—for instance, that one ought not to commit adultery. But what we find much more prominently is a set of character-traits, a list of certain types of person—the courageous man, the niggardly man, the boaster, the lavish spender, and so on. The basic moral question, for Aristotle, is not. What shall I do? but, What shall I be? These contrasts between doing and being, nega – tive and positive, and modern as against Greek mo – rality were noted by John Stuart Mill; I quote from the Essay on Liberty: Christian morality (so-called) has all the characters of a reaction; it is, in great part, a protest against Paganism. Its ideal is negative rather than positive, passive rather than active; Innocence rather than Nobleness; Abstinence from Evil, rather than energetic Pursuit of the Good; in its precepts (as has been well said) “Thou shalt not” predominates unduly over “Thou shalt . . . ” Whatever exists of magnanimity, high-mindedness, personal dignity, even the sense of honour, is derived from the purely human, not the religious part of our education, and never could have grown out of a standard of ethics in which the only worth, professedly recognized, is that of obedience. The philosophy of moral principles, which is charac – teristic of Kant and the post-Kantian era, is some – thing of which hardly a trace exists in Plato. . . . Plato says nothing about rules or principles or laws, except when he is talking politics. Instead he talks about virtues and vices, and about certain types of human character. The key word in Platonic ethics is Virtue; the key word in Kantian ethics is Duty. And modern ethics is a set of footnotes, not to Plato, but to Kant. . . . Attention to the novelists can be a welcome cor – rection to a tendency of philosophical ethics of the last generation or two to lose contact with the ordi – nary life of man which is just what the novelists, in their own way, are concerned with. Of course there are writers who can be called in to illustrate prob – lems about Duty (Graham Greene is a good exam – ple). But there are more who perhaps never mention the words duty, obligation, or principle. Yet they are all concerned—Jane Austen, for instance, en – tirely and absolutely—with the moral qualities or defects of their heroes and heroines and other characters. This points to a radical one-sidedness in the philosophers’ account of morality in terms of principles: it takes little or no account of qualities, of what people are. It is just here that the old-fashioned word Virtue used to have a place; and it is just here that the work of Plato and Aristotle can be instruc – tive. Justice, for Plato, though it is closely con – nected with acting according to law, does not mean acting according to law: it is a quality of character, and a just action is one such as a just man would do. Telling the truth, for Aristotle, is not, as it was From Ethics and the Moral Life. Copyright © 1958 by Macmillan. Reprinted by permission of Palgrave Macmillan. Virtue and the Moral Life BERNARD MAYO The British philosopher Bernard Mayo (1920 –2000) is the author of Ethics and the Moral Life , from which this excerpt is taken. He contrasts moral theories based on right actions with those that emphasize moral character. He argues that saints and heroes demonstrate that moral examples are what is really important in morality, not rigid rules. We should strive not to regiment our lives according to moral tenets, but to be virtuous people. 02-Vaughn-Chap02.indd 62 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 63 (or forbidding) all actions of a certain type in situa- tions of a certain type, and, secondly, a statement to the effect that this is a situation of that type, falling under that rule. In practice the emphasis may be on supplying only one of these premises, the other being assumed or taken for granted: one may answer the question “What ought I to do?” either by quoting a rule which I am to adopt, or by showing that my case is legislated for by a rule which I do adopt. . . . [I]f I am in doubt whether to tell the truth about his condition to a dying man, my doubt may be resolved by showing that the case comes under a rule about the avoidance of unnecessary suffering, which I am assumed to accept. But if the case is without precedent in my moral career, my problem may be soluble only by adopting a new principle about what I am to do now and in the future about cases of this kind. This second possibility offers a connection with moral ideas. Suppose my perplexity is not merely an unprecedented situation which I could cope with by adopting a new rule. Suppose the new rule is thoroughly inconsistent with my existing moral code. This may happen, for instance, if the moral code is one to which I only pay lip-service, if . . . its authority is not yet internalised, or if it has ceased to be so; it is ready for rejection, but its final rejec – tion awaits a moral crisis such as we are assuming to occur. What I now need is not a rule for decid – ing how to act in this situation and others of its kind. I need a whole set of rules, a complete moral – ity, new principles to live by. Now, according to the philosophy of moral char – acter, there is another way of answering the funda – mental question “What ought I to do?” Instead of quoting a rule, we quote a quality of character, a virtue: we say “Be brave,” or “Be patient” or “Be le – nient.” We may even say “Be a man”: if I am in doubt, say, whether to take a risk, and someone says “Be a man,” meaning a morally sound man, in this case a man of sufficient courage. (Compare the very different ideal invoked in “Be a gentleman.” I shall not discuss whether this is a moral ideal.) Here, too, we have the extreme cases, where a man’s moral perplexity ex – tends not merely to a particular situation but to his whole way of living. And now the question “W hat ought I to do?” turns into the question “What ought I to be?”—as, indeed, it was treated in the Of course, there are connections between being and doing. It is obvious that a man cannot just be ; he can only be what he is by doing what he does; his moral qualities are ascribed to him because of his actions, which are said to manifest those qualities. But the point is that an ethics of Being must in – clude this obvious fact, that Being involves Doing; whereas an ethics of Doing, such as I have been ex – amining, may easily overlook it. As I have suggested, a morality of principles is concerned only with what people do or fail to do, since that is what rules are for. And as far as this sort of ethics goes, people might well have no moral qualities at all except the possession of principles and the will (and capacity) to act accordingly. When we speak of a moral quality such as cour – age, and say that a certain action was courageous, we are not merely saying something about the action. We are referring, not so much to what is done, as to the kind of person by whom we take it to have been done. We connect, by means of imputed motives and intentions, with the character of the agent as courageous. This explains, incidentally, why both Kantians and Utilitarians encounter, in their differ – ent ways, such difficulties in dealing with motives, which their principles, on the face of it, have no room for. A Utilitarian, for example, can only praise a courageous action in some such way as this: the action is of a sort such as a person of courage is likely to perform, and courage is a quality of char – acter the cultivation of which is likely to increase rather than diminish the sum total of human hap – piness. But Aristotelians have no need of such circum – locution. For them a courageous action just is one which proceeds from and manifests a certain type of character, and is praised because such a character trait is good, or better than others, or is a virtue. An evaluative criterion is sufficient: there is no need to look for an imperative criterion as well, or rather instead, according to which it is not the character which is good, but the cultivation of the character which is right. . . . No doubt the fundamental moral question is just “What ought I to do?” And according to the philoso – phy of moral principles, the answer (which must be an imperative “Do this”) must be derived from a con – junction of premises consisting (in the simplest case) firstly of a rule, or universal imperative, enjoining 02-Vaughn-Chap02.indd 63 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 64 PART 1: PRINCIPLES AND THEORIES first place. (“Be brave.”) It is answered, not by quot – ing a rule or a set of rules, but by describing a quality of character or a type of person. And here the ethics of character gains a practical simplicity which off – sets the greater logical simplicity of the ethics of principles. We do not have to give a list of charac – teristics or virtues, as we might list a set of princi – ples. We can give a unity to our answer. Of course we can in theory give a unity to our principles: this is implied by speaking of a set of principles. But if such a set is to be a system and not merely aggregate, the unity we are looking for is a logical one, namely the possibility that some prin – ciples are deductible from others, and ultimately from one. But the attempt to construct a deductive moral system is notoriously difficult, and in any case ill-founded. Why should we expect that all rules of conduct should be ultimately reducible to a few? Saints and Heroes But when we are asked “What shall I be?” we can readily give a unity to our answer, though not a logical unity. It is the unity of character. A person’s character is not merely a list of dispositions; it has the organic unity of something that is more than the sum of its parts. And we can say, in answer to our morally perplexed questioner, not only “Be this” and “Be that,” but also “Be like So-and-So”— where So-and-So is either an ideal type of character, or else an actual person taken as representative of the ideal, as exemplar. Examples of the first are Plato’s “ just man” in the Republic; Aristotle’s man of practical wisdom, in the Nicomachean Ethics ; Augustine’s citizen of the City of God; the good Communist; the American way of life (which is a collective expression for a type of character). Exam – ples of the second kind, the exemplar, are Socrates, Christ, Buddha, St. Francis, the heroes of epic writ – ers and of novelists. Indeed the idea of the Hero, as well as the idea of the Saint, are very much the expression of this attitude to morality. Heroes and saints are not merely people who did things. They are people whom we are expected, and expect our – selves, to imitate. And imitating them means not merely doing what they did; it means being like them. Their status is not in the least like that of leg – islators whose laws we admire; for the character of a legislator is irrelevant to our judgment about his legislation. The heroes and saints did not merely give us principles to live by (though some of them did that as well): they gave us examples to follow. Kant, as we should expect, emphatically rejects this attitude as “fatal to morality.” According to him, examples serve only to render visible an instance of the moral principle, and thereby to demonstrate its practical feasibility. But every exemplar, such as Christ himself, must be judged by the independent criterion of the moral law, before we are entitled to recognize him as worthy of imitation. I am not sug – gesting that the subordination of exemplars to prin – ciples is incorrect, but that it is one-sided and fails to do justice to a large area of moral experience. Imitation can be more or less successful. And this suggests another defect of the ethics of princi – ples. It has no room for ideals, except the ideal of a perfect set of principles (which, as a matter of fact, is intelligible only in terms of an ideal character or way of life), and the ideal of perfect conscien – tiousness (which is itself a character-trait). This re – sults, of course, from the “black-or-white” nature of moral verdicts based on rules. There are degrees by which we approach or recede from the attainment of a certain quality or virtue; if there were not, the word “ideal” would have no meaning. Heroes and saints are not people whom we try to be just like, since we know that is impossible. It is precisely be – cause it is impossible for ordinary human beings to achieve the same qualities as the saints, and in the same degree, that we do set them apart from the rest of humanity. It is enough if we try to be a little like them. . . . 02-Vaughn-Chap02.indd 64 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 65 they often see the need to reconceptualize these considerations. Features of the Ethics of Care Some advocates of the ethics of care resist gener- alizing this approach into something that can be fitted into the form of a moral theory. They see it as a mosaic of insights and value the way it is sensitive to contextual nuance and particular narratives rather than making the abstract and universal claims of more familiar moral theories. 2 Still, I think one can discern among various versions of the ethics of care a number of major features. First, the central focus of the ethics of care is on the compelling moral salience of attending to and meeting the needs of the particular others for whom we take responsibility. Caring for one’s child, for instance, may well and defensibly be at the fore – front of a person’s moral concerns. The ethics of care recognizes that human beings are dependent for many years of their lives, that the moral claim of those dependent on us for the care they need is pressing, and that there are highly important moral aspects in developing the relations of caring that enable human beings to live and progress. All per – sons need care for at least their early years. Pros – pects for human progress and flourishing hinge fundamentally on the care that those needing it receive, and the ethics of care stresses the moral force of the responsibility to respond to the needs of the dependent. Many persons will become ill and dependent for some periods of their later lives, including in frail old age, and some who are per – manently disabled will need care the whole of their lives. Moralities built on the image of the indepen – dent, autonomous, rational individual largely over – look the reality of human dependence and the The ethics of care is only a few decades old. 1 Some theorists do not like the term “care” to designate this approach to moral issues and have tried substituting “the ethic of love,” or “relational ethics,” but the dis – course keeps returning to “care” as the so far more satisfactory of the terms considered, though dissat – isfactions with it remain. The concept of care has the advantage of not losing sight of the work in – volved in caring for people and of not lending itself to the interpretation of morality as ideal but im – practical to which advocates of the ethics of care often object. Care is both value and practice. By now, the ethics of care has moved far beyond its original formulations, and any attempt to evalu – ate it should consider much more than the one or two early works so frequently cited. It has been devel – oped as a moral theory relevant not only to the so- called private realms of family and friendship but to medical practice, law, political life, the organiza – tion of society, war, and international relations. The ethics of care is sometimes seen as a potential moral theory to be substituted for such dominant moral theories as Kantian ethics, utilitarianism, or Aristotelian virtue ethics. It is sometimes seen as a form of virtue ethics. It is almost always devel – oped as emphasizing neglected moral considerations of at least as much importance as the consider – ations central to moralities of justice and rights or of utility and preference satisfaction. And many who contribute to the understanding of the ethics of care seek to integrate the moral considerations, such as justice, which other moral theories have clarified, satisfactorily with those of care, though The Ethics of Care VIRGINIA HELD Virginia Held has taught philosophy at Hunter College and The Graduate Center of the City University of New York. In this reading, she explores the ethics of care, identifying its central themes, showing how it relates to an “ethic of justice,” and distinguishing it from virtue ethics. From The Ethics of Care: Personal, Political, and Global by Virginia Held (2006). “The Ethics of Care as Moral Theory.” 02-Vaughn-Chap02.indd 65 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 66 PART 1: PRINCIPLES AND THEORIES morality for which it calls. The ethics of care attends to this central concern of human life and delin – eates the moral values involved. It refuses to relegate care to a realm “outside morality.” How caring for particular others should be reconciled with the claims of, for instance, universal justice is an issue that needs to be addressed. But the ethics of care starts with the moral claims of particular others, for instance, of one’s child, whose claims can be compelling regardless of universal principles. Second, in the epistemological process of trying to understand what morality would recommend and what it would be morally best for us to do and to be, the ethics of care values emotion rather than rejects it. Not all emotion is valued, of course, but in contrast with the dominant rationalist approaches, such emotions as sympathy, empathy, sensitivity, and responsiveness are seen as the kind of moral emotions that need to be cultivated not only to help in the implementation of the dictates of reason but to better ascertain what morality recommends. 3 Even anger may be a component of the moral indig – nation that should be felt when people are treated unjustly or inhumanely, and it may contribute to (rather than interfere with) an appropriate inter – pretation of the moral wrong. This is not to say that raw emotion can be a guide to morality; feelings need to be reflected on and educated. But from the care perspective, moral inquiries that rely entirely on reason and rationalistic deductions or calcula – tions are seen as deficient. The emotions that are typically considered and rejected in rationalistic moral theories are the egoistic feelings that undermine universal moral norms, the favoritism that interferes with impar – tiality, and the aggressive and vengeful impulses for which morality is to provide restraints. The ethics of care, in contrast, typically appreciates the emo – tions and relational capabilities that enable morally concerned persons in actual interpersonal contexts to understand what would be best. Since even the helpful emotions can often become misguided or worse—as when excessive empathy with others leads to a wrongful degree of self-denial or when benevolent concern crosses over into controlling domination—we need an ethics of care, not just care itself. The various aspects and expressions of care and caring relations need to be subjected to moral scrutiny and evaluated, not just observed and described. Third, the ethics of care rejects the view of the dominant moral theories that the more abstract the reasoning about a moral problem the better because the more likely to avoid bias and arbitrari – ness, the more nearly to achieve impartiality. The ethics of care respects rather than removes itself from the claims of particular others with whom we share actual relationships. 4 It calls into ques – tion the universalistic and abstract rules of the dominant theories. When the latter consider such actual relations as between a parent and child, if they say anything about them at all, they may see them as permitted and cultivating them a prefer – ence that a person may have. Or they may recog – nize a universal obligation for all parents to care for their children. But they do not permit actual relations ever to take priority over the require – ments of impartiality. As Brian Barry expresses this view, there can be universal rules permitting people to favor their friends in certain contexts, such as deciding to whom to give holiday gifts, but the latter partiality is morally acceptable only be – cause universal rules have already so judged it. 5 The ethics of care, in contrast, is skeptical of such abstraction and reliance on universal rules and questions the priority given to them. To most ad – vocates of the ethics of care, the compelling moral claim of the particular other may be valid even when it conflicts with the requirement usually made by moral theories that moral judgments be universalizeable, and this is of fundamental moral importance. 6 Hence the potential conflict between care and justice, friendship and impartiality, loy – alty and universality. To others, however, there need be no conflict if universal judgments come to incorporate appropriately the norms of care previ – ously disregarded. Annette Baier considers how a feminist approach to morality differs from a Kantian one and Kant’s claim that women are incapable of being fully moral because of their reliance on emotion rather than reason. She writes, “Where Kant concludes ‘so much the worse for women,’ we can conclude ‘so much the worse for the male fixation on the special skill of 02-Vaughn-Chap02.indd 66 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 67 drafting legislation, for the bureaucratic mentality of rule worship, and for the male exaggeration of the importance of independence over mutual interdependence.” 7 Margaret Walker contrasts what she sees as femi – nist “moral understanding” with what has tradition – ally been thought of as moral “knowledge.” She sees the moral understanding she advocates as involving “attention, contextual and narrative appreciation, and communication in the event of moral delibera – tion.” This alternative moral epistemology holds that “the adequacy of moral understanding decreases as its form approaches generality through abstraction.” 