Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

In The Construction of Social Reality, John Searle argues that there are two kinds of facts--some that are independent of human observers, and some that require..

In lieu of an abstract, here is a brief excerpt of the content:The Mettle of Moral Fundamentalism: A Reply to Robert Baker*Tom L. Beauchamp (bio)AbstractThis article is a reply to Robert Baker’s attempt to rebut moral fundamentalism, while grounding international bioethics in a form of contractarianism. Baker is mistaken in several of his interpretations of the alleged moral fundamentalism and findings of the Advisory Committee on Human Radiation Experiments. He also misunderstands moral fundamentalism generally and wrongly categorizes it as morally (...) bankrupt. His negotiated contract model is, in the final analysis, itself a form of the moral fundamentalism he declares bankrupt.Robert baker’s imaginative and incisive articles on international bioethics (Baker 1998a & b) are rich in history and philosophy, but they are as profoundly misguided as they are misdirected. In this comment, I will concentrate both on a pivotal interpretation and criticism that he offers of the Report of the Advisory Committee on Human Radiation Experiments (ACHRE 1996) and on his philosophical thesis that a moral fundamentalism of principles and rights is bankrupt. Baker seriously misinterprets the ACHRE report, distorts and fails to refute moral fundamentalism, and ultimately embraces a form of the very fundamentalism that he declares bankrupt. These three topics are connected in that Baker’s misconceptions of the ACHRE report launch his critique of moral fundamentalism and his mistaken understanding of moral fundamentalism drives his critique of the ACHRE report. 1 [End Page 389]Some Misunderstandings of the Human Radiation CommitteeBaker proclaims a conflict between ACHRE’s moral fundamentalism and multiculturalism. He presents this conflict as primarily a factual issue regarding whether different cultures and eras accept different moral principles—“the difference claim,” in his vernacular (Baker 1998a, pp. 208–9). This interpretation eventuates in a critique of the work of both ACHRE and Ruth Macklin:[W]hen Macklin and the Radiation Committee consider the challenge of multiculturalism, they construe this challenge, not as dispute about anthropological fact, but as a dispute about philosophical theory. More specifically, they treat any assertion of the difference claim as a form of “ethical relativism.”... They thus respond to the multiculturalist’s factual observations—even to factual observations by anthropologists—as if they were philosophical analyses.(Baker 1998a, p. 209)Baker thinks that a factual question has been fallaciously transformed into a philosophical one. However, this false dilemma is a figment of his fancy. He provides no citation to ACHRE to show that it holds this view, and for an understandable reason: This position is neither stated nor presumed in the Report. ACHRE is quite clear that relativism involves both an anthropological (I would prefer to say historical) dispute about fact and a philosophical dispute about value—and that they are not the same.The Committee and its staff proceeded as follows: They first collected a large body of historical documents and facts about the practices, policies, and values that prevailed during the period they were studying. Chapters 1 through 3 and 5 through 13, 12 of the Report’s 18 chapters, display the results of this empirical work. The Committee concluded, on this basis, that research investigators and government officials were aware of the obligations generated by universal principles. The ACHRE report specifically lists six “basic” moral principles and maintains that these principles were pervasively recognized at the time of the radiation experiments (ACHRE 1996, pp. 114ff, 124). ACHRE received testimony, conducted interviews, and compiled documents that indicated how deeply these principles were woven into the fabric of American culture at the time, so deeply that no responsible research investigator could have been unaware of them. ACHRE did not move beyond its list of six principles to a broader thesis about the (factual) universality of other principles and did not examine other cultures or periods of history; such work would [End Page 390] have exceeded ACHRE’s mandate and would have done more to obscure than to further its arguments.ACHRE also found that some government officials had attempted to hide their wrongdoing—a clear indication that these officials were aware of the relevant moral principles and knew that they should not have been treating persons as they did (ACHRE 1996, pp. 152–53; Chapman 1946). These factual findings were not armchair philosophy or empirical guesswork... