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Common-sense morality.

Common-Sense Morality

There is considerable arbitrariness in any selection of philosophical work within the last year or so that is both unlikely to have gained the attention of most bioethics scholars outside of philosophy and of special importance for bioethics. Given the broad concerns of contemporary bioethics, a plausible case can be made that most work on the basic issues of ethics and political philosophy is relevant and important for bioethics and bioethics scholars.

Two issues that I will not focus on here at least deserve mention. First, over the last decade the foundations of ethics has received renewed attention in debates about objectivity in ethics and about the various new or not-so-new forms of moral realism that have been defended and criticized. I have not selected this work for attention here, though it is of central importance for how bioethics should be conceived and done, primarily because contributions in the last year or so have not fundamentally reshaped or moved these debates forward. [1] Second, in political philosophy the important debate framed by Amartya Sen, and more indirectly begun by John Rawls, over what egalitarians should seek to equalize has had significant new contributions. [2] The most direct relevance of this debate to bioethics concerns what equality, if any, should be a goal in health policy and should shape intensifying debates over access to health care and health care rationing. However, there has been little effort to apply the broader debate in political philosophy to issues of health policy.

Most work in bioethics is not overtly self-conscious about the underlying normative moral theory assumed in addressing concrete problems in bioethics. Nonspecialists in philosophy are understandably reluctant to address basic issues of normative moral theory and have also been driven by the desire to make their work more of practical relevance than of theoretical depth. To the extent that theory is appealed to at all, it is usually "middle level" theory, in which so-called principles of biomedical ethics are applied to cases and issues, not general moral theory, as in Tom Beauchamp and James Childress's enormously influential Principles of Biomedical Ethics, 3d ed. (New York: Oxford University Press, 1989). As a result, bioethics has taken little note of intense recent debates over central agent-relative features of what some have called common-sense or ordinary morality, a general view to which, in some version, most work in bioethics implicitly appeals.

In an important book published last year--The Limits of Morality (Oxford: Oxford University Press, 1989)--Shelly Kagan has developed a systematic attack on two fundamental features of ordinary morality: the beliefs in agent-relative options and agent-relative constraints (Kagan labels the believer in options and constraints the "moderate"). Agent-relative options permit individuals to give special weight to their own projects, commitments, and interests in their moral reasoning and thereby to fail to maximize the good as determined from an impersonal point of view. The belief in options is a deep and important part of ordinary morality; few persons believe we are morally required always to maximize the good, for example, by devoting our lives to the relief of suffering and poverty at the expense of our own personal concerns, and fewer still live in accordance with such a view. Moderates hold that moral requirements either to benefit others or to prevent harms to others are far more limited. Nevertheless, moderates are committed to the belief that if an action will benefit another, that gives us a reason for doing it, and that in some cases, such as the stock example of easily saving a drowning child, the action is ethically required. The most natural justification for options is the apparently excessive sacrifices or costs that would be imposed on persons by a moral requirement always to maximize the good. However, the "appeal to costs" to the agent could also justify doing harm, not just allowing harm, and so moderates who reject (as virtually all do) options to do harm require an independent justification of constraints against harming for their defense of options.

An important part of Kagan's argument is showing the interdependence of the beliefs in options and constraints within ordinary morality. Agent-relative constraints prohibit individuals from performing particular kinds of actions, such as harming others, even when doing so would maximize the good as determined from an impersonal point of view, and more specifically even when harming another would prevent more of the very same kinds of harmings by other persons. Agent-relative constraints are commonly thought to give special moral weight to what individuals do, as opposed to what they allow to happen, and to what they bring about intentionally, as opposed to a foreseen but unintended side-effect of what they do. Constraints too are a deep and pervasive feature of ordinary moral beliefs which are thought to justify persons having a special concern with their own agency or actions, as opposed to the actions of others which they might affect.