8 The ethics of care may seek to limit the applica – bility of universal rules to certain domains where they are more appropriate, like the domain of law, and resist their extension to other domains. Such rules may simply be inappropriate in, for instance, the contexts of family and friendship, yet relations in these domains should certainly be evaluated , not merely described, hence morality should not be limited to abstract rules. We should be able to give moral guidance concerning actual relations that are trusting, considerate, and caring and concerning those that are not. Dominant moral theories tend to interpret moral problems as if they were conflicts between egoistic individual interests on the one hand, and universal moral principles on the other. The ex – tremes of “selfish individual” and “humanity” are recognized, but what lies between these is often overlooked. The ethics of care, in contrast, focuses especially on the area between these extremes. Those who conscientiously care for others are not seeking primarily to further their own individual interests; their interests are intertwined with the persons they care for. Neither are they acting for the sake of all others or humanity in general; they seek instead to preserve or promote an actual human relation between themselves and particu- lar others . Persons in caring relations are acting for self-and-other together. Their characteristic stance is neither egoistic nor altruistic; these are the options in a conflictual situation, but the well- being of a caring relation involves the cooperative well-being of those in the relation and the well- being of the relation itself. In trying to overcome the attitudes and prob – lems of tribalism and religious intolerance, dominant moralities have tended to assimilate the domains of family and friendship to the tribal, or to a source of the unfair favoring of one’s own. Or they have seen the attachments people have in these areas as among the nonmoral private preferences people are permitted to pursue if restrained by impartial moral norms. The ethics of care recognizes the moral value and importance of relations of family and friend – ship and the need for moral guidance in these do – mains to understand how existing relations should often be changed and new ones developed. Having grasped the value of caring relations in such con – texts as these more personal ones, the ethics of care then often examines social and political arrange – ments in the light of these values. In its more devel – oped forms, the ethics of care as a feminist ethic offers suggestions for the radical transformation of society. It demands not just equality for women in existing structures of society but equal consider – ation for the experience that reveals the values, im – portance, and moral significance, of caring. A fourth characteristic of the ethics of care is that like much feminist thought in many areas, it re-conceptualizes traditional notions about the public and the private. The traditional view, built into the dominant moral theories, is that the house – hold is a private sphere beyond politics into which government, based on consent, should not intrude. Feminists have shown how the greater social, po – litical, economic, and cultural power of men has structured this “private” sphere to the disadvantage of women and children, rendering them vulnerable to domestic violence without outside interference, often leaving women economically dependent on men and subject to a highly inequitable division of labor in the family. The law has not hesitated to in – tervene into women’s private decisions concerning reproduction but has been highly reluctant to in – trude on men’s exercise of coercive power within the “castles” of their homes. Dominant moral theories have seen “public” life as relevant to morality while missing the moral significance of the “private” domains of family and friendship. Thus the dominant theories have assumed that morality should be sought for unrelated, 02-Vaughn-Chap02.indd 67 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 68 PART 1: PRINCIPLES AND THEORIES independent, and mutually indifferent individuals assumed to be equal. They have posited an abstract, fully rational “agent as such” from which to con – struct morality, 9 while missing the moral issues that arise between interconnected persons in the contexts of family, friendship, and social groups. In the context of the family, it is typical for rela – tions to be between persons with highly unequal power who did not choose the ties and obligations in which they find themselves enmeshed. For in – stance, no child can choose her parents yet she may well have obligations to care for them. Relations of this kind are standardly noncontractual, and con- ceptualizing them as contractual would often un – dermine or at least obscure the trust on which their worth depends. The ethics of care addresses rather than neglects moral issues arising in relations among the unequal and dependent, relations that are often laden with emotion and involuntary, and then notices how often these attributes apply not only in the household but in the wider society as well. For instance, persons do not choose which gender, racial, class, ethnic, religious, national, or cultural groups to be brought up in, yet these sorts of ties may be important aspects of who they are and how their experience can contribute to moral understanding. A fifth characteristic of the ethics of care is the conception of persons with which it begins. This will be dealt with in the next section. The Critique of Liberal Individualism The ethics of care usually works with a conception of persons as relational, rather than as the self-sufficient independent individuals of the dominant moral the – ories. The dominant theories can be interpreted as importing into moral theory a concept of the person developed primarily for liberal political and eco – nomic theory, seeing the person as a rational, auton – omous agent, or a self-interested individual. On this view, society is made up of “independent, autono – mous units who cooperate only when the terms of cooperation are such as to make it further the ends of each of the parties,” in Brian Barry’s words. 10 O r, i f they are Kantians, they refrain from actions that they could not will to be universal laws to which all fully rational and autonomous individual agents could agree. What such views hold, in Michael Sandel’s critique of them, is that “what separates us is in some important sense prior to what connects us—epistemologically prior as well as morally prior. We are distinct individuals first and then we form relationships.” 11 In Martha Nussbaum’s liberal fem – inist morality, “the flourishing of human beings taken one by one is both analytically and norma – tively prior to the flourishing” of any group. 12 The ethics of care, in contrast, characteristically sees persons as relational and interdependent, morally and epistemologically. Every person starts out as a child dependent on those providing us care, and we remain interdependent with others in thor – oughly fundamental ways throughout our lives. That we can think and act as if we were independent depends on a network of social relations making it possible for us to do so. And our relations are part of what constitute our identity. This is not to say that we cannot become autonomous; feminists have done much interesting work developing an alterna – tive conception of autonomy in place of the liberal individualist one. 13 Feminists have much experience rejecting or reconstituting relational ties that are oppressive. But it means that from the perspective of an ethics of care, to construct morality as if we were Robinson Crusoes, or, to use Hobbes’s image, mushrooms sprung from nowhere, is misleading. 14 As Eva Kittay writes, this conception fosters the il – lusion that society is composed of free, equal, and independent individuals who can choose to asso – ciate with one another or not. It obscures the very real facts of dependency for everyone when they are young, for most people at various periods in their lives when they are ill or old and infirm, for some who are disabled, and for all those engaged in unpaid “dependency work.” 15 And it obscures the innumer – able ways persons and groups are interdependent in the modern world. Not only does the liberal individualist concep – tion of the person foster a false picture of society and the persons in it, it is, from the perspective of the ethics of care, impoverished also as an ideal. The ethics of care values the ties we have with particular other persons and the actual relationships that partly constitute our identity. Although persons often may and should reshape their relations with 02-Vaughn-Chap02.indd 68 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 69 singular noun. Some moral philosophers have tried to establish a definitional distinction between “ethics” and “morality”; I think such efforts fail, and I use the terms more or less interchangeably, though I certainly distinguish between the moral or ethical beliefs groups of people in fact have and moral or ethical recommendations that are justifiable or admirable. 2. See, for example, Annette C. Baier, Moral Prejudices : Essays on Ethics (Cambridge, Mass.: Harvard University Press, 1994), esp. chap. 1; Peta Bowden, Caring: Gender Sen – sitive Ethics (London: Routledge, 1997); and Margaret Urban Walker, “Feminism, Ethics, and the Question of Theory,” Hypatia: A Journal of Feminist Philosophy 7 (1992): 23–38. 3. See, for example, Baier, Moral Prejudices, Virginia Held, Feminist Morality : Transforming Culture , Society, and Politics (Chicago: University of Chicago Press, 1993); Diana Tietjens Meyers, Subjection and Subjectivity (New York: Routledge, 1994); and Margaret Urban Walker, Moral Understandings : A Feminist Study in Ethics (New York: Routledge, 1998). 4. See, for example, Seyla Benhabib, Situating the Self : Gender, Community , and Postmodernism in Contemporary Ethics (New York: Routledge, 1992); Marilyn Friedman, What Are Friends For? Feminist Perspectives on Personal Relationships (Ithaca, N.Y.: Cornell University Press, 1993); Held, Feminist Morality ; and Eva Feder Kittay, Love’s Labor: Essays on Women , Equality, and Dependency (New York: Routledge, 1999). 5. See Brian Barry, Justice as Impartiality (Oxford: Oxford University Press, 1995); Diemut Bubeck, Care , Gender, and Justice (Oxford: Oxford University Press, 1995), pp. 239–40; and Susan Mendus, Impartiality in Moral and Political Philosophy (Oxford: Oxford University Press, 2002). 6. It is often asserted that to count as moral, a judgment must be universalizeable: If we hold that it would be right (or wrong) for one person to do something, then we are committed to holding that it would be right (or wrong) for anyone similar in similar circumstances to do it. The sub – ject terms in moral judgments must thus be universally quantified variables and the predicates universal. “I ought to take care of Jane because she is my child ” is not univer – sal; “all parents ought to take care of their children” is. The former judgment could be universalizeable if it were derived from the latter, but if, as many advocates of the ethics of care think, it is taken as a starting moral commit – ment (rather than as dependent on universal moral judg – ments), it might not be universalizeable. 7. B a ier, Moral Prejudices, p. 26. 8. Margaret Urban Walker, “Moral Understandings: Alternative ‘Epistemology’ for a Feminist Ethics,” Hypatia 4 (summer 1989): 15–28, pp. 19–20. 9. Good examples are Stephen L. Darwall, Impartial Reason (Ithaca, N.Y.: Cornell University Press, 1983), and others—distancing themselves from some persons and groups and developing or strengthening ties with others—the autonomy sought within the ethics of care is a capacity to reshape and cultivate new re – lations, not to ever more closely resemble the unen – cumbered abstract rational self of liberal political and moral theories. Those motivated by the ethics of care would seek to become more admirable rela – tional persons in better caring relations. Even if the liberal ideal is meant only to instruct us on what would be rational in the terms of its ideal model, thinking of persons as the model pres – ents them has effects that should not be welcomed. As Annette Baier writes, “Liberal morality, if un – supplemented, may unfit people to be anything other than what its justifying theories suppose them to be, ones who have no interest in each other’s inter – e s t s .” 16 There is strong empirical evidence of how adopting a theoretical model can lead to behavior that mirrors it. Various studies show that studying economics, with its “repeated and intensive expo – sure to a model whose unequivocal prediction” is that people will decide what to do on the basis of self-interest, leads economics students to be less cooperative and more inclined to free ride than other students. 17 The conception of the person adopted by the dominant moral theories provides moralities at best suitable for legal, political, and economic interac – tions between relative strangers, once adequate trust exists for them to form a political entity. 18 The ethics of care is, instead, hospitable to the relatedness of persons. It sees many of our responsibilities as not freely entered into but presented to us by the acci – dents of our embeddedness in familial and social and historical contexts. It often calls on us to take responsibility, while liberal individualist morality focuses on how we should leave each other alone. The view of persons as embedded and encumbered seems fundamental to much feminist thinking about mo – rality and especially to the ethics of care. . . . notes 1. I use the term “ethics” to suggest that there are multiple versions of this ethic, though they all have much in common, making it understandable that some prefer “the ethic of care.” I use “the ethics of care” as a collective and 02-Vaughn-Chap02.indd 69 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 70 PART 1: PRINCIPLES AND THEORIES David Gauthier, Morals by Agreement (Oxford: Oxford University Press, 1986). 10. Brian Barry, The Liberal Theory of Justice (London: Oxford University Press, 1973), p. 166. 11. Michael Sandel, Liberalism and the Limits of Justice (C a m – bridge, U.K.: Cambridge University Press, 1982), p. 133. Other examples of the communitarian critique that ran parallel to the feminist one are Alasdair Maclntyre, After Virtue : A Study in Moral Theory (Notre Dame, Ind.: University of Notre Dame Press, 1981), and Whose Justice ? Which Rationality? (Notre Dame, Ind.: University of Notre Dame Press, 1988); Charles Taylor, Hegel and Modern Society (Cambridge , U.K.: Cam – bridge University Press, 1979); and Roberto Mangabeire Unger, Knowledge and Politics (New York: Free Press, 1975). 12. Martha Nussbaum, Sex and Social Justice (New York: Oxford University Press, 1999), p. 62. 13. See, for example, Diana T. Meyers, Self , Society, and Personal Choice (New York: Columbia University Press, 1989); Grace Clement, Care, Autonomy , and Justice (Boulder, Colo.: Westview Press, 1996); Diana T. Meyers, ed., Feminists Rethink the Self (Boulder, Colo.: Westview Press, 1997); and Catriona MacKenzie and Natalie Stoljar, eds., Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self (New York: Oxford University Press, 2000). See also Marina Oshana, “Personal Autonomy and Society,” Journal of Social Philosophy 29(1) (spring 1998): 81–102. 14. This image is in Thomas Hobbes’s The Citizen : Philosophical Rudiments Concerning Government and Society, ed. B. Gert (Garden City, N.Y.: Doubleday, 1972), p. 205. For a contrasting view, see Sibyl Schwarzenbach, “On Civic Friendship,” Ethics 107(1) (1996): 97–128. 15. Kittay, Love’s Labor. 16. B a ier, Moral Prejudices, p. 29. 17. See Robert A. Frank, Thomas Gilovich, and Dennis T. Regan, “Does Studying Economics Inhibit Cooperation?” Journal of Economic Perspectives 7(2) (spring 1993): 159–71; and Gerald Marwell and Ruth Ames, “Economists Free Ride, Does Anyone Else?: Experiments on the Provision of Public Goods, IV,” Journal of Public Economics 15( 3) (June 1981): 295–310. 18. See Virginia Held, Rights and Goods: Justifying Social Action (Chicago: University of Chicago Press, 1989), chap. 5, “The Grounds for Social Trust.” moral saints SUSAN WOLF Susan Wolf is a professor of philosophy at the University of North Carolina, Chapel Hill, working mostly in ethics and the related areas of philosophy of mind, philoso – phy of action, political philosophy, and aesthetics. In this selection, she examines the idea of moral saints, exploring the implications of moral sainthood for utilitarianism, Kantian ethics, and moral philosophy generally. I don’t know whether there are any moral saints. But if there are, I am glad that neither I nor those about whom I care most are among them. By moral saint I mean a person whose every action is as morally good as possible, a person, that is, who is as morally worthy as can be. Though I shall in a moment acknowledge the variety of types of person that might be thought to satisfy this description, it seems to me that none of these types serve as unequivocally compelling personal ideals. In other words, I believe that moral perfection, in the sense of moral saintliness, does not constitute a model of personal well-being toward which it would be par – ticularly rational or good or desirable for a human being to strive. Outside the context of moral discussion, this will strike many as an obvious point. But, within that context, the point, if it be granted, will be granted with some discomfort. For within that con – text it is generally assumed that one ought to be as morally good as possible and that what limits there are to morality’s hold on us are set by features of human nature of which we ought not to be proud. If, as I believe, the ideals that are derivable from From Susan Wolf, “Moral Saints,” Journal of Philosophy , vol. LX XIX, no. 8, 1982. 02-Vaughn-Chap02.indd 70 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 71 makes him a moral saint is rather that he pays little or no attention to his own happiness in light of the overriding importance he gives to the wider con- cerns of morality. In other words, this person sacri – fices his own interests to the interests of others, and feels the sacrifice as such. Roughly, these two models may be distinguished according to whether one thinks of the moral saint as being a saint out of love or one thinks of the moral saint as being a saint out of duty (or some other intellectual appreciation and recognition of moral principles). We may refer to the first model as the model of the Loving Saint; to the second, as the model of the Rational Saint. The two models differ considerably with respect to the qualities of the motives of the individuals who conform to them. But this difference would have limited effect on the saints’ respective public person – alities. The shared content of what these individuals are motivated to be—namely, as morally good as possible—would play the dominant role in the de – termination of their characters. Of course, just as a variety of large-scale projects, from tending the sick to political campaigning, may be equally and maxi – mally morally worthy, so a variety of characters are compatible with the ideal of moral sainthood. One moral saint may be more or less jovial, more or less garrulous, more or less athletic than another. But, above all, a moral saint must have and cultivate those qualities which are apt to allow him to treat others as justly and kindly as possible. He will have the standard moral virtues to a nonstandard degree. He will be patient, considerate, even-tempered, hos – pitable, charitable in thought as well as in deed. He will be very reluctant to make negative judgments of other people. He will be careful not to favor some people over others on the basis of properties they could not help but have. Perhaps what I have already said is enough to make some people begin to regard the absence of moral saints in their lives as a blessing. For there comes a point in the listing of virtues that a moral saint is likely to have where one might naturally begin to wonder whether the moral saint isn’t, after all, too good—if not too good for his own good, at least too good for his own well-being. For the moral virtues, given that they are, by hypothesis, all present common sense and philosophically popular moral theories do not support these assumptions, then something has to change. Either we must change our moral theories in ways that will make them yield more palatable ideals, or, as I shall argue, we must change our conception of what is involved in af – firming a moral theory. In this paper, I wish to examine the notion of a moral saint, first, to understand what a moral saint would be like and why such a being would be unat – tractive, and, second, to raise some questions about the significance of this paradoxical figure for moral philosophy. I shall look first at the model(s) of moral sainthood that might be extrapolated from the morality or moralities of common sense. Then I shall consider what relations these have to conclusions that can be drawn from utilitarian and Kantian moral theories. Finally, I shall speculate on the implica – tions of these considerations for moral philosophy. Moral Saints and Common Sense Consider first what, pretheoretically, would count for us—contemporary members of Western culture— as a moral saint. A necessary condition of moral sainthood would be that one’s life be dominated by a commitment to improving the welfare of others or of society as a whole. As to what role this com – mitment must play in the individual’s motivational system, two contrasting accounts suggest themselves to me which might equally be thought to qualify a person for moral sainthood. First, a moral saint might be someone whose concern for others plays the role that is played in most of our lives by more selfish, or, at any rate, less morally worthy concerns. For the moral saint, the promotion of the welfare of others might play the role that is played for most of us by the enjoyment of material comforts, the opportunity to engage in the intellectual and physical activities of our choice, and the love, respect, and companionship of people whom we love, respect, and enjoy. The happiness of the moral saint, then, would truly lie in the happiness of others, and so he would devote himself to others gladly, and with a whole and open heart. On the other hand, a moral saint might be some – one for whom the basic ingredients of happiness are not unlike those of most of the rest of us. What 02-Vaughn-Chap02.indd 71 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 72 PART 1: PRINCIPLES AND THEORIES one which rests on the decision not to justify every activity against morally beneficial alternatives, and this is a decision a moral saint will never make. Presumably, an interest in high fashion or interior design will fare much the same, as will, very possi – bly, a cultivation of the finer arts as well. A moral saint will have to be very, very nice. It is important that he not be offensive. The worry is that, as a result, he will have to be dull-witted or humorless or bland. This worry is confirmed when we consider what sorts of characters, taken and refined both from life and from fiction, typically form our ideals. One would hope they would be figures who are morally good—and by this I mean more than just not mor – ally bad—but one would hope, too, that they are not just morally good, but talented or accomplished or attractive in nonmoral ways as well. We may make ideals out of athletes, scholars, artists—more frivo – lously, out of cowboys, private eyes, and rock stars. We may strive for Katharine Hepburn’s grace, Paul Newman’s “cool”; we are attracted to the high- spirited passionate nature of Natasha Rostov; we admire the keen perceptiveness of Lambert Strether. Though there is certainly nothing immoral about the ideal characters or traits I have in mind, they cannot be superimposed upon the ideal of a moral saint. For although it is a part of many of these ideals that the characters set high, and not merely acceptable, moral standards for themselves, it is also essential to their power and attractiveness that the moral strengths go, so to speak, alongside of specific, independently admirable, nonmoral ground projects and dominant personal traits. When one does finally turn one’s eyes toward lives that are dominated by explicitly moral com – mitments, moreover, one finds oneself relieved at the discovery of idiosyncrasies or eccentricities not quite in line with the picture of moral perfection. One prefers the blunt, tactless, and opinionated Betsy Trotwood to the unfailingly kind and patient Agnes Copperfield; one prefers the mischievous – ness and the sense of irony in Chesterton’s Father Brown to the innocence and undiscriminating love of St. Francis. It seems that, as we look in our ideals for people who achieve nonmoral varieties of personal excellence in the same individual, and to an extreme degree, are apt to crowd out the nonmoral virtues, as well as many of the interests and personal characteristics that we generally think contribute to a healthy, well- rounded, richly developed character. In other words, if the moral saint is devoting all his time to feeding the hungry or healing the sick or raising money for Oxfam, then necessarily he is not reading Victorian novels, playing the oboe, or im – proving his backhand. Although no one of the in – terests or tastes in the category containing these latter activities could be claimed to be a necessary element in a life well lived, a life in which none of these possible aspects of character are developed may seem to be a life strangely barren. The reasons why a moral saint cannot, in gen – eral, encourage the discovery and development of significant nonmoral interests and skills are not logical but practical reasons. There are, in addition, a class of nonmoral characteristics that a moral saint cannot encourage in himself for reasons that are not just practical. There is a more substantial tension between having any of these qualities un – ashamedly and being a moral saint. These qualities might be described as going against the moral grain. For example, a cynical or sarcastic wit, or a sense of humor that appreciates this kind of wit in others, requires that one take an attitude of resignation and pessimism toward the flaws and vices to be found in the world. A moral saint, on the other hand, has reason to take an attitude in opposition to this—he should try to look for the best in people, give them the benefit of the doubt