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Negotiating International Bioethics: A Response to Tom Beauchamp and Ruth MacklinRobert Baker (bio)AbstractCan the bioethical theories that have served American bioethics so well, serve international bioethics as well? In two papers in the previous issue of the Kennedy Institute of Ethics Journal, I contend that the form of principlist fundamentalism endorsed by American bioethicists like Tom Beauchamp and Ruth Macklin will not play on an international stage. Deploying techniques (...) of postmodern scholarship, I argue that principlist fundamentalism justifies neither the condemnation of the Nazi doctors at Nuremberg, nor, as the Report of the Advisory Committee on the Human Radiation Experiments (ACHRE) demonstrates, condemnation of Cold War radiation researchers. Principlist fundamentalism thus appears to be philosophically bankrupt. In this issue of the Journal, Beauchamp and Macklin reject this claim, arguing that I have misread the ACHRE report and misunderstood Nazism. They also argue that the form of post-postmodern negotiated human rights theory that I proffer is adequate only insofar as it is itself really fundamentalist; insofar as I take postmodernism seriously, however, I mire international bioethics in relativism. In this response, I reaffirm my anti-fundamentalism, provide further evidence in support of my reading of the ACHRE report, and defend my post-postmodern version of rights theory. I also develop criteria for a minimally adequate theoretical framework for international bioethics.Universal Morality Reconsidered 1Paradoxically, the need for content-full universal moral principles tends to be most deeply felt and most adamantly asserted in the face of striking evidence of their absence. People are inspired to claim that Nazis must accept the universal principle that doing harm is wrong because they are appalled by the horror of the Holocaust. Yet the event itself provides palpable evidence that the Nazis saw no wrong in doing harm. One has the suspicion that claims of universalism [End Page 423] confound philosophical aspirations with empirical observations. This distinction makes a significant difference because empirical claims can be disconfirmed by data, whereas philosophical claims can only be challenged on the level of theory.I am, like Tom Beauchamp and James Childress, a common morality theorist. Thus, I believe, as they do, that ethics “relies heavily on ordinary shared moral beliefs for its content, rather than relying on pure reason, natural law, a special moral sense, and the like” (Beauchamp and Childress 1994, p. 100). For most of human history sexism and slavery were considered moral. They certainly were the norm. Thus, if one looks to common morality as the source of moral content, empirical claims of moral universalism appear suspect. Insofar as one would condemn sexism and slavery, one needs to find some theoretical justification for condemnation that goes beyond a consensus on moral content (hence my embrace of the structural analogue of human rights theory).Beauchamp, however, takes a very different view. He asserts in his critique of my position, that: “it is an institutional fact about the substance of morality (not merely [as Baker claims] the formal features of the concept of morality and not merely my view of it) that it contains fundamental and shared precepts. It is by appeal to this shared moral substance that persons are enabled to make justifiable cross-temporal and cross-cultural judgments” (Beauchamp 1998, p. 395). Beauchamp is thus claiming that it is both an empirical and a conceptual truth there is common core underlying the morality of all societies. He fleshes this claim out in another passage.[T]he term morality refers to norms about right and wrong human conduct that are so widely shared that they form a stable... communal consensus.... These standards sometimes vary from society to society, but embedded in the beliefs of all moral societies are the core dimensions of morality: Persons must keep their promises, must respect the rights of others, must not kill or cause harm to innocent persons, must not abuse children, and the like. All morally committed persons are comfortable with these norms and do not doubt their relevance and importance.(Beauchamp 1998, p. 394)Insofar as Beauchamp is making an empirical claim in this passage, the examples cited are problematic. “Promise keeping,” for example, cannot be a cultural universal because the practice is... