Democratic pluralism and majority rule

Abstract

I argue that Metz’s undertaking, in seeking a ‘comprehensive basic norm’ to underpin African ethics, is similar to Hans Kelsen’s postulation of the Grundnorm in his Pure Theory of Law. But African ethics does not need to be underpinned by an approach such as Kelsen’s. In my view, Metz’s preference for seeking to develop a Grundnorm rests upon a failure to attend carefully to the distinctness of African ethical thinking from Western ethical thinking. This failure is manifest in a spurious distinction (on which Metz relies) between ‘moral anthropology’ / ‘cultural studies’ and ‘normative theory’. It is also manifest in Metz’s failure to attend carefully to the work of Wiredu and Bujo, both of whom present systematic, critical analyses of African ethical thinking while implicitly rejecting the quest for a Grund norm as being unAfrican.     

Medical Ethics Research Between Theory and Practice

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.     

Theological Ethics, Moral Philosophy, and Natural Law

The article deals with the relationship between theological ethics and moral philosophy. The former is seen as a theoretical reflection on Christian ethics, the latter as one on secular ethics. The main questions asked are: (1) Is there one and only one pre-theoretical knowledge about acting rightly? (2) Does philosophy provide us with the theoretical framework for understanding both Christian and secular ethics? Both questions are answered in the negative. In the course of argument, four positions are presented: theological ‘unificationism’, philosophical ‘unificationism’, theological ‘separationism’ and Lutheran ‘dualism’. It is argued that the latter position is most convincing. It is dual in the sense of being both a theory of Christian ethics and of including a recognition of natural law. Hence, it unites a particularistic and a universalistic point of view. In the last section a reformulation of the Lutheran position is attempted in making use of the ethical theory of Knud E. Løgstrup's The Ethical Demand.     

Engagement and suffering in responsible caregiving: On overcoming maleficience in health care

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as ‘clinical phronesis,’ i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of ‘virtue ethics,’ yet one that is informed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their “disengaged” form (reflecting the malaise of “modern medicine”). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the ‘silent world of doctor and patient’ — provides may deny or refuse any ‘given’ connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of ‘calculative reasoning’ only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can ‘save the life of medical ethics’ — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can ‘prevent the death of medical ethics.’     

Justice and care: The implications of the Kohlberg-Gilligan debate for medical ethics

Carol Gilligan has identified two orientations to moral understanding; the dominant ‘justice orientation’ and the under-valued ‘care orientation’. Based on her discernment of a ‘voice of care’, Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.     

Analogies between al-Māturīdī’s and Duns Scotus’s Ethical Perspectives

Al-Māturīdī and Duns Scotus share an ethical paradigm that represents the middle ground between divine command and natural law theories in ethics. While al-Māturīdī’s theory can generally be located between Ash?arite divine command and Mu?tazilite natural law theories in Islamic ethics, Scotus’s theory can be placed between William of Ockham’s divine command and Thomas Aquinas’s natural law theories in Christian ethics. Although the starting point of their ethical perspectives is fundamentally based on criticism of natural law theory, neither theologian can be labelled as a typical divine command theorist. This moderate theory may therefore be described as the theory of soft divine command. The main purpose of this article is to draw attention to some similarities between al-Māturīdī’s and Duns Scotus’s ethical perspectives: First, both theologians highlight the composite picture of human nature in terms of morality. In other words, they posit that humans have two opposite tendencies: ‘affection for justice’ and ‘affection for advantage’. Second, although both theologians grant reason an ontological authority in determining what is good and bad, this authority is not limitless. Finally, both theologians argue that, unless one takes account of God’s freedom and wisdom, the moral order in the world cannot be fully comprehended.     

Ethics and Culture in Mental Health Care

This article examines the complex relationship between culture, values, and ethics in mental health care. Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions. Five clinical cases are presented to illustrate the range of ethical issues faced by mental health clinicians working in a multicultural environment, including issues of therapeutic boundaries, diagnosis, treatment choice, confidentiality and informed consent, and the just distribution of limited health care resources.     

