Common-sense morality.

Common-Sense Morality There is considerable arbitrariness in any selection of philosophical work within the last year or so that is both unlikely to have gained the attention of most bioethics scholars outside of philosophy and of special importance for bioethics. Given the broad concerns of contemporary bioethics, a plausible case can be made that most work on the basic issues of ethics and political philosophy is relevant and important for bioethics and bioethics scholars. Two issues that I will not focus on here at least deserve mention. First, over the last decade the foundations of ethics has received renewed attention in debates about objectivity in ethics and about the various new or not-so-new forms of moral realism that have been defended and criticized. I have not selected this work for attention here, though it is of central importance for how bioethics should be conceived and done, primarily because contributions in the last year or so have not fundamentally reshaped or moved these debates forward. [1] Second, in political philosophy the important debate framed by Amartya Sen, and more indirectly begun by John Rawls, over what egalitarians should seek to equalize has had significant new contributions. [2] The most direct relevance of this debate to bioethics concerns what equality, if any, should be a goal in health policy and should shape intensifying debates over access to health care and health care rationing. However, there has been little effort to apply the broader debate in political philosophy to issues of health policy. Most work in bioethics is not overtly self-conscious about the underlying normative moral theory assumed in addressing concrete problems in bioethics. Nonspecialists in philosophy are understandably reluctant to address basic issues of normative moral theory and have also been driven by the desire to make their work more of practical relevance than of theoretical depth. To the extent that theory is appealed to at all, it is usually "middle level" theory, in which so-called principles of biomedical ethics are applied to cases and issues, not general moral theory, as in Tom Beauchamp and James Childress's enormously influential Principles of Biomedical Ethics, 3d ed. (New York: Oxford University Press, 1989). As a result, bioethics has taken little note of intense recent debates over central agent-relative features of what some have called common-sense or ordinary morality, a general view to which, in some version, most work in bioethics implicitly appeals. In an important book published last year--The Limits of Morality (Oxford: Oxford University Press, 1989)--Shelly Kagan has developed a systematic attack on two fundamental features of ordinary morality: the beliefs in agent-relative options and agent-relative constraints (Kagan labels the believer in options and constraints the "moderate"). Agent-relative options permit individuals to give special weight to their own projects, commitments, and interests in their moral reasoning and thereby to fail to maximize the good as determined from an impersonal point of view. The belief in options is a deep and important part of ordinary morality; few persons believe we are morally required always to maximize the good, for example, by devoting our lives to the relief of suffering and poverty at the expense of our own personal concerns, and fewer still live in accordance with such a view. Moderates hold that moral requirements either to benefit others or to prevent harms to others are far more limited. Nevertheless, moderates are committed to the belief that if an action will benefit another, that gives us a reason for doing it, and that in some cases, such as the stock example of easily saving a drowning child, the action is ethically required. The most natural justification for options is the apparently excessive sacrifices or costs that would be imposed on persons by a moral requirement always to maximize the good. …