as long as possible, try to improve regrettable situations as long as there is any hope of success. This suggests that, although a moral saint might well enjoy a good episode of Father Knows Best, he may not in good conscience be able to laugh at a Marx Brothers movie or enjoy a play by George Bernard Shaw. An interest in something like gourmet cooking will be, for different reasons, difficult for a moral saint to rest easy with. For it seems to me that no plausible argument can justify the use of human resources involved in producing a paté de canard en croute against possible alternative beneficent ends to which these resources might be put. If there is a justification for the institution of haute cuisine, it is 02-Vaughn-Chap02.indd 72 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 73 qualities and being a moral saint it does not follow that having any of these qualities is immoral. For it is not part of common-sense morality that one ought to be a moral saint. Still, if someone just hap- pened to want to be a moral saint, he or she would not have or encourage these qualities, and, on the basis of our common-sense values, this counts as a reason not to want to be a moral saint. . . . Moral Saints and Moral Theories I have tried so far to paint a picture—or, rather, two pictures—of what a moral saint might be like, draw – ing on what I take to be the attitudes and beliefs about morality prevalent in contemporary, common- sense thought. To my suggestion that common- sense morality generates conceptions of moral saints that are unattractive or otherwise unacceptable, it is open to someone to reply, “so much the worse for common-sense morality.” After all, it is often claimed that the goal of moral philosophy is to cor – rect and improve upon common-sense morality, and I have as yet given no attention to the question of what conceptions of moral sainthood, if any, are gen – erated from the leading moral theories of our time. A quick, breezy reading of utilitarian and Kantian writings will suggest the images, respectively, of the Loving Saint and the Rational Saint. A utilitarian, with his emphasis on happiness, will certainly prefer the Loving Saint to the Rational one, since the Loving Saint will himself be a happier person than the Rational Saint. A Kantian, with his emphasis on reason, on the other hand, will find at least as much to praise in the latter as in the former. Still, both models, drawn as they are from common sense, appeal to an impure mixture of utilitarian and Kantian intuitions. A more careful examination of these moral theories raises questions about whether either model of moral sainthood would really be advocated by a believer in the explicit doctrines as – sociated with either of these views. Certainly, the utilitarian in no way denies the value of self-realization. He in no way disparages the development of interests, talents, and other per – sonally attractive traits that I have claimed the moral saint would be without. Indeed, since just these fea – tures enhance the happiness both of the individuals who possess them and of those with whom they in conjunction with or colored by some version of high moral tone, we look in our paragons of moral excellence for people whose moral achievements occur in conjunction with or colored by some inter – ests or traits that have low moral tone. In other words, there seems to be a limit to how much mo – rality we can stand. . . . Moreover, there is something odd about the idea of morality itself, or moral goodness, serving as the object of a dominant passion in the way that a more concrete and specific vision of a goal (even a con – crete moral goal) might be imagined to serve. Mo – rality itself does not seem to be a suitable object of passion. Thus, when one reflects, for example, on the Loving Saint easily and gladly giving up his fishing trip or his stereo or his hot fudge sundae at the drop of the moral hat, one is apt to wonder not at how much he loves morality, but at how little he loves these other things. One thinks that, if he can give these up so easily, he does not know what it is to truly love them. There seems, in other words, to be a kind of joy which the Loving Saint, either by nature or by practice, is incapable of experiencing. The Rational Saint, on the other hand, might retain strong nonmoral and concrete desires—he simply denies himself the opportunity to act on them. But this is no less troubling. The Loving Saint one might suspect of missing a piece of perceptual machinery, of being blind to some of what the world has to offer. The Rational Saint, who sees it but foregoes it, one suspects of having a different problem—a path – ological fear of damnation, perhaps, or an extreme form of self-hatred that interferes with his ability to enjoy the enjoyable in life. In other words, the ideal of a life of moral saint – hood disturbs not simply because it is an ideal of a life in which morality unduly dominates. The normal person’s direct and specific desires for objects, ac – tivities, and events that conflict with the attainment of moral perfection are not simply sacrificed but removed, suppressed, or subsumed. The way in which morality, unlike other possible goals, is apt to dom – inate is particularly disturbing, for it seems to re – quire either the lack or the denial of the existence of an identifiable, personal self. . . . It must be remembered that from the fact that there is a tension between having any of these 02-Vaughn-Chap02.indd 73 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 74 PART 1: PRINCIPLES AND THEORIES aspirations on his sleeve. If it is not too difficult, the utilitarian will try not to make those around him uncomfortable. He will not want to appear “holier than thou”; he will not want to inhibit others’ abil – ity to enjoy themselves. In practice, this might make the perfect utilitarian a less nauseating companion than the moral saint I earlier portrayed. But insofar as this kind of reasoning produces a more bearable public personality, it is at the cost of giving him a personality that must be evaluated as hypocritical and condescending when his private thoughts and attitudes are taken into account. Still, the criticisms I have raised against the saint of common-sense morality should make some dif – ference to the utilitarian’s conception of an ideal which neither requires him to abandon his utili – tarian principles nor forces him to fake an interest he does not have or a judgment he does not make. For it may be that a limited and carefully monitored allotment of time and energy to be devoted to the pursuit of some nonmoral interests or to the devel – opment of some nonmoral talents would make a person a better contributor to the general welfare than he would be if he allowed himself no indul – gences of this sort. The enjoyment of such activities in no way compromises a commitment to utilitar – ian principles as long as the involvement with these activities is conditioned by a willingness to give them up whenever it is recognized that they cease to be in the general interest. This will go some way in mitigating the picture of the loving saint that an understanding of utilitari – anism will on first impression suggest. But I think it will not go very far. For the limitations on time and energy will have to be rather severe, and the need to monitor will restrict not only the extent but also the quality of one’s attachment to these interests and traits. They are only weak and somewhat peculiar sorts of passions to which one can consciously remain so conditionally committed. Moreover, the way in which the utilitarian can enjoy these “extra- curricular” aspects of his life is simply not the way in which these aspects are to be enjoyed insofar as they figure into our less saintly ideals. The problem is not exactly that the utilitarian values these aspects of his life only as a means to an end, for the enjoyment he and others get from these associate, the ability to promote these features both in oneself and in others will have considerable posi – tive weight in utilitarian calculations. This implies that the utilitarian would not support moral sainthood as a universal ideal. A world in which everyone, or even a large number of people, achieved moral sainthood—even a world in which they strove to achieve it—would probably contain less happiness than a world in which people realized a diversity of ideals involving a variety of personal and perfectionist values. More pragmatic consid – erations also suggest that, if the utilitarian wants to influence more people to achieve more good, then he would do better to encourage them to pursue happiness-producing goals that are more attractive and more within a normal person’s reach. These considerations still leave open, however, the question of what kind of an ideal the committed utilitarian should privately aspire to himself. Utili – tarianism requires him to want to achieve the greatest general happiness, and this would seem to commit him to the ideal of the moral saint. One might try to use the claims I made earlier as a basis for an argument that a utilitarian should choose to give up utilitarianism. If, as I have said, a moral saint would be a less happy person both to be and to be around than many other possible ideals, perhaps one could create more total happiness by not trying too hard to promote the total happiness. But this argument is simply unconvincing in light of the empirical circumstances of our world. The gain in happiness that would accrue to oneself and one’s neighbors by a more well-rounded, richer life than that of the moral saint would be pathetically small in comparison to the amount by which one could increase the general happiness if one devoted oneself explicitly to the care of the sick, the down – trodden, the starving, and the homeless. Of course, there may be psychological limits to the extent to which a person can devote himself to such things without going crazy. But the utilitarian’s individual limitations would not thereby become a positive feature of his personal ideals. The unattractiveness of the moral saint, then, ought not rationally convince the utilitarian to aban – don his utilitarianism. It may, however, convince him to take efforts not to wear his saintly moral 02-Vaughn-Chap02.indd 74 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 75 duties to ourselves, duties to increase our natural as well as our moral perfection. These duties are un- limited in the degree to which they may dominate a life. If action in accordance with and motivated by the thought of these duties is considered virtuous, it is natural to assume that the more one performs such actions, the more virtuous one is. Moreover, of virtue in general Kant says, “it is an ideal which is unattainable while yet our duty is constantly to approximate to it.” 1 On this interpretation, then, the Kantian moral saint, like the other moral saints I have been considering, is dominated by the moti – vation to be moral. Which of these interpretations of Kant one pre – fers will depend on the interpretation and the importance one gives to the role of the imperfect duties in Kant’s over-all system. Rather than choose between them here, I shall consider each briefly in turn. On the second interpretation of Kant, the Kantian moral saint is, not surprisingly, subject to many of the same objections I have been raising against other versions of moral sainthood. Though the Kantian saint may differ from the utilitarian saint as to which actions he is bound to perform and which he is bound to refrain from performing, I suspect that the range of activities acceptable to the Kantian saint will remain objectionably restrictive. Moreover, the manner in which the Kantian saint must think about and justify the activities he pursues and t he character traits he develops will strike us, as it did with the utilitarian saint, as containing “one thought too many.” As the utilitarian could value his activities and character traits only insofar as they fell under the description of “contributions to the general happiness,” the Kantian would have to value his activities and character traits insofar as they were manifestations of respect for the moral law. If the development of our powers to achieve physical, intellectual, or artistic excellence, or the activities directed toward making others happy are to have any moral worth, they must arise from a reverence for the dignity that members of our spe – cies have as a result of being endowed with pure practical reason. This is a good and noble motiva – tion, to be sure. But it is hardly what one expects to be dominantly behind a person’s aspirations to aspects are not a means to, but a part of, the general happiness. Nonetheless, he values these things only because of and insofar as they are a part of the general happiness. He values them, as it were, under the description “a contribution to the general hap – piness.” This is to be contrasted with the various ways in which these aspects of life may be valued by nonutilitarians. A person might love literature be – cause of the insights into human nature literature affords. Another might love the cultivation of roses because roses are things of great beauty and deli – cacy. It may be true that these features of the re – spective activities also explain why these activities are happiness-producing. But, to the nonutilitarian, this may not be to the point. For if one values these activities in these more direct ways, one may not be willing to exchange them for others that produce an equal, or even a greater amount of happiness. From that point of view, it is not because they produce happiness that these activities are valuable; it is be – cause these activities are valuable in more direct and specific ways that they produce happiness. . . . The Kantian believes that being morally worthy consists in always acting from maxims that one could will to be universal law, and doing this not out of any pathological desire but out of reverence for the moral law as such, Or, to take a different for – mulation of the categorical imperative, the Kantian believes that moral action consists in treating other persons always as ends and never as means only. Presumably, and according to Kant himself, the Kantian thereby commits himself to some degree of benevolence as well as to the rules of fair play. But we surely would not will that every person become a moral saint, and treating others as ends hardly requires bending over backwards to protect and promote their interests. On one interpretation of Kantian doctrine, then, moral perfection would be achieved simply by unerring obedience to a limited set of side-constraints. On this interpretation, Kantian theory simply does not yield an ideal conception of a person of any fullness comparable to that of the moral saints I have so far been portraying. On the other hand, Kant does say explicitly that we have a duty of benevolence, a duty not only to allow others to pursue their ends, but to take up their ends as our own. In addition, we have positive 02-Vaughn-Chap02.indd 75 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 76 PART 1: PRINCIPLES AND THEORIES concerned with what kind of life it is in a person’s interest to lead, but with what kind of interests it would be good for a person to have, and it need not be in a person’s interest that he acquire or maintain objectively good interests. Indeed, the model of the Loving Saint, whose interests are identified with the interests of morality, is a model of a person for whom the dictates of rational self-interest and the dictates of morality coincide. Yet, I have urged t hat we have reason not to aspire to this ideal and that some of us would have reason to be sorry if our children aspired to and achieved it. The moral point of view, we might say, is the point of view one takes up insofar as one takes the recognition of the fact that one is just one person among others equally real and deserving of the good things in life as a fact with practical consequences, a fact the recognition of which demands expression in one’s actions and in the form of one’s practical deliberations. Competing moral theories offer al – ternative answers to the question of what the most correct or the best way to express this fact is. In doing so, they offer alternative ways to evaluate and to compare the variety of actions, states of affairs, and so on that appear good and bad to agents from other, nonmoral points of view. But it seems that alternative interpretations of the moral point of view do not exhaust the ways in which our actions, char – acters, and their consequences can be comprehen – sively and objectively evaluated. Let us call the point of view from which we consider what kinds of lives are good lives, and what kinds of persons it would be good for ourselves and others to be, the point of view of individual perfection. Since either point of view provides a way of com – prehensively evaluating a person’s life, each point of view takes account of, and, in a sense, subsumes the other. From the moral point of view, the perfection of an individual life will have some, but limited, value—for each individual remains, after all, just one person among others. From the perfectionist point of view, the moral worth of an individual’s re – lation to his world will likewise have some, but lim – ited, value—for, as I have argued, the (perfectionist) goodness of an individual’s life does not vary pro – portionally with the degree to which it exemplifies moral goodness. dance as well as Fred Astaire, to paint as well as Picasso, or to solve some outstanding problem in abstract algebra, and it is hardly what one hopes to find lying dominantly behind a father’s action on behalf of his son or a lover’s on behalf of her beloved. . . . Moral Saints and Moral Philosophy In pointing out the regrettable features and the nec – essary absence of some desirable features in a moral saint, I have not meant to condemn the moral saint or the person who aspires to become one. Rather, I have meant to insist that the ideal of moral saint – hood should not be held as a standard against which any other ideal must be judged or justified, and that the posture we take in response to the recognition that our lives are not as morally good as they might be need not be defensive. 2 It is misleading to insist that one is permitted to live a life in which the goals, relationships, activities, and interests that one pur – sues are not maximally morally good. For our lives are not so comprehensively subject to the require – ment that we apply for permission, and our non – moral reasons for the goals we set ourselves are not excuses, but may rather be positive, good reasons which do not exist despite any reasons that might threaten to outweigh them. In other words, a person may be perfectly wonderful without being perfectly moral. Recognizing this requires a perspective which contemporary moral philosophy has generally ig – nored. This perspective yields judgments of a type that is neither moral nor egoistic. Like moral judg – ments, judgments about what it would be good for a person to be are made from a point of view outside the limits set by the values, interests, and desires that the person might actually have. And, like moral judgments, these judgments claim for themselves a kind of objectivity or a grounding in a perspective which any rational and perceptive being can take up. Unlike moral judgments, however, the good with which these judgments are concerned is not the good of anyone or any group other than the individual himself. Nonetheless, it would be equally misleading to say that these judgments are made for the sake of the individual himself. For these judgments are not 02-Vaughn-Chap02.indd 76 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 2: Bioethics and Moral Theories 77 our values cannot be fully comprehended on the model of a hierarchical system with morality at the top. The philosophical temperament will naturally incline, at this point, toward asking, “What, then, is at the top—or, if there is no top, how are we to decide when and how much to be moral?” In other words, there is a temptation to seek a metamoral— though not, in the standard sense, metaethical— theory that will give us principles, or, at least, informal directives on the basis of which we can develop and evaluate more comprehensive personal ideals. Perhaps a theory that distinguishes among the various roles a person is expected to play within a life—as professional, as citizen, as friend, and so on—might give us some rules that would offer us, if nothing else, a better framework in which to think about and discuss these questions. I am pessimistic, however, about the chances of such a theory to yield substantial and satisfying results. For I do not see how a metamoral theory could be constructed which would not be subject to considerations parallel to those which seem inherently to limit the appro – priateness of regarding moral theories as ultimate comprehensive guides for action. This suggests that, at some point, both in our philosophizing and in our lives, we must be willing to raise normative questions from a perspective that is unattached to a commitment to any particular well-ordered system of values. It must be admitted that, in doing so, we run the risk of finding norma – tive answers that diverge from the answers given by whatever moral theory one accepts. This, I take it, is the grain of truth in G. E. Moore’s “open question” argument. In the background of this paper, then, there lurks a commitment to what seems to me to be a healthy form of intuitionism. It is a form of in – tuitionism which is not intended to take the place of more rigorous, systematically developed, moral theories—rather, it is intended to put these more rigorous and systematic moral theories in their place. notes 1. Immanuel Kant, The Doctrine of Virtue, Mary J. Gregor, trans. (New York: Harper & Row, 1964), p. 71. 2. George Orwell makes a similar point in “Reflections on Gandhi,” in A Collection of Essays by George Orwell It may not be the case that the perfectionist point of view is like the moral point of view in being a point of view we are ever obliged to take up and ex- press in our actions. Nonetheless, it provides us with reasons that are independent of moral reasons for wanting ourselves and others to develop our char – acters and live our lives in certain ways. When we take up this point of view and ask how much it would be good for an individual to act from the moral point of view, we do not find an obvious answer. 3 The considerations of this paper suggest, at any rate, that the answer is not “as much as possible.” This has implications both for the continued de – velopment of moral theories and for the develop – ment of metamoral views and for our conception of moral philosophy more generally. From the moral point of view, we have reasons to want people to live lives that seem good from outside that point of view. If, as I have argued, this means that we have reason to want people to live lives that are not morally per – fect, then any plausible moral theory must make use of some conception of supererogation. 4 If moral philosophers are to address themselves at the most basic level to the question of how people should live, however, they must do more than adjust the content of their moral theories in ways that leave room for the affirmation of nonmoral values. They must examine explicitly the range and nature of these nonmoral values, and, in light of this ex – amination, they must ask how the acceptance of a moral theory is to be understood and acted upon. For the claims of this paper do not so much conflict with the content of any particular currently popular moral theory as they call into question a metamoral assumption that implicitly surrounds discussions of moral theory more generally. Specifically, they call into question the assumption that it is always better to be morally better. The role morality plays in the development of our characters and the shape of our practical delib – erations need be neither that of a universal medium into which all other values must be translated nor that of an ever-present filter through which all other values must pass. This is not to say that moral value should not be an important, even the most impor – tant, kind of value we attend to in evaluating and improving ourselves and our world. It is to say that 02-Vaughn-Chap02.indd 77 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 78 PART 1: PRINCIPLES AND THEORIES 4. The variety of forms that a conception of supererogation might take, however, has not generally been noticed. Moral theories that make use of this notion typically do so by identifying some specific set of principles as universal moral requirements and supplement this list with a further set of directives which it is morally praiseworthy but not required for an agent to follow. [See, e.g., Charles Fried, Right and Wrong (Cambridge, Mass.: Harvard, 1979).] But it is possible that the ability to live a morally blameless life cannot be so easily or definitely secured as this type of theory would suggest. The fact that there are some situa – tions in which an agent is morally required to do something and other situations in which it would be good but not required for an agent to do something does not imply that there are specific principles such that, in any situation, an agent is required to act in accordance with these principles and other specific principles such that, in any situation, it would be good but not required for an agent to act in accordance with those principles. (New York: Harcourt Brace Jovanovich, 1945), p. 176: “sainthood is . . . a thing that human beings must avoid . . . It is too readily assumed that . . . the ordinary man only rejects it because it is too difficult; in other words, that the average human being is a failed saint. It is doubtful whether this is true. Many people genuinely do not wish to be saints, and it is probable that some who achieve or aspire to saint – hood have never felt much temptation to be human beings.” 3. A similar view, which has strongly influenced mine, is expressed by Thomas Nagel in “The Fragmentation of Value,” in Mortal Questions (New York: Cambridge, 1979), pp. 128–141. Nagel focuses on the difficulties such appar – ently incommensurable points of view create for specific, isolable practical decisions that must be made both by individuals and by societies. In focusing on the way in which these points of view figure into the development of individual personal ideals, the questions with which I am concerned are more likely to lurk in the background of any individual ’s life. 02-Vaughn-Chap02.indd 78 26/05/16 4:26 PM 08/31/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics
