3.the Nature of Applied Ethics

1Th N t f A l i d Ethi

TOM L BEAUCHAMP

Th t " l i d t h i " d it " t i l t h i " i t i h 1970 h h i l h d th d i b t dd i l

bl i i t d i f i l thi ( i l l d i l thi d b it h i ) P i t l th d b t i t h i th t

ti f h d i l b j t i h i i f f t i tiacceptable risk in the workplace the legal enforcement of morality civil disobedience unjust war and the privacy of information

H i t i l B k d

D i t th t i i f th t " l i d t h i " i t i t h t f t b j t tt b t d t i t ti F l l i b t i t b l ih

controversial opinions engage in civil disobedience commit suicide and chooseone's religious viewpoint are matters of perennial interest as are questions of unjustwars and the moral status of animals Although moral philosophers have longd i d th bl it i bl th t h t j h i l h t h h

t th h i t f l h i l h h d l d t h d f l i dthi M l h i l h h t d i t i l l f l t d t h i f th i h t h

d d th i t t h t t t i th t l t A t i l i i id f thi t h t i l lit it i ll h h t h d if h th i t b l i d t t bli li ttl l bl d d

t i t i lIt is not obvious that applied ethics is the offspring of or even dependent upon

general moral philosophy Its early successes in the 1970s owed more to argumentsdirected at pressing and emerging moral problems in society than to traditional theori f thi M i d i i d l i l h i l h i l d t h l i l thi l i t i lth d th f i i l d i d i i b i i i d i t i f i

h d d d th i Th i d i i d l f d l f f t d b i th id i t di i d i i d l l i b t i i l lit d i

f f b d i j t i d i t d t l b l Th i i d b i i li h t ' i h t i l i h t th t th i t l

1

TOM L BEAUCHAMP

t d th i h t f i d th t l l ill ft i l d d t h i lissues that stimulated the imagination of philosophers and nonphilosophers alike(A volume that nicely illustrates the state of one area of interdisciplinary ethicalinquiry around 1970 is the massive compendium on research involving human

b j t t i t ld Experimentation with Human Beings [ K t 1972])I th l t 1960 d l 1970 h i l h i i l i t t t

ith l f th d i i l i h i t t d i l bl l d ith f th h l t h f i l b i i i d th i l d b h i l i P h th t i f l t i l f l d i th d l t f h l

l l i t t i l i d thi l d l h i l h M bl f applied ethics have since been framed in the vocabularies of these two disciplinesThis is not surprising since moral philosophy and law have common concerns overmatters of basic social importance and share various principles requirements and

i t i f id L i i t th b l i ' f t l t ilit i t l i i t i l i d l i d ti d f t i l t i i h t

f ff C l i t i l h i d d d t d b i t i l t h ti f l t i l i ll f l i d thi

D i th 1970 d l 1980 b f h i l h b t f h itheir careers around interests in applied ethics an almost unprecedented development in a profession generally skeptical that "applied ethics" was either a scholarlyenterprise or had a future in the university The late 1970s and early 1980s sawth b l i t i f l b k d t d t h i l h i l t t t f b j t

l i d thi V i t l l b k b l i h d i l i d thi i t th l t1970 h d b i d t i l l th th i t f l i i lh i l h i l t h i Thi i t t i h d idl i th l t 1970 d

1980

Problems of Definition

M h i l h h i d l i d thi th t t t t i l t ithl l l l t h i ith th l f l i t i l

bl Th th t d l i t l t h t b d t i th l bl H it i t d ll t d t h t

t i h t f d t t t i l j d t i ibl b l ith t l t h i t l l i i l ( h "O ht t t t t

l t th d f t h " "O ht t k i " "Oought not to inflict harm or risk of harm;" "One ought to treat people fairly andwith equal respect;" and "One ought to respect the autonomy of others") This s the socalled gap between theory and practice Theory and principles must it

b l t d i b di f i h t ti i i ld t i t i l i d th lik B t i i l h i h ()? Thi

ti h l h " l i d t h i " i d i f f l t ti t d t dd d fA d i l it d b t f l t h t l i d thi i b t d f d th li

ti f l t h i l t h i t t i l l bl ( h l th d f i t i

2

THE NATURE OF APPLIED ETHICS

ffd b G t 1982 5 1 2 ) Thi d f i i t i i t h t ill t recognize it as reflecting either the appropriate method or content of applied ethicsA weaker and more defensible view is that "applied ethics" refers to any useof philosophical methods to treat moral problems practices and policies in the

f i t h l t d th lik Thi b d k i t t t th l f l t h i i i l d d t i i t

b l l i th l It b th t d t d i f th t ithi th f i f h i l h b t it ld b i d t i d h i l hflti i i f i t d i i l i biA d i f f t bi i f d i th id t h t " l i d t h i " i ith

