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Principles and Duties: A Critique of Common Morality Theory

Published online by Cambridge University Press:  04 March 2022

Robert Baker
Robert Baker*
Affiliation:
Union College, Schenectady, New York 12308, USA
*
*Corresponding author: Email. [email protected]
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Abstract

Tom Beauchamp and James Childress‘s revolutionary textbook, Principles of Biomedical Ethics, shaped the field of bioethics in America and around the world. Midway through the Principle’s eight editions, however, the authors jettisoned their attempt to justify the four principles of bioethics —autonomy, beneficence, nonmaleficence, justice—in terms of ethical theory, replacing it with the idea that these principles are part of a common morality shared by all rational persons committed to morality, at all times, and in all places. Other commentators contend that their theory has never been empirically confirmed and is unfalsifiable, since counterexamples can be deemed irrational, or as held by those living lives not committed to morality. The thesis of this paper is that common morality theory is the artifact of a category mistake—conflating common areas regulated by moral norms with common norms regulating moral conduct—that accords mid-twentieth century American liberal morality the status of transcultural, transtemporal, eternal moral truths. Such a conception offers bioethicists no tools for analyzing moral change—moral progress, regress, reform, evolution, devolution, or revolution—no theoretical basis for deconstructing structural classicism, racism, and sexism, or for facilitating international cooperation on ethical issues in the context of culturally based moral differences.

Keywords

common moralityPrinciples of Biomedical Ethicsmoral revolutionsNazi medical ethic sracial hygiene
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 31 , Issue 2 , April 2022 , pp. 199 - 211
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Notes

1. Turner, L. Zones of consensus and zones of conflict: Questioning the “common morality” presumption in bioethics. Kennedy Institute of Ethics Journal 2003;13(3):193–218 CrossRefGoogle ScholarPubMed.

2. Moreno, J. “Principles of Biomedical Ethics,” On, Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics. 8th ed. New York: Oxford University Press; 2019: blurb on the back coverGoogle Scholar.

3. Principles. 1st ed.; 1979:vii. See note 2 for complete citation.

4. No American code of medical ethics issued by a professional medical society used the word “autonomy” prior to the 1979 publication of Principles. See, for example, Baker, R, Caplan, AL, Emanuel, LL, Latham, SR. The American Medical Ethics Revolution: How the AMA’s Code of Ethics Has Transformed Physicians’ Relationships to Patients, Professionals and the Public. Baltimore, MD: The Johns Hopkins University Press; 1999:315–88CrossRefGoogle Scholar.

5. “Scientistic” is an adjective characterizing an exaggerated faith in the virtues of science or scientific methodology.

6. Parsons T. The Social System, Glencoe, IL: Free Press of Glencoe; 1951:464–5, at 450.

7. Principles, 1st ed.; 1979, at 136, see note 2 for complete citation.

8. Veatch, RM. Disrupted Dialogue: Medical Ethics and the Collapse of Physician-Humanist Communication (1770–1980). New York: Oxford University Press; 2005:208 Google Scholar.

9. Boston Women’s Health Book Collective. “Preface,” Our Bodies, Our Selves; 1973; available at https://www.google.com/search?client=safari&rls=en&q=Our+Body,+Ourselves,+Preface,+tps://wgs+10016.commons.gc.cuny.edu/preface-from-the-1973-edition-of-our-bodies-ourselves/&spell=1&sa=X&ved=2ahUKEwjLpd2b9t_wAhVMHs0KHefeAQkQBSgAegQIAhAw&biw=1440&bih=766 (last accessed 23 May 2021).

10. Board of Trustees, American Hospital Association, Statement on A Patient’s Bill of Rights, November 17, 1972, Approved 1973, available at http://ethics.iit.edu/codes/AHA%201972.pdf (last accessed 19 May 2021, see also Principles, 1st ed.; 1979:136, see note 2 for complete citation.

11. Principles, 1st ed.; 1979:287, see note 2 for complete citation.

12. Emerson, RW. Self-reliance. In: Essays: First Series: The Complete Works of Ralph Waldo Emerson. Boston, MA: Houghton Mifflin; 1903:57 Google Scholar, at 2. Cited at Principles. 1st ed.; 1979:13. See note 2 for complete citation.

13. Kuhn, TS. The Structure of Scientific Revolutions. 4th ed. Chicago: University of Chicago Press; 2012:24 CrossRefGoogle Scholar.

14. Baker, R. The Structure of Moral Revolutions: Studies of Changes in the Morality of Abortion, Death, and the Bioethics Revolution. Cambridge, MA: The MIT Press; 2019:153–94CrossRefGoogle Scholar.

15. Second Continental Congress. Declaration of Independence; 1776 July 4; available at http://www.digitalhistory.uh.edu/active_learning/explorations/revolution/declaration_of_independence.cfm (last accessed 9 Apr 2021).