for each question answer with 2 to 3 sentences max 1. What is the difference between ‘descriptive’ versus ‘normative’ claims? 2. What are the key features of moral claims or norms, according to Vaughn
3 CHAPTER 1 Moral Reasoning in Bioethics Second, it would be difficult to imagine moral issues more important— more closely gathered around the line between life and death, health and illness, pain and relief, hope and despair— than those addressed by bioethics. Whatever our view of these questions, there is little doubt that they matter immensely. Whatever answers we give will surely have weight, however they fall. Third, as a systematic study of such ques tions, bioethics holds out the possibility of an swers. The answers may or may not be to our liking; they may confirm or confute our precon ceived notions; they may take us far or not far enough. But, as the following pages will show, the trail has more light than shadow— and thinking critically and carefully about the prob lems can help us see our way forward. ethics and bioethics Morality is about people’s moral judgments, principles, rules, standards, and theories— all of which help direct conduct, mark out moral prac tices, and provide the yardsticks for measuring moral worth. We use morality to refer gener ally to these aspects of our lives (as in “Morality is essential”) or more specifically to the beliefs or practices of particular groups or persons (as in “American morality” or “Kant’s morality”). Moral , of course, pertains to morality as just defined, though it is also sometimes employed as a synonym for right or good, just as immoral is often meant to be equivalent to wrong or bad. Ethics , as used in this text, is not synonymous with morality . Ethics is the study of morality using the tools and methods of philosophy. Philosophy is a discipline that systematically examines life’s Any serious and rewarding exploration of bio ethics is bound to be a challenging journey. What makes the trip worthwhile? As you might expect, this entire text is a long answer to that question. You therefore may not fully appreciate the trek until you have already hiked far along the trail. The short answer comes in three parts. First, bioethics— like ethics, its parent disci pline— is about morality, and morality is about life. Morality is part of the unavoidable, bitter sweet drama of being persons who think and feel and choose. Morality concerns beliefs regarding morally right and wrong actions and morally good and bad persons or character. Whether we like it or not, we seem confronted continually with the necessity to deliberate about right and wrong, to judge someone morally good or bad, to agree or disagree with the moral pronounce ments of others, to accept or reject the moral outlook of our culture or community, and even to doubt or affirm the existence or nature of moral concepts themselves. Moral issues are thus inescapable— including (or especially) those that are the focus of bioethics. In the twenty first century, few can remain entirely untouched by the pressing moral questions of fair distribution of health care resources, abortion and infanti cide, euthanasia and assisted suicide, exploitative research on children and populations in devel oping countries, human cloning and genetic en gineering, assisted reproduction and surrogate parenting, prevention and treatment of HIV/ AIDS, the confidentiality and consent of patients, the refusal of medical treatment on religious grounds, experimentation on human embryos and fetuses, and the just allocation of scarce life saving organs. 01-Vaughn-Chap01.indd 3 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 4 PART 1: PRINCIPLES AND THEORIES some or all of these as proper guides for our ac tions and judgments. In normative ethics, we ask questions like these: What moral principles, if any, should inform our moral judgments? What role should virtues play in our lives? Is the principle of autonomy justified? Are there any exceptions to the moral principle of “do not kill”? How should we resolve conflicts between moral norms? Is contractarianism a good moral theory? Is utilitarianism a better theory? A branch that deals with much deeper ethical issues is metaethics. Metaethics is the study of the meaning and justification of basic moral be liefs. In normative ethics we might ask whether an action is right or whether a person is good, but in metaethics we would more likely ask what it means for an action to be right or for a person to be good. For example, does right mean has the best consequences , or produces the most happi – ness, or commanded by God ? It is the business of metaethics to explore these and other equally fundamental questions: What, if anything, is the difference between moral and nonmoral be liefs? Are there such things as moral facts? If so, what sort of things are they, and how can they be known? Can moral statements be true or false— or are they just expressions of emotions or attitudes without any truth value? Can moral norms be justified or proven? The third main branch is applied ethics, the use of moral norms and concepts to resolve practical moral issues. Here, the usual challenge is to employ moral principles, theories, argu ments, or analyses to try to answer moral ques tions that confront people every day. Many such questions relate to a particular professional field such as law, business, or journalism, so we have specialized subfields of applied ethics like legal ethics, business ethics, and journalistic ethics. Probably the largest and most energetic subfield is bioethics. Bioethics is applied ethics focused on health care, medical science, and medical technology. ( Biomedical ethics is often used as a synonym, and medical ethics is a related but narrower term used most often to refer to ethical problems in big questions through critical reasoning, logical argument, and careful reflection. Thus ethics— also known as moral philosophy — is a reasoned way of delving into the meaning and import of moral concepts and issues and of evaluating the merits of moral judgments and standards. (As with morality and moral , we may use ethics to say such things as “Kant’s ethics” or may use ethical or unethical to mean right or wrong, good or bad.) Ethics seeks to know whether an action is right or wrong, what moral standards should guide our conduct, whether moral prin ciples can be justified, what moral virtues are worth cultivating and why, what ultimate ends people should pursue in life, whether there are good reasons for accepting a particular moral theory, and what the meaning is of such notions as right , wrong , good , and bad . Whenever we try to reason carefully about such things, we enter the realm of ethics: We do ethics. Science offers another way to study morality, and we must carefully distinguish this approach from that of moral philosophy. Descriptive ethics is the study of morality using the meth odology of science. Its purpose is to investigate the empirical facts of morality— the actual be liefs, behaviors, and practices that constitute people’s moral experience. Those who carry out these inquiries (usually anthropologists, sociol ogists, historians, and psychologists) want to know, among other things, what moral beliefs a person or group has, what caused the subjects to have them, and how the beliefs influence behav ior or social interaction. Very generally, the dif ference between ethics and descriptive ethics is this: In ethics we ask, as Socrates did, How ought we to live? In descriptive ethics we ask, How do we in fact live? Ethics is a big subject, so we should not be surprised that it has three main branches, each dealing with more or less separate but related sets of ethical questions. Normative ethics is the search for, and justification of, moral standards, or norms. Most often the standards are moral principles, rules, virtues, and theories, and the lofty aim of this branch is to establish rationally 01-Vaughn-Chap01.indd 4 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 5 about art; norms of etiquette about polite social behavior; grammatical norms about correct use of language; prudential norms about what is in one’s interests; and legal norms about lawful and unlawful acts. But moral norms differ from these nonmoral kinds. Some of the features they are thought to possess include the following. Normative Dominance. In our moral practice, moral norms are presumed to dominate other kinds of norms, to take precedence over them. Philosophers call this characteristic of moral norms overridingness because moral consider ations so often seem to override other factors. A maxim of prudence, for example, may suggest that you should steal if you can avoid getting caught, but a moral prohibition against stealing would overrule such a principle. An aesthetic (or pragmatic) norm implying that homeless people should be thrown in jail for blocking the view of a beautiful public mural would have to yield to moral principles demanding more humane treat ment of the homeless. A law mandating brutal actions against a minority group would conflict with moral principles of justice and would there fore be deemed illegitimate. We usually think that immoral laws are defective, that they need to be changed, or that, in rare cases, they should be defied through acts of civil disobedience. Universality. Moral norms (but not exclusively moral norms) have universality: Moral princi ples or judgments apply in all relevantly similar situations. If it is wrong for you to tell a lie in a particular circumstance, then it is wrong for everyone in relevantly similar circumstances to tell a lie. Logic demands this sort of consistency. It makes no sense to say that Maria’s doing action A in circumstances C is morally wrong, but John’s doing A in circumstances relevantly similar to C is morally right. Universality, how ever, is not unique to moral norms; it’s a charac teristic of all normative spheres. Impartiality. Implicit in moral norms is the notion of impartiality— the idea that everyone medical practice.) Ranging far and wide, bio ethics seeks answers to a vast array of tough ethical questions: Is abortion ever morally per missible? Is a woman justified in having an abor tion if prenatal genetic testing reveals that her fetus has a developmental defect? Should people be allowed to select embryos by the embryos’ sex or other genetic characteristics? Should human embryos be used in medical research? Should human cloning be prohibited? Should physicians, nurses, physicians’ assistants, and other health care professionals always be truthful with patients whatever the consequences? Should severely im paired newborns be given life prolonging treat ment or be allowed to die? Should people in persistent vegetative states be removed from life support? Should physicians help terminally ill patients commit suicide? Is it morally right to con duct medical research on patients without their consent if the research would save lives? Should human stem cell research be banned? How should we decide who gets life saving organ trans plants when usable organs are scarce and many patients who do not get transplants will die? Should animals be used in biomedical research? The ethical and technical scope of bioethics is wide. Bioethical questions and deliberations now fall to nonexpert and expert alike— to pa tients, families, and others as well as to philoso phers, health care professionals, lawyers, judges, scientists, clergy, and public policy specialists. Though the heart of bioethics is moral philoso phy, fully informed bioethics cannot be done without a good understanding of the relevant nonmoral facts and issues, especially the medi cal, scientific, technological, and legal ones. ethics and the moral life Morality then is a normative, or evaluative, enter prise. It concerns moral norms or standards that help us decide the rightness of actions, judge the goodness of persons or character, and prescribe the form of moral conduct. There are, of course, other sorts of norms we apply in life— nonmoral norms. Aesthetic norms help us make value judg ments 01-Vaughn-Chap01.indd 5 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 6 PART 1: PRINCIPLES AND THEORIES the moral life— is to do moral reasoning. If our moral judgments are to have any weight at all, if they are to be anything more than mere per sonal taste or knee jerk emotional response, they must be backed by the best of reasons. They must be the result of careful reflection in which we arrive at good reasons for accepting them, reasons that could be acknowledged as such by any other reasoning persons. Both logic and our commonsense moral ex perience demand that the thorough sifting of reasons constitutes the main work of our moral deliberations— regardless of our particular moral outlook or theory. We would think it odd, per haps even perverse, if someone asserted that physician assisted suicide is always morally wrong— and then said she has no reasons at all for believing such a judgment but just does. What ever our views on physician assisted suicide, we would be justified in ignoring her judgment, for we would have no way to distinguish it from personal whim or wishful thinking. Likewise she herself (if she genuinely had no good reasons for her assertion) would be in the same boat, adrift with a firm opinion moored to nothing solid. Our feelings, of course, are also part of our moral experience. When we ponder a moral issue we care about (abortion, for example), we may feel anger, sadness, disgust, fear, irritation, or sympathy. Such strong emotions are normal and often useful, helping us empathize with others, deepening our understanding of human suffering, and sharpening our insight into the consequences of our moral decisions. But our feelings can mislead us by reflecting not moral truth but our own psychological needs, our own personal or cultural biases, or our concern for personal advantage. Throughout history, some people’s feelings led them to conclude that women should be burned for witchcraft, that whole races should be exterminated, that black men should be lynched, and that adherents of a different religion were evil. Critical reasoning can help restrain such terrible impulses. It can help us put our feelings in proper perspective and achieve a measure of impartiality. Most of should be considered equal, that everyone’s inter ests should count the same. From the perspective of morality, no person is any better than any other. Everyone should be treated the same unless there is a morally relevant difference between persons. We probably would be completely baf fled if someone seriously said something like “murder is wrong . . . except when committed by myself,” when there was no morally relevant dif ference between that person and the rest of the world. If we took such a statement seriously at all, we would likely not only reject it but also would not even consider it a bona fide moral statement. The requirement of moral impartiality pro hibits discrimination against people merely be cause they are different— different in ways that are not morally relevant. Two people can be dif ferent in many ways: skin color, weight, gender, income, age, occupation, and so forth. But these are not differences relevant to the way they should be treated as persons. On the other hand, if there are morally relevant differences between people, then we may have good reasons to treat them differently, and this treatment would not be a violation of impartiality. This is how phi losopher James Rachels explains the point: The requirement of impartiality, then, is at bottom nothing more than a proscription against arbitrariness in dealing with people. It is a rule that forbids us from treating one person differ ently from another when there is no good reason to do so . But if this explains what is wrong with racism, it also explains why, in some special kinds of cases, it is not racist to treat people dif ferently. Suppose a film director was making a movie about the life of Martin Luther King, Jr. He would have a perfectly good reason for ruling out Tom Cruise for the starring role. Obviously, such casting would make no sense. Because there would be a good reason for it, the director’s “dis crimination” would not be arbitrary and so would not be open to criticism. 1 Reasonableness. To participate in morality— to engage in the essential, unavoidable practices of 01-Vaughn-Chap01.indd 6 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 7 purports to explain right actions, or make judg ments about right or wrong actions. Moral values, on the other hand, generally concern those things that we judge to be morally good, bad, praiseworthy, or blameworthy. Nor mally we use such words to describe persons (as in “He is a good person” or “She is to blame for hurting them”), their character (“He is virtu ous”; “She is honest”), or their motives (“She did wrong but did not mean to”). Note that we also attribute nonmoral value to things. If we say that a book or bicycle or vacation is good, we mean good in a nonmoral sense. Such things in them selves cannot have moral value. Strictly speaking, only actions are morally right or wrong , but persons are morally good or bad (or some degree of goodness or badness). With this distinction we can acknowledge a all, it can guide us to moral judgments that are trustworthy because they are supported by the best of reasons. The moral life, then, is about grappling with a distinctive class of norms marked by normative dominance, universality, impartiality, and rea sonableness. As we saw earlier, these norms can include moral principles, rules, theories, and judgments. We should notice that we commonly apply these norms to two distinct spheres of our moral experience— to both moral obligations and moral values . Moral obligations concern our duty, what we are obligated to do. That is, obligations are about conduct, how we ought or ought not to behave. In this sphere, we talk primarily about actions . We may look to moral principles or rules to guide our actions, or study a moral theory that IN DEPTH MORALITY AND THE LAW Some people confuse morality with the law, or iden – tify the one with the other, but the two are distinct though they may often coincide. Laws are norms enacted or enforced by the state to protect or pro – mote the public good. They specify which actions are legally right or wrong. But these same actions can also be judged morally right or wrong, and these two kinds of judgments will not necessarily agree. Lying to a friend about a personal matter, deliberately trying to destroy yourself through reckless living, or failing to save a drowning child (when you easily could have) may be immoral— but not illegal. Racial bias, discrimination based on gender or sexual orien – tation, slavery, spousal rape, and unequal treatment of minority groups are immoral— but, depending on the society, they may not be illegal. Much of the time, however, morality and the law overlap. Often what is immoral also turns out to be illegal. This is usually the case when immoral actions cause substantial harm to others, whether physical or economic. Thus murder and embezzlement are both immoral and illegal, backed by social disapproval and severe sanctions imposed by law. Controversy often arises when an action is not obviously or seri – ously harmful but is considered immoral by some who want the practice prohibited by law. The conten – tious notion at work is that something may be made illegal solely on the grounds that it is immoral, re – gardless of any physical or economic harm involved. This view of the law is known as legal moralism , and it sometimes underlies debates about the legalization of abortion, euthanasia, reproductive technology, con traception, and other practices. Many issues in bioethics have both a moral and legal dimension, and it is important not to confuse the two. Sometimes the question at hand is a moral one (whether, for example, euthanasia is ever morally permissible); whether a practice should be legal or illegal then is beside the point. Sometimes the ques – tion is about legality. And sometimes the discussion concerns both. A person may consider physician- assisted suicide morally acceptable but argue that it should nevertheless be illegal because allowing the practice to become widespread would harm both patients and the medical profession. 01-Vaughn-Chap01.indd 7 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 8 PART 1: PRINCIPLES AND THEORIES simple fact of the moral life: A good person can do something wrong, and a bad person can do something right. A Gandhi can tell a lie, and a Hitler can save a drowning man. In addition, we may judge an action right or wrong depending on the motive behind it. If John knocks a stranger down in the street to pre vent her from being hit by a car, we would deem his action right (and might judge him a good person). But if he knocks her down because he dislikes the color of her skin, we would believe his action wrong (and likely think him evil). The general meaning of right and wrong seems clear to just about everyone. But we should be careful to differentiate degrees of meaning in these moral terms. Right can mean either “obliga tory” or “permissible.” An obligatory action is one that would be wrong not to perform. We are obli gated or required to do it. A permissible action is one that is permitted. It is not wrong to perform it. Wrong means “prohibited.” A prohibited action is one that would be wrong to perform. We are obli gated or required not to do it. A supererogatory action is one that is “above and beyond” our duty. It is praiseworthy— a good thing to do— but not required. Giving all your possessions to the poor is generally considered a supererogatory act. moral principles in bioethics As noted earlier, the main work of bioethics is trying to solve bioethical problems using the potent resources and methods of moral phi losophy, which include, at a minimum, critical reasoning, logical argument, and conceptual analysis. Many, perhaps most, moral philoso phers would be quick to point out that beyond these tools of reason we also have the consider able help of moral principles. (The same could be said about moral theories, which we explore in the next chapter.) Certainly to be useful, moral principles must be interpreted, often filled out with specifics, and balanced with other moral concerns. But both in everyday life and in bio ethics, moral principles are widely thought to be indispensable to moral decision making. We can see appeals to moral principles in countless cases. Confronted by a pain racked, terminally ill patient who demands to have his life ended, his physician refuses to comply, rely ing on the principle that “it is wrong to inten tionally take a life.” Another physician makes a different choice in similar circumstances, insist ing that the relevant principle is “ending the suf fering of a hopelessly ill patient is morally permissible.” An infant is born anencephalic (without a brain); it will never have a conscious life and will die in a few days. The parents decide to donate the infant’s organs to other children so they might live, which involves taking the organs right away before they deteriorate. A critic of the parents’ decision argues that “it is unethical to kill in order to save.” But someone else appeals to the principle “save as many chil dren as possible.” 