"professional ethics" Problems such as the allocation of scarce medical resourcesunjust wars abortion conflicts of interest in surrogate decisionmaking hatecrimes pornography war and terrorism whistleblowing the entrapment of public

ffiil i t t i l j t i h i l d th f i d t i l i t f t i f t i t d b d f i l d t t ll t i i th d i

f l i d thi Th t l ti b t th t f " l i d t h i "l d t i d t i f b t h th t t d th t h d f l i d thi

Problems of Moral Content

Th i f l t i l t f h d i th l i t t th i tf t t i l i d thi i t l t t l t d

i d i t l t l t Th t i fit f h i d f thl i f f i l thi b t th b l i d t th h

i t i t t i l d thi f ll t Th fit d f d thi d i d f f i l i t i t t i l ti t d d Th d i t i

t h t t i tti f l i d thi l d i j t i f i t i b external standards such as those of public opinion law the common moralityreligious ethics and philosophical ethics The third claims that distinct forms of

t i l thi internal t f i d i t i t t i t h ld l i f l d b b d ( t l ) l t l f k

Internalism

S h i l h h i t i d t h t t b l i h d ti id th i f t i l thi I f l t i l i thi l i t t i A l d i M l t ' f

"practice" to designate a cooperative arrangement in pursuit of goods that areinternal to a structured communal life He holds that "goods internal to a practice"such as those found in the professions are achievable only by engaging n the

ti d f i t it t d d f ll S t d d i t l t thf i t h f d t i h t it t b d titi E h

f i h h i t d ifi h t t h t t i t d i t i i if i l t l t i t it i t ( M l t 1984 17 175 187 1 9 0 2 0 3 )

H d B d d F k Mill ff f f i t l i t l i thf d t i f d i l thi

3

TOM L BEAUCHAMP

Physicians by virtue of becoming socialized into the medical profession accept allei t t f l l h i h dfi th t f d i l ti Thl i ri t t l t f th l d t i i b t h i i i t h if i l l d i d i t th i t t h i i Th professional integ-

rity of physicians is constituted by allegiance to this internal morality (Brody andMill 1998 386)

These writers and others like them maintain that moral frameworks in the professions derive from rolespecific duties and professional virtues

N bl d i t t h t f i l l i t l b l i t id i d l H i t l lit t i l t b d t l

h i h t ll t b l Trdit i d f i l t d dt f l d d f t t l f i l d i

d i i b i j l i i i d th fild ft i l i f l i t k th i d f i b l i i d l i l t d th

ity than they are entitled to claimBrody and Miller address this problem by distinguishing between the core moral

norms appropriate to a profession and the dogmatic and unsystematic provisionsf d i d f f i l thi A th it i t l lit

d h l d l i th f f i l h "Even the core f d i l litt b t h h t f l l l t d d t t d t i t l d th

t t i ill b i d t b th h li i d i t h i i t b li f l d b i t l l th i t t th h i t " ( B d d Mill 19983 9 3 4 397 h i ddd)

T h h t thi i i f t l t i t l i It h t h t i t l t d dmay be shallow and expendable whereas some external standards are deep andessential Even current practice standards might be weak and insupportable Wealso know from recent history that a meaningful reconstruction of traditional prof i l d i t i t t i l liti t d t l t l h i l ik l t

b l t th i t l t d d f f i l litC i d thi h i t i l l I th l t 1960 th b k A Time to Speak: On

Human Values and Social Research b i l h l i t H b t K l b l i h d j t b f t i l f d f b f h b j tb i l i t i t (Kl 1968) K l ' b k d th f t i d

k ll l t i i l i t i t t th f t t h t th h d i d f i i iin standards of research ethics Careful attention was subsequently paid to themoral judgments that psychologists should make in carrying out their research andto the many defects of standards in the then prevailing practices Problems weref d i ti h th i t l d t i f b j t th l l t i f d t i i d i i d l l i d t i f i b l f d th f fiil i ti t b t i b j t It b l t h t th ili tit d d d t t dd th ti

