The Elimination Of Morality

Philosophy, I maintain, does not deliver a verdict upon moral questions; and it follows that bioethics, conceived of as the search for that verdict, is a futile and misguided enterprise. The moral conclusions to be found in the books and articles written by bioethicists are not ones that philosophy produces or sanctions. They are no more than the opinions bioethicists hold upon the matters they discuss .

There is no better description of Anne Maclean’s criticism of bioethics. The fragment above is written at the beginning of her book The Elimination of Morality, and expresses the substance of her conclusion. If read thoroughly, it implies the following:
1. Somehow bioethicists (which for some reasons she identifies with the philosophers she criticises in her book ) do think that they deliver a ‘verdict upon moral questions’;

2. Bioethics is a futile and misguided enterprise if or when conceived as the search for that verdict . Thus if we do not conceive bioethics as the search for that verdict, the implication disappears;

3. Further, the moral conclusions of bioethicists (or philosophers) are not the products of philosophy itself. Fair enough: similarly, the medical conclusion of a health professional is not the product of medicine itself, nor are the conclusions of physicists about physics the conclusions of physics itself. The professionals do not identify with their professions, so philosophers do not either;

4. Such conclusions (produced by bioethicists/philosophers) are the opinions of those particular individuals who produce them – therefore they cannot have a reasonable pretence of being objective.
If we were to take Maclean’s word for it, all the bioethicists that she criticises (namely John Harris, Peter Singer, James Rachels, and R. M. Hare) pretend to deliver verdicts, and they pretend that the verdicts they deliver are ‘Made in Philosophy’; they all see themselves as ‘moral experts’.

According to bioethicists (like those mentioned above), for a proposition to be a moral judgement, it must be rationally justified, and a judgement or decision is rationally justified if it satisfies two conditions: it must be supported by a reason or principle, and that reason or principle must be “demonstrably rational to accept” .
But, argues Maclean, “moral questions are not intellectual questions, and morality is not a logical system” .

These general objections stand apart from the other specific criticisms that she makes of particular issues discussed in particular books of particular bioethicists. Her position can be summarized in the following words: “bioethicists claim to be ethical experts, and claim that ethics must obey the rules of logic; look, there are conflicting moral statements in bioethics. Therefore, bioethicists are not ethical experts and bioethics does not obey the rules of logic”. Otherwise, if philosophers do not make such claims that she says they do, her whole construction falls apart. She herself does argue on particular theories and thought exercises, complying with the same logical rules she accuses them of .

Therefore, although she places bioethicists at one extreme, she refuses to place herself at the other . As Tuija Takala rightfully writes, “in an academic field of study, it would be quite odd to disregard reason altogether. If the general rules of scientific reasoning are not applied, no conclusions could be argued for – or falsified, for that matter” .


Going back to the favourite target of Maclean’s favourite victim, namely John Harris’s The Value of Life , barely arrived at page 3 one can read the following:
[t]he resolution of moral dilemmas both requires and presupposes a willingness and an ability to question and challenge basic beliefs, and to show whether or not they can be justified. And this activity in turn requires that we understand the concepts used to frame these beliefs, and are clear as to what they mean and imply.

Both these activities are essentially philosophical. That does not of course mean that only people who self-consciously regard themselves as philosophers, or who are professional philosophers, can undertake them. Philosophy, unlike medicine, has never been the exclusive preserve of professionals, and one of the tasks of this book is to show how the resolution of the dilemmas of medical practice raises important issues of personal morality and of public policy in which we all have an interest.

Thus, apparently philosophers do not claim an exclusive and exclusionary title of ethical experts for themselves. If, for instance, we take Harris’s formulation “philosophy, unlike medicine, has never been the exclusive preserve of professionals” and Maclean’s “philosophers have no special authority to make moral judgements”, the contradiction between the two authors does not appear as harsh as she presents it. From Harris’s perspective, “anyone who is prepared to think critically and seriously about them [moral dilemmas – n.a.] can contribute to their resolution” .

