Suppose that one is at least a minimal realist about a given domain, in that one thinks that that domain contains truths that are not in any interesting sense of our own making. Given such an understanding, what can be said for and against the method of reflective equilibrium as a procedure for investigating the domain? One fact that lends this question some interest is that many philosophers do combine commitments to minimal realism and a reflective equilibrium methodology. Here, for (...) example, is David Lewis on philosophy: Our “intuitions” are simply opinions: our philosophical theories are the same. Some are commonsensical, some are sophisticated; some are particular; some general; some are more firmly held, some less. But they are all opinions, and a reasonable goal for a philosopher is to bring them into equilibrium. Our common task it to find out what equilibria there are that can withstand examination, but it remains for each of us to come to rest at one or another of them… Once the menu of well-worked out theories is before us, philosophy is a matter of opinion. Is that to say that there is no truth to be had? Or that the truth is of our own making, and different ones of us can make it differently? Not at all! If you say flatly that there is no god, and I say that there are countless gods but none of them are our worldmates, then it may be that neither of us is making any mistake of method. We may each be bringing our opinions to equilibrium in the most careful possible way, taking account of all the arguments, distinctions, and counterexamples. But one of us, at least, is making a mistake of fact. Which one is wrong depends on what there is (1983: x-xi). In addition to philosophy in general, the method of reflective equilibrium has also been endorsed as the appropriate procedure for investigating various other subject.. (shrink)

This is the first book that explains how you actually go about doing good bioethics. John McMillan develops an account of the nature of bioethics; he reveals how a number of methodological spectres have obstructed bioethics; and then he shows how moral reason can be brought to bear upon practical issues via an 'empirical, Socratic' approach.

The COVID-19 coronavirus pandemic raises a host of challenging ethical questions at every level of society. However, some of the most acute questions relate to decision making in intensive care. The problem is that a small but significant proportion of patients develop severe viral pneumonitis and respiratory failure. It now seems likely that the number of critically ill patients will overwhelm the capacity of intensive care units within many health systems, including the National Health Service in the UK. The experience (...) of Northern Italy—a couple of weeks ahead of the UK, suggests that it will simply not be possible to provide mechanical ventilation to every patient who might need it. When the crunch comes, the unpalatable question facing clinicians is which patient to save. There are some obvious strategies to avoid or reduce the problem—through measures to increase intensive care capacity, and via society-level interventions to reduce the spread of the virus. These are vitally important, but unfortunately they are unlikely to prevent the problem of demand outstripping supply from occurring. What, then, should clinicians do? How should they allocate the scarce resource of intensive care—particularly over the coming weeks as the crisis escalates? There are different values at stake in triage decisions, but at a basic level the key values are those of benefit and …. (shrink)

After initially emerging in China, the coronavirus outbreak has advanced rapidly. The World Health Organization has recently declared it a pandemic, with Europe becoming its new epicentre. Italy has so far been the most severely hit European country and demand for critical care in the northern region currently exceeds its supply. This raises significant ethical concerns, among which is the allocation of scarce resources. Professionals are considering the prioritisation of patients most likely to survive over those with remote chances, and (...) this news has triggered an intense debate about the right of every individual to access healthcare. The proposed analysis suggests that the national emergency framework in which prioritisation criteria are currently enforced should not lead us to perceive scarce resources allocation as something new. From an ethical perspective, the novelty of the current emergency is not grounded in the devastating effects of scarce resources allocation, which is rife in recent and present clinical practice. Rather, it has to do with the extraordinarily high number of people who find themselves personally affected by the implications of scarce resources allocation and who suddenly realise that the principle of ‘equals should be treated equally’ may no longer be applicable. Along with the need to allocate appropriate additional financial resources to support the healthcare system, and thus to mitigate the scarcity of resources, the analysis insists on the relevance of a medical ethics perspective that does not place the burden of care and choice solely on physicians. (shrink)

CIOMS has been criticised for not adequately consulting stakeholders about its revised ethical guidelines regarding medical research.

BackgroundAs the COVID-19 pandemic develops, healthcare professionals are looking for support with, and guidance to inform, the difficult decisions they face. In the absence of an authoritative national steer in England, professional bodies and local organisations have been developing and disseminating their own ethical guidance. Questions inevitably arise, some of which are particularly pressing during the pandemic, as events are unfolding quickly and the field is becoming crowded. My central question here is: which professional ethical guidance should the professional follow?Main (...) bodyAdopting a working definition of “professional ethical guidance”, I offer three domains for a healthcare professional to consider, and some associated questions to ask, when determining whether – in relation to any guidance document – they should “bin it or pin it”. First, the professional should consider the source of the guidance: is the issuing body authoritative or, if not, at least sufficiently influential that its guidance should be followed? Second, the professional should consider the applicability of the guidance, ascertaining whether the guidance is available and, if so, whether it is pertinent. Pertinence has various dimensions, including whether the guidance applies to this professional, this patient and/or this setting, whether it is up-to-date, and whether the guidance addresses the situation the professional is facing. Third, the professional should consider the methodology and methods by which the guidance was produced. Although the substantive quality of the guidance is important, so too are the methods by which it was produced. Here, the professional should ask whether the guidance is sufficiently inclusive – in terms of who has prepared it and who contributed to its development – and whether it was rigorously developed, and thus utilised appropriate processes, principles and evidence.ConclusionAsking and answering such questions may be challenging, particularly during a pandemic. Furthermore, guidance will not do all the work: professionals will still need to exercise their judgment in deciding what is best in the individual case, whether or not this concerns COVID-19. But such judgments can and should be informed by guidance, and hopefully these preliminary observations will provide some useful pointers for time-pressed professionals. (shrink)