Externalism

A th t l b t t t i t l t d d f f i l d i t i tt i l l i t ? A t l lit i t h t i t d l

4


t h t t i l t t th f i t l lit P b l i i ilaw religious institutions and philosophical ethics have all served (whether justifiably or not) as sources of external morality

One influential answer in philosophy to the question of which external source ist i t i t h t t h i l th id th i t b i f l i d

thi A l i f d i th k f B d G t d D Cl Thi t i t h t t k d j d t i l i d thi th t b " i li f d t h i l t h " Th l f t h i th i t id " f

k h i h ll f th d i t i ti " d t i " i di t t h t t i t i t i l ll l " Th b l i t h t t h i th

will alert attentive persons to issues of applied ethics identify the morally relevantfeatures of circumstances determine the difference between morally acceptable andunacceptable solutions to problems and show which conditions are necessary and

f f i t t j t i f th i l t i f l l (Cl d G t 19902 3 1 2 f G t t l 1997 3 6 1 5 1 9 )

G t d Cl d t h l d t h t th i l li i t t lt d d f f i l thi O l t h i th d ll th t h i

f t l l f l d d i b l f d d i P t f th t h i llassume a similar partisan stance Independent of this confusion over whether oneparticular theory is morally authoritative it is often unclear whether and if sohow a philosophical theory is to be used to criticize internal standards or address a d i f f i l t l bl If ld b f i d t t h t t h i l th l i d h b t b i ld k t t i l t i l d li ti b

i l ki th i t h t th ifi H t t h h th d l i t t h t th f thi d iti i l ikl t B t h ithi d i t h t h i l h th t h i t h t i f t t d th th i t t f th i l litf h i h th i E if i d i i d l i i d t h t t i ltheory is correct (authoritative) he or she needs to deal responsibly with the factthat other morally serious and informed individuals reject this conviction

Skepticism about the practical relevance of theory is not surprising in light of thef t t h t h i l h h t d i t i l l t i d t l i d j t i f lit t l i f l t t i h l j d t d t d

d t b i i i l f l t t ti t h i t l t i l l bl d l i t d f f i l thi G l t h iill i t d ll i t d f t i l k b th dd h i l h i l

bl t h t i t h l d i d f ti A l t h h b t l ity philosophical theories are primarily attempts to understand or unify moralitynot attempts to specify its practical commitments

Mixed interncdism and externalism

A thid t f h t th t t f l id thi i t l t f b t h i t l i d t l i It t t ith th i t i t h t l it

t i l t d i d i f f t i di lt d M bf th f i d th t t d i t i t t i b d b l t d d h t

5

TOM L BEAUCHAMP

fid t l b t h i b h i ( i t l l i t ) b t l b thmoral standards of the broader culture or community (an external morality) Theauthority to practice is itself granted by society on the condition that its professionsand institutions will in a responsible manner be educated in and adhere to the high

l t d d t d b t h t i t If f i d i t i t t it d t f t h i ti t h t th ili l l f th l

i t ill b h d i ti Th i l t d d di t th t ti ill f i t t i t I t l liti i th f i

ill d i l b th i i i f i t d d t tht l litiA theory of this description has been advanced by H Tristram Engelhardt He

holds that profound disagreement exists about the nature and requirements ofprofessional practice across larger communities such as Orthodox Judaism RomanC t h l i i H i d i d l h i

There is no way to discover either a canonical contentfull secular morality or thet ll t t f l l l t i t t h th t b d b th

lit f h d l i i t h t b id l f i d M l t d t see the world in the same way Moral strangers [cannot] resolve contentfull moral

t i b d t i l t M l f i d th th h d dii d l h d h h i i ( E l h d t d Wild 1994 136

l 13547)

A d i t E l h d t t t f l l lit d i f f t i t iTh t l k f O t h d J d i f l d t i h t i t

bl t b l l f t h t ti f th J i h ti h i h t itd i t i t i F thi ti l t d d f h t i b l i t d permissible for professionals in medicine politics law and business derive from themore general moral commitments of a larger community beyond the narrowercommunity of professionals