2 In such ways moral principles help guide our actions and inform our judg ments about right and wrong, good and evil. As discussed in Chapter 2, moral principles are often drawn from a moral theory, which is a moral standard on the most general level. The principles are derived from or supported by the theory. Many times we simply appeal directly to a plausible moral principle without thinking much about its theoretical underpinnings. Philosophers make a distinction between ab solute and prima facie principles (or duties). An absolute principle applies without exceptions. An absolute principle that we should not lie de mands that we never lie regardless of the cir cumstances or the consequences. In contrast, a prima facie principle applies in all cases unless an exception is warranted. Exceptions are justi fied when the principle conflicts with other principles and is thereby overridden. W. D. Ross is given credit for drawing this distinction in his 1930 book The Right and the Good . 3 It is essen tial to his account of ethics, which has a core of several moral principles or duties, any of which might come into conflict. Physicians have a prima facie duty to be truth ful to their patients as well as a prima facie duty to promote their welfare. But if these duties come 01-Vaughn-Chap01.indd 8 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 9 their consent, treating competent patients against their will, physically restraining or confining pa tients for no medical reason— such practices con stitute obvious violations of personal autonomy. Not all restrictions on autonomy, however, are of the physical kind. Autonomy involves the capacity to make personal choices, but choices cannot be considered entirely autonomous unless they are fully informed. When we make decisions in ignorance— without relevant information or blinded by misinformation— our autonomy is diminished just as surely as if someone physi cally manipulated us. If this is correct, then we have a plausible explanation of why lying is generally prohibited: Lying is wrong because it undermines personal autonomy. Enshrined in bioethics and in the law, then, is the precept of informed consent , which demands that patients be allowed to freely consent to or decline treat ments and that they receive the information they need to make informed judgments about them. In many ways, autonomy is a delicate thing, easily compromised and readily thwarted. Often a person’s autonomy is severely undermined not by other people but by nature, nurture, or his or her own actions. Some drug addicts and alcohol ics, people with serious psychiatric illness, and those with severe mental impairment are thought to have drastically diminished autonomy (or to be essentially nonautonomous). Bioethical ques tions then arise about what is permissible to do to them and who will represent their interests or make decisions regarding their care. Infants and children are also not fully autonomous, and the same sorts of questions are forced on parents, guardians, and health care workers. Like all the other major principles discussed here, respect for autonomy is thought to be prima facie. It can sometimes be overridden by considerations that seem more important or compelling— considerations that philosophers and other thinkers have formulated as princi ples of autonomy restriction. The principles are articulated in various ways, are applied widely to all sorts of social and moral issues, and are themselves the subject of debate. Chief among in conflict— if, for example, telling a patient the truth about his condition would somehow result in his death— a physician might decide that the duty of truthfulness should yield to the weight ier duty to do good for the patient. Moral principles are many and varied, but in bioethics the following have traditionally been extremely influential and particularly relevant to the kinds of moral issues that arise in health care, medical research, and biotechnology. In fact, many— perhaps most— of the thorniest issues in bioethics arise from conflicts among these basic principles. In one formulation or another, each one has been integral to major moral theories, providing evidence that the principles capture something essential in our moral expe rience. The principles are (1) autonomy, (2) non maleficence, (3) beneficence, (4) utility, and (5) justice. 4 Autonomy Autonomy refers to a person’s rational capacity for self governance or self determination— the ability to direct one’s own life and choose for oneself. The principle of autonomy insists on full respect for autonomy. One way to express the prin ciple is: Autonomous persons should be allowed to exercise their capacity for self-determination. According to one major ethical tradition, autono mous persons have intrinsic worth precisely because they have the power to make rational decisions and moral choices. They therefore must be treated with respect, which means not violating their autonomy by ignoring or thwarting their ability to choose their own paths and make their own judgments. The principle of respect for autonomy places severe restraints on what can be done to an autonomous person. There are exceptions, but in general we are not permitted to violate people’s autonomy just because we disagree with their decisions, or because society might benefit, or because the violation is for their own good. We cannot legitimately impair someone’s autonomy without strong justification for doing so. Con ducting medical experiments on patients without 01-Vaughn-Chap01.indd 9 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 10 PART 1: PRINCIPLES AND THEORIES these is the harm principle: a person’s autonomy may be curtailed to prevent harm to others. To prevent people from being victimized by thieves and murderers, we have a justice system that prosecutes and imprisons the perpetrators. To discourage hospitals and health care workers from hurting patients through carelessness or fraud, laws and regulations limit what they can do to people in their care. To stop someone from spreading a deadly, contagious disease, health officials may quarantine him against his will. Another principle of autonomy restriction is paternalism. Paternalism is the overriding of a person’s actions or decision making for her own good. Some cases of paternalism (sometimes called weak paternalism ) seem permissible to many people— when, for example, seriously de pressed or psychotic patients are temporarily restrained to prevent them from injuring or kill ing themselves. Other cases are more controver sial. Researchers hoping to develop a life saving treatment give an experimental drug to some one without his knowledge or consent. Or a physician tries to spare the feelings of a compe tent, terminally ill patient by telling her that she will eventually get better, even though she in sists on being told the truth. The paternalism in such scenarios (known as strong paternalism) is usually thought to be morally objectionable. Many controversies in bioethics center on the morality of strong paternalism. Nonmaleficence The principle of nonmaleficence asks us not to intentionally or unintentionally inflict harm on others. In bioethics, nonmaleficence is the most widely recognized moral principle. Its aphoris tic expression has been embraced by practitio ners of medicine for centuries: “Above all, do no harm.” A more precise formulation of the prin ciple is: We should not cause unnecessary injury or harm to those in our care . In whatever form, nonmaleficence is the bedrock precept of count less codes of professional conduct, institutional regulations, and governmental rules and laws designed to protect the welfare of patients. A health care professional violates this prin ciple if he or she deliberately performs an action that harms or injures a patient. If a physician intentionally administers a drug that she knows will induce a heart attack in a patient, she obvi ously violates the principle—she clearly does something that is morally (and legally) wrong. But she also violates it if she injures a patient through recklessness, negligence, or inexcusable ignorance. She may not intend to hurt anyone, but she is guilty of the violation just the same. Implicit in the principle of nonmaleficence is the notion that health professionals must exer cise “due care.” The possibility of causing some pain, suffering, or injury is inherent in the care and treatment of patients, so we cannot realisti cally expect health professionals never to harm anyone. But we do expect them to use due care— to act reasonably and responsibly to minimize the harm or the chances of causing harm. If a physician must cause patients some harm to effect a cure, we expect her to try to produce the least amount of harm possible to achieve the re sults. And even if her treatments cause no actual pain or injury in a particular instance, we expect her not to use treatments that have a higher chance of causing harm than necessary. By the lights of the nonmaleficence principle, subjecting patients to unnecessary risks is wrong even if no damage is done. Beneficence The principle of beneficence has seemed to many to constitute the very soul of morality— or very close to it. In its most general form, it says that we should do good to others . (Benevolence is dif ferent, referring more to an attitude of goodwill toward others than to a principle of right action.) Beneficence enjoins us to advance the welfare of others and prevent or remove harm to them. Beneficence demands that we do more than just avoid inflicting pain and suffering. It says that w e should actively promote the well-being of others and prevent or remove harm to them . In bioethics, there is little doubt that physicians, nurses, researchers, and other professionals have 01-Vaughn-Chap01.indd 10 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 11 possible benefits of the treatment outweigh its risks by an acceptable margin. Suppose a man’s clogged artery can be successfully treated with openheart surgery, a procedure that carries a considerable risk of injury and death. But imag ine that the artery can also be successfully opened with a regimen of cholesterol lowering drugs and a low fat diet, both of which have a much lower chance of serious complications. The principle of utility seems to suggest that the latter course is best and that the former is mor ally impermissible. The principle also plays a major role in the creation and evaluation of the health policies of institutions and society. In these large arenas, most people aspire to fulfill the requirements of beneficence and maleficence, but they recognize that perfect beneficence or maleficence is im possible: Trade offs and compromises must be made, scarce resources must be allotted, help and harm must be balanced, life and death must be weighed— tasks almost always informed by the principle of utility. Suppose, for example, we want to mandate the immunization of all schoolchildren to pre vent the spread of deadly communicable dis eases. The cost in time and money will be great, but such a program could save many lives. There is a down side, however: A small number of children— perhaps as many as 2 for every 400,000 immunizations— will die because of a rare allergic reaction to the vaccine. It is impos sible to predict who will have such a reaction (and impossible to prevent it), but it is almost certain to occur in a few cases. If our goal is social beneficence, what should we do? Children are likely to die whether we institute the program or not. Guided by the principle of utility (as well as other principles), we may decide to proceed with the program since many more lives would likely be saved by it than lost because of its implementation. Again, suppose governmental health agencies have enough knowledge and resources to de velop fully a cure for only one disease— either a rare heart disorder or a common form of skin such a duty. After all, helping others, promoting their good, is a large part of what these profes sionals are obliged to do. But not everyone thinks that we all have a duty of active beneficence. Some argue that though there is a general (applicable to all) duty not to harm others, there is no general duty to help others. They say we are not obligated to aid the poor, feed the hungry, or tend to the sick. Such acts are not required, but are supererogatory, beyond the call of duty. Others contend that though we do not have a general duty of active beneficence, we are at least sometimes obligated to look to the welfare of people we care about most— such as our parents, children, spouses, and friends. In any case, it is clear that in cer tain professions— particularly medicine, law, and nursing— benefiting others is often not just supererogatory but obligatory and basic. Utility The principle of utility says that we should pro – duce the most favorable balance of good over bad (or benefit over harm) for all concerned. The prin ciple acknowledges that in the real world, we cannot always just benefit others or just avoid harming them. Often we cannot do good for people without also bringing them some harm, or we cannot help everyone who needs to be helped, or we cannot help some without also hurting or neglecting others. In such situations, the principle says, we should do what yields the best overall outcome— the maximum good and minimum evil, everyone considered. The utility principle, then, is a supplement to, not a substi tute for, the principles of autonomy, beneficence, and justice. In ethics this maxim comes into play in sev eral ways. Most famously it is the defining pre cept of the moral theory known as utilitarianism (discussed in Chapter 2). But it is also a stand alone moral principle applied everywhere in bio ethics to help resolve the kind of dilemmas just mentioned. A physician, for example, must decide whether a treatment is right for a patient, and that decision often hinges on whether the 01-Vaughn-Chap01.indd 11 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 12 PART 1: PRINCIPLES AND THEORIES cancer. Trying to split resources between these two is sure to prevent development of any cure at all. The heart disorder kills 200 adults each year; the cancer occurs in thousands of people, causing them great pain and distress, but is rarely fatal. How best to maximize the good? On which disease should the government spend its time and treasure? Answering this question (and others like it) requires trying to apply the utility principle— a job often involving complex calculations of costs and benefits and frequently generating controversy. Justice In its broadest sense, justice refers to people get ting what is fair or what is their due. In practice, most of us seem to have a rough idea of what justice entails in many situations, even if we cannot articulate exactly what it is. We know, for example, that it is unjust for a bus driver to make a woman sit in the back of the bus because of her religious beliefs, or for a judicial system to arbitrarily treat one group of citizens more harshly than others, or for a doctor to care for some patients but refuse to treat others just be cause he dislikes them. Questions of justice arise in different spheres of human endeavor. Retributive justice , for ex ample, concerns the fair meting out of punish ment for wrongdoing. On this matter, some argue that justice is served only when people are punished for past wrongs, when they get their just deserts. Others insist that justice demands that people be punished not because they de serve punishment, but because the punishment will deter further unacceptable behavior. Dis- tributive justice concerns the fair distribution of society’s advantages and disadvantages— for example, jobs, income, welfare aid, health care, rights, taxes, and public service. Distributive jus tice is a major issue in bioethics, where many of the most intensely debated questions are about who gets health care, what or how much they should get, and who should pay for it. Distributive justice is a vast topic, and many theories have been proposed to identify and justify the properties, or traits, of just distribu tions. A basic precept of most of these theories is what may plausibly be regarded as the core of the principle of justice: Equals should be treated equally. (Recall that this is one of the defining elements of ethics itself, impartiality.) The idea is that people should be treated the same unless there is a morally relevant reason for treating them differently. We would think it unjust for a physician or nurse to treat his white diabetic patients more carefully than he does his black diabetic patients— and to do so without a sound medical reason. We would think it unfair to award the only available kidney to the trans plant candidate who belongs to the “right” po litical party or has the best personal relationship with hospital administrators. The principle of justice has been at the heart of debates about just distribution of benefits and burdens (including health care) for society as a whole. The disagreements have generally not been about the legitimacy of the principle, but about how it should be interpreted. Different theories of justice try to explain in what respects equals should be treated equally. Libertarian theories emphasize personal free doms and the right to pursue one’s own social and economic well being in a free market with out interference from others. Ideally the role of government is limited to night watchman functions— the protection of society and free economic systems from coercion and fraud. All other social or economic benefits are the respon sibility of individuals. Government should not be in the business of helping the socially or eco nomically disadvantaged, for that would require violating people’s liberty by taking resources from the haves to give to the have nots. So uni versal health care is out of the question. For the libertarian, then, people have equal intrinsic worth, but this does not entitle them to an equal distribution of economic advantages. Individu als are entitled only to what they can acquire through their own hard work and ingenuity. Egalitarian theories maintain that a just dis tribution is an equal distribution. Ideally, social 01-Vaughn-Chap01.indd 12 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 13 But moral objectivism is directly challenged by a doctrine that some find extremely appeal ing and that, if true, would undermine ethics itself: ethical relativism. According to this view, moral standards are not objective but are rela tive to what individuals or cultures believe. There simply are no objective moral truths, only relative ones. An action is morally right if en dorsed by a person or culture and morally wrong if condemned by a person or culture. So eutha nasia is right for person A if he approves of it but wrong for person B if she disapproves of it, and the same would go for cultures with similarly diverging views on the subject. In this way, moral norms are not discovered but made; the indi vidual or culture makes right and wrong. Ethi cal relativism pertaining to individuals is known as subjective relativism, more precisely stated as the view that right actions are those sanctioned by a person. Ethical relativism regarding cultures is called cultural relativism, the view that right actions are those sanctioned by one’s culture. In some ways, subjective relativism is a com forting position. It relieves individuals of the burden of serious critical reasoning about mo rality. After all, determining right and wrong is a matter of inventorying one’s beliefs, and any sincerely held beliefs will do. Morality is essen tially a matter of personal taste, which is an ex tremely easy thing to establish. Determining what one’s moral views are may indeed involve deliberation and analysis—but neither of these is a necessary requirement for the job. Subjective relativism also helps people short circuit the un pleasantness of moral debate. The subjective relativist’s familiar refrain—“That may be your truth, but it’s not my truth”—has a way of stop ping conversations and putting an end to rea soned arguments. The doctrine, however, is difficult to maintain consistently. On issues that the relativist cares little about (the moral rightness of gambling, say), she may be content to point out that moral norms are relative to each individual and that “to each his own.” But on more momentous topics (such as genocide in Africa or the Middle benefits— whether jobs, food, health care, or some thing else— should be allotted so that every one has an equal share. Treating people equally means making sure everyone has equal access to certain minimal goods and services. To achieve this level of equality, individual liberties will have to be restricted, measures that libertari ans would never countenance. In a pure egali tarian society, universal health care would be guaranteed. Between strict libertarian and egalitarian views of justice lie some theories that try to achieve a plausible fusion of both perspectives. With a nod toward libertarianism, these theories may exhibit a healthy respect for individual liberty and limit governmental interference in econo mic enterprises. But leaning toward egalitarian ism, they may also mandate that the basic needs of the least well off citizens be met. In bioethics, the principle of justice and the theories used to explain it are constantly being marshaled to support or reject health care poli cies of all kinds. They are frequently used— along with other moral principles— to evaluate, design, and challenge a wide range of health care pro grams and strategies. They are, in other words, far from being merely academic. ethical relativism The commonsense view of morality and moral standards is this: There are moral norms or principles that are valid or true for everyone. This claim is known as moral objectivism, the idea that at least some moral standards are ob jective. Moral objectivism, however, is distinct from moral absolutism, the belief that objective moral principles allow no exceptions or must be applied the same way in all cases and cultures. A moral objectivist can be absolutist about moral principles, or she can avoid absolutism by ac cepting that moral principles are prima facie. In any case, most people probably assume some form of moral objectivism and would not take seriously any claim implying that valid moral norms can be whatever we want them to be. 01-Vaughn-Chap01.indd 13 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 14 PART 1: PRINCIPLES AND THEORIES East), she may slip back into objectivism and declare that genocide is morally wrong— not just wrong for her but wrong period . Such inconsistencies hint that there may be something amiss with subjective relativism, and indeed there is: It seems to conflict violently with commonsense realities of the moral life. For one thing, the doctrine implies that each person is morally infallible. An action is morally right for someone if he approves of it— if he sincerely believes it to be right. His approval makes the action right, and— if his approval is genuine— he cannot be mistaken. His believing it to be right makes it right, and that’s the end of it. If he endorses infanticide as a method of population control, then infanticide is morally permissible. His sincere approval settles the issue, and he cannot be in error. But our commonsense moral experience suggests that this relativist account is absurd. Our judgments about moral matters— actions, principles, and people— are often wide of the mark. We are morally fallible, and we are rightly suspicious of anyone who claims to be otherwise. There is a more disturbing way to frame this point. Suppose former Iraqi leader Saddam Hussein approved of slaughtering thousands of Iraqis during his reign. Suppose Hitler approved of killing millions of Jews during World War II. Suppose American serial killer and cannibal Jeffrey Dahmer approved of his murdering 17 men and boys. Then by the lights of subjec tive relativism, all these mass killings were mor ally right because their perpetrators deemed them so. But we would find this conclusion almost impossible to swallow. We would think these actions morally wrong whether the killers ap proved of their own actions or not. Subjective relativism also implies that an other commonplace of the moral life is an illu sion: moral disagreement. Consider: Hernando tells Sophia that allowing seriously impaired infants to die is morally right. Sophia replies that allowing seriously impaired infants to die is morally wrong. We may think that Hernando and Sophia are having a straightforward dis agreement over an important moral issue. But according to subjective relativism, no such dis agreement is happening or could ever happen. In stating his approval of the actions in ques tion, Hernando is essentially expressing his per sonal taste on the issue, and Sophia is expressing her personal taste. He is saying he likes some thing; she says she does not like it— and they could both be correct. Subjective relativism im plies that they are not uttering conflicting claims IN DEPTH ANTHROPOLOGY AND MORAL DIVERSITY Many moral philosophers have been quick to point out that differences in moral judgments from culture to culture do not in themselves prove a difference in moral standards. Some anthropologists have made the same argument. Solomon Asch, for example, says, We consider it wrong to take food away from a hungry child, but not if he is overeating. We consider it right to fulfill a promise, but not if it is a promise to commit a crime. . . . It has been customary to hold that diverse evaluations of the same act are automatic evidence for the presence of different principles of evaluation. The preceding examples point to an error in this interpretation. Indeed, an examination of the relational factors points to the operation of constant principles in situations that differ in concrete details. . . . Anthropological evidence does not furnish proof of relativism. We do not know of societies in which bravery is despised and cowardice held up to honor, in which generosity is considered a vice and ingratitude a virtue. It seems rather that the relations between valuation and meaning are invariant. 