Many people believe that all human life is of equal value. Most of them also believe that all human beings have a moral status superior to that of nonhuman animals. But how are these beliefs to be defended? The mere difference of species cannot in itself determine moral status. The most obvious candidate for regarding human beings as having a higher moral status than animals is the superior cognitive capacity of humans. People with profound mental retardation pose a problem for (...) this set of beliefs, because their cognitive capacities are not superior to those of many animals. I argue that we should drop the belief in the equal value of human life, replacing it with a graduated view that applies to animals as well as to humans. (shrink)

In the previous article the hermeneutical approach to ethics was outlined. In my presentation, I would like to illustrate further the methodological consequences of this approach by using two points in contemporary applied ethics. The question is: to what extent is the hermeneutical approach casuistically applicable. We start with the presupposition that the hermeneutical approach does not offer answers to the question of current applied ethics — namely, to the question of what is or is not acceptable in a particular (...) problem situation — but rather, intends to clarify our moral, i.e. normative, response to problem situations. It tries to offer a precise articulation of the normative components of a successful moral decision, without presuming its detailed result. Hermeneutical ethics harks back to conceptual possibilities from the philosophical tradition to clarify the fundamental problem posed by current moral casuistry, and this for two reasons. The first is the idea that these traditional concepts are still at work in our experience and speech, such that, in taking up the tradition, the structure of our present experience is highlighted. The second is the idea that our present experience has moved away from this tradition on certain important points, such that a confrontation with these other possibilities can reveal the recent and relative character of what seems self-evident. To start with, I would like to examine the recent discussions in the media on postmenopausal pregnancy, in particular the argument that a pregnancy resulting from a medical treatment of these ‘older mothers’ is unnatural. Appealing to nature has come into discredit in ethics and in public discussions. Yet, I will defend the position that the notion of naturalness is still part of our moral experience. In other words, when we abandon any appeal to the moral significance of our biological nature, we are no longer able to express essential aspects of our moral experience. This, however, does not deny that the moral meaning of nature needs to be rethought and more accurately articulated; the appeal to nature is not obvious. At the end of my presentation, I will show that an appeal to nature also has a role to play in the recent discussions on cloning human embryos. (shrink)

Health care professionals’ and trainees’ conceptions of their responsibilities to patients can change over time for a number of reasons: evolving career goals, desires to serve different patient populations, and changing family obligations, for example. Some changes in conceptions of responsibility are healthy, but others express moral damage. Clinicians’ changes in their conceptions of what they are responsible for express moral damage when their responses to others express a meager, rather than robust, sense of what they owe others. At least (...) two important expressions of moral damage in the context of health care are these: callousness and divestiture. Callousness describes the poor condition of a clinician's capacity for moral perception; when her capacity to accurately appreciate features of moral relevance that configure others’ needs, vulnerabilities, and desert of care diminishes, such that she fails to respond with care to those for whom she has duties to care, she is callous. Callousness has been explored in detail elsewhere,1 and so the focus of this paper is divestiture. A clinician divests when the value of responding with care to others becomes less centrally and importantly constitutive of his personal and professional identity. Divestiture has important consequences for patients and health professions education, which I will explore here. (shrink)

As the title implies, this article asks what an adequate practical ethic is and what a hermeneutic of moral experience can mean for practical ethics. We will use some elements from Ricoeur’s work to examine our view critically and develop it further. We will ask how experience can be an object of hermeneutical study and how we can tie narrativity and normativity together.

The problem of developing a moral philosophy of medicine is explored in this essay. Among the challenges posed to this development are the general mistrust of moral philosophy and philosophy in general created by post-modernist philosophical and even anti-philosophical thinking. This reaction to philosophical systematization is usually called antifoundationalism. I distinguish different forms of antifoundationalism, showing that not all forms of their opposites, foundationalism, are alike, especially with regards to claims made about the certitude of moral thought. I conclude that (...) we are correct to mistrust absolutist principles in a moral philosophy of medicine, but can find some center within the practice of medicine itself for a moral foundation. (shrink)