Th d l t h i t k i thi t i k t i l th b t t if d t i f l l i d thi d l k i h f d t i th

f d t i f t f l i d thi th th h i t i l t i iti N i t l lit it t i th t l lit f t i llt ( E l h d t d Wild 1994 1 3 7 8 E l h d t 1 9 9 6 1 0 5 2 4 )Thi t h i i h t i t th l t i b t t l d i t l

liti b t it h k B h i i d i i t it i t overlook basic similarities; that is to neglect the core of near identical moral goalsinterests and commitments that exist among welltrained professionals from differ

t l t l b k d F l h i i ll th ld h l d t h i f h l i l l i t i h b i l i t t i i d i f t di

ti t t i d th lik Th i h d l i i t (h i i t d ) d h d f f i l ti th iti

P d i l l thi th l t t th d f h d t ithi"th iti f l f i d " t h t f th i f th t Th th i i h i i l h d i f i t i h it

6


f f i d h i h bl t b l d l i b l t di th l f thprofessions and professional ethics However in communities of almost any sizethere exists a pluralism of viewpoint These communities are not lacking in subgroups with different moral points of view and hopes to revise prevailing conditions

ti d d C h i i t f b i t i d t i i d t il i t i th l t i f i i l i h t d th lik k f f l id i t

th iti ith t d t l itiA t h k i t h t thi i d i t l i t t l i t t f f t i l

l d l t l t h t i it j d t Th lidit f l d j d t d d i thi t t h i d t b

nity; no transcendent principle warrants crosscultural appraisal It follows thatthere are no universal human rights that protect individuals Human rights are bydefinition valid claims that are justified by reference to morally relevant features ofh b i t b f t l t d d

It i l d i f f l t t h i thi th ll t d bli li i t b f h i d i l l i t i i t It i t h thi th t f

i t l i i i i t i t i t t i b t it i b i l i t t l i tif d itii bli li k it t f t h ith th d ld d bl t

apply ethics to our deepest social problems

Problems of Method and Justification

S l d l f t h d ti l l d t h d d l f t i f t ih b d i d i l i d thi Th f th t i f l t i l d lt t d i thi ti Th fit d l h j t i f i t i d t h d f t d ti t h t h i l d t h i l th Th d approaches justification and method from a bottomup perspective that emphasizesmoral tradition experience and particular circumstances The third refuses toassign priority to either a topdown or a bottomup strategy

Top-down models

I th fit d l i t i l l i d t t i l itti Thi d l f t th i h i h i t l l ll l t t h i k

ll it t h d i l l i l l ( i i l i d l i h t t ) t t h t f l l d th l Th f l l i i th d d t i f i l d i

"applying" a rule:

1 Every act of description A is obligatory2 A t b i f d i t i A T h f3 A t b i b l i t

Thi d l l i b l i th i l f j d t b h t d i t ld b i l d l i i l b t it l t l l i b l

d i i h i h t h i d l i i l j i i t i thi

7

TOM L BEAUCHAMP

t d i t i l ti i t i t t i l l d j d t Whil h i thmoral life conforms roughly to this conception of moral priority much does not

There are several problems with this moralpriority thesis First moral judgmentsin hard cases almost always require that we make the norms themselves more

ifi ( th ti " P b l f S i f t i " b l ) b f b it i l i t d i l i i l I th f i f i

d i ki t i l j d t ft t t k i t t f t lb l i f b t th ld l t l t t i j d t f l ik l t d

i d t t h l fill t d i i h t t l i i l d t h iTh i l l i i t i th S d th f t f i t t ialso be such that no general norm (principle or rule) clearly applies and the different moral norms that can be brought to bear on a set of facts may yield inconclusive results For example destroying a nonviable human embryo or fetus does notl l i l t l i t killi d d th l t h t h i h t t t t b d i l i t i t d t l l l t thi l i E

if h f t t i h t th h i f f t d th h i f l t h td l t ill t j d t t h t i i t i b l ith th

' h i f f t d l S l t i th i h t t f f t d b i i thright set of rules to bear on these facts are not reducible either to a deductive formof judgment or to the resources of a general ethical theory

The topdown model also creates a potentially infinite regress of ustification a di d d f fil j t i f i t i b h l l f l t

i t i h i h l l t j t i f it If t d d j t i f i dtil b h t d j t i f i d i t it ld th

ti f thi h t h t th j t i f i d i i l j d t I thld h d l thi bl b ti t h t i l f j t i f i

t h t it i i t i l t t h l d b t f t h t thi t t d t h t th j t i f ll th i i l d l i t d d t h t t t h i ltheory is well equipped to meet