16. Jefferson’s language is taken from Locke, J. Second Treatise of Government. Indianapolis, IN: Hackett (1689); 1980:46 Google Scholar, at chap. VII, sec. 87. Jefferson substituted “pursuit of happiness” for Locke’s original wording “health and property.” The substitute language was from a passage in Locke’s 1690 Essay Concerning Human Understanding. “The necessity of pursuing happiness [is] the foundation of liberty. As therefore the highest perfection of intellectual nature lies in a careful and constant pursuit of true and solid happiness; so, the care of ourselves, that we mistake not imaginary for real happiness, is the necessary foundation of our liberty.” Locke, J. An Essay Concerning Human Understanding. Fraser, AC, ed. Oxford: Clarendon Press; 1894:348 Google Scholar, at 1.

17. Although a slave-owner, Jefferson believed that the slave trade was immoral, and argued for its abolition and for slaves eventual emancipation. He held these beliefs before and after writing the Declaration of Independence—yet he still believed that the Negro race was inferior to the white race. His two collaborators on the Declaration, Benjamin Franklin and James Madison held similar views. Both owned, or had owned, slaves, both rejected the slave trade, but both were unclear about how to emancipate those enslaved. Franklin, however, co-founded the first American anti-slavery society which, in 1789, petitioned congress to free all Negro slaves. See: Cohen, W. Thomas Jefferson and the problem of slavery. The Journal of American History 1969;56(3):503–26CrossRefGoogle Scholar; Helo, A, Onuf, P. Jefferson, morality, and the problem of slavery. The William and Mary Quarterly 2003;60(3):583–614 CrossRefGoogle Scholar; Broadwater J. James Madison and the dilemma of American slavery. In Leibiger S, ed. A Companion to James Madison and James Monroe. Malden, MA: Wiley-Blackwell; 2013:306–23. Franklin B. An Address to the Public from the Pennsylvania Society for Promoting the Abolition of Slavery, and the Relief of Free Negroes Unlawfully Held in Bondage; 1789; available at https://en.wikisource.org/wiki/An_Address_to_the_Public (last accessed 18 May 2021).

18. Boyd, JP, Butterfield, LH, Bryan, MR, eds. The Papers of Thomas Jefferson. Princeton: Princeton University Press; 1950:426 Google Scholar, at I; available at https://www.monticello.org/thomas-jefferson/jefferson-s-three-greatest-achievements/the-declaration/transcript-of-the-rough-of-the-declaration/ (last accessed 3 Apr 2021).

19. Baker, R. A paradigm emerges: Principled anti-paternalism. In: Structure of Moral Revolutions; 2019:173–82CrossRefGoogle Scholar. See note 14 for complete citation.

20. Principles. 4th ed.; 1994:viii. See note 2 for full citation.

21. Principles. 4th ed.; 1994:102. See note 2 for full citation.

22. Principles. 4th ed.; 1994:101. See note 2 for full citation.

23. Macklin, R. Against Relativism: Cultural Diversity and The Search for Ethical Universals in Medicine. New York: Oxford University Press; 1999 Google Scholar; Macklin, R. Ethics in Global Health: Research, Policy, and Practice. New York: Oxford University Press; 2012 Google Scholar.

24. Principles. 8th ed.; 2019:3, italics added, except for the last. See note 2 for full citation.

25. Principles. 8th ed.; 2019:446. See note 2 for full citation.

26. Bautz, B. What is the common morality, really? Kennedy Institute of Ethics Journal 2016;26(1):29–45 CrossRefGoogle Scholar; Trotter, G. The authority of the common morality. Journal of Medicine and Philosophy 2020;45:427–40CrossRefGoogle ScholarPubMed.

27. Appiah, KA. The Honor Code: How Moral Revolutions Happen. New York: W.W. Norton; 2010:1–52, 137–72Google Scholar.

28. Principles. 8th ed.; 2019:3. See note 2 for full citation.

29. Gert B. Cited at Principles. 7th ed.; 2013:413. 8th ed.; 2019:446.

30. Principles. 8th ed.; 2019:446. See note 2 for full citation.

31. Principles. 8th ed.; 2019:448. See note 2 for full citation.

32. United Nations General Assembly, 23 October 1953, Protocol amending the Slavery Convention signed at Geneva on 25 September 1926; available at https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.14_protocolslavery.pdf (last accessed 11 May 2021).

33. Principles. 4th ed.; 2019:448, 449. See note 2 for full citation.

34. Van Wees H. Genocide in the ancient world. In Bloxham D, Moses AD, eds. The Oxford Handbook of Genocide Studies. Oxford: Oxford University Press. For a famous example of ancient genocide practices in warfare see Joshua 6:21 “And they utterly destroyed all that was in the city, both man and woman, young and old, and ox, and sheep, and ass, with the edge of the sword.”

