Truth-telling to competent patients is widely affirmed as a cardinal moral and biomedical obligation in contemporary Western medical practice. In contrast, Chinese medical ethics remains committed to hiding the truth as well as to lying when necessary to achieve the family's view of the best interests of the patient. This essay intends to provide an account of the framing commitments that would both justify physician deception and have it function in a way authentically grounded in the familist moral concerns of (...) Confucianism. It reflects on the moral conditions and possibilities for sustaining a Confucian understanding of truth-telling and consent in mainland China. (shrink)

A fascinating study of moral languages and their discontents, Ethics after Babel explains the links that connect contemporary moral philosophy, religious ethics, and political thought in clear, cogent, even conversational prose. Princeton's paperback edition of this award-winning book includes a new postscript by the author that responds to the book's noted critics, Stanley Hauerwas and the late Alan Donagan. In answering his critics, Jeffrey Stout clarifies the book's arguments and offers fresh reasons for resisting despair over the prospects of democratic (...) discourse. (shrink)

This paper attempts to defend pragmatic approaches to bioethics against detractors, showing how particular critics have failed or succeeded. The paper divides bioethics from a pragmatic point of view into three groups. The first group is called "bioethical pragmatism" that will be represented by two book-chapters from the anthology, Pragmatic Bioethics . The second group is called "clinical pragmatism" championed by Fins, Baccetta, and Miller. Finally, a third group, which has roots in the legal tradition, has been called "freestanding pragmatism" (...) and is portrayed by Grey, Posner, and Wolf. Each group has been criticized in journal articles, and, in turn, this paper critiques some of the (mis)understandings put forth by Tollefsen, Jansen, and Arras about the capabilities and status of pragmatism in bioethical discussions. Finally, it concludes with cautionary notes about pragmatic bioethics in hopes that pragmatists will learn from their own insights about the human condition and the discipline of bioethics. (shrink)

The state that we inhabit plays a significant role in shaping our lives. For not only do its institutions constrain the kinds of lives we can lead, but it also claims the right to punish us if our choices take us beyond what it deems to be appropriate limits. Political philosophers have traditionally tried to justify the state's power by appealing to their preferred theories of justice, as articulated in complex and wide-ranging moral theories—utilitarianism, Kantianism, and the like. One of (...) John Rawls's greatest contributions to political philosophy has been his recognition that this is the wrong way for this field to approach its task. He points to what he calls “the fact of reasonable pluralism,” which is the incontestable fact that in a free society people striving to lead their lives ethically will subscribe to conflicting moral and religious doctrines, many of which will be “reasonable” in the special sense of leaving their adherents willing to cooperate with those with whom they have moral disagreements. And this means that political philosophers can no longer rely on any particular “comprehensive” doctrine in their attempts to justify the state. For doing so would be unfair to those who subscribe to a conflicting reasonable doctrine; it would mean that the coercive power of the state would not be justified to them in terms they can accept, even while they were forced to abide by its terms. (shrink)

Though responses to Stout's book, "Democracy and Tradition," have touched on his discussion of rights, none has comprehensively examined his position on the subject. Having endorsed several objections Stout raises against some influential views on democracy and rights, this article proceeds to criticize Stout's description and theoretical account of the natural and human rights traditions. The central argument is that Stout cannot successfully both affirm the traditions and adhere to his account.

For decades now, moral philosophy and bioethics have been dominated variously by universalist and particularist impulses, both of which exert legitimate pull on our thinking. Although there is little prospect of settling the debate by recourse to theory, classifying the cases in which particularist and universalist demands compete reveals a rough practical guide.

Cultural difference has been largely ignored within bioethics, particularly within the end-of-life discourses and practices that have developed over the past two decades in the U.S. healthcare system. Yet how should culturebe taken into account?

Current approaches in bioethics largely overlook the multicultural social environment within which most contemporary ethical issues unfold. For example, principlists argue that the common morality of society supports four basic ethical principles. These principles, and the common morality more generally, are supposed to be a matter of shared common sense. Defenders of case-based approaches to moral reasoning similarly assume that moral reasoning proceeds on the basis of common moral intuitions. Both of these approaches fail to recognize the existence of multiple (...) cultural and religious traditions in contemporary multicultural societies. In multicultural settings, patients and their families bring many different cultural models of morality, health, illness, healing, and kinship to clinical encounters. Religious convictions and cultural norms play significant roles in the framing of moral issues. At present, mainstream bioethics fails to attend to the particular moral worlds of patients and their family members. A more anthropologically informed understanding of the ethical issues that emerge within health care facilities will need to better recognize the role of culture and religion in shaping modes of moral deliberation. (shrink)

: This response to Lynn Jansen's critique of clinical pragmatism concentrates on two themes: (1) contrasting approaches to moral epistemology and (2) the connection between theory and practice in clinical ethics. Particular attention is paid to the status of principles and the role of consensus, with some closing speculations on how Dewey might view the current state of bioethics.

