: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in (...) moral problem solving are discussed. (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.

: "Clinical pragmatism" is an important new method of moral problem solving in clinical practice. This method draws on the pragmatic philosophy of John Dewey and recommends an experimental approach to solving moral problems in clinical practice. Although the method may shed some light on how clinicians and their patients ought to interact when moral problems are at hand, it nonetheless is deficient in a number of respects. Clinical pragmatism fails to explain adequately how moral problems can be solved experimentally, (...) it underestimates the relevance and importance of judgment in clinical ethics, and it presents a questionable account of the role that moral principles should play in moral problem solving. (shrink)

Bioethicists’ attraction to principlism is rooted in a Western view of how matters that affect the public ought to be deliberated and decided: their resolution ought to be so structured and constrained that it can be understood and verified even by those at a remove from the circumstances of the problem. That view of deliberation, itself fostered by the Western view of government, has encouraged principlism to spread from its source in human subjects research into other areas of bioethics discourse.

Recent work done at the intersection of classical American pragmatism and bioethics promises much: a clarified self-understanding for bioethics, a modus vivendi for progress, and liberation from misguided and misguiding theories and principles. The revival of pragmatism outside bioethics in the past twenty years, however, has been of a distinctly anti-realist orientation. Richard Rorty, for example, has urged that there is no objective truth or good for philosophy to be concerned with. I ask whether the work in Pragmatic Bioethics follows (...) this perilous Rortyan trend. It will move towards anti-realism if its account of the good abandons any notion of truth or objectivity, and if, in its discussion of specific problems, it divides these problems into public and the private, urging consensus as the goal of the one, and an unconstrained notion of happiness as the goal of the other. In a final section, I suggest that bioethics done in the spirit of Royce's Philosophy of Loyalty might have much to offer to those dissatisfied with anti-realism. (shrink)

Moral deliberation involves a constant interplay among specific judgments, general moral values and principles, and background beliefs about the world. We may also construct broad moral theories to explain how our judgments and general commitments hang together, but there is little hope of settling on any one comprehensive moral theory.

First published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.