35. See Heath, M. Aristotle on natural slavery. Phronesis 2008;53(3): 243–70CrossRefGoogle Scholar.

Here is Aristotle’s characterization of “slaves by nature:” “Those who are as different [from other men] as the soul from the body or man from beast—and they are in this state if their work is the use of the body, and if this is the best that can come from them—are slaves by nature. For them it is better to be ruled in accordance with this sort of rule, if such is the case for the other things mentioned. Aristotle Politics, Politics1.2, at 1252b5–9; 1.6 at 1254b16–21, 1255a28-b2; 3.14, at 1285al9–21.

36. Plato, Laws 773e. The classic analysis is Vlastos, G. Slavery in Plato’s thought. Philosophical Review 1941;50(3):289–304 CrossRefGoogle Scholar.

37. Principles. 8th ed.; 2019:448, 449.

38. Kleingeld, P. On dealing with Kant’s sexism and racism. SGIR Review 2019;2(2): 3–22 Google Scholar, at 7, italics in the original.

39. Wilfrid Sellars version of passage B76 in Kant’s 1787 Critique of Pure Reason.

40. Kant I. Critique of Pure Reason, 1781 (A548), 1786 (B576). Muller FM, trans. New York: The Macmillan Company; 1896.

41. Locke, Second Treatise, at chap. IV, sec. 24. See note 16 for complete citation. For further elaboration on this comment see Baker, Structure, 20–1. See note 14 for complete citation.

42. Principles. 1979:285–7. 1st ed., see note 2.

43. Ramm, R. Ärztlizche Rechts-und Standeskunde Der Artz als Gesundheitserzieher. Berlin: De Gruyter; 1943 CrossRefGoogle Scholar; English edition, Ramm R. Medical Jurisprudence and Rules of the Medical Profession. Cooper MW, trans. New York: Springer International; 2019.

44. Duties: 86, see note 43 for complete citation.

45. Duties: 117, see note 43 for complete citation.

46. Ploetz A. Grundlinien einer Rassen-Hygiene (Foundations of Racial-Hygiene). Berlin: S. Fischer; 1895.

47. Duties: 128, 129, see note 43 for complete citation.

48. Proctor RN. Nazi science and Nazi medical ethics: Some myths and misconceptions. Perspectives in Biology and Medicine 2000;43(3):335–46.

49. Duties: 118–20, see note 43 for complete citation.

50. United States Holocaust Memorial Museum. Hadamar Trial, Holocaust Encyclopedia; available at https://encyclopedia.ushmm.org/content/en/article/the-hadamar-trial (last accessed 19 Apr 2021).

51. Czech H. Hans Asperger, national socialism, and “race hygiene” in Nazi-era Vienna. Molecular Autism 2018; 9:29; see also Baron-Cohen S, Klin A, Silberman S, Buxbaum JD. Did Hans Asperger actively assist the Nazi euthanasia program? Molecular Autism 2018;9:28.

52. Bruns, F, Chelouche, T. Lectures on inhumanity: Teaching medical ethics in German medical schools under Nazism. Annals of Internal Medicine 2017;166(8):591–5CrossRefGoogle ScholarPubMed.

53. Principles. 8th ed.; 2019:1. See note 2.

54. Dr. Karl Brandt cited in Schmidt U. Karl Brandt: The Nazi Doctor, Medicine and Power in the Third Reich. London: Continuum; 2007:376.

55. Hitler, A. Mein Kampf. Boston, MA: Houghtin Mifflin (1925–1926); 1943:402 Google Scholar, cited at Lifton, RJ. The Nazi Doctors: Medical Killing and the Psychology of Genocide. New York: Basic Books; 1986:430–31Google Scholar, italics in the original.

56. Duties: 89–92, see note 43 for complete citation.

57. Duties: 92, emphasis in the original, see note 43 for complete citation.

58. Duties: 95, see note 43 for complete citation.

59. Duties: 118–20, see note 43 for complete citation.

60. Principles. 8th ed.; 2019:3. See note 2 for complete citation.

61. Schmidt: 42–47. See note 54 for complete citation.

62. Binding, K, Hoche, A. Die Freigabe der Vernichtung lebensunwerten Leben. Leipzig: Felix Meiner; 1920 Google Scholar. Sassone, R. trans. The Release and Destruction of Life Devoid of Value. Santa Ana, CA; 1975.

63. Schmidt: 36, 37. See note 54.

64. World Medical Association. Proceedings. World Medical Association Bulletin 1949; 1(1): 6–12, at 7.

65. Baker, R. The Declaration of Helsinki and the foundations of global bioethics. In: Schmidt, U, Frewer, A, Sprumont, , eds. Ethical Research: The Declaration of Helsinki and the Past, Present, and Future of Human Experimentation. New York: Oxford University Press; 2020:47–69 Google Scholar, at 51.

66. Schmidt: 43. See note 54 for complete citation.

67. Dadrian VN. The role of Turkish physicians in the world war i genocide of Ottoman Armenians. Holocaust and Genocide Studies 1986;1(2):169–92, at 176.

68. Dadrian VN: 176.