Bioethical and bio‐political questions are increasingly tackled by committees, councils, and other advisory boards that work on different and often interrelated levels. Research ethics committees work on an institutional or clinical level; local advisory boards deal with biomedical topics on the level of particular political regions; national and international political advisory boards try to answer questions about morally problematic political decisions in medical research and practice. In accordance with the increasing number and importance of committees, the quality of their work (...) and their functional status are being subjected to more and more scrutiny. Besides overall criticism regarding the quality of their work, particular committees giving political advice are often suspected of being incompatible with democratic values, such as respect for affected parties, representation of diverse values and transparency in the decision‐making processes. Based on the example of the German National Ethics Council, whose inauguration caused a still ongoing debate on the aims and scopes of committees in general, this paper discusses: (1) the requirements of modern democratic societies in dealing with complex scientific‐technical problems; (2) the composition and organisation of committees working as political advisory boards; and (3) the appointment procedures and roles of laymen and experts, and here in particular of ethicists, who may legitimately be taken on by a committee. I will argue that bioethics committees do not necessarily endanger democratic values, but can considerably improve their realisation in democratic decision‐making procedures – if, and only if, they do not act as substitutes for parliamentarian processes, but help prepare parliamentarian processes to be organised as rationally as possible. (shrink)

This paper is a critique of Norman Daniels' and James Sabin's ‘Accountability for Reasonableness’ framework for making priority-setting decisions in health care in the face of widespread disagreement about values. Accountability for Reasonableness has been rapidly gaining worldwide acceptance, arguably to the point of becoming the dominant paradigm in the field of health policy. The framework attempts to set ground rules for a procedure that ensures that whatever decisions result will be fair, reasonable, and legitimate to the extent that even (...) those who would be adversely affected will have reason to abide by them. I argue that the framework's four conditions are inadequate to this task. While we certainly require a fair and legitimate procedure for making priority setting decisions in health care despite a lack of consensus on relevant ethical and political issues, we must significantly revise the four conditions, and we cannot avoid facing our substantive disagreements head on if we hope to arrive at decisions that would (and should) be acceptable to everyone. I offer two suggestions. First, there is need for greater public involvement in all stages of deliberation. Second, we should give up on the idea that we can simplify the task of democratic deliberation by disallowing particular kinds or reasons and types of reasoning. Reasons of all kinds should be on the table, but then should be judged on their merits, such as consistency, plausibility and explanatory power, without any regard for their alleged sources of authority. (shrink)

This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy, which has been called “experimental philosophical bioethics” (bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people’s moral judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive (...) ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments. (shrink)

Ever since the introduction of reflective equilibrium in ethics, it has been argued that reflective equilibrium either leads to moral relativism, or that it turns out to be a form of intuitionism in disguise. Despite these criticisms, reflective equilibrium remains the most dominant method of moral justification in ethics. In this paper, I therefore critically examine the most recent attempts to defend the method of reflective equilibrium against these objections. Defenders of reflective equilibrium typically respond to the objections by saying (...) that either reflective equilibrium can in fact safeguard moral objectivity or alternatively, even if it cannot, that there simply are no reasonable alternatives. In this paper, I take issue with both responses. First, I argue that given the non-foundationalist aspirations of reflective equilibrium, moral objectivity cannot be maintained. Second, I argue that reflective equilibrium is not the only game in town once intuitionism has been discarded. I argue that given their own normative ambitions, combined with their rejection of intuitionism, proponents of reflective equilibrium have reason to take alternative methods of moral justification, and more specifically transcendental arguments, more seriously than they have done so far. I end by sketching the outlines of what this alternative methodology might look like. (shrink)

The law serves functions that are not often taken seriously enough by ethicists, namely feasibility and practicability. A consequence of feasibility is that most laws do not meet the demands of ideal ethical theory. A consequence of practicability is that law requires elaborated and explicit methodologies that determine how to do things with norms. These two consequences form the core idea behind this book, which employs methods from legal theory to inform and examine debates on methodology in applied ethics, particularly (...) bioethics. It is argued that almost all legal methods have counterparts in applied ethics, which indicates that much can be gained from comparative study of the two. The author first outlines methods as used in legal, focusing on deductive reasoning with statutes as well as analogical reasoning with precedent cases. He then examines three representative kinds of contemporary ethical theories, Beauchamp and Childress’s principlism, Jonsen and Toulmin’s casuistry, and two versions of consequentialism—Singer’s preference utilitarianism and Hooker’s rule-consequentialism—with regards to their methods. These examinations lead to the Morisprudence Model for methods in applied ethics. (shrink)

An updated and expanded successor to Culver and Gert's Philosophy in Medicine, this book integrates moral philosophy with clinical medicine to present a comprehensive summary of the theory, concepts, and lines of reasoning underlying the ...

It is often claimed that irreducibly normative truths would have unacceptable metaphysical implications, and are incompatible with a scientific view of the world. The book argues, on the basis of a general account of the relevance of ontological questions, that this claim is mistaken. It is also a mistake to think that interpreting normative judgments as beliefs would make it impossible to explain their connection with action. An agent’s acceptance of a normative judgment can explain that agent’s subsequent action because (...) it is part of being a rational agent that such an agent’s beliefs about reasons normally, but not invariably, make a difference to the agent’s subsequent behavior. Because facts about reasons are not entities existing apart from us, there is no epistemological problem of how we can “be in touch with” such facts. There are serious worries about normative knowledge, but the problems involved are internal to the normative domain itself. The best solution to these problems would be an overall account of the domain of reasons in normative terms, supported by an argument from reflective equilibrium. But no existing account, constructivist, or based on desires or on an idea of rationality, is plausible, and no alternative is likely to succeed. Conclusions about reasons for action must rest on more piecemeal applications of the method of reflective equilibrium. (shrink)