Bottom-up models

S it i l i d thi t t h i t t t i l h t i ld i i d th th l i i l d t h i Th b l it h t l i d j t i f i t i d b t t t t d Th

i t t f i t i i l t d ti i i h t d il d ti l i th t t i i t f h i h

commonly make moral decisions They also depict an evolving structure of moralbeliefs based on exemplary lives and narratives experience with hard cases andanalogy from prior practice

B t t d l t t i l l i l d l d i t i t t h d l i C i t h b th t i d l d i d i l i d thi b t i f f ti

t i l i d th t h d l lif P t f th h l i i l d i t i i th d f k l d t i T h t i th

i f t i d i h t f i i l d i f i l t l i t i l i t (J d T l i 1988) F l h i i

8


d d i t h d i i l i f i t h l i f t i t t f i missible killing But progressively after dealing with many agonizing cases they andsociety came to frame many of these acts as forms of permissible allowing to die oreven as morally required acts of acknowledging refusals of treatment All practical

l l b t killi d l t t i di i d f d ti thb th i i l l i t i l t l t i f idl i A

i t ' l i f i d t h i t t h h b d d d l t d i t i d t f d t h t it d f t i i h t d j d tA l t th t h i t ti i l i ti id t b t th h t

f thi t h d h th d i i f j i t f j d b t h i t t i i case the judgments in their decision are positioned to become authoritative for othercourts hearing cases with similar facts Defenders of bottomup reasoning see moralauthority as analogous: social ethics develops from a social consensus formed

d h i h th b t d d t i t h t l f thl t d l i d A h i t f i i l d i i l d t

t i t b i i l f d t i it l l i d k l d l i t i ( l i i l ) i it l i t d i t i f

t h i l f l t iCase analysis which is central to casuistry has long been used in law schools

and business schools Training in the case method is widely believed to sharpenskills of legal and business reasoning as well as moral reasoning One can tear a

t d th t t b t t f t t i i i l i t t i I tht h t d l tti t h d t d t lik h l i

b t i h t d b t t i Th b j t i i t d lit t bl d t f d l l t i t h t k i th t t

k i h t d t i i d th k i t h t thi i thth b i f f d t i l l

Th t h d i l h t b d t d f l i t ble facts and judge the weight of evidence enabling the transfer of that weight to newcases This task is accomplished by generalizing and mastering the principles thatcontrol the transfer usually principles at work in the reasoning of judges Use of the

t h d i b i h l i f i d l f d t i t h t t tht d t i th d i i k i l ft i i t i l i i i t th f t f

l i t t i H th f th t h d i t t i t t il t ith th f t i i d j d i t h t i h t t d t f d

f ki i t d i i i h i tA ith t d t h i i bl li i it f d f d f b t t

up theories First defenders sometimes write as if paradigm cases or particularcircumstances speak for themselves or inform moral judgment by their facts aloneClearly they do not To move constructively from case to case or to attend to the

l t f t f t i l i t t i i d l f l l t t th i t t i Th l i t t f th i t t i

b t th f i t t i d l i k i i t t i All l i li i ti t i d i t t h t b j t t i ik

lik th i l t t Th ti di f th i t l i k i t b h i d b l i t l f B t t t

9

TOM L BEAUCHAMP

t h f t i i l l i t i l l l ents in the case or set of facts at hand

"Paradigm cases" and "morally relevant features of circumstances" seem to combine facts that can be generalized to other situations (for example "The employeebl th h i t l th l " ) d t t l d l (f l " K l d b l l h i h t t d i l th d i f thl " ) Th t t l d l l t i l l d i t i t f th f t f t i l