Whether or not moral philosophers claim they are moral experts, they do claim that their endeavour is useful in medical practice. However, the principlist approach in particular, and with it most of the other philosophical moral theories involved in the field, are attacked from a different perspective, too. This is the ‘anti-theory’ approach. Certainly, the ‘anti-theory’ criticism of philosophy is very complex, and a fair account of it would go far beyond the purposes of this thesis. However, we cannot ignore its arguments.
But before that, let us briefly see what the main features of the principlist approach are. Wide branches of both bioethics and medical ethics declare themselves to be ‘principle-based’. The most influential account of principles in medical ethics is given by two American authors, Tom Beauchamp and James Childress in their famous Principles in Biomedical Ethics. According to the two authors,
a set of principles in a moral account should function as an analytical framework that expresses the general values underlying rules in the common morality , where ‘common morality’ refers to a basic set of norms that are universally shared (the two authors place in this category rules against lying, stealing, promise keeping etc.) .

The four principles argued for, and widely endorsed by large communities of health professionals and ethicists of medicine ever since the book (now at its fifth edition) was first published in 1979, are the following:

(1) Respect for autonomy, “a norm of respecting the decision-making capacities of autonomous persons”;

(2) Non-maleficence, “a norm of avoiding the causation of harm”;

(3) Beneficence, “a group of norms for providing benefits against risks and costs”;

(4) Justice, “a group of norms for distributing benefits, risks, and costs fairly” .

Along with discussing the substance of the presented principles, Beauchamp and Childress identify four moral theories working in the field of biomedical ethics, namely utilitarianism, Kantianism, communitarianism, and the ethics of care .

The same year when Beauchamp and Childress’s book was first published (1979), the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research in the US issued the Belmont Report, where three principles were emphasized, with their respective applications relevant for medical research. These principles are respect for persons, beneficence and justice, which create the need to implement informed consent, risk/benefit assessment and fair selection of subjects for research.
Both accounts, that developed by Beauchamp and Childress and the Belmont Report, represent the starting point of much of the principlism in medical ethics, that was to follow.

Anne Maclean’s criticism of bioethics is but a ‘breeze’ of a sophisticated and vivid attack against philosophers. This attack centres, in this case, on the following issue: because they are inevitably abstract (even when informed and made as flexible as possible), philosophical moral theories and principles can never be made as concrete as necessary so as to fit particular cases. As Earl Winkler asks, how can we ever be certain that we correctly interpret a concrete case, so as to decide that it is a matter of a certain moral principle? Can we always specify sufficient reasons for which that particular case is morally similar to another?

Instead, Winkler suggests that an ethics focused on context would be fit for particular cases, for the particular views of individual moral agents, for the practices of particular moral communities. He disapproves of the deductive methods of philosophy in applied ethics, and insists that the inductive construction of moral explanations – starting with cases and moving on to a ‘considered moral judgement’ – is more fit for the practical assessment of moral dilemmas.

Winkler’s criticism, even if indeed valid, is not of direct relevance for the purposes of this thesis. As long as we are concerned with the analysis of formal documents, the issue of the involvement of (principlist) philosophers in the medical practice is not involved. Interestingly, Winkler himself is not very keen to draw the conclusions he seems to be leading the reader towards, and in his conclusion he admits that his analysis is not in the sense that moral philosophy or ethical theory are useless when it comes to moral practice.
As it appears, the possible uses of philosophy, if indeed there are any, are not without controversy.
The existence of different norms associated with different cultures and the presumably eternal incapacity (or internal impossibility) of philosophical ethics to give solutions that are uncontroversial at least within philosophy itself are likely to create further problems for the acceptance of a role of philosophers in medical ethics.
Although I do not deny that there may be exceptions, philosophers do not claim a total role of decision makers within medical ethics. Instead, they do claim that their involvement is useful, at least at the level of identifying and sanctioning flaws in argumentation that are likely to pass unnoticed in a medical discourse lacking a consistent and informed critical attitude. And, as we shall see further in this thesis, the same may be the case for the political discourse in the field of bioethics.

If there are no ethical experts, it may be that centuries of ethical discourse have made and sanctioned mistakes, and it may be that health care professionals as well as political decision makers, and whichever other instance involved, with the assistance of philosophers, could take advantage of the ensuing lessons.

By: Artur Victoria