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Bioethics and philosophy.

K. Danner Clouser was the first philosopher to teach ethics in a medical school.

The question of the relationship of philosophy to the moral problems of medicine is one that has been on my mind almost daily for twenty-five years. From the very beginning of my career, I have been constantly alert to whatever connection I could find between the theories of philosophers and the everyday moral dilemmas of physicians and patients.

Philosophy has indeed contributed significantly to medical ethics. Though the connection between the lofty theories of ethics and the moral dilemmas of health professionals and patients is complicated and problematic, the forced dialogue between the theories and the problems has been crucial in helping to systematize, to focus, and to pose the fruitful, organizing questions. Remember that twenty-five to thirty years ago, medical ethics was hardly even individuated as a field. It was a mixture of religion, whimsy, exhortation, legal precedents, various traditions, philosophies of life, miscellaneous moral rules, and epithets (uttered by either wise or witty physicians). I believe philosophy provided the push toward systematization, consistency, and clarity, as progress within medicine increasingly erupted into moral dilemmas. The maneuvers, ploys, and strategies of philosophy have been important for bringing system and organization to medical ethics. It asks probing and organizing questions; it understands how to discover and work with assumptions, implications, and foundations. Conceptual analysis, which is central to the "doing of philosophy," has been central also to the doing of medical ethics. In the late 1960s I often referred to what I was doing as "conceptual geography," to suggest that I was showing what and how these certain crucial concepts were related to each other.

But do any of philosophy's contributions to bioethics imply that bioethics is philosophy? Of course not. At least not in any straightforward way. Other disciplines approach these moral problems from their own perspective--e.g., law, sociology, journalism, religion, and medicine itself. Bioethics essentially concerns a particular arena of human activity and the morality relating to it. Many disciplines have morally relevant insights into these activities, as well as organizing concepts.

According to some, bioethics brought fame and fortune to philosophy, a public notice and acclaim it had never had: it brought burgeoning classes and massive opportunities for funding. It brought to philosophy a new air of excitement--a new challenge, a new database to explore and exploit. Bioethics brought purpose and immediacy to philosophy. Philosophers were needed--even wanted! They had to reach conclusions and make recommendations for action. exciting new world! On the other hand, however, many philosophers would claim that bioethics brought nothing but sophistry and degradation, a kind of prostitution of what was good and pure in philosophy. These latter believed either that bioethicists (so-called) were peddling sham knowledge (philosophy which was inadequate or inappropriate for the job to be done), or that bioethicists were doing something unworthy of the higher calling of philosophy--unworthy because bioethics was seen as a mechanic's job of merely applying the intellectual masterpieces of real philosophers to practical and mundane problems, and real philosophers, after all, do not traffic in the mundane. So some philosophers undeniably disdained bioethics.

I believe at the very core of what bioethics has contributed to philosophical ethics is the reality of moral experience--the unrelenting, inescapable gridlock of real situations demanding a moral resolution. What philosophy has learned and how it has responded take various forms, but the heart of the contribution from bioethics is the hard reality of its cases. Trying out one's theory on real situations, thick with details, is very different from the philosopher's typical hypothetical case, which, if not simply invented, is so highly abstracted from real circumstances that only enough details remain to defend selectively the particular point the philosopher wants to make thereby. His or her use of cases is much more to illustrate theory than to test it. But when solving the moral problem is the main point, the relentlessness of the details becomes readily apparent. There is no refuge; there is one quagmire after another; retreating to the theory is not a viable option. So what happened when elegant theories met the issues of biomedical ethics was that these theories were tested--and found woefully inadequate. Some more so than others.

As I said, the core of the contribution of bioethics to philosophy was concrete experience. But the spinoff from that encounter has taken a variety of forms. One reaction I have already alluded to--namely, to say that bioethics simply is not philosophy. Another reaction is for philosophy to be constantly revising theories that have been found inadequate. This move takes seriously the challenge of the bioethical problems and, as with any theory found inadequate by experience, attempts to reconstitute itself to overcome the deficiency. Another benefit accruing to philosophy is that in the process of forcing its standard ethical theories to speak to real issues, those standard theories are intensely reexamined with renewed vigor and deeper insight. The challenge of real moral problems, as it were, brings out the best in the theories--or leads us to squeeze out every drop of significance we can find in those theories.

Still another contribution of bioethics to philosophy is the reaction within philosophy to the arguable importance of ethical theory in the face of concrete circumstances. This has focused a great deal of attention on a typical philosophical inquiry-namely, that concerning the relationship of theory to practice. With respect to ethical theory, it has given rise to the antitheory movement, which is almost a growth industry.

I certainly believe that bioethics is an appropriate area for philosophical concern. Bioethics is not entirely philosophy, and philosophy is certainly not entirely bioethics. But philosophy--in its parasitic way--has always seemed to do its thing with respect to important areas of life--such as law, science, education, religion, art, and so on. So why not the moral aspect of the biomedical world?
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Author:Clouser, K. Danner
Publication:The Hastings Center Report
Date:Nov 1, 1993
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