Bioethics

Another way in which it has been claimed that we can come to know what moral principles or rules we should follow is through our intuition. In practice this usually means that we adopt conventionally accepted moral principles or rules, perhaps with some adjustments in order to avoid inconsistency or arbitrariness. On this view, a moral theory should, like a scientific theory, try to match the data; and the data that a moral theory must match is provided by our moral intuitions. As in science, if a plausible theory matches most, but not all, of the data, then the anomalous data might be rejected on the grounds that it is more likely that there was an error in the procedures for gathering that particular set of data than that the theory as a whole is mistaken. But ultimately the test of a theory is its ability to explain the data. The problem with applying this model of scientific justification to ethics is that the “data” of our moral intuitions is unreliable, not just at one or two specific points, but as a whole. Here the facts that cultural relativists draw upon are relevant (even if they do not establish that cultural relativism is the correct response to it). Since we know that our intuitions are strongly influenced by such things as culture and religion, they are ill‐suited to serve as the fixed points against which an ethical theory must be tested. Even where there is cross‐cultural agreement, there may be some aspects of our intuitions on which all cultures unjustifiably favor our own interests over those of others. For example, simply because we are all human beings, we may have a systematic bias that leads us to give an unjustifiably low moral status to nonhuman animals. Or, because, in virtually all known human societies, men have taken a greater leadership role than women, the moral intuitions of all societies may not adequately reflect the interests of females.

Some philosophers think that it is a mistake to base ethics on principles or rules. Instead they focus on what it is to be a good person – or, in the case of the problems with which this book is concerned, perhaps on what it is to be a good nurse or doctor or researcher. They seek to describe the virtues that a good person, or a good member of the relevant profession, should possess. Moral education then consists of teaching these virtues and discussing how a virtuous person would act in specific situations. The question is, however, whether we can have a notion of what a virtuous person would do in a specific situation without making a prior decision about what it is right to do. After all, in any particular moral dilemma, different virtues may be applicable, and even a particular virtue will not always give unequivocal guidance. For instance, if a terminally ill patient repeatedly asks a nurse or doctor for assistance in dying, what response best exemplifies the virtues of a healthcare professional? There seems no answer to this question, short of an inquiry into whether it is right or wrong to help a patient in such circumstances to die. But in that case we seem bound, in the end, to come back to discussing such issues as whether it is right to follow moral rules or principles, or to do what will have the best consequences.

In the late twentieth century, some feminists offered new criticisms of conventional thought about ethics. They argued that the approaches to ethics taken by the influential philosophers of the past – all of whom have been male – give too much emphasis to abstract principles and the role of reason, and give too little attention to personal relationships and the part played by emotion. One outcome of these criticisms has been the development of an “ethic of care,” which is not so much a single ethical theory as a cluster of ways of looking at ethics which put an attitude of caring for others at the center, and seek to avoid reliance on abstract ethical principles. The ethic of care has seemed especially applicable to the work of those involved in direct patient care. Not all feminists, however, support this development. Some worry that presenting an ethic of care in opposition to a “male” ethic based on reasoning reflects and reinforces stereotypes of women as more emotional and less rational than men. They also fear that it could lead to women continuing to carry a disproportionate share of the burden of caring for others.

In this discussion of ethics we have not mentioned anything about religion. This may seem odd, in view of the close connection that has often been made between religion and ethics, but it reflects our belief that, despite this historical connection, ethics and religion are fundamentally independent. Logically, ethics is prior to religion. If religious believers wish to say that a deity is good, or praise her or his creation or deeds, they must have a notion of goodness that is independent of their conception of the deity and what she or he does. Otherwise they will be saying that the deity is good, and when asked what they mean by “good,” they will have to refer back to the deity, saying perhaps that “good” means “in accordance with the wishes of the deity.” In that case, sentences such as “God is good” would be a meaningless tautology. “God is good” could mean no more than “God is in accordance with God’s wishes.” As we have already seen, there are ideas of what it is for something to be “good” that are not rooted in any religious belief. While religions typically encourage or instruct their followers to obey a particular ethical code, it is obvious that others who do not follow any religion can also think and act ethically.

To say that ethics is independent of religion is not to deny that theologians or other religious believers may have a role to play in bioethics. Religious traditions often have long histories of dealing with ethical dilemmas, and the accumulation of wisdom and experience that they represent can give us valuable insights into particular problems. But these insights should be subject to criticism in the way that any other proposals would be. If in the end we accept them, it is because we have judged them sound, not because they are the utterances of a pope, a rabbi, a mullah, or a holy person.

Ethics is also independent of the law, in the sense that the rightness or wrongness of an act cannot be settled by its legality or illegality. Whether an act is legal or illegal may often be relevant to whether it is right or wrong, because it is arguably wrong to break the law, other things being equal. Many people have thought that this is especially so in a democracy, in which everyone has a say in making the law. Another reason why the fact that an act is illegal may be a rea‐ son against doing it is that the legality of an act may affect the consequences that are likely to flow from it. If active voluntary euthanasia is illegal, then doctors who practice it risk going to jail, which will cause them and their families to suffer, and also mean that they will no longer be able to help other patients. This can be a powerful reason for not practicing voluntary euthanasia when it is against the law, but if there is only a very small chance of the offense becoming known, then the weight of this consequentialist reason against breaking the law is reduced accordingly. Whether we have an ethical obligation to obey the law, and, if so, how much weight we should give it, is itself an issue for ethical argument.

Though ethics is independent of the law, in the sense just specified, laws are subject to evaluation from an ethical perspective. Many debates in bioethics focus on questions about what practices should be allowed – for example, should we allow research on stem cells taken from human embryos, sex selection, or cloning? – and committees set up to advise on the ethical, social, and legal aspects of these questions often recommend legislation to prohibit the activity in question, or to allow it to be practiced under some form of regulation. Discussing a question at the level of law and public policy, however, raises somewhat different considerations than a discussion of personal ethics, because the consequences of adopting a public policy generally have much wider ramifications than the consequences of a personal choice. That is why some healthcare professionals feel justified in assisting a terminally ill patient to die, while at the same time opposing the legalization of physician‐assisted suicide. Paradoxical as this position may appear – and it is certainly open to criticism – it is not straightforwardly inconsistent.