The importance of meta-ethics in engineering education

Our shared moral framework is negotiated as part of the social contract. Some elements of that framework are established (tell the truth under oath), but other elements lack an overlapping consensus (just when can an individual lie to protect his or her privacy?). The tidy bits of our accepted moral framework have been codified, becoming the subject of legal rather than ethical consideration. Those elements remaining in the realm of ethics seem fragmented and inconsistent.Yet, our engineering students will need to navigate the broken ground of this complex moral landscape. A minimalist approach would leave our students with formulated dogma—principles of right and wrong such as the National Society for Professional Engineers (NSPE) Code of Ethics for Engineers—but without any insight into the genesis of these principles. A slightly deeper, micro-ethics approach would teach our students to solve ethical problems by applying heuristics—giving our students a rational process to manipulate ethical dilemmas using the same principles simply referenced a priori by dogma. A macro-ethics approach—helping students to inductively construct a posteriori principles from case studies—goes beyond the simple statement or manipulation of principles, but falls short of linking personal moral principles to the larger, social context. Ultimately, it is this social context that requires both the application of ethical principles, and the negotiation of moral values—from an understanding of meta-ethics.The approaches to engineering ethics instruction (dogma, heuristics, case studies, and meta-ethics) can be associated with stages of moral development. If we leave our students with only a dogmatic reaction to ethical dilemmas, they will be dependent on the ethical decisions of others (a denial of their fundamental potential for moral autonomy). Heuristics offers a tool to deal independently with moral questions, but a tool that too frequently reduces to casuistry when rigidly applied to “simplified” dilemmas. Case studies, while providing a context for engineering ethics, can encourage the premature analysis of specific moral conduct rather than the development of broad moral principles—stifling our students’ facility with meta-ethics. Clearly, if a moral sense is developmental, ethics instruction should lead our students from lower to higher stages of moral development.     

The Ethics of Enhanced Interrogations and Torture: A Reappraisal of the Argument

This article critically reviews what is known about the ethical status of psychologists’ putative involvement with enhanced interrogations and torture (EITs). We examine three major normative ethical accounts (utilitarian, deontic, and virtue ethics) of EITs and conclude, contra the American Psychological Association, that reasonable arguments can be made that in certain cases the use of EITs is ethical and even, in certain circumstances, morally obligatory. We suggest that this moral question is complex as it has competing moral values involved, that is, the humane treatment of detainee competes with the ethical value/duty/virtue of protecting innocent third parties. We also suggest that there is an ethical duty to minimize harm by making only judicious and morally responsible allegations against the psychologists alleged to be involved in EITs. Finally, we make recommendations regarding completing the historical record, improvements in the professional ethics code, and the moral treatment of individuals accused in this controversy.     

Ethical and institutional frameworks for interactional justice in public organizations: a comparative analysis of selected Western and Chinese sources

This paper explores both differences and points of contact between selected contemporary theories of public ethics in the West and China. China is in a greater state of flux in this connection, with new, eclectic approaches to ethical justification for moral agency gaining prominence. There are thematic parallels between East and West in their distinct strains of institutionalism (in which neither individual moral agency nor the justice claims of individuals have much play). However, there are recent Chinese theoretical proposals – many incorporating Western sources – that address this quandary, namely the institutional overdetermination of moral agency. These proposals are joined to contributions from feminist and liberation ethics in a critical reconsideration of overridingness in formal ethics. Contemporary Chinese ethics connect moral claims to kin, community, and reciprocity networks, particularly as traditional philosophy is recovered in new theoretical syntheses. The grounding of Confucian ethics in kin and community offers an instructive contrast to formal Western ethical systems, as do radical strains of Western ethics that suggest that transcendence is found in the self's extension toward others in need. This paper considers these ethical themes in connection with hypothetical instances of interactional justice in organizations.     

Addressing fragmented human–nonhuman interactions through an ubuntu ‘mixed’ ethics

In this paper, I address human-induced environmental ills we face using an ubuntu-inspired ethical lens. I follow ubuntu scholars to stress the significance for moral agents to embody virtues. Virtue development is essential to carry out obligations and address human impacts on the environment. Thaddeus Metz, in particular, has drawn attention to how embodying ubuntu virtues of humility and friendliness can prompt moral agents to be other-regarding. The view I developed in this paper differs from his ubuntu-inspired account in at least two significant ways. First, humans cannot be in harmonious relationships with some species such as Black Mambas, Hyenas and sea urchins even if they can interact. Second, we must acknowledge the consequentialist dimension of ubuntu ethics and prioritise the different aspects of ubuntu ‘mixed’ ethics, ranking them to offer possibilities for a more realistic recommendation to change our moral life. This paper demonstrates that the three dimensions of ubuntu ‘mixed’ ethics are fundamental because we need to think about moral consequences, right action and our virtue in accounting for our actions.     