Th l th t l l ti th l tht th t t f l i i l l

B t t t l t bl h th i t fliti l gies judgments and case interpretations Defenders stress that cases and particularcircumstances point beyond themselves and evolve into generalizations but theyalso may evolve in the wrong way if they were improperly grounded from the

t t B t t t h l t h d l i l t t b i d d l t f l t f l t f t f

Th bl l d t ti b t th j t i f i t f th t H d j t i f t i ? I it l b i l ti d l ? M i h t

t d i f f t l i d l t ti " i h t " ? Without some stable framework of norms there seems to be a lack of control overjudgment and no way to prevent prejudiced or poorly formulated social conventions This criticism is a variant of the muchdiscussed problem that bottomup

t l k i t i l d i t f l t l b l i d h l d l i i I d t i f t i f th ll l t f t f d d

th h k j d t b t d th i d i i d l ld t f t i l i t d i i bi j d i i l f l t h t i h k d b

t b l t f i t i l i i l d h i h tTh h t f th bl b t h t th t t t h d i t h t

t t t h t i t l f t h h t t h t d i l th f d t l i t f comparison and analogy in moral thinking but that lacks initial moral premises Itis certain that we reason morally by analogy almost daily and we are often confident in our conclusions However such analogies also often fail and analogies

t l i f t t h t i t Thi t h d th l ith thbl t h t tt h ti t i t i i t i l l h

i f f th f t i t t t th t i th d i t i l d d f l t t t

Coherentism

"The top" (principles theories) and "the bottom" (cases particular udgments) areboth now widely regarded as insufficient resources for applied ethics Neither gen

l i i l t i l i t h f f i i t t t l i ith th d d libilit P i i l d t b d if f

d l i d i l l i t i f l i i l I t d f t db t t d l t i f th d l i l

f d t " f l t i i l i b i " d " h t h "

10


J h R l ' l b t d t f " f l t i i l i b i " h b th t influential model of this sort In developing and maintaining a system of ethics heargues it is appropriate to start with the broadest possible set of considered moraljudgments about a subject and to erect a provisional set of principles that reflectsth R f l t i ilibi i i t i t i i thi ( d th t t i )

f l t i t t i f l i i l t h t i l t l t d th l tl b l i f t k th h t ibl

" C i d d j d t " i t h i l t f i t j d t i h i hl b l i f d iti t l ik l t b t d i t h t d i t t i

bi E l j d t b t th f i l d i i i t i ligious intolerance terrorism torture and political conflicts of interest These considered judgments occur at all levels of generality "from those about particularsituations and institutions through broad standards and first principles to formal

d b t t diti l t i "E th i d d j d t t h t t " i i l l fid i t "

R l " l ib l t i i " Th l f f l t i ilibi i t t hd d j t i d d j d t i d t d th h t ith th

i f t l l i t t W t t ith d d tof moral lightness and wrongness and then construct a more general and morespecific account that is consistent with these paradigm judgments rendering themas coherent as possible We then test the resultant actionguides to see if they yieldi h t lt If d j t th id i th d th

W l t l t b l ilibi th i d d j t i b t d t t i l l ( R l 1971 20ff 4 6 5 0 5 7 9 8 0

[1999 d 17ff 4 0 5 5 0 8 9 ] 1996 8 381 384 399)T t k l i th thi f t l t t i i i t h t

t t t d t h f t l i i (1) d i t i b t b t d b f f i l (i d t i i th b f i i l t f th d ) d (2)

distribute organs by time on the waiting list (in order to give every candidate anequal opportunity) As they stand these two distributive principles are not coherentbecause using either will undercut or even eliminate the other We can retain both(1) d (2) i th f f i d i t i b t i b t t d ill h t i t dl i i t b t h i i l t t h ith t f h t if i t t

d b l th i t t i t th i t t Th l i i t d t ill i t h t b d h t ith th i i l d l h

di d i i i t i i t th l d l d th l f bilit t i j t h f th l l t i f i d i l d

We have no reason in applied ethics to anticipate that the process of achievingmoral coherence will either come to an end or be perfected A moral frameworkadequate for applied ethics is more a process than a finished product; and moral

bl h d l i th t i t b l t f t d d i t i b t i h l d b i d d j t i d f t i l d j t t b f l t i ilibi W h l d i l i d thi t h t f

di h f i h d f l i t t i t h t h l l t l f k ( R l 1971 1 9 5 2 0 1 [1999 d 1716] )

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TOM L BEAUCHAMP

One problem with this general model is that a bare coherence of norms neverprovides a sufficient basis for justification because the body of substantive udg-ments and principles that cohere could themselves be morally unsatisfactory Thispoints to the great importance but also the great difficulty of starting with con-sidered judgments that are themselves morally justified These considered judgmentspresumably will have a history rich in moral experience that undergirds our confi-dence that they are credible and trustworthy; but how is one to justify such a claimin the case of any proposed set of considered judgments? After all the personscodes institutions or cultures from which the premises descend may not them-selves be highly reliable For example the Hippocratic tradition the starting-pointin medical ethics for centuries has turned out to be a limited and generally unreli-able basis for medical ethics