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Theory of International Bioethics: Multiculturalism, Postmodernism, and the Bankruptcy of Fundamentalism 1Robert Baker (bio)AbstractThis first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews “moral fundamentalism,” the theory that cross-cultural moral judgments and international bioethical codes are justified by certain “basic” or “fundamental” moral principles that are universally accepted in all cultures and eras. Initially propounded by the judges at the (...) 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model—a model of negotiated moral order—as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.Man in the Twentieth Century can not be circumscribed by the standards of any single culture.American Anthropological Association (1948) in a statement officially denouncing the 1948 United Nation’s Declaration of Human Rights.Recently... so-called “liberal” medicine has revived the old rights of a clinic understood in terms of a special contract, a tacit pact made between one man and another. This patient gaze has even been attributed the power of assuming [a role in clinical decision making].Miracles are not so easy to come by....Michel Foucault (1975, p. 5) [End Page 201]An Overview of the AnalysisInternational bioethics originated in the trauma of the Holocaust, specifically, in the 1946–1947 Nuremberg “Doctors Trial” when a tribunal of three American judges convicted Nazi medical researchers of “crimes against humanity.” In justifying their judgment, the Nuremberg Tribunal cited 10 principles for morally permissible research, which, they claimed, were based on “fundamental” principles that civilized societies “all agree” upon and accept as the foundations of their “moral, ethical, and legal” norms. Foremost among the principles was one stating that morally permissible human experiments require the informed voluntary consent of the subject. The Nuremberg judgment soon became associated with the ideal of human rights declared in the 1948 United Nations Charter. These two ideas—fundamental principles of morality and human rights—have been linked in all major formulations of international bioethics promulgated in the past 50 years, including the Council of Europe’s 1997 Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine (Council of Europe 1997; Dommel and Alexander 1997). In this paper, I explore the received justification for international bioethics—the idea that it is grounded in fundamental principles accepted in all societies—tracing it from its initial, almost off-hand, promulgation by the Nuremberg Tribunal, through its more thoughtful development by such bioethicists as Ruth Macklin, to its more complex use by the President’s Advisory Committee on Human Radiation Experiments.After a brief review of the evolution of the received justification, I discuss the viability of this justification in the face of the critique implicit in two important intellectual movements: multiculturalism and postmodernism. In the international context, multiculturalism asserts the claim that there are no common moral principles shared by all cultures. Postmodernism asserts a similar claim against all universal standards, moral and nonmoral. In the 1990s, bioethicists have attempted to respond to these claims in various ways. These responses are documented, analyzed, and then shown to be “bankrupt,” in the sense that they undercut the most important objective of moral fundamentalism: the justification of transcultural moral judgments, such as the condemnation of the Nazi doctors.A second article, which follows the present one in the same issue of the Kennedy Institute of Ethics Journal, revisits the contractarian tradition [End Page 202] of Hobbes and Locke, as it has been reinterpreted by David Gauthier (1986), John Rawls (1971, 1993), and Robert Nozick (1974), to develop the idea of negotiated moral order as the basis of international bioethics. When conceptualized as a negotiated moral order, international bioethics can accept the genuine insights... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Theory of International Bioethics: The Negotiable and the Non-NegotiableRobert Baker (bio)AbstractThe preceding article in this issue of the Kennedy Institute of Ethics Journal presents the argument that “moral fundamentalism,” the position that international bioethics rests on “basic” or “fundamental” moral principles that are universally accepted in all eras and cultures, collapses under a variety of multicultural and postmodern critiques. The present article looks to the contractarian tradition of (...) Hobbes and Locke—as reinterpreted by David Gauthier, Robert Nozick, and John Rawls—for an alternative justification for international bioethics. Drawing on the central themes of this tradition, it is argued that