5 01-Vaughn-Chap01.indd 14 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 15 it a solemn duty to surgically remove the clito rises of young girls; others say this is immoral and cruel. Some commend the killing of people who practice a different religion; others believe such intolerance is morally reprehensible. We are forced to conclude that diversity of moral judgments among cultures is a reality. But what of premise 1— is it also true? It says that because cultures have different moral beliefs, they must also have different moral standards, which means morality is relative to cultures. If diverse moral standards arise from each culture, then morality cannot be objective, applying to all people everywhere. There is no objective mo rality, just moralities . Premise 1, however, is false. First, from the fact that cultures have divergent moral beliefs on an issue, it does not logically follow that there is no objective moral truth to be sought, that there is no opinion that is objectively correct. People may disagree about the existence of bio logical life on Mars, but the disagreement does not demonstrate that there is no fact of the matter or that no statement on the subject could be objectively true. Disagreements on a moral question may simply indicate that there is an objective fact of the matter but that someone (or everyone) is wrong about it. Second, a conflict between moral beliefs does not necessarily indicate a fundamental conflict between basic moral norms. Moral dis agreements between cultures can arise not just because their basic moral principles clash, but because they have differing nonmoral beliefs that put those principles in a very different light. From the annals of anthropology, for example, we have the classic story of a culture that sanc tions the killing of parents when they become elderly but not yet enfeebled. Our society would condemn such a practice, no doubt appealing to moral precepts urging respect for parents and for human life. But consider: This strange (to us) culture believes that people enter heaven when they die and spend eternity in the same physical condition they were in when they passed away. Those who kill their parents are doing so because at all— they are discussing different subjects, their own personal feelings or preferences. But this strange dance is not at all what we think we are doing when we have a moral disagreement. Be cause subjective relativism conflicts with what we take to be a basic fact of the moral life, we have good reason to doubt it. Cultural relativism seems to many to be a much more plausible doctrine. In fact, many people think it obviously true, supported as it is by a convincing argument and the common con viction that it is admirably consistent with social tolerance and understanding in a pluralistic world. The argument in its favor goes like this: 1. If people’s moral judgments differ from culture to culture, moral norms are relative to culture (there are no objective moral standards). 2. People’s moral judgments do differ from culture to culture. 3. Therefore, moral norms are relative to culture (there are no objective moral standards). Is this a good argument? That is, does it pro vide us with good reason to accept the conclu sion (statement 3)? For an argument to be good, its conclusion must follow logically from the premises, and the premises must be true. In this case, the conclusion does indeed follow logically from the premises (statements 1 and 2). The truth of the premises is another matter. Let us look first at premise 2. All sorts of empirical evidence— including a trove of anthro pological and sociological data— show that the premise is in fact true. Clearly, the moral beliefs of people from diverse cultures often do differ drastically on the same moral issue. Some soci eties condone infanticide; others condemn it. Some approve of the killing of wives and daugh ters to protect a family’s honor; others think this tradition evil. Some bury their dead; others cre mate them. Some judge the killing of one’s elders to be a kindly act; others say it is cold hearted murder. Some think polygamy morally permis sible; others believe it deplorable. Some consider 01-Vaughn-Chap01.indd 15 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 16 PART 1: PRINCIPLES AND THEORIES terrorist bombing of Pan Am flight 103 over Lockerbie, Scotland, killing 270 people (a tragedy for which the Libyan government eventually took responsibility). Then the bombing was morally right, and those who placed the bomb on board did no wrong. But all this seems very much at odds with our moral experience. We think it makes perfect sense sometimes to con demn other cultures for morally wrong actions. Now consider the notion of moral progress. We sometimes compare what people did in the past with what they do now, noting that current practices are morally better than they used to be. We no longer countenance such horrors as massacres of native peoples, slavery, and lynch ings, and we think that these changes are signs of moral progress. But cultural relativism implies that there cannot be any such thing as moral progress. To claim legitimately that there has been moral progress, there must be an objective, trans cultural standard for comparing cultures of the past and present. But according to cultural rela tivism, there are no objective moral standards, just norms relative to each culture. On the other hand, if there is moral progress as we think there is, then there must be objective moral standards. Cultural relativism also has a difficult time explaining the moral status of social reformers. We tend to believe they are at least sometimes right and society is wrong. When we contem plate social reform, we think of such moral ex emplars as Martin Luther King, Jr., Mahatma Gandhi, and Susan B. Anthony, all of whom agi tated for justice and moral progress. But one of the consequences of cultural relativism is that social reformers could never be morally right. By definition, what society judges to be morally right is morally right, and since social reformers disagree with society, they could not be right— ever. But surely on occasion it’s the reformers who are right and society is wrong. There is also the serious difficulty of using cultural relativism to make moral decisions. Cultural relativism says that moral rightness is whatever a culture or society approves of, but determining which culture or society one truly they do not want their elders to spend eternity in a state of senility but rather in good health. This culture’s way is not our way; we are unlikely to share these people’s nonmoral beliefs. But it is probable that they embrace the same moral principles of respect for parents and life that we do. According to some anthropologists, diverse cultures often share basic moral standards while seeming to have little or nothing in common. The argument we are considering, then, fails to support cultural relativism. Moreover, many considerations count strongly against the view. Specifically, the logical implications of the doc trine give us substantial reasons to doubt it. Like subjective relativism, cultural relativism implies moral infallibility, a very hard implica tion to take seriously. As the doctrine would have it, if a culture genuinely approves of an action, then there can be no question about the action’s moral rightness: It is right, and that’s that. Cul tures make moral rightness, so they cannot be mistaken about it. But is it at all plausible that cul tures cannot be wrong about morality? Through out history, cultures have approved of ethnic cleansing, slavery, racism, holocausts, massacres, mass rape, torture of innocents, burning of heretics, and much more. Is it reasonable to conclude that the cultures that approved of such deeds could not have been mistaken? Related to the infallibility problem is this difficulty: Cultural relativism implies that we cannot legitimately criticize other cultures. If a culture approves of its actions, then those ac tions are morally right— and it does not matter one bit whether another culture disapproves of them. Remember, there is no objective moral code to appeal to. Each society is its own maker of the moral law. It makes no sense for society X to accuse society Y of immorality, for what soci ety Y approves of is moral. Some may be willing to accept this consequence of cultural relativism, but look at what it would mean. What if the people of Germany approved of the extermination of millions of Jews, Gypsies, and others during World War II? Then the extermination was morally right. Suppose the people of Libya approved of the 01-Vaughn-Chap01.indd 16 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 17 of moral precepts, codes, or commandments to guide the conduct of adherents. In Western civilization, this content has been so influential in moral (and legal) matters that many now take for granted that religion is the fundamental basis of morality. Secular or nontheistic sys tems of ethics (for example, the ethics of Stoicism, Confucianism, Buddhism, utilitarianism, and contractarianism) have also shaped how we think about morality. But for millions of people, religion is the fountainhead of the moral law. Many religious people, however, do not em brace a moral theory related to a religious tradi tion. They are comfortable being guided by one of the nontheistic systems. Others prefer the very influential moral perspective known as natural law theory (discussed in Chapter 2)—a view that comes in both secular and religious versions but has been nurtured and adopted by the Roman Catholic Church. Still others accept the perva sive idea that morality itself comes from God. An important query in ethics is whether this latter view of morality is correct: whether morality depends fundamentally on religion, whether— to state the question in its traditional form— the moral law is constituted by the will of God. The view that morality does have this kind of dependence is known as the divine command t he or y. It says that right actions are those com manded by God, and wrong actions are those forbidden by God. God is the author of the moral law, making right and wrong by his will. But many people— both religious and non religious— have found this doctrine troubling. Philosophers have generally rejected it, including some famous theistic thinkers such as Thomas Aquinas (1225– 1274), Gottfried Leibniz (1646– 1710), and Immanuel Kant (1724– 1804). The problem is that the theory presents us with a disconcerting dilemma first spelled out in Pl a t o’s Euthyphro . In this dialogue, Socrates asks a penetrating question that is often expressed like this: Are actions morally right because God commands them, or does God command them because they are morally right? In the first option, God creates the moral law (the divine belongs to seems almost impossible. The prob lem is that we each belong to many social groups, and there is no fact of the matter regarding which one is our “true” society. Suppose you are an African American Catholic Republican living in an artists colony in Alabama and enjoying the advantages of membership in an extremely large extended family. What is your true society? If you cannot identify your proper society, you cannot tell which cultural norms apply to you. Some people may be willing to overlook these problems of cultural relativism because they be lieve it promotes cultural tolerance, an attitude that seems both morally praiseworthy and in creasingly necessary in a pluralistic world. After all, human history has been darkened repeatedly by the intolerance of one society toward another, engendering vast measures of bloodshed, pain, oppression, injustice, and ignorance. The thought is that because all cultures are morally equal, there is no objective reason for criticizing any of them. Tolerance is then the best policy. Cultural relativism, however, does not neces sarily lead to tolerance and certainly does not logically entail it. In fact, cultural relativism can easily justify either tolerance or intolerance. It says that if a society sanctions tolerance, then toler ance is morally right for that society. But if a soci ety approves of intolerance, then intolerance is morally right for that society— and the society cannot be legitimately criticized for endorsing such an attitude. According to cultural relativism, intolerance can be morally permissible just as tol erance can. In addition, though moral relativists may want to advocate universal tolerance, they cannot consistently do so. To say that all cultures should be tolerant is to endorse an objective moral norm, but cultural relativists insist that there are no objective moral norms. To endorse universal tolerance is to abandon cultural relativism. ethics and religion How is ethics related to religion? One obvious connection is that historically religion has always had moral content—mostly in the form 01-Vaughn-Chap01.indd 17 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 18 PART 1: PRINCIPLES AND THEORIES norms. The religious may then claim that God is good— good because he abides perfectly by the moral law and guides the conduct of believers a c c ord i n g l y. If moral standards are not grounded in the divine will, if they are logically independent of religion, then morality is a legitimate concern for the religious and nonreligious alike, and every one has equal access to moral reflection and the moral life. The best evidence for the latter is ethics itself. The fact is that people do ethics. They use critical reasoning and experience to deter mine moral norms, explore ethical issues, test moral theories, and live a good life. The results of these explorations are moral outlooks and stan dards founded on good reasons and arguments and assented to by reflective people everywhere. In bioethics, the informed opinions of reli gious people are as relevant as those of secular ists. But all parties must be willing to submit their views to the tests and criteria of critical reasoning and evidence. But even if ethics does not have this indepen dent status, there are still good reasons for reli gious believers to know how to use the critical tools that ethics offers. First, like many secular moral rules, religious moral codes are often vague and difficult to apply to conflicts and issues, es pecially in complex fields such as bioethics. Get ting around this problem requires interpreting the codes, and this task involves consideration of broader norms or theories, a typical job for ethics. Second, like everyone else, believers must deal with moral conflicts of all sorts— including clashes between the moral beliefs of religious adherents, religious leaders, and religious tradi tions. What is often needed is a neutral standard and critical analyses to arrive at a resolution— tools that ethics can easily provide. Third, public debate on ethical issues in a diverse society re quires ground rules— chief among them being that positions must be explained and reasons must be given in their support. Unexplained as sertions without supporting reasons or argu ments are likely to be ignored. In this arena, ethics is essential. command theory); in the second, the moral law is independent of God’s will so that even God is subject to it. Critics of the divine command theory have argued that the first option implies the moral law is entirely arbitrary. The second option denies the theory. The arbitrariness is thought to arise like this: If actions are morally right just because God commands them to be so, then it is possible that any actions whatsoever could be morally right. The murder and rape of innocents, the oppres sion of the weak, the abuse of the poor— these and many other awful deeds would be morally permissible if God so willed. There would be no independent standard to judge that these acts are wrong, no moral reasons apart from God’s will to suggest that such deeds are evil. God would be free to establish arbitrarily any actions whatsoever as morally right. Defenders of the divine command theory have replied to the arbitrariness charge by saying that God would never command some thing evil because God is all good. But critics point out that if the theory is true, the assertion that God is all good would be meaningless, and the traditional religious idea of the goodness of God would become an empty notion. If God makes the moral law, then the moral term good would mean “commanded by God.” But then “God is good” would mean something like “God does what God commands” or even “God is what God is,” which tells us nothing about the goodness of God. Likewise, “God’s commands are good” would translate as “God’s commands are God’s commands.” This attempt to escape the charge of arbitrariness seems to have intol erable implications. Theists and nontheists alike find this horn of Socrates’ dilemma— the idea of an arbitrary, divinely ordained morality— incredible. They therefore reject the divine command theory and embrace the other horn, the view that right and wrong are independent of God’s will. Moral standards are external to God, binding on both God and mortals. If there are divine commands, they will conform to these independent moral 01-Vaughn-Chap01.indd 18 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 19 fallacies, exploiting emotions and prejudices, daz zling with rhetorical gimmicks, hiding or distort ing the facts, threatening or coercing people— the list is long. Good arguments prove something whether or not they persuade. Persuasive ploys can change minds but do not necessarily prove any thing. So we formulate an argument to try to show that a particular claim (the conclusion) should be believed, and we analyze an argument to see if it really does show what it purports to show. If the argument is good, we are entitled to believe its conclusion. If it is bad, we are not entitled to believe it. Consider these two simple arguments: argument 1 Law enforcement in the city is a complete failure. Incidents of serious crime have doubled. argument 2 It’s wrong to take the life of an innocent person. Abortion takes the life of an innocent person. So abortion is wrong. In Argument 1, the conclusion is “Law en forcement in the city is a complete failure,” which is supported by the premise “Incidents of serious crime have doubled.” The conclusion of Argu ment 2 is “abortion is wrong,” and it is backed by two premises: “It’s wrong to take the life of an innocent person” and “Abortion takes the life of an innocent person.” Despite the differences be tween these two passages (differences in content, the number of premises, and the order of their parts), they are both arguments because they ex emplify basic argument structure: a conclusion supported by at least one premise. Though the components of an argument seem clear enough, people often fail to distin guish between arguments and strong statements that contain no arguments at all. Suppose we change Argument 1 into this: Law enforcement in the city is a complete failure. Nothing seems to work anymore. This situation is intolerable. moral arguments Critical reasoning is something we employ every time we carefully and systematically assess the truth of a statement or the merits of a logical argument. We ask: Are there good reasons for be lieving this statement? Is this a good argument— does it prove its case? These sorts of questions are asked in every academic field and in every serious human endeavor. Wherever there is a need to acquire knowledge, to separate truth from falsity, and to come to a reliable understanding of how the world works, these questions are asked and answers are sought. Ethics is no excep tion. Critical reasoning in ethics— called moral reasoning — employs the same general principles of logic and evidence that guide the search for truth in every other field. So we need not wonder whether we use critical reasoning in ethics but whether we use it well. Argument Fundamentals Most critical reasoning is concerned in one way or another with the construction or evaluation of arguments. As you may have guessed, here argument denotes not an altercation but a pat terned set of assertions: at least one statement providing support for another statement. We have an argument when one or more statements give us reasons for believing another one. The supporting statements are premises , and the supported statement is the conclusion . In critical reasoning, the term statement also has a techni cal meaning. A statement (or claim) is an asser tion that something is or is not the case and is therefore the kind of utterance that is either true or false. You need to understand at the outset that argu – ment in this sense is not synonymous with persua – sion . An argument provides us with reasons for accepting a claim; it is an attempted “proof ” for an assertion. But persuasion does not necessarily involve giving any reasons at all for accepting a claim. To persuade is to influence people’s opin ions, which can be accomplished by offering a good argument but also by misleading with logical 01-Vaughn-Chap01.indd 19 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 20 PART 1: PRINCIPLES AND THEORIES Now look at this one: argument 3 1. All dogs are mammals. 