Kagan's book is critical, not constructive, in intent, arguing that neither the belief in options nor the belief in constraints can be successfully defended within ordinary morality. Underlying his criticisms of ordinary morality is a belief in consequentialism, but the criticisms make no appeal to consequentialism and no positive defense of it is offered in his book. There is relatively little reference to other philosophical literature on these issues, a limitation of the book. It is filled, however, with arguments that could be offered in defense of agent-relative options and constraints (in many instances Kagan constructs more plausible arguments for them than have their adherents) together with careful and powerful criticism of those arguments. [2] What is the importance of this book and the broader debate of which it is a part for bioethics scholars who are not specialists in ethical theory? In part, it is the pervasiveness of appeals to options and constraints, together with the distinctions between doing and allowing and between intending and foreseeing, in bioethics. Their importance to the debates over life-sustaining treatment, physician-assisted suicide, and euthanasia are obvious, but they also shape physicians' professional norms (for example, "First, do no harm") and arise in many other substantive issues. Moreover, many of the arguments Kagan considers and criticizes in evaluating possible defenses of options and constraints, such as appeals to individual autonomy and respect for persons, are common and fundamental in much work in bioethics. One need not be entirely convinced by Kagan's criticisms of ordinary morality, as I am not (see my "Defending Moral Options," forthcoming in Philosophy and Phenomenological Research), to benefit from confronting his systematic critique.

Of course, the debate over agent-relative options and constraints did not begin with work in the last year or so. Two of the more important treatments of the issue in the past decade are Samuel Scheffler, The Rejection of Consequentialism (Oxford: Oxford University Press, 1982); and Thomas Nagel, The View from Nowhere (New York: Oxford University Press, 1986). But too much work in bioethics contains relatively superficial, undeveloped, and uncritical appeals to the moral distinctions, principles, and arguments that Kagan subjects to analysis and criticism. More careful attention to the ongoing debate to which Kagan's book contributes could philosophically and ethically deepen future work in bioethics.


[1] Perhaps the most useful source of this literature is Essays on Moral Realism, ed. Geoffrey Sayre-McCord (Ithaca, NY: Cornell University Press, 1988). Among significant contributions within the last year or so are David O. Brink, Moral Realism and the Foundations of Ethics (Cambridge: Cambridge University Press, 1989) and David Copp, "Explanation and Justification in Ethics," Ethics 100 (January 1990), 237-58.

[2] Sen's paper framing the debate is "Equality of What?" in Tanner Lectures in Human Values, ed. S. McMurrin (Cambridge: Cambridge University Press, 1980). Rawls's stimulus, of course, was A Theory of Justice (Cambridge: Harvard University Press, 1971). Another major contribution is Ronald Dworkin, "What is Equality? Part 1: Equality of Welfare," Philosophy and Public Affairs 10:3 (1981), 185-246 and "What is Equality? Part 2: Equality of Resources," Philosophy and Public Affairs 10:4 (1981), 283-345. In the last year or so, important contributions include G.A. Cohen, "On the Currency of Egalitarian Justice," Ethics 99 (July 1989), 906-44; and Richard Arneson, "Equality and Equal Opportunity for Welfare," Philosophical Studies 56 (1989), 77-93.

[3] The last year or so has not been without important new defenses of the nonconsequentialist distinctions and principles that Kagan criticizes. Among the more important are: Warren S. Quinn, "Actions, Intentions and Consequences: The Doctrine of Doing and Allowing," Philosophical Review 48:3 (1989), 287-312 and "Actions, Intentions and Consequences: The Doctrine of Double Effect," Philosophy and Public Affairs 18:4 (Fall 1989), 334-51; F.M. Kamm "Harming Some to Save Others," Philosophical Studies 57 (1989), 227-60.

Dan Brock is professor of philosophy and professor of human values in medicine, Brown University, Providence, RI.
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Title Annotation:The Best of Bioethics; books on bioethics
Author:Brock, Dan
Publication:The Hastings Center Report
Article Type:bibliography
Date:Nov 1, 1990
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