This paper takes up the question of the role of philosophical moral theory in our attempts to resolve the ethical problems that arise in health care, with particular reference to the contention that we need theory to be determinative of our choice of actions. Moral theorizing is distinguished from moral theories and the prospects for determinacy from the latter are examined through a consideration of the most promising candidates: utilitarianism, deontology and the procedures involved in reflective equilibrium. It is argued (...) that the current lack of any generally accepted method of solving moral problems, together with the extreme improbability of philosophy achieving a plausibly determinate theory, should encourage us to approach the problems in a spirit of agnosticism regarding the way in which theoretical material might be of relevance. The practical test for both moral theorizing and moral theories is thus not determinacy but the degree to which they increase our understanding of moral problems by serving, as they do in philosophy, as a means of inquiry into their nature. (shrink)

In this editorial essay I explore the possibilities of ‘improvement scholarship’ in order to set the scene for the theme of, and the other papers in, this issue. I contrast a narrow conception of quality improvement research with a much broader and more inclusive conception, arguing that we should greatly extend the existing dialogue between ‘problem-solving’ and ‘critical’ currents in improvement research. I have in mind the potential for building a much larger conversation between those people in ‘improvement science’ who (...) are expressly concerned with tackling the problems facing healthcare and the wider group of colleagues who are engaged in health-related scholarship but who do not see themselves as particularly interested in quality improvement, indeed who may be critical of the language or concerns of QI. As one contribution to that conversation I suggest that that the increasing emphasis on theory and rigour in improvement research should include more focus on normative theory and rigour. The remaining papers in the issue are introduced including the various ways in which they handle the ‘implicit normativity’ of QI research and practice, and the linked theme of combining relatively ‘tidy’ and potentially ‘unruly’ forms of knowledge. (shrink)