2. Rex is a dog. 3. Therefore, Rex is a mammal. Again, there is no way for the premises to be true while the conclusion is false. The deductive form of the argument guarantees this. So a deductive argument is intended to have this sort of airtight structure. If it actually does have this structure, it is said to be valid . Argu ment 2 is deductive because it is intended to provide logically conclusive support to its con clusion. It is valid because, as a matter of fact, it does offer this kind of support. A deductive argument that fails to provide conclusive sup port to its conclusion is said to be invalid . In such an argument, it is possible for the premises to be true and the conclusion false. Argument 3 is in tended to have a deductive form, and because it actually does have this form, the argument is also valid. An elementary fact about deductive argu ments is that their validity (or lack thereof ) is a separate issue from the truth of the premises. Validity is a structural matter, depending en tirely on how an argument is put together. Truth concerns the nature of the claims made in the premises and conclusion. A deductive argument is supposed to be built so that if the premises are true, the conclusion must be true— but in a par ticular case, the premises might not be true. A valid argument can have true or false premises and a true or false conclusion. (By definition, of course, it cannot have true premises and a false conclusion.) In any case, being invalid or having false premises dooms a deductive argument. Inductive arguments are supposed to give probable support to their conclusions. Unlike deductive arguments, they are not designed to support their conclusions decisively. They can establish only that, if their premises are true, their conclusions are probably true (more likely to be true than not). Argument 1 is an inductive argument meant to demonstrate the probable Now there is no argument, just an expression of annoyance or anger. There are no statements giving us reasons to believe a conclusion. What we have are some unsupported assertions that may merely appear to make a case. If we ignore the distinction between genuine arguments and nonargumentative material, critical reasoning is undone. Assuming we can recognize an argument when we see it, how can we tell if it is a good one? Fortunately, the general criteria for judging the merits of an argument are simple and clear. A good argument— one that gives us good rea sons for believing a claim— must have (1) solid logic and (2) true premises. Requirement (1) means that the conclusion should follow logi cally from the premises, that there must be a proper logical connection between supporting statements and the statement supported. Re quirement (2) says that what the premises assert must in fact be the case. An argument that fails in either respect is a bad argument. There are two basic kinds of arguments— deductive and inductive— and our two require ments hold for both of them, even though the logical connections in each type are distinct. Deductive arguments are intended to give logi – cally conclusive support to their conclusions so that if the premises are true, the conclusion ab solutely must be true. Argument 2 is a deductive argument and is therefore supposed to be con structed so that if the two premises are true, its conclusion cannot possibly be false. Here it is with its structure laid bare: argument 21. It’s wrong to take the life of an innocent person. 2. Abortion takes the life of an innocent person. 3. Therefore, abortion is wrong. Do you see that, given the form or structure of this argument, if the premises are true, then the conclusion has to be true ? It would be very strange— illogical, in fact— to agree that the two premises are true but that the conclusion is false. 01-Vaughn-Chap01.indd 20 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 21 Using our natural reasoning ability, we can ex amine how the premises are linked to the conclu sion and can see quickly whether the conclusion follows from the premises. We are most likely to make an easy job of it when the arguments are simple. Many times, however, we need some help, and help is available in the form of methods and guidelines for evaluating arguments. Having a familiarity with common argument patterns, or forms, is especially useful when as sessing the validity of deductive arguments. We are likely to encounter these forms again and again in bioethics as well as in everyday life. Here is a prime example: argument 51. If the surgeon operates, then the patient will be cured. 2. The surgeon is operating. 3. Therefore, the patient will be cured. This argument form contains a conditional premise— that is, a premise consisting of a con ditional, or if then, statement (actually a com pound statement composed of two constituent statements). Premise 1 is a conditional state ment. A conditional statement has two parts: the part beginning with if (called the anteced- ent ) and the part beginning with then (k nown as the consequent ). So the antecedent of premise 1 is “If the surgeon operates,” and the conse quent is “then the patient will be cured.” The best way to appreciate the structure of such an argument (or any deductive argument, for that matter) is to translate it into traditional argument symbols in which each statement is symbolized by a letter. Here is the symbolization for Argument 5: 1. If p , then q . 2. p. 3. Therefore, q . We can see that p represents “the surgeon operates,” and q represents “the patient will be cured.” But notice that we can use this same symbolized argument form to represent countless other arguments— arguments with truth that “law enforcement in the city is a com plete failure.” Like all inductive arguments (and unlike deductive ones), it can have true prem ises and a false conclusion. So the sole premise— “incidents of serious crime have doubled”— can be true while the conclusion is false. If inductive arguments succeed in lending probable support to their conclusions, they are said to be strong . Strong arguments are such that if their premises are true, their conclusions are probably true. If they fail to provide this proba ble support, they are termed weak . Argument 1 is a weak argument because its premise, even if true, does not show that more likely than not law enforcement in the city is a complete failure. After all, even if incidents of serious crime have doubled, law enforcement may be successful in other ways, or incidents of serious crime may be up for reasons unrelated to the effectiveness of law enforcement. But consider this inductive argument: argument 41. Eighty five percent of the students at this university are Republicans. 2. Sonia is a student at this university. 3. Therefore, Sonia is probably a Republican. This argument is strong. If its premises are true, its conclusion is likely to be true. If eighty five percent of the university’s students are Republicans, and Sonia is a university student, she is more likely than not to be a Republican, too. When a valid (deductive) argument has true premises, it is a good argument. A good deduc tive argument is said to be sound . Argument 2 is valid, but we cannot say whether it is sound until we determine the truth of the premises. Argu ment 3 is valid, and if its premises are true, it is sound. When a strong (inductive) argument has true premises, it is also a good argument. A good inductive argument is said to be cogent . Argument 1 is weak, so there is no way it can be cogent. Argument 4 is strong, and if its premises are true, it is cogent. Checking the validity or strength of an argu ment is often a plain, commonsense undertaking. 01-Vaughn-Chap01.indd 21 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 22 PART 1: PRINCIPLES AND THEORIES 1. If p , then q . 2. Not p . 3. Therefore, not q . The advantage of being able to recognize these and other common argument forms is that you can use that skill to determine readily the validity of many deductive arguments. You know, for example, that any argument having the same form as modus ponens or modus tollens must be valid, and any argument in one of the common invalid forms must be invalid. Patterns of Moral Arguments All that you have learned about argument fun damentals thus far applies directly to that sub species of argument we are most interested in: moral argument. A moral argument is an argu ment whose conclusion is a moral statement, an assertion that an action is right or wrong or that a person or motive is good or bad. We utter a moral statement when we say such things as “Physician assisted suicide is wrong,” or “Maria should not have had an abortion,” or “Dr. Jones is a good person.” We are constantly making moral statements and including them in our moral arguments, which we frequently devise and hold up for inspection and evaluation. Recall Argument 2, a simple (and common) moral argument: 1. It’s wrong to take the life of an innocent person. 2. Abortion takes the life of an innocent person. 3. Therefore, abortion is wrong. Here, we can see all the standard features of a typical moral argument: (1) At least one premise (premise 1) is a moral statement asserting a gen eral moral norm such as a moral principle; (2) at least one premise (premise 2) is a nonmoral statement describing an action or circumstance; and (3) the conclusion is a moral statement ex pressing a moral judgment about a specific action or circumstance. different statements but having the same basic structure. It just so happens that the underlying ar gument form for Argument 5 is extremely common— common enough to have a name, modus ponens (or affirming the antecedent). The truly useful fact about modus ponens is that any argument having this form is valid. We can plug any statements we want into the formula and the result will be a valid argument, a circum stance in which if the premises are true, the con clusion must be true. Another common argument form is modus tollens (or denying the consequent). For example: argument 6 1. If the dose is low, then the healing i s slow. 2. The healing is not slow. 3. Therefore, the dose is not low. 1. If p , then q . 2. Not q . 3. Therefore, not p . Modus tollens is also a valid form, and any argument using this form must also be valid. There are also common argument forms that are invalid . Here are two of them: affirming the consequent argument 7 1. If the patient is getting better, then drugs are unnecessary. 2. Drugs are unnecessary. 3. Therefore, the patient is getting better. 1. If p , then q . 2. q. 3. Therefore, p . denying the antecedent argument 8 1. If the rate of infection is increasing, then the patients will die. 2. The rate of infection is not increasing. 3. Therefore, the patients will not die. 01-Vaughn-Chap01.indd 22 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 23 we cannot legitimately arrive at a moral conclu sion. That is, from a nonmoral premise alone, a moral conclusion does not logically follow. For example, from the nonmoral fact that abortions are frequently performed, we cannot conclude that abortion is immoral. Nonmoral premises cannot support a conclusion expressing a moral judgment. Likewise, we cannot reason from a moral premise alone (one affirming a general moral principle) to a conclusion about the moral ity of a particular action. We need a nonmoral premise affirming that the particular action in question is an instance of the general class of ac tions referred to in the general moral premise. In Argument 2, the moral premise tells us it’s wrong to take the life of an innocent person, but we need the nonmoral premise to assert that abortion is an instance of taking the life of an innocent Notice how natural this pattern seems. If we want to argue that a particular action (or kind of action) is wrong, for example, we must provide a reason for this moral judgment. The natural (and logical) move is to reach for a general moral principle that supports the judgment. Why is performing surgery on Mrs. Johnson without her consent wrong? Because, we might say, treating people without their consent is a viola tion of their autonomy (a moral principle), and performing surgery on Mrs. Johnson without her consent would be an instance of such a vio lation (a nonmoral fact). This natural way of proceeding reflects the logical realities of moral reasoning. In a moral ar gument, we must have at least one moral premise to draw a conclusion about the morality of a par ticular state of affairs. Without a moral premise, REVIEW: Valid and Invalid Argument Forms Valid Forms Affirming the Antecedent ( Modus Ponens) Denying the Consequent ( Modus Tollens) If p, then q. If p, then q. p. Not q. Therefore, q. Therefore, not p. Example: Example: If Spot barks, a burglar is in the house. If it’s raining, the park is closed. Spot is barking. The park is not closed. Therefore, a burglar is in the house. Therefore, it’s not raining. Invalid Forms Affirming the Consequent Denying the Antecedent If p, then q. If p, then q. q. Not p. Therefore, p. Therefore, not q. Example: Example: If the cat is on the mat, she is asleep. If the cat is on the mat, she is asleep. She is asleep. She is not on the mat. Therefore, she is on the mat. Therefore, she is not asleep. 01-Vaughn-Chap01.indd 23 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 24 PART 1: PRINCIPLES AND THEORIES IN DEPTH FALLACIES IN MORAL REASONING The world is full of bad arguments. Many of them occur again and again in different guises and con – texts, being so common that they have been given names and are studied by those who wish to avoid such mistakes. These common, defective arguments are called fallacies. Here are a few that often crop up in moral reasoning. STR AW M A N The straw man fallacy is the misrepresentation of a person’s views so they can be more easily attacked or dismissed. Suppose you argue that because an immunization program will save the lives of thou – sands of children and will likely cause the death of only 1 child out of every 500,000, we should fund the immunization program. But then your opponent replies that you think the life of a child isn’t worth much. Thus your point has been distorted, made to look extreme or unsavory— and is now an easier target. The straw man fallacy, of course, proves nothing, though many people fall for it every day. APPEAL TO THE PERSON Closely related to the straw man fallacy is appeal to the person (also known as the ad hominem fallacy). Appeal to the person is the rejecting of a statement on the grounds that it comes from a particular person, not because the statement, or claim, itself is false or dubious. For example: You can safely discard anything that Susan has to say about abortion. She’s a Catholic. Johnson argues that our current health care system is defective. But don’t listen to him— he’s a liberal. These arguments are defective because they ask us to reject a claim because of a person’s character, background, or circumstances— things that are gen- erally irrelevant to the truth of claims. A statement must stand or fall on its own merits. The personal characteristics of the person espousing the view do not necessarily have a bearing on its truth. Only if we can show that someone’s dubious traits some – how make the claim dubious are we justified in re – jecting the claim because of a person’s personal characteristics. Such a circumstance is rare. APPEAL TO IGNORANCE As its name implies, this fallacy tries to prove some – thing by appealing to what we don’t know. The appeal to ignorance is arguing either that (1) a claim is true because it has not been proven false or (2) a claim is false because it has not been proven true. For example: No one has proven that a fetus is not a person, so it is in fact a person. It is obviously false that a fetus is a person because science has not proven that it is a person. The first argument tries to prove a claim by pointing out that it has not been proven false. The second argument tries to prove that a claim is false because it has not been proven true. Both kinds of arguments are bogus because they assume that a lack of evidence proves something. But a lack of evi – dence can prove nothing. Being ignorant of the facts does not enlighten us. Notice that if a lack of evi – dence could prove something, then you could prove just about anything you wanted. You could reason, for instance, that since no one can prove that horses cannot fly, horses must be able to fly. BEGGING THE QUESTION The fallacy of begging the question is trying to prove a conclusion by using that very same conclusion as support. It is arguing in a circle. This way of trying to prove something says, in effect, “X is true because X is true.” Here is a classic example: The Bible says that God exists. The Bible is true because God wrote it. Therefore, God exists. The conclusion here (“God exists”) is supported by premises that assume that very conclusion. 01-Vaughn-Chap01.indd 24 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 25 premises (moral and nonmoral) are left unsaid and are merely implied. Sometimes premises are unstated because they are obvious assumptions that need not be mentioned. But if we are to per form a thorough evaluation of an argument, we must drag the implicit premises into the open so they can be fully assessed. Such careful scrutiny is especially important in moral arguments be cause the implicit premises are often question able assumptions— the secret, weak links in the chain of reasoning. For example: argument 91. In vitro fertilization is an entirely unnatural process, as far from natural reproduction as one could imagine. 2. Therefore, in vitro fertilization should not be used. As it stands, this is a bad argument; the con clusion does not follow from the premise. But there is an implied (moral) premise lurking here, person. After all, that a fetus is a person— the kind of entity that is deserving of full moral rights— is not obviously true and not assented to by everyone. We must spell out in a premise what we take to be the nonmoral fact of the matter. This discussion underscores a previously mentioned fact about moral disagreements. When people disagree on a moral issue, they may or may not be disagreeing about moral principles. They may actually share the relevant moral principles but disagree about the non moral facts— or vice versa. So when people take contradictory stands on the conclusion of a moral argument, the source of the conflict could lie with the moral premises or the nonmoral premises or both. Unfortunately, in everyday life moral argu ments do not come with their premises clearly labeled, so we need to be able to identify the premises ourselves. This job is made more diffi cult by a simple fact of the moral life: Often Here’s another one: All citizens have the right to a fair trial because those whom the state is obliged to protect and give consideration are automatically due judicial criminal proceedings that are equitable by any reasonable standard. This passage may at first seem like a good argu – ment, but it isn’t. It reduces to this unimpressive assertion: “All citizens have the right to a fair trial because all citizens have the right to a fair trial.” The conclusion is “All citizens have the right to a fair trial,” but that is more or less what the premise says. The premise — “those whom the state is obliged to protect and give consideration are auto – matically due judicial criminal proceedings that are equitable by any reasonable standard”— is equiva- lent to “All citizens have the right to a fair trial.” SLIPPERY SLOPE The metaphor behind this fallacy suggests the danger of stepping on a dicey incline, losing your footing, and sliding to disaster. The fallacy of slippery slope, then, is arguing erroneously that a particular action should not be taken because it will lead inevitably to other actions resulting in some dire outcome. The key word here is erroneously. A slippery slope sce- nario becomes fallacious when there is no reason to believe that the chain of events predicted will ever happen. For example: If dying patients are permitted to refuse treatment, then soon doctors will be refusing the treatment on their behalf. Then physician- assisted suicide will become rampant, and soon killing patients for almost any reason will become the norm. This argument is fallacious because there are no reasons for believing that the first step will ultimately result in the chain of events described. If good reasons could be given, the argument might be salvaged. 01-Vaughn-Chap01.indd 25 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 26 PART 1: PRINCIPLES AND THEORIES and if we make it explicit, the argument will be valid: 1. In vitro fertilization is an entirely unnatural process, as far from natural reproduction as one could imagine. 2. Any process that is unnatural should not be used. 3. Therefore, in vitro fertilization should not be used. Now the argument is complete, and we can see both the nonmoral premise (premise 1) and the moral premise (premise 2), which is a moral principle. But now that we have brought the moral premise into the light of day, we can see that it is false or at least debatable. We use many processes and products that are unnatural (for example, modern pharmaceuticals, intravenous feeding, surgery, CAT scans, artificial limbs, and contact lenses), but we generally do not regard them as morally impermissible. Very often we can tell that an argument has an unstated premise because there is a logical leap between the stated premises and the con clusion. The inference from stated premises to conclusion does not work unless the missing premise is supplied. A good candidate for the implicit premise will make the argument valid or strong and will be plausible in the context of the argument. The most straightforward ap proach, however, is to treat the argument as de ductive and look for a premise that will make the argument valid, as we did in Argument 9. Evaluating Premises As we have seen, good arguments have true premises. But how do we know if the premises are true? Fortunately, there are ways to test, or evaluate, the truth of premises. The tests differ, however, depending on whether the premises are nonmoral or moral. Checking the truth of nonmoral premises can involve the exploration of either empirical or conceptual matters. An empirical belief, or claim, is one that can be confirmed by sense experience— that is, by observation or scientific investigation. Most nonmoral premises are em pirical claims that we can check by examining our own experience or that of others or by con sulting the relevant scientific findings. By these methods we can test (and support) a wide variety of empirical assertions, such as many of the non moral premises examined earlier: “Incidents of serious crime have doubled”; “Eighty five percent of the students at this university are Republicans”; “If the patient is getting better, then drugs are unnecessary.” In bioethics, among the most controversial nonmoral premises are those affirming that a medical treatment or program will or will not have a particular effect on people. The issue is whether it will help or harm and to what degree. Sometimes reliable data are available to resolve the issue. Sometimes no clear evidence exists, leaving people to make educated guesses that are often in dispute. In any case, critical reasoning in bioethics demands that we always seek the most reliable evidence available and try to assess its worth ob jectively. It requires that our empirical claims be supported by good empirical evidence and that we expect the same from others who make em pirical assertions. A conceptual matter has to do with the mean ing of terms, something we need to pay attention to because disputes in bioethics sometimes hinge on the meaning of a concept. For example, in disagreements about the moral permissibility of abortion, the crux of the matter is often how the disputants define person (as in Argument 2), or human life , or human being . Similarly, whether someone supports or opposes euthanasia often hangs on how it is defined. Some, for example, define it in the narrow sense of taking direct action to kill someone for his sake (mercy killing), while others insist on a wider sense that en compasses both mercifully killing and allowing to die. Whether we are devising our own argu ments or evaluating those of others, being clear on the meaning of terms is essential, and any proposed definition must be backed by good reasons. 