Ill-placed democracy: ethics consultations and the moral status of voting

As groups around the country begin to craft standards for clinical ethics consultations, one focus of that work is the proper procedure for conducting ethics consults. From a recent empirical look into the workings of ethics consult services (ECSs), one worrisome finding is that some ECSs rely on a committee vote when making a recommendation. This article examines the practice of voting and its moral standing as a procedural strategy for arriving at a clinical ethics recommendation. I focus here on the type of clinical ethics conflicts that are most likely to lead an ECS to vote, namely, conflicts involving ethical uncertainty--or, in the Greek, aporia. I argue that in cases of aporia, voting on an ethics conflict is not a morally justifiable procedure. Then on the same grounds that I use to show that voting is ethically problematic, I raise broader concerns about the common practice of making recommendations by other procedures. In contrast to the standard approach of adjudicating between moral claims, I argue that ECSs can best resolve aporetic conflict through the process of clinical ethics mediation.     

Subsidized abortion: moral rights and moral compromise

The right of indigent women to have government-subsidized abortions is considered in light of the opposing societal opinions on the morality of abortion. Arguments for funding abortions as another facet of health care, and the welfare rights and freedom of indigents, are discussed. A compromise between pro- and anti-abortion factions in society is suggested--the elimination of government funding for elective abortions while continuing to allow them for those who can pay.     

Present sakes and future prospects: the status of early abortion

The author accepts that the late fetus is essentially a baby, making late abortion the conceptual equivalent of infanticide, but he argues that the absence of mentality in the embryo is such that it cannot be victimized, let alone murdered. He concludes that it is probably impossible to determine objectively the moral status of the fetus as it develops in the middle period between two and seven months.     

Commentary on Fiester's "Ill-placed democracy: ethics consultations and the moral status of voting"

Autumn Fiester identifies an important element in clinical ethics consultation (CEC) that she labels, from the Greek, aporia, "state of perplexity," evidenced in CEC as ethical ambiguity. Fiester argues that the inherent difficulties of cases so characterized render them inappropriate for voting and more amenable to mediation and the search for consensus. This commentary supports Fiester's analysis and adds additional reasons for rejecting voting as a process for resolving disputes in CEC including: it distorts the analysis by empowering individual voters preferences and biases rather than focusing on the interests and wishes of the patient and family; it offers an insufficiently sensitive model for resolving the awesome, nuanced, conflicted, and ethically complex issues surrounding life and death; it marginalizes minority opinions that may have moral validity.     

Evolutionary ethics and moral theory

Conclusion This example, like the others, demands further discussion. My conclusion must therefore remain modest: an agent-neutral theory of our moral competence is not biologically implausible. Agent-centered rules like tit-for-tat, prerogatives, special obligations, and duties not to harm others might be best regarded as belonging to the theory of moral performance rather than the theory of moral competence. For biologists who may think otherwise, the general argument of this essay is that any claims to the contrary must be based on more empirically well-developed theories of our moral competence and moral performance.More adequate theories of both kinds are worth developing, even if by themselves they determine nothing about how we ought to live our lives. Biology may help us understand the broad taxonomical categories of moral performance. It may also explain why, at the deepest levels of our moral thinking, we so easily slide into agent-neutral ways of reasoning. But how we ought to live our lives is something that must be determined by social experiment and moral argumentation. Discoveries regarding the empirical nature of morality cannot be made independently of the actual workings of our moral competence, which is itself only one factor in broader social and psychological processes that are capable of leading human beings down any number of more or less morally laudable paths.

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Negotiating the moral order: paradoxes of ethics consultation

Ethics consultation at the bedside has been hailed as a better way than courts and ethics committees to empower patients and make explicit the value components of treatment decisions. But close examination of the practice of ethics consultation reveals that it in fact risks subverting those ends by interpolating a third (expert) party into the doctor-patient encounter. In addition, the practice of bioethics through consultation does the broader cultural work of fashioning a shared moral order in the face of manifestly plural individual commitments. In doing so, however, bioethics furthers medicine's position as a privileged domain of public moral discourse in contemporary American society.     

Theological ethics, moral philosophy, and public moral discourse.

The advent and growth of bioethics in the United States in the late 1960s and early 1970s precipitated an era of public moral discourse, that is, the deliberate attempt to analyze and formulate moral argument for use in public policy. The language for rational discussion of moral matters evolved from the parent disciplines of moral philosophy and theological ethics, as well as from the idioms of a secular, pluralistic world that was searching for policy answers to difficult bioethical questions. This article explores the basis and content of the unique contributions of both theological and philosophical ethics to the development of public moral discourse.     

The notion of the moral: the relation between virtue ethics and virtue epistemology

In this paper I argue that virtue ethics should be understood as a form of ethics which integrates various domains of the practical in relation to which virtues are excellences. To argue this it is necessary to distinguish two senses of the “moral”: the broad sense which integrates the domains of the practical and a narrow classificatory sense. Virtue ethics, understood as above, believes that all genuine virtue should be understood as what I call virtues proper. To possess a virtue proper (such as an excellent disposition of open-mindedness, an epistemic virtue) is to possess a disposition of overall excellence in relation to the sphere or field of the virtue (being open to the opinions of others). Overall excellence in turn involves excellence in integrating to a sufficient degree, standards of excellence in all relevant practical domains. Epistemic virtues, sporting virtues, moral virtues, and so on are all virtues proper. In particular it is impossible for an epistemic virtue to be a moral (narrow sense) vice.