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)

For many individuals, religious traditions provide important resources for moral deliberation. While contemporary philosophical approaches in bioethics draw upon secular presumptions, religion continues to play an important role in both personal moral reasoning and public debate. In this analysis, I consider the connections between religious traditions and understandings of morality, medicine, illness, suffering, and the body. The discussion is not intended to provide a theological analysis within the intellectual constraints of a particular religious tradition. Rather, I offer an interpretive analysis (...) of how religious norms often play a role in shaping understandings of morality. While many late 19th and early 20th century social scientists predicted the demise of religion, religious traditions continue to play important roles in the lives of many individuals. Whether bioethicists are sympathetic or skeptical toward the normative claims of particular religious traditions, it is important that bioethicists have an understanding of how religious models of morality, illness, and healing influence deliberations within the health care arena. (shrink)

Pragmatic bioethics represents a novel approach to the discipline of bioethics, yet has met with criticisms which have beset the discipline of bioethics in the past. In particular, pragmatic bioethics has been criticized for its excessively fuzzy approach to fundamental questions of normativity, which are crucial to a field like bioethics. Normative questions need answers, and consensus is not always enough. The approach here is to apply elements of the discourse ethics of Habermas and Putnam to the sphere of bioethics, (...) in order to develop a normative structure out of the framework of bioethical inquiry as it stands. The idea here is that the process of inquiry contains its own normative structure as it aims to discover norms. Such an approach, which fuses pragmatic bioethics with discourse ethics, may rightly be called a "Pragmatic Discourse Bioethics.". (shrink)

I investigate Thomas Aquinas's metaphysical account of human death, which is defined in terms of a rational soul separating from its material body. The question at hand concerns what criterion best determines when this separation occurs. Aquinas argues that a body has a rational soul only insofar as it is properly organised to support the soul's vegetative, sensitive, and rational capacities. According to the ‘higher‐brain’ concept of death, when a body can no longer provide the biological foundation necessary for the (...) operation of conscious rational thought and volition, a substantial change occurs in which the rational soul departs and the body left behind is a ‘humanoid animal’ or a mere ‘vegetable.’I argue that the separation of soul and body does not occur until the body ceases to function as a unified, integrated organism. A rational soul is not only the seat of a human being's rational capacities; it is also the principle of the body's sensitive and vegetative capacities. Since Aquinas defines a human being as a composite of soul and body, and not with merely the exercise of rational capacities, the determination of death requires incontrovertible evidence that the body has ceased all the operations that correspond to the soul's proper capacities. The evidence of this is the body's loss of its integrative organic unity and the criterion for determining when this loss occurs is the irreversible cessation of whole‐brain functioning. (shrink)

Do bioethicists need yet another theoretical approach with which to frame their disagreements? Many pragmatists contend that pragmatism, unlike its liberal and utilitarian counterparts, is uniquely commendable in (a) beginning from our lived experiences and (b) locating those experiences amid our social relations. In place of an " principlism," pragmatism offers a practical "bedside-bioethic"; in lieu of "autonomy run amuk," pragmatism proposes an ethic rooted in our communal resources. To date, however, efforts to develop such a bioethic have been stymied (...) by pragmatists' own abstract theoretical commitments, commitments that prevent them, most directly, from beginning with the lived experiences and communal resources of those who hold theological commitments. This self-imposed methodological constraint, I argue, has needlessly thwarted pragmatism's most striking methodological promise: its potential to cultivate productive debates among secular and theologically-informed participants. (shrink)

This essay seeks to develop and illustrate an approach to comparison based on "ad hoc" frames. A frame is defined by a question, to which dif- ferent thinkers can be seen as offering complementary and/or competing responses. Pursuing a middle ground between universalist conceptions of comparison and particularist rejections of comparison, this approach brings various positions into dialogue in a manner that is not inherently totalizing. The article draws extensively on Hegel's philosophy of religion to articulate this approach to comparison (...) and its presuppositions. The sec- ond section of the essay seeks to illustrate the value of this approach by using the question of how traditional practices are inherited to frame a comparison of Hegel on habit and the Confucian thinker Xunzi on ritual. This comparison functions principally to indicate the process of comparison and suggest the value of pursuing this comparison in greater depth. (shrink)

Though responses to Stout's book, "Democracy and Tradition," have touched on his discussion of rights, none has comprehensively examined his position on the subject. Having endorsed several objections Stout raises against some influential views on democracy and rights, this article proceeds to criticize Stout's description and theoretical account of the natural and human rights traditions. The central argument is that Stout cannot successfully both affirm the traditions and adhere to his account.

Comparative religious ethics is a complicated scholarly endeavor, striving to harmonize intellectual goals that are frequently conceived as quite different, or even intrinsically opposed. Against commonly voiced suspicions of comparative work, this essay argues that descriptive, comparative, and normative interests may support rather than conflict with each other, depending on the comparison in question, and how it is pursued. On the basis of a brief comparison of the early Christian Augustine of Hippo and the early Confucians Mencius and Xunzi on (...) the topic of "human nature," this paper advocates a particular account of comparative religious ethics, and argues for the complexity of the idea of "human nature." Different elements of this family of concerns are central to religious ethics generally, and to theories and practices of moral development and personal formation specifically. (shrink)

When addressing cultural and religious differences in the clinical setting we need to be realists. Despite our public homage to pluralism and good intentions, it is just not possible to overcome all the differences that might exist and achieve perfect understanding of others. Try as we may, we will never be able to see perfectly the world through another's eyes. Instead of reaching for such perfection, we should instead reach for an approximation of shared understanding that will promote discourse and (...) civility when peoples of different races, genders, cultures, religions, and sexual preferences interact in the clinic. (shrink)