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Posted on August 11, 2014 at 12:08 AM

In my last blog I asked the question, “What is ethics doing?” where I contrasted the armchair, academic ethics that I knew as a graduate student with the clinical ethics cases in which I am now involved in clinical ethics consultations. I alluded to the famous paper by Stephen Toulmin (1922-2009), “How medicine saved the life of ethics” by providing ethics with many practical value laden problems to address. The very process of becoming involved with applied ethics and ethical problems of practicing physicians in the healthcare system was itself as, or perhaps more, transformational for ethics than it was for medicine. Even though medicine needed a serious study of its value-laden issues, which has evolved into bioethics and clinical ethics, the very activity of doing applied ethics has evolved into a better defined field of inquiry with a clearer purpose. But what about the armchair, academic pursuits of philosophical ethics of old? Is there anything left for it to do? This is the question I will attempt to answer in this blog.

Perhaps the most complete model of an ethical framework was Aristotle’s (384-382 BC) Nichomachean Ethics, which fully articulated a coherent, normative philosophical moral system. The good life for humans according to Aristotle was grounded in the rational, teleological structure of the universe. All individual things in nature contained an inherent rational function that defined their nature as individual things, including human beings. For a thing to fulfills its function or rational nature it was a mark of excellence and in a real sense made it more like God or the first or prime mover, which was the highest form of pure, rational activity. For humans to fulfill their rational function in practical terms required finding a balance in all their activities between excess and deficiency which, Aristotle called the mean. Finding this rational balance in all endeavors and allowing that balance to become part of one’s daily life habits produced an excellent state of character or virtue, which also over time resulted in human flourishing or happiness. The good political state was one that accommodated individual human flourishing or virtue. Thus, metaphysics was assumed to ground both morality, i.e. the pursuit of the good life for individual humans, and politics, i.e. the element or framework in which human life was possible in its natural social setting of community. 

Aristotle’s works were destroyed in subsequent centuries but fortunately preserved by Islamic and other scholars and rediscovered in the West and incorporated into Christianity by the great Christian theologian Thomas Aquinas (1225-1274). The god of Aristotle’s Metaphysics became the God of the Judeo-Christian tradition and the ancient Greek good life for humans is transformed into the good Christian life. Christian morality became grounded in the natural function of humankind and is articulated in Natural Law theory. Again, morality is assumed, very much parallel to Aristotle’s way of thinking, to be rooted in the very nature of divine, teleological creation. The natural ends of the universe frame the good life and the objective nature of right and wrong for humans. This standard of morality was largely assumed by the Christian church and was dominant until the emergence of modern science and the new scientific worldview. 

Modern philosophy, as expressed by Renee Descartes (1596-1650), John Locke (1632-1404) and others during this era reflected the fundamentally different relationship human beings had in relation to the universe and morality. Nature became a lifeless object of study, which lent itself to the development of the scientific method and the rise of the modern natural sciences and eventually social sciences. Reason is no longer assumed to be embedded in the natural order of things and thus there is no natural rational basis for morality. Instead the role of reason is to observe, describe and quantify natural phenomena and use reason as a tool to solve human problems and identify human goals. Thus, the quest of much of modern philosophy is to find a new rational basis for metaphysics and morality to replace the ancient Aristotelian paradigm. 

I think Alasdair MacIntyre (1929- ) in After Virtue is right in saying that the modern era failed in this quest. This conclusion is hardly surprising when put in perspective. The rise of modern science was a rejection of the ancient Aristotelian worldview in which objective, inherent reason and God were assumed. In the modern worldview, they are no longer assumed. They must be shown to be either empirically verifiable or rationally justifiable. But this is a challenge that the tools of scientific reason cannot accomplish, though it did not keep philosophers from trying. The result is a series of failed, quasi-relgious efforts culminating with what MacIntyre sees as an era of emotivism in which the striking feature of moral debates is their interminable character, i.e. there is no rational way of securing moral agreement. He rightly sees philosophical theories as presenting theoretical approaches that were completely detached from their practical implications. For example the philosophical emotivists promoted an understanding of ethical claims as meaningless because they did not meet the criteria for meaning according to scientific standards. However, never did the emotivists consider the impact on human societies if they actually took seriously such a theory and acted as though all moral claims are meaningless. It seems apparent we humans must take morality seriously, but how do we do so with such a limited role for reason? 

Philosophical ethics, during much of the first half or more of the 20th century in American universities, was devoted to analysis and meaning of moral terms with little concern for the history of its failed predecessors. Little effort was made to develop grand, normative ethical theories that would compete for universal assent. With a diversity of moral views being expressed in America and the West, no single substantive moral perspective, e.g. Christian moral philosophy, could become dominant. Ethics from a practical point of view became part of the challenge of learning to live with diverse values and acceptable levels of disparities in a democratic system. This means that the moral setting of contemporary America contains fundamentally different understandings of politics and the good life for human beings. So where does this leave ethics as we understand it in bioethics and clinical ethics?

My sense is there is still no dominant understanding of philosophical ethics in contemporary philosophy and bioethics. But it is clear that the coming of age of bioethics and other applied areas of ethics and philosophy have impacted our understanding of philosophical ethics. Whether fully articulated or not, solutions to thorny value questions in medicine and scientific research today must accommodate a plurality of values within a democratic society. Because philosophical ethics cannot assert the authority of a final, content rich normative standard of right and wrong, the most we can hope for is mutual accommodation and compromise in working out viable options for peaceful living. Thus, the emphasis must be on achieving outcomes that ameliorate problematic human situations in which the vulnerable must be protected and rights of participants must be upheld. So instead of assuming a normative standard for what is good or right, these terms now just connote positive outcomes or results—good and right become the ends of ethical inquiry as opposed to being assumed from the beginning. This approach is the mark of philosophical pragmatism best articulated by John Dewey (1859-1952) but more recently brought to a new level of awareness and relevance by Richard Rorty (1931-2007). Rorty, like Dewey, wants us to give up the quasi-religious quest for final answers and change our focus to using our reflective, analytical abilities in philosophy to help to reduce human suffering and promoting ways in which humans can live and flourish in their lives. Philosophical ethics, like all philosophical inquiry, should heed this advice and strive to reframe our moral vocabulary to fit the practical conditions in which we live and work. This in effect seems like what has been happening in bioethics for the last few decades. 

Though many on the political and religious right find these conclusions unacceptable we are living in a world that is smaller and more diverse by virtue of our shared knowledge and advanced ways of communication. Learning to live peacefully and working out our problems through shared peaceful procedural processes is part of democratic life. Philosophical ethics must learn, as Dewey had hoped it would over a hundred years ago, to function as a creative, intelligent force to make the world a better place for human living. My hope is that philosophical ethics as part of bioethics and clinical ethics will continue to evolve and will be appreciated as a practical, valuable resource not only in bioethics but also by academic philosophy and in public policy.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website. 

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