关于医学伦理学教育的几点思考

医学伦理学教育中长期存在的一些问题尚未很好解决.由于较多强调课程的道德教育功能,对其作为独立学科存在的性质和意义仍重视不够,医学伦理学是进行道德分析、准则与价值评判的理论体系,通过医学伦理学的学习和训练,应使学生能够对有关问题在广阔的背景中进行深层次思考并做出独立判断.我们应在进一步更新观念的基础上,改进哲学、伦理学基础教育,以促进医学伦理学教育的发展,而其意义已远超出医学伦理学之外.     

Being, Doing, and Knowing: Developing Ethical Competence in Health Care

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested.     

Simone Weil: The Ethics of Affliction and the Aesthetics of Attention

ABSTRACT

For Simone Weil the invocation of ‘rights’ to address extreme human suffering–what she calls ‘affliction’–is ‘ludicrously inadequate’. Rights, Weil argues, invite a response, whereas what the afflicted require is not dialogue but simply to be heard. For Weil, hearing the ‘cry’ of the afflicted is the basis of all justice. The task of such a hearing is given over to Weil’s concept of attention, which demands an ethics of creative silence. This paper will argue that central to Weil’s ethics of attention, and thus the way she thinks we should show compassion and act justly, is the Kantian aesthetic concept of disinterestedness. I will argue that whilst Weil is influenced by Kant in multiple ways, it is his aesthetics, rather than his normative moral theory, that is most at play in her own ethical theory of attention.     

Ethics: universal or global? The trends in studies of ethics in the context of globalization

The article discusses how theory and practice in global ethics affect each other. First, the author explores how the study of ethics has changed in the era of globalization and ponders what the role of the field of study of global ethics is in this context. Second, she wants to show how the logical fallacies in widening study field of ethics produce false polarizations between facts and value judgements in social ethics made in various cultural contexts. She further elaborates how these false polarizations prevent constructive cross-cultural and transnational discussions on ethical guidelines and principles that are needed to produce joint action (plans) to deal with serious ethical issues globally and nationally. Finally, the paper argues that in order to find a way to solve our shared complex ethical problems in global context, we need to get back to basics by focusing on the method of ethics, that is, self-critical and logical analysis of sound argumentation and justification of our values and moral principles.     

Some aspects of medical ethics from the perspective of bioengineering

The problem of ethics in medical care as seen from the bioengineering results from the almost incredible technological achievements based on scientific research: On the one hand there is inadequate handling of technology and fear on the part of the patient; on the other hand there is admiration on the part of the physicians and the nursing staff. This article will survey the points of criticism concerning ethical behavior and will present and evaluate general problems of mechanization in medical care. General phenomena of human interaction, and especially problems related to medical care, will be discussed. It will be necessary to develop clinical medical technology, aiming primarily at ‘realizing the patient's concern’. After analyzing these concerns, it is necessary for the clinical medical engineer to develop an ‘invisible’ technology. Criteria for such an ‘invisible’ technology (function, design, automatic control, methods of implantation, whether chronic application is necessary) are being demonstrated by particular devices (artifical heart, functional electro-stimulation, diaphragmatic pace-maker).     

The ethical dimension of analytical psychology

The centrality of the ethical dimension in Carl Gustav Jung's analytical psychology is demonstrated through careful reference to fundamental moments in the Jungian text. Tracking Jung's statements about the primacy of the ‘moral function’ (or ‘moral factor’) in the cure of neurosis as well as in the process of individuation, the ethical nature of the psychotherapeutic praxis proposed by Jung is highlighted. This allows us to see the ethical aspect of psychological conflicts, and thus to understand better why individuation can be seen as a ‘moral achievement’. Finally, the intelligible ethical structure of Jungian psychotherapeutic praxis is exposed.