international bioethics can be rationally reconstructed as a negotiated moral order that respects culturally and individually defined areas of nonnegotiability. Further, the theory of a negotiated moral order is consistent with traditional ideals about human rights, is flexible enough to absorb the genuine insights of multiculturalism and postmodernism, and yet is strong enough to justify transcultural and transtemporal moral judgments, including the condemnation of the Nazi doctors at Nuremberg. This theory also is consistent with the history of the ethics of human subjects experimentation and offers insights into current controversies such as the controversy over changing the consent rule for experiments in emergency medicine and the controversy over exempting certain clinical trials of inexpensive treatments for preventing the perinatal transmission of AIDS from the ethical standards of the sponsoring country.The Preamble to the Council of Europe’s (1997) Convention on Human Rights and Biomedicine, the most recently ratified code of international bioethics, is noteworthy because it never mentions “principles,” the concept most frequently cited by the fundamentalists as basic to international bioethics. Instead it stresses rights, a concept that has been utterly ignored by the fundamentalist theorists of international bioethics. The Preamble exemplifies a conception of international [End Page 233] bioethics as an ethics of covenants and conventions grounded in human rights. In the full text of the Preamble, the term “rights” appears eight times and the expressions “convention” and “covenant” are used six times; the term “principle” does not appear at all. In this essay, I develop a theoretical framework for international bioethics based on conventions, covenants, and areas of “nonnegotiability”—a concept that serves as a functional analogue to the traditional notion of “human rights.” I also shall argue that, unlike the theory of basic principles central to moral fundamentalism, the theory of negotiated morality appears immune to the multicultural and postmodern critiques of international bioethics that were analyzed in the preceding article in this issue of the Kennedy Institute of Ethics Journal (Baker 1998).Negotiated Moral Order: A Model for International BioethicsReconsidering ContractarianismThe linkage of “conventions” and “covenants” with human rights that is evident in the Council of Europe’s Convention on Human Rights and Biomedicine traces back directly to the moral and political theories of Thomas Hobbes and John Locke. Such philosophers as David Gauthier (1986), Robert Nozick (1974), and John Rawls (1971, 1993) recently have reinvigorated this classic contractarian line of analysis. In this section, I shall reconsider classical contractarian theory from a perspective informed by these more recent analyses.The most riveting feature of all forms of contractarian theory is the metaphor of the contract itself, particularly the legitimating role it accords to assent. Because contractarians look to the assent of those who would be bound by a moral norm as ultimately the sole source of a norm’s legitimacy, the most important corollary of contractarian moral theory is that moral norms are illegitimate insofar as agents either in principle could not, hypothetically would not, or actually will not rationally assent to be bound by them. Contractarians also argue that because legal norms are legitimated by acceptance of the authority of those who promulgate them, the authority of such norms is bounded by the actual or hypothetical assent of the governed. These features of contractarian analysis generate the correlative concepts of human rights and civil rights.Less often remarked, but nonetheless integral to the metaphor of the social contract, is the contractarian recognition that the interests of the [End Page 234] parties who contract to form civil society are naturally in conflict (or, as Hobbes put... (shrink)

A survey of Western feminist ethics over the past thirty years reveals considerable diversity; nonetheless, much recent work in this area is characterized by its adoption of a naturalistic approach. Such an approach is similar to that found in contemporary naturalized epistemology and philosophy of science, yet feminist naturalism has a unique focus. This paper explains what feminist naturalism can contribute to moral philosophy, both by critiquing moral concepts that obscure or rationalize women’s subordination and by paying attention to real-life (...) practices of moral inquiry, including those used by women. (shrink)

Part I The Imperative Mood 'Virtue, then, is a disposition governing our choices '. ARISTOTLE, Eth. Nic. 36 Prescriptive Language. ...