01-Vaughn-Chap01.indd 26 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 27 there was something wrong with utilitarianism or that other considerations (including alterna tive theories) outweigh utilitarian concerns. Another possible source of support for moral premises is what philosophers call our considered moral judgments . These are moral judgments we deem plausible or credible after careful reflection that is as unbiased as possible. They may apply to both particular cases and more general moral statements. For example, after deliberation we might conclude that “inflicting undeserved and unnecessary pain on someone is wrong,” or that “emergency care for accident victims should be provided regardless of their race or religion,” or that “amputating a patient’s leg for no good reason is never morally permissible.” Like moral principles and theories, such judgments can vary in how much weight they carry in moral argu ments and can be given more or less credibility (or undermined completely) by relevant reasons. (We examine more closely the relationships among theories, principles, and considered judgments in Chapter 2.) Moral premises can be called into question by showing that they somehow conflict with credible principles, theories, or judgments. One way to do this is to cite counterexamples , in stances in which the moral principle in question seems not to hold. Recall that a counterexample helps us see that the moral premise in Argument 9 is dubious. The premise says “Any process that is unnatural should not be used,” but we often use unnatural products or processes (CAT scans and contact lenses, for instance) and do not think these actions morally wrong. In the same way, we can use counterexamples to evaluate the moral premise in Argument 2: 1. It’s wrong to take the life of an innocent person. 2. Abortion takes the life of an innocent person. 3. Therefore, abortion is wrong. Are there no exceptions to premise 1? Is it always wrong to kill an innocent person? We can imagine cases in which this premise seems Moral premises are like nonmoral ones in that they, too, should be supported by good reasons and be subjected to serious scrutiny. But just how are moral premises supported and scrutinized? Support for a moral premise (a moral principle or standard) can come from at least three sources: other moral principles, moral theories, or our most reliable moral judgments. Probably the most common way to support a moral principle is to appeal to a higher level principle (which often turns out to be one of the four major moral principles discussed earlier). Suppose the moral premise in question is “The patient’s wishes about whether surgery is performed on him should not be ignored.” Some would argue that this principle is derived from, or is based on, the higher princi ple that autonomous persons should be allowed to exercise their capacity for self determination. Or let’s say the premise is “Individuals in a persis tent vegetative state should never have their feed ing tubes removed so they can ‘die with dignity.’” Many would base this assertion on the principle that human life is sacred and should be preserved at all costs. Frequently, the higher principle ap pealed to is plausible, seemingly universal, or ac cepted by all parties so that further support for the principle is not necessary. At other times, the higher principle itself may be controversial and in need of support. Moral premises can also be supported by a moral theory, a general explanation of what makes an action right or a person or motive good. (In Chapter 2 we discuss moral theories in depth.) For example, traditional utilitarianism is a moral theory affirming that right actions are those that produce the greatest happiness for all concerned. Appealing to utilitarianism, then, someone might insist that a baby born with severe brain damage who will die within a few days should not be allowed to wither slowly away in pain but should be given a lethal injection. The justification for this policy is that it would produce the least amount of unhappiness (in cluding pain and suffering) for all concerned, including baby, parents, and caregivers. Those who reject this policy would have to argue that 01-Vaughn-Chap01.indd 27 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 28 PART 1: PRINCIPLES AND THEORIES of prose. In any case, your job is to come up with a single conclusion statement for each con clusion—even if you have to paraphrase large sections of text to do it. When you identify the conclusion, the hunt for premises gets easier. Step 3. Identify the premises. Like the search for a conclusion, unearthing the premises may involve condensing large sections of text into manage able form—namely, single premise statements. To do this, you need to disregard extraneous material and keep your eye on the ‘‘big picture.’’ Remember that in moral arguments you are looking for both moral and nonmoral premises. Let’s see how this procedure works on the follow ing passage:  John and Nancy Jones had a two year old son who suffered from a serious but very curable bowel obstruction.  For religious reasons, the Joneses decide to treat their son with prayer instead of modern medicine.  They refused medical treat ment even though they were told by several doc tors that the child would die unless medically treated.  As it turned out, the boy did die.  The Joneses were arrested and charged with involuntary manslaughter.  Were the Joneses wrong to refuse treatment for their son?  The answer is yes.  Regardless of what faith or religious dogma would have the Joneses do, they allowed their child to die.  According to just about any moral outlook, the care of a child by the parents is a fundamental obligation.  Above all other concerns, parents have a duty to ensure the health and safety of their children and to use whatever means are most likely to secure those benefits.  In other words, allowing a child to die when the death could easily have been prevented is morally reprehensible.  The Joneses were therefore guilty of a shockingly immoral act. The first order of business is to find the con clusion, and in doing so we can see that the first paragraph is entirely background information. The conclusion is in sentence 12, and with this information, we can tell that sentence 7 is a short affirmation of the conclusion. We can also locate either doubtful or at least not obviously true. What about situations in which many lives can be saved by taking the life of one person? What if all 50 people in a lifeboat at sea will drown unless one of them is cast overboard? What if the one unlucky person agrees to be cast over board to save all the others? Or suppose a person is dying of cancer and is suffering unspeakable pain that cannot be relieved by any medical means— and she begs for a lethal injection of morphine. Some would argue that these scenar ios raise serious questions about premise 1, sug gesting that at least in its current form, it may not be true. In response to these counterexamples, some who wish to defend the premise might modify it to take the scenarios into account or even try to show that despite its implications premise 1 is justified. Assessing Whole Arguments Moral argument, like any other kind of argu ments, usually come to us embedded in larger tracts of speech or writing. Often the premises and conclusion are embellished or obscured by other elements—by explanations, asides, reiter ations, descriptions, examples, amplifications, or irrelevancies. So how do we evaluate such arguments in the rough? Following this procedure will help: Step 1. Study the text until you thoroughly under stand it. You can’t locate the conclusion or prem ises until you know what you’re looking for—and that requires having a clear idea of what the author is driving at. Don’t attempt to find the conclusion or premises until you ‘‘get it.’’ This understanding entails having an overview of a great deal of text, a bird’s eye view of the whole work. Step 2. Find the conclusion. When you evaluate arguments surrounded by a lot of other prose, your first task is to find the conclusion . There may be a single conclusion, or several main conclu sions, or one primary conclusion with several subconclusions. Or the conclusion may be nowhere explicitly stated but embodied in meta phorical language or implied by large expanses 01-Vaughn-Chap01.indd 28 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 29 inductive argument metaethics moral absolutism moral argument moral objectivism morality normative ethics paternalism subjective relativism summary Morality refers to beliefs about right and wrong actions and morally good and bad persons or character. Ethics is the study of morality using the tools and methods of philosophy. The study of morality using the methodology of science is known as descriptive ethics. Ethics has three main branches: (1) normative ethics, the search for, and justification of, moral standards, or norms; (2) metaethics, the study of the meaning and justification of basic moral beliefs; and (3) applied ethics, the use of moral norms and concepts to resolve practical moral issues. Bioethics is applied ethics focused on health care, medical science, and medical technology. Moral norms differ from other kinds of norms because they are characterized by (1) normative dominance, (2) universality, (3) impartiality, and (4) reasonableness. We apply moral norms to two distinct spheres of our moral experience— obligations and values. Moral obligations concern our duty, what we are obligated to do or not do, and refer primarily to right and wrong actions. Moral values generally concern those things that we judge to be morally good, bad, praiseworthy, or blameworthy. A right action can be obligatory (one that would be wrong not to perform) or permissible (one that is not wrong to perform). A prohibited action would be one that would be wrong to perform. A supererogatory action is one that is “above and beyond ” our duty. In bioethics, five moral principles have been extremely influential and particularly relevant: (1) autonomy (autonomous persons should be allowed to exercise their capacity for self determination); (2) nonmaleficence (we should the premises. The nonmoral premise is in sen tence 8: the nonmoral fact is that the Joneses permitted their child to die. The moral premise is stated most explicitly in sentence 11. Sentences 9 and 10 are equivalent to 11, although stated more ge ne r a l l y. The bare bones arguments then is:  Regardless of what faith or religious dogma would have the Joneses do, they allowed their child to die.  In other words, allowing a child to die when the death could easily have been prevented is morally reprehensible.  The Joneses were therefore guilty of a shock ingly immoral act. This argument is deductively valid, so the crucial question is whether the premises are true. Presumably the nonmoral premise 8 is an uncontested assertion. We can imagine that everyone knows that the Joneses let their child die. Premise 11, the moral statement, seems to be a plausible moral principle—some would say it’s just common sense. Most people would find it difficult to think of a credible counterexample to it. But that is precisely what is at issue here: whether it’s ever morally permissible to allow a child to die when the death can easily be pre vented. To justify premise 11, those who accept it may appeal to a moral theory (utilitarianism or Kantian ethics, say) or to more general moral principles such as ‘‘always act to preserve life,’’ ‘‘treat persons with respect,’’ or ‘‘humans have a right to life.’’ On the other hand, it’s hard to see how the rejection of premise 11 could be based on anything other than a religious moral principle. key terms applied ethics bioethics cultural relativism deductive argument descriptive ethics divine command theory ethical relativism ethics 01-Vaughn-Chap01.indd 29 26/05/16 4:25 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 30 PART 1: PRINCIPLES AND THEORIES 1. Noah promised to drive Thelma to Los Angeles, so he should stop bellyaching and do it. 2. The refugees were shot at and lied to, and the authorities did nothing to stop any of this. The authorities should have intervened. 3. There was never any imminent threat from the Iraqi government, so the United States should not have invaded Iraq. 4. The Indian government posed an imminent threat to Pakistan and the world, so the Pakistanis were justified in attacking Indian troops. 5. Burton used a gun in the commission of a crime; therefore he should get a long prison term. 6. Ellen knew that a murder was going to take place. It was her duty to try to stop it. 7. Ahmed should never have allowed his daughter to receive in vitro fertilization. Such a procedure is unnatural. 8. The doctors performed the experiment on twenty patients without their consent. Obviously, that was wrong. 9. What you did was immoral. You hacked into a database containing personal information on thousands of people and invaded their privacy. 10. Ling spent all day weeding Mrs. Black ’s garden for no pay. The least Mrs. Black should do is let Ling borrow some gardening tools. Exercise 1.2 For each of the following arguments, specify the conclusion and premises and indicate where possible whether it is cogent or sound. 1. Anyone who runs away from an automobile accident should be arrested. Janet ran away from an automobile accident. She should be arrested. 2. I write in response to the Nov. 4 News article, ‘‘Plans for group home, storage facility opposed.” As the sister and not cause unnecessary harm to others); (3) be neficence (we should do good to others and prevent or remove harm); (4) utility (we should produce the most favorable balance of good over bad for all concerned); and (5) justice (we should treat equals equally). According to ethical relativism, moral stan dards are not objective but are relative to what individuals or cultures believe. A familiar argu ment for cultural relativism is that if people’s moral judgments differ from culture to culture, then moral norms are relative to culture, and people’s moral judgments obviously do differ from culture to culture. But the first premise in the ar gument is false. In addition, cultural relativism seems implausible because it implies moral infal libility, immunity of all cultures from moral crit icism from the outside, the automatic wrongness of the moral stance of social reformers, and the incoherence of the idea of moral progress. More over, cultural relativism does not necessarily lead to tolerance and does not logically entail it. The divine command theory says that right actions are those commanded by God, and wrong actions are those forbidden by God. But many religious and nonreligious people have rejected the theory because it seems to imply that God’s commands are arbitrary. Most critical reasoning is concerned in one way or another with the construction or evalua tion of arguments. All the skills required in deal ing with arguments generally can be applied directly to handling moral arguments in partic ular. A moral argument is one whose conclusion is a moral statement, an assertion that an action is right or wrong or that a person or motive is good or bad. ARGUMENT EXERCISES (All answers appear in the Appendix.) Exercise 1.1 In each of the following passages, add a moral premise to turn it into a valid moral argument. 01-Vaughn-Chap01.indd 30 26/05/16 4:26 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 31 2. Anyone who disagrees with the basic moral dictums of the prevailing culture should be censored. Dr. Tilden’s graduation speech clearly was inconsistent with the prevailing moral opinions on campus. She should be reprimanded. Exercise 1.4 Identify the moral arguments in each of the following passages. Specify the premises and the conclusion, adding implicit premises where needed. 1. The movie Lorenzo’s Oil is about a family’s struggle to find a cure for their young son’s fatal genetic disease, an illness that usually kills boys before they reach their eleventh birthday. The script is based on the true story of a family’s attempt to save Lorenzo, their son, from this fatal genetic disease through the use of a medicinal oil. The movie is a tear jerker, but it ends on a hopeful note that suggests that the oil will eventually cure Lorenzo and that the oil is an effective treatment for the genetic disease. The problem is, there is no cure for the disease and no good scientific evidence showing that the oil works. But the movie touts the oil anyway—and gives false hope to every family whose son suffers from this terrible illness. Worse, the movie overplays the worth of the oil, seriously misleading people about the medical facts. The movie, therefore, is immoral. It violates the ageless moral dictum to, above all else, ‘‘do no harm.’’ Lorenzo’s Oil may be just a movie, but it has done harm nonetheless. 2. I, like many of my fellow Muslims, was appalled by the latest bombing in Saudi Arabia (‘Among the Saudis, Attack Has Soured Qaeda Supporters,’ front page, Nov. 11). Yet I was disturbed to get the sense that Saudis were angered by this latest act of barbarity because the targets were mainly Arab and Muslim. guardian of a profoundly retarded woman who lives in a group home, I can assure the gentlemen quoted that their fears are very much unfounded. The home in which my sister resides is large, lovely, brand new, well staffed and well maintained. It does nothing but enhance the community, bring neighbors together and create a wonderfully diverse neighborhood— Letter to the editor, Buffalo News 3. Scrawling ‘‘Rape all Asian bitches and dump them’’ on classroom walls is not a hate crime, and graffiti should be protected by the First Amendment, according to assis tant professor of communication Laura Leets. This is outrageous. I hope Ms. Leets is simply arguing from a narrow legalistic interpretation and is merely insensitive to the tremendous hurt such graffiti can inflict, not to mention the additional damage caused when a professor on campus defends it. Words can be just as destructive as physical violence. Drawing a technical distinction between the two is at best insensitive, at worst evil—Letter to the editor, Stanford Magazine 4. Yolanda took the money from petty cash even though she had plenty of money in her pocket. People shouldn’t steal unless they are destitute. She shouldn’t have taken that money. 5. There is one principle we can never avoid: We should never do anything to disrespect human life. The artificial use of human cells—as scientists are now doing in stem cell research—shows a complete disregard for human life. Stem cell research is immoral. Exercise 1.3 Evaluate the following arguments: 1. Any form of expression or speech that offends people of faith should not be tolerated. Penthouse magazine definitely offends people of faith. Ban it! 01-Vaughn-Chap01.indd 31 26/05/16 4:26 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics 32 PART 1: PRINCIPLES AND THEORIES Richard M. Fox and Joseph P. DeMarco, Moral Reason – ing , 2nd ed. (New York: Harcourt, 2001). William K. Frankena, Ethics , 2nd ed. (Englewood Cliffs, NJ: Prentice Hall, 1973). Bernard Gert, Morality: Its Nature and Justification (New York: Oxford University Press, 1998). John Stewart Gordon, “Bioethics,” The Internet Ency – clopedia of Philosophy , http://www.iep.utm.edu/ (15 October 2015). Chris Gowans, “Moral Relativism,” in The Stanford Encyclopedia of Philosophy (Spring 2004), ed. Edward N. Zalta, http://plato.stanford.edu/archives/spr2004/ entries/moral relativism/. C. E. Harris, Applying Moral Theories (Belmont, CA: Wadsworth, 1997). The Hastings Center , http://w w w.thehastingscenter.org/ (15 October 2015). Melville Herskovits , Cultural Relativism: Perspectives in Cultural Pluralism (New York: Vintage, 1972). Albert R. Jonsen, The Birth of Bioethics (New York: Oxford University Press, 1998). Kai Nielsen, Ethics Without God (Buffalo, NY: Prometheus, 197 3). Louis P. Pojman, Ethics: Discovering Right and Wrong , 4th ed. (Belmont, CA: Wadsworth, 2002). Louis P. Pojman and Lewis Vaughn, eds., The Moral Life , 3rd ed. (New York: Oxford University Press, 2007). James Rachels, The Elements of Moral Philosophy , 4th ed. (New York: McGraw Hill, 2003). Theodore Schick, Jr. and Lewis Vaughn, Doing Philoso – phy , 2nd ed. (New York: McGraw Hill, 2002), chap. 5. Russ Shafer Landau, Whatever Happened to Good and Evil? (New York: Oxford University Press, 2004). Peter Singer, ed., A Companion to Ethics (C a mbr id ge , UK: Blackwell, 1993). Walter T. Stace, “Ethical Relativism,” in The Concept of Morals (New York: Macmillan, 1965), 8– 58. Bonnie Steinbock, ed., The Oxford Handbook of Bioethics (Oxford: Oxford University Press, 2007). Paul Taylor, Principles of Ethics (Encino, CA: Dickenson, 197 5). Lewis Vaughn, Doing Ethics: Moral Reasoning and Con – temporary Issues (New York: W.W. Norton, 2008). Lewis Vaughn, The Power of Critical Thinking , 2nd ed. (New York: Oxford University Press, 2008). Thomas F. Wall, Thinking Critically About Moral Problems (Belmont, CA: Wadsworth, 2003). G. J. Warnock, The Object of Morality (London: Methuen & Co. 1971). You quote one person as saying of the bombing in Riyadh in May, “At that time it was seen as justifiable because there was an invasion of a foreign country, there was frustration.” Another says, “Jihad is not against your own people.” Regardless of whether the victims are Muslim or not, the vicious murder of innocent human beings is reprehensible and repugnant, an affront to everything Islam stands for. Any sympathy for Al Qaeda among the minority of Saudis should have evaporated after the May bombings in Riyadh, and it should have surprised no one in Saudi Arabia that Al Qaeda would attack a housing complex full of Arabs and Muslims. That is what Al Qaeda is: a band of bloodthirsty murderers.—Letter to the editor, New York Times further reading Anita L. Allen, New Ethics: A Guided Tour of the Twenty- First Century Moral Landscape (New York: Miramax, 2004). John Arras, “Theory and Bioethics,” The Stanford Ency – clopedia of Philosophy (Summer 2013), Edward N. Zalta (ed.), http://plato.stanford.edu/archives/sum2013/ entries/theory bioethics/ (15 October 2015). Robert Audi, Moral Knowledge and Ethical Character (New York: Oxford University Press, 1997). Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics , 5th ed. (New York: Oxford University Press, 2001). Bioethics.com , http://www.bioethics.com/ (15 October 2 015). Richard B. Brandt, Ethical Theory (Englewood Cliffs, NJ: Prentice Hall, 1959). Steven M. Cahn and Joram G. Haber, Twentieth Century Ethical Theory (Upper Saddle River, NJ: Prentice Hall, 19 95). Jean Bethke Elshtain, “Judge Not?,” First Things 46 (October 1994): 36– 41. Fred Feldman, Introductory Ethics (Englewood Cliffs, NJ: Prentice Hall, 1978). 01-Vaughn-Chap01.indd 32 26/05/16 4:26 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics Chapter 1: Moral Reasoning in Bioethics 33 notes 1. James Rachels, The Elements of Moral Philosophy, 4th ed. (New York: McGraw Hill, 2003), 14. 2. This example is derived from James Rachels’ unique description of the case in “Ethical Theory and Bioethics,” from A Companion to Bioethics, ed. Helga Kuhse and Peter Singer (Oxford: Blackwell, 2001), 16– 17. 3. W. D. Ross, The Right and the Good (O x ford : Clarendon Press, 1930). 4. In their classic text Principles of Biomedical Ethics (New York: Oxford University Press, 2001), Tom L. Beauchamp and James F. Childress work out a comprehensive approach to biomedical ethics using a framework of four moral principles. They choose to treat beneficence and nonmaleficence separately and regard utility as part of beneficence. 5. Solomon Asch, Social Psychology (Englewood Cliffs, NJ: Prentice Hall, 1952), 378– 79. 01-Vaughn-Chap01.indd 33 26/05/16 4:26 PM 08/29/2018 – RS0000000000000000000001179164 (Kelso Cratsley) – Bioethics
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