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)

Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits (...) the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals. (shrink)

It is widely assumed that disability is typically a bad thing for those who are disabled. Our purpose in this essay is to critique this view and defend a more nuanced picture of the relationship between disability and well-being. We first examine four interpretations of the above view and argue that it is false on each interpretation. We then ask whether disability is thereby a neutral trait. Our view is that most disabilities are neutral in one sense, though we cannot (...) make simple generalizations about disability's relationship to well-being in other important senses. After defending this view, we discuss its practical implications for selective abortion for disability, nondisabled people's interactions with disabled people, and the use of QALYs in health policy. (shrink)

: Phenomena of moral conflict and disagreement have led writers in ethics to two antithetical conclusions: Either valid moral distinctions hold universally or they hold relative to a particular and contingent moral framework, and so cannot be applied with universal validly. Responding to three articles in this issue of the Journal that criticize his previously published views on the common morality, the author maintains that one can consistently deny universality to some justified moral norms and claim universality for others. Universality (...) is located in the common morality and nonuniversality in other parts of the moral life, called "particular moralities." The existence of universal moral standards is defended in terms of: (1) a theory of the objectives of morality, (2) an account of the norms that achieve those objectives, and (3) an account of normative justification (both pragmatic and coherentist). (shrink)

This book represents the most comprehensive account to date of an important but widely contested approach to ethics--intuitionism, the view that there is a plurality of moral principles, each of which we can know directly. Robert Audi casts intuitionism in a form that provides a major alternative to the more familiar ethical perspectives. He introduces intuitionism in its historical context and clarifies--and improves and defends--W. D. Ross's influential formulation. Bringing Ross out from under the shadow of G. E. Moore, he (...) puts a reconstructed version of Rossian intuitionism on the map as a full-scale, plausible contemporary theory. A major contribution of the book is its integration of Rossian intuitionism with Kantian ethics; this yields a view with advantages over other intuitionist theories and over Kantian ethics taken alone. Audi proceeds to anchor Kantian intuitionism in a pluralistic theory of value, leading to an account of the perennially debated relation between the right and the good. Finally, he sets out the standards of conduct the theory affirms and shows how the theory can help guide concrete moral judgment. The Good in the Right is a self-contained original contribution, but readers interested in ethics or its history will find numerous connections with classical and contemporary literature. Written with clarity and concreteness, and with examples for every major point, it provides an ethical theory that is both intellectually cogent and plausible in application to moral problems. (shrink)

Alasdair MacIntyre explores some central philosophical, political and moral claims of modernity and argues that a proper understanding of human goods requires a rejection of these claims. In a wide-ranging discussion, he considers how normative and evaluative judgments are to be understood, how desire and practical reasoning are to be characterized, what it is to have adequate self-knowledge, and what part narrative plays in our understanding of human lives. He asks, further, what it would be to understand the modern condition (...) from a neo-Aristotelian or Thomistic perspective, and argues that Thomistic Aristotelianism, informed by Marx's insights, provides us with resources for constructing a contemporary politics and ethics which both enable and require us to act against modernity from within modernity. This rich and important book builds on and advances MacIntyre's thinking in ethics and moral philosophy, and will be of great interest to readers in both fields. (shrink)

This chapter is divided into three parts. First I outline what makes something an objective list theory of well-being. I then go on to look at the motivations for holding such a view before turning to objections to these theories of well-being.

This book clarifies the meaning of the most important and pervasive concepts and tools in bioethical argumentation and assesses the methodological suitability of the main methods for clinical decision-making and argumentation. The first part of the book is devoted to the most developed or promising approaches regarding bioethical argumentation, namely those based on principles, values and human rights. The authors then continue to deal with the contributions and shortcomings of these approaches and suggest further developments by means of substantive and (...) procedural elements and concepts from practical philosophy, normative systems theory, theory of action, human rights and legal argumentation. Furthermore, new models of biomedical and health care decision-making, which overcome the aforementioned criticism and stress the relevance of the argumentative responsibility, are included. (shrink)

While much attention has been given to the use of principles in biomedical ethics and increasing attention is given to alternative theoretical approaches, relatively little attention has been devoted to the critical task of how one resolves conflicts among competing principles. After summarizing the system of principles and some problems in conceptualizing the principles, several strategies for reconciling conflicts among principles are examined including the use of single-principle theories (pure libertarianism, pure utilitarianism, and pure Hippocratism), balancing theories, conflicting appeals theories, (...) and lexical ordering. Then a mixed strategy is proposed in which consequentialist principles are balanced between themselves as are nonconsequentialist principles, after which the result of balancing the nonconsequentialist principles is lexically ranked over the result of balancing the consequentialist ones. Finally, strategies involving specifying and rule generation are discussed concluding that most current specification and rule-generating theories must involve some degree of lexical ordering of principles. (shrink)