Although Burke, Bentham, Hegel and Marx do not often agree, all criticized certain ethical theories, in particular theories of rights, for being too abstract. The complaint is still popular. It was common in Existentialist and in Wittgensteinian writing that stressed the importance of cases and examples rather than principles for the moral life; it has been prominent in recent Hegelian and Aristotelian flavoured writing, which stresses the importance of the virtues; it is reiterated in discussions that stress the distinctiveness and (...) particularity of moral vicissitudes and query the importance of ethical theory. Recent critics of abstraction are opposed not only to theories of rights, and the Kantian notions with which these are linked, but also to consequentialist ethical theories. The two ethical theories that are most influential in the English-speaking world now both stand accused of being too abstract. (shrink)

John Mackie's stimulating book is a complete and clear treatise on moral theory. His writings on normative ethics-the moral principles he recommends-offer a fresh approach on a much neglected subject, and the work as a whole is undoubtedly a major contribution to modern philosophy.The author deals first with the status of ethics, arguing that there are not objective values, that morality cannot be discovered but must be made. He examines next the content of ethics, seeing morality as a functional device, (...) basically the same at all times but changing significantly in response to changes in the human condition. He sketches a practical moral system, criticizing but also borrowing from both utilitarian and absolutist views. Thirdly, the frontiers of ethics, areas of contact with psychology, metaphysics, theology, law and politcs, are explored.Throughout, his aim is to discuss a wide range of questions that are both philosophical and practical, working within a distinctive version of subjectivism-an "error" theory of the apparent objectivity of values. John Mackie has drawn on the contributions of such classic thinkers as Plato, Aristotle, Hobbes, Hume, Kant and Sidgwick, and on more recent discussions, to produce a thought-provoking account that will inspire both the general reader and the student of philosophy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Defense of Fundamental Principles and Human Rights: A Reply to Robert Baker *Ruth Macklin (bio)AbstractThis article seeks to rebut Robert Baker’s contention that attempts to ground international bioethics in fundamental principles cannot withstand the challenges posed by multiculturalism and postmodernism. First, several corrections are provided of Baker’s account of the conclusions reached by the Advisory Committee on Human Radiation Experiments. Second, a rebuttal is offered to Baker’s claim (...) that an unbridgeable moral gap exists between Western individualism and non-Western communalism. In conclusion, this article argues that Baker’s “nonnegotiable primary goods” cannot do the work of “classical human rights” and that the latter framework is preferable from both a practical and a theoretical standpoint.Robert baker has written two interesting and thoughtful essays in support of his theory of international bioethics (Baker 1998a & b). Both essays are rich in content and comprehensive in scope. In the first of the two, “Multiculturalism, Postmodernism, and the Bankruptcy of Fundamentalism”—hereafter, “Multiculturalism”—Baker argues that attempts to ground international bioethics in fundamental principles cannot withstand the challenges posed by multiculturalism and postmodernism. As one of the bioethicists whose writings are the object of Baker’s critique, I undertake in this reply first, to elaborate my own position and to comment on related aspects of Baker’s thesis. 1 Next, I offer some corrections of Baker’s account of the conclusions reached by the Advisory Committee on Human Radiation Experiments, of which I was a member. Finally, I compare Baker’s “nonnegotiable [End Page 403] primary goods” with “classical human rights” and conclude that the latter framework is preferable from both a practical and a theoretical standpoint.In his second essay, “The Negotiable and the Non-Negotiable”—hereafter, “The Negotiable”—Baker puts forth a positive theory designed to meet the challenges of multiculturalism and postmodernism and, at the same time, to justify transcultural and transhistorical moral judgments. Baker (1998a, p. 203) describes his theoretical model as an effort “to validate the conception of international bioethics as a continually renegotiated moral order.” Although I find Baker’s proposal intriguing, I believe his rejection of fundamental principles can result in an unacceptable ethical relativism. To abandon “classical human rights,” along with the fundamental moral principles from which they derive, opens the door to all forms of cultural oppression in the name of “the most fundamental of all human rights, the right to define primacy for oneself” (Baker 1998b, p. 246). Alternatively, one can view Baker’s “nonnegotiable primary goods” as virtually equivalent to classical human rights, but much more difficult to identify, both theoretically