The role of moral principles in applied philosophy: A case study in medical ethics.

摘要

This dissertation is an examination of applied ethics and medical ethics and the recent "public turn" to moral philosophy. I have chosen medical ethics as it is the most developed area of applied philosophy and has made the mark as an autonomous field of study. In tune with the Zeitgeist, philosophers are securing new employment on hospital review boards, on national commissions, as consultants and as teachers in professional ethics. What does this welter of activity signify, and what does moral philosophy contribute to the public understanding and to moral understanding, if that is its task?; While questions concerning the role of philosophy in public affairs have a considerable lineage, the advances and successes of the most sophisticated areas of medicine bring new questions to the fore. The case study of the congenitally handicapped newborn infant is presented in Chapter Two. Cases in newborn intensive care challenge our basic moral assumptions about the "goodness" of life, and color our illusions about the power of medicine to conquer disease and death. With the available life-saving technology, physicians, parents and "ethicists" struggle over the issue of selective nontreatment and the underlying moral principles for saving some lives but not others.; Chapter Three moves beyond the case discussion to a presentation of what I view as the more systemic problems in medicine. Found within its own historical trajectory, there are important changes with respect to the nature of explanation in medicine, the preoccupation with the scientific control of disease and the effects of the current biomedical disease model on the norms of medical practice. Concepts of disease have and continue to influence how medical knowledge is generated, who has the power to disseminate and control that knowledge, and the norms of applying knowledge in the clinical context. Models of explanation (the disease concept) in medicine serve a paradigmatic and ideological role, and as such will be coupled to the norms of medical practice.; In the final chapter, I pose the following questions: What is the function of moral principles in ethics and medical ethics? What social and historical circumstances make it appropriate to discuss problems of medical ethics in the language of principles? I reject the approach that there are absolute moral principles that are truly "applied" to cases and instead offer a pragmatic approach to moral principles that are context-bound, yet retain a sense of endurance and objectivity.