Vulnerability does not mean much for our contemporary morality. It is antithetical to our emphasis on individualism and rationality; it requires that we attend to the body and to our feelings. Yet only by recognizing the depth and breadth of our vulnerability can we affirm our humanity.

There is the world of ideas and the world of practice; the French are often for sup pressing the one and the English the other; but neither is to be suppressed. -Matthew Arnold The Function of Criticism at the Present Time From its inception, bioethics has confronted the need to reconcile theory and practice. At first the confrontation was purely intellectual, as writers on ethical theory (within phi losophy, theology, or other humanistic disciplines) turned their attention to topics from the (...) world of medical practice. Recently the confrontation has grown more intense. The ap pointment of clinical ethicists in hospitals and other health care settings is an accelerating trend in North America. Concomitantly, those institutions involved in training peo ple in clinical ethics have added organized exposure to the world of practice, in the form of placement requirements, to the normal academic course load. In common with other dis ciplines, bioethics has begun to see clinical training as a con dition of didactic theory and apprenticeship. (shrink)

Not long ago, a colleague chided me for using the term "the biological revolution. " Like many others, I have employed it as an umbrella term to refer to the seemingly vast, rapidly-moving, and fre quently bewildering developments of contemporary biomedicine: psy chosurgery, genetic counseling and engineering, artificial heart-lung machines, organ transplants-and on and on. The real "biological revo lution," he pointed out, began back in the nineteenth century in Europe. For it was then that death rates and infant mortality (...) began to decline, the germ theory of disease was firmly established, Darwin took his famous trip on the Beagle, and Gregor Mendel stumbled on to some fundamental principles of heredity. My friend, I think, was both right and wrong. The biological revolution did have its roots in the nineteenth century; that is when it first began to unfold. Yet, like many intellectual and scientific upheav als, its force was not felt for decades. Indeed, it seems fair to say that it was not until after the Second World War that the full force of the earlier discoveries in biology and medicine began to have a major impact, an impact that was all the more heightened by the rapid bi omedical developments after the war. (shrink)

Yet these forces are largely ignored by a professional bioethics that concentrates on the theoretical justification of decisions.The original essays in this ...

How developing a more expansive, non-formal conception of reason produces richer ethical understandings of human situations, explored and illustrated with many real examples. In Re-Reasoning Ethics, Barry Hoffmaster and Cliff Hooker enhance and empower ethics by adopting a non-formal paradigm of rational deliberation as intelligent problem-solving and a complementary non-formal paradigm of ethical deliberation as problem-solving design to promote human flourishing. The non-formal conception of reason produces broader and richer ethical understandings of human situations, not the simple, constrained depictions provided (...) by moral theories and their logical applications in medical ethics and bioethics. Instead, it delivers and vindicates the moral judgment that complex, contextual, and dynamic situations require. Hoffmaster and Hooker demonstrate how this more expansive rationality operates with examples, first in science and then in ethics. Non-formal reason brings rationality not just to the empirical world of science but also to the empirical realities of human lives. Among the many real cases they present is that of how women at risk of having children with genetic conditions decide whether to try to become pregnant. These women do not apply the formal principle of maximizing expected utility (as advised by genetic counselors) and instead imagine scenarios of what their lives could be like with an affected child and assess whether they could accept the worst of these scenarios. Hoffmaster and Hooker explain how moral compromise and a liberated, extended, and enriched reflective equilibrium expand and augment rational ethical deliberation and how that deliberation can rationally design ethical practices, institutions, and policies. (shrink)