and practically.Moral FundamentalismThe difference between my defense of universal moral principles and Baker’s critique rests, at least in part, on an interpretation of what is meant by “moral fundamentalism.” (I must confess to a distaste for the ‘ism’ because of the connotations and consequences of fundamentalism in other spheres.) Baker (1998a, p. 203) defines “moral fundamentalism” as the position “that certain basic or fundamental moral principles are accepted in all eras and cultures and thus are universally applicable to agents and actions in any era or culture.” A central feature of this definition is the requirement that all eras and cultures accept these fundamental moral principles. By this definition, the position I embrace does not count as “moral fundamentalism,” because I maintain that certain fundamental moral principles ought to be binding on all cultures or societies even if those cultures or societies do not accept them. 2 Universal acceptance is not a necessary condition for universal applicability.Part of the problem with Baker’s (and probably also my own) analysis is that it shifts constantly and imperceptibly back and forth between a variety of concepts: “moral principles,” “ethical standards,” “morality,” and “moral judgments.” In one instance, Baker (1998a, p. 209) notes my citation of a remark of Ruth Benedict (1934) that “morality differs in [End Page 404] every society.” That is what Ruth Benedict wrote; but nowhere did she specify that she had moral principles in mind. Indeed, her complete sentence reads as follows: “Morality differs in every society and is a convenient term for socially approved habits” (Benedict 1934, emphasis added... (shrink)

The idea that ethics can be derived from a common morality, while controversial, has become very influential in biomedical ethics. Although the concept is employed by several theories, it has most prominently been given a central role in principlism, an ethical theory endorsed by Tom Beauchamp and James Childress in Principles of Biomedical Ethics (2009).1 This text has become a cornerstone of medical ethics education, an achievement that has been commended by critics and supporters alike. It articulates a system of (...) ethical decision making that is firmly rooted in claims about the common morality. Beauchamp and Childress’s theory of common morality has been both defended and criticized in the bioethics .. (shrink)

In Moral Passages, Kathryn Pyne Addelson presents an original moral theory suited for contemporary life and its moral problems. Her basic principle is that knowledge and morality are generated in collective action, and she develops it through a critical examination of theories in philosophy, sociology and women's studies, most of which hide the collective nature and as a result hide the lives and knowledge of many people. At issue are the questions of what morality is, and how moral theories (whether (...) traditional or feminist) are implemented. Addelson takes up a large number of historical cases and contemporary social problems, including teen pregnancy, contraception and abortion, and gay rights. These cases allow her to see how the knowledge and lives of some people are declared deviant or immoral, while those of others appear to show the public consensus. One case she uses throughout the book is Margaret Sanger's early work on birth control with the anarcho-syndicalist movement--a revisionist history that reveals rather than hides the collective nature of morality and knowledge. Addelson shows how the usual individualist philosophies promote theories which hide the authority of the professionals who make them. A collectivist approach, she argues, must show the part professionals play in collective action. Her aim is to allow professional knowledge makers to be morally and intellectually responsible. Based on Addelson's twenty years of work in feminist philosophy and interactionist sociology as well as her long-standing involvement in women's community organization, Moral Passages investigates how morality and knowledge are collectively enacted in today's world. (shrink)

Naturalized bioethics represents a revolutionary change in how health care ethics is practised. It calls for bioethicists to give up their dependence on utilitarianism and other ideal moral theories and instead to move toward a self-reflexive, socially inquisitive, politically critical, and inclusive ethics. Wary of idealisations that bypass social realities, the naturalism in ethics that is developed in this volume is empirically nourished and acutely aware that ethical theory is the practice of particular people in particular times, places, cultures, and (...) professional environments. These essays situate the bioethicist within the clinical or research context, take seriously the web of relationships in which all human beings are nested, and explore a number of the different kinds of power relations that inform health care encounters. Naturalized Bioethics aims to help bioethicists, doctors, nurses, allied health professionals, disability studies scholars, medical researchers, and other health professionals address the ethical issues surrounding health care. (shrink)