Among the different approaches to questions of biomedical ethics, there is a view that stresses the importance of a patient’s right to make her own decisions in evaluative questions concerning her own well-being. This approach, the autonomy-based approach to biomedical ethics, has usually led to the adoption of a subjective theory of well-being on the basis of its commitment to the value of autonomy and to the view that well-being is always relative to a subject. In this article, it is (...) argued that these two commitments need not lead to subjectivism concerning the nature of well-being. (shrink)

The notion that it is useful to specify norms progressively in order to resolve doubts about what to do, which I developed initially in a 1990 article, has been only partly assimilated by the bioethics literature. The thought is not just that it is helpful to work with relatively specific norms. It is more than that: specification can replace deductive subsumption and balancing. Here I argue against two versions of reliance on balancing that are prominent in recent bioethical discussions. Without (...) meaning to address the substance or the overall merits of either view I criticize, I attack Gert, Culver and Clouser's implicit reliance on some overall dimension of balancing as a basis of resolving conflicts among norms and Beauchamp and Childress's residual acceptance of 'justified balancing'. The former authors' description of resolving conflicts depends upon a type of value commensurability that (as they otherwise seem to admit) does not obtain, while the latter authors' role for justified balancing would be better served by continued specification. (shrink)

In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life determinations, (...) the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient 's values. In order to act in the patient 's best interests, or the patient 's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient 's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient 's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician- patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today. (shrink)

Natural law theory has been undergoing a revival, especially in political philosophy and jurisprudence. Yet, most fundamentally, natural law theory is not a political theory, but a moral theory, or more accurately a theory of practical rationality. According to the natural law account of practical rationality, the basic reasons for actions are basic goods that are grounded in the nature of human beings. Practical rationality aims to identify and characterize reasons for action and to explain how choice between actions worth (...) performing can be appropriately governed by rational standards. These standards are justified by reference to features of the human goods that are the fundamental reasons for action. This book is a defence of a contemporary natural law theory of practical rationality, demonstrating its inherent plausibility and engaging systematically with rival egoist, consequentialist, Kantian and virtue accounts. (shrink)

Book reviewed in this article: For the Patient's Good: The Restoration of Beneficence in Health Care. By Edmund D. Pellegrino and David C. Thomasma.

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

The Right and the Good, a classic of twentieth-century philosophy by the great scholar Sir David Ross, is now presented in a new edition with a substantial introduction by Philip Stratton-Lake, a leading expert on Ross. Ross's book is the pinnacle of ethical intuitionism, which was the dominant moral theory in British philosophy for much of the nineteenth and early twentieth century. Intuitionism is now enjoying a considerable revival, and Stratton-Lake provides the context for a proper understanding of Ross's great (...) work today. (shrink)

In recent years, virtue theories have enjoyed a renaissance of interest among general and medical ethicists. This book offers a virtue-based ethic for medicine, the health professions, and health care. Beginning with a historical account of the concept of virtue, the authors construct a theory of the place of the virtues in medical practice. Their theory is grounded in the nature and ends of medicine as a special kind of human activity. The concepts of virtue, the virtues, and the virtuous (...) physician are examined along with the place of the virtues of trust, compassion, prudence, justice, courage, temperance, and effacement of self-interest in medicine. The authors discuss the relationship between and among principles, rules, virtues, and the philosophy of medicine. They also address the difference virtue-based ethics makes in confronting such practical problems as care of the poor, research with human subjects, and the conduct of the healing relationship. This book woith the author's previous volumes, A Philosophical Basis of Medical Practice and For the Patient's Good, are part of their continuing project of developing a coherent moral philosophy of medicine. (shrink)

The concept of well-being is one of the oldest and most important topics in philosophy and ethics, going back to ancient Greek philosophy and Aristotle. Following the boom in happiness studies in the last few years it has moved to centre stage, grabbing media headlines and the attention of scientists, psychologists and economists. Yet little is actually known about well-being and it is an idea often poorly articulated. The Routledge Handbook of Philosophy of Well-Being provides a comprehensive, outstanding guide and (...) reference source to the key topics and debates in this exciting subject. Comprising over forty chapters by a team of international contributors, the Handbook is divided into six parts: well-being in the history of philosophy current theories of well-being, including hedonism, and perfectionism examples of well-being and its opposites, including friendship and virtue and pain and death theoretical issues such as well-being and value, harm, identity and well-being and children well-being in moral and political philosophy well-being and related subjects including law, economics, and medicine. Essential reading for students and researchers in ethics and political philosophy, it will also be an invaluable resource for those in related disciplines such as psychology, politics and sociology. (shrink)

Dan Haybron presents an illuminating examination of well-being, drawing on important recent work in the science of happiness. He shows that we are remarkably prone to error in judgements of our own personal welfare, and suggests that we should rethink traditional assumptions about the good life and the good society.

_Moral Theory_ sets out the basic system used to solve moral problems, the system that consequentialists deride as 'traditional morality'. The central concepts, principles and distinctions of traditional morality are explained and defended: rights; justice; the good; virtue; the intention/foresight distinction; the acts/omissions distinction; and, centrally, the fundamental value of human life.