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The Uncommon Ethics of the Medical Profession: A Response to My Critics

Published online by Cambridge University Press:  04 March 2022

Rosamond Rhodes
Rosamond Rhodes*
Affiliation:
Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
*
Corresponding author: Email. [email protected]
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Abstract

In responding to my critics, James Childress, Tom Beauchamp, Soren Holm, and Ruth Macklin, I reprise my arguments for medical ethics being an uncommon morality. I also elaborate on points that required further clarification. I explain the role of trust and trustworthiness in the creation of a profession. I also describe my views on the relationship of the medical profession to the society in which medicine is practiced. Finally, I defend my claim that medical ethics “is constructed by medical professionals for medical professionals” by describing the profession’s unique vantage point for regulating and policing the profession’s uncommon powers and privileges.

Keywords

common moralityuncommon moralitymedical ethicsJames ChildressTom BeauchampSoren HolmRuth Macklin
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 31 , Issue 2 , April 2022 , pp. 212 - 219
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Notes

1. Rhodes, R. The Trusted Doctor: Medical Ethics and Professionalism. New York: Oxford University Press; 2020.CrossRefGoogle Scholar

2. Rhodes, R. Why not common morality? Journal of Medical Ethics 2019;45(12):770–7.CrossRefGoogle Scholar

3. Rhodes, R. Medical ethics: Common or uncommon morality? Cambridge Quarterly of Healthcare Ethics 2020;29(3):404–20.CrossRefGoogle ScholarPubMed

4. Rhodes, R. In defense of uncommon morality: A Response to: Leonard Fleck, “Medical Ethics: A Distinctive Species of Ethics,” Leslie Francis, “Beyond Common or Uncommon Morality” and Tuija Takala and Matti Häyry, “In Search of Medical Ethics and Its Foundation with Rosamond Rhodes,” (CQ 29 (3)). Cambridge Quarterly of Healthcare Ethics 2022;31(1):144–149. https://doi.org/10.1017/S096318012100089X.CrossRefGoogle Scholar

5. Here I am drawing on work by G.E. Moore and Bernard H. Baumrin that explains what makes a field of knowledge autonomous and distinct from other fields. Moore GE. Ethics. New York, NY: H. Holt; 1912; Baumrin, BH. The autonomy of medical ethics: Medical science vs. medical practice. Metaphilosophy 1985;16(2&3):93–102.CrossRefGoogle Scholar

6. Even though ordinary language extends the title “professional” broadly to include people who perform a task as their job, I am constricting the term based on my criteria. In my use of the designation, the title “profession” is ethically significant because it implies both trust and fiduciary responsibilities.

7. Fleck, LM. Medical ethics: A distinctive species of ethics. Cambridge Quarterly of Healthcare Ethics 2020;29(3):421–5.CrossRefGoogle ScholarPubMed

8. Macklin, R. Another defense of common morality. Cambridge Quarterly of Healthcare Ethics 2022;31(2):177–84CrossRefGoogle ScholarPubMed.

9. This diagram offers an overview of how common morality and professional ethics co-exist. The examples I offer are presented as an illustrative sample. I present no argument for the examples being a definitive complete list. Differences in the size of circles that represent various professions reflect no more than my limited ability in creating the Venn diagram. Neither the positioning nor the size of the circles is intended as a claim about their relative importance. I want only to indicate that there is some overlap in duties in some cases and not in others.

10. Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics. 8th ed. New York: Oxford University Press; 2019, at 3.Google ScholarPubMed

11. See note 5, Beauchamp, Childress 2019, at 5.

12. In their article, Childress and Beauchamp maintain that neither Robert Baker nor I have adequately understood their position. I am happy to be in such good company.

In spite of decades of sincerely trying to make sense of their largely accepted account of medical ethics, it still looks to me like an amalgam of Platonic realism, some version of virtue theory, a smidgen of Rawlsian constructivist reflective equilibrium, and bits and pieces of views that Beauchamp and Childress found appealing over time. I grant that I have been unable to discern the justification for the four principles or comprehend how the conglomerated additional elements fit together and interact. For those reasons, I am willing to accept Soren Holm’s suggestion that my comments may address “sociological common morality” rather that Beauchamp and Childress’s version of common morality.

13. Childress, JF, Beauchamp, TL. Common morality principles in biomedical ethics: Responses to critics. Cambridge Quarterly of Healthcare Ethics 2022;31(2):164–76CrossRefGoogle ScholarPubMed.

14. Holm, S. What is the foundation of medical ethics—Common morality, professional norms, or moral philosophy? Cambridge Quarterly of Healthcare Ethics 2022;31(2):192–98CrossRefGoogle ScholarPubMed.

15. See note 14, Holm 2022.

16. See note 14, Holm 2022.

17. See note 14, Holm 2022.

18. See note 13, Childress and Beauchamp 2021, at 13–14.

19. See note 14, Holm 2021, at 6–7.

20. Francis raised similar questions. Francis, L. Beyond common or uncommon morality. Cambridge Quarterly of Healthcare Ethics 2020;29(3):426–8CrossRefGoogle ScholarPubMed.

21. Takala and Hӓyry also raised similar concerns. Takala, T, Hӓyry, M. In search of medical ethics and its foundation with Rosamond Rhodes. Cambridge Quarterly of Healthcare Ethics 2020;29(3):429–36.CrossRefGoogle ScholarPubMed

22. See note 1, Rhodes 2020, at 345, 31, 40.

23. Baier A. Trust and antitrust. Ethics 1986;96(2):231–60.

24. O’Neill, O. Autonomy and Trust in Bioethics: The 2001 Gifford Lectures. Cambridge: Cambridge University Press; 2002.CrossRefGoogle Scholar

25. O’Neill, O. Linking Trust to Trustworthiness. International Journal of Philosophical Studies 2018;26(2):293–300.CrossRefGoogle Scholar

26. O’Neill, O. Justice, Trust and Accountability. Cambridge: Cambridge University Press; 2005.Google Scholar

27. Hobbes, T. The Clarendon Edition of the Works of Thomas Hobbes, Malcolm, N, ed. Oxford. UK: Oxford University Press; 2012.Google Scholar

28. See note 27, Hobbes 2012, at 204; 14, 11, 66.

29. Rhodes, R. Hobbes’s account of authorizing a sovereign. In: Adams, M, ed. A Companion to Hobbes. Oxford, UK: Wiley-Blackwell; 2021, at 203–20.CrossRefGoogle Scholar

30. See note 14, Holm 2022.