In addition vagueness surrounds the precise nature and scope of the method ofappeals to coherence A philosopher seeking coherence might be pursuing one ormore of several different interests: evaluating public policy constructing a moralphilosophy improving his or her personal set of moral beliefs and so on The focusmight be on judgments on policies on cases or on finding moral truth It is alsonot clear how we should and should not achieve coherence or how to be sure thatwe have done so

In light of the differences in the models explored in this section and the diverseliterature in applied philosophy it is questionable whether applied ethics has a dis-tinct method or type of justification Applied philosophers appear to do what philoso-phers have always done: they analyze concepts examine the hidden presuppositionsof moral opinions and theories offer criticism and constructive accounts of the moralphenomena in question and criticize strategies that are used to justify beliefs policiesand actions They seek a reasoned defense of a moral viewpoint and they use con-sidered judgments and moral frameworks to distinguish justified moral claims fromunjustified ones They try to stimulate the moral imagination promote analyticalskills and weed out prejudice undue emotion false authority and the like

From this perspective differences between traditional ethical theory and appliedethics can be easily exaggerated In philosophy journals that publish both appliedand theoretical work no sharp line of demarcation is apparent between the con-cepts and norms of ethical theory and applied ethics There is not even a discerniblecontinuum from theoretical to applied The applied-theoretical distinction thereforeneeds to be used with caution (Beauchamp 1984: 514-31; Gert 1984: 532-48)

Problems of Specification

It is now generally agreed in literature on the problems addressed in the previoustwo sections that specific policy guidelines and truly practical udgments cannot besqueezed from abstract principles and general ethical theories alone Additionalcontent must be introduced from some quarter General theories and principles f used at all must be made specific for contexts; otherwise moral guidelines will beempty and ineffectual The implementation of these general norms must take ac-count of feasibility efficiency cultural pluralism political procedures uncertainty

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b t rik li b d i f f t d ti l dil d th lik I short theories and principles must be specified for a context

Specification should not be understood as a process of producing general norms;it assumes they are already available It is the process of making these norms

t t h t th i f l l id d t S i f i t i i d i th i d t i t f th l t i th i d ti

idi it hil t i i th l i t t i th i i lFilli t th i t t f th ith h i h t t i l i h d b

i th f th t l b l i i h t th l Th i d H R i h d t it b " l l i t

where when why how by what means to whom or by whom the action is to bedone or avoided" (Richardson 2000: 289; see also Richardson 1990: 2 7 9 3 1 0 )

For example without further specification the principle "respect the autonomy oft t " i t t h d l l i t d bl f h t t

k f i l i i l d i i d h i l i h b j t A df iiti f " t f t " ( " l l i t t t i t h i l i b t riht") i h t l i f ' i b t ld t th l

d it if S i f t i i d i f f t k i d f lli t thanalysis of meaning It adds content For example one possible specification of"respect the autonomy of competent persons" is "respect the autonomy of competent persons after they become incompetent by following their advance directives"

Wh i th f thi t i l i f t i b t l t diff i l t i i l i d d i t i ld if f t h f l l" R t th t f t t ( f t th b i t t ) b f l l i t h i d d i t i if d l if th d i t i l d t i i

t th i t t h d " A th bl th f ifiti ill ti T h t i l d i f d l id l i d l i i ill b

f t h i f d t h d l l i t Thi i specification is one way to practice applied ethics and it may be the best way

In progressive specification there must remain a transparent connection to heinitial norm that gives moral authority to the string of norms that develop overti Th i l th ibilit f th i f i t i b i

bl d it i ibl t h t d i f f t ti ill ff d i f f t i f t i Thti i f t i ll b t t t i d j t i f i b l Of t ll

i f t i j t i f i b l Th t f f i l i t i (it h i d l i i d j d t ) h ft b t d i

th h b b i d d l f t t i P f i l t h r i t i thiway protect shoddy moral reflection In the process of specification overconfidencein one's specifications is a moral vice that can have profound consequences

Moral disagreement in the course of formulating specifications is inevitable n t t I i b l t i d i l t i l ti

i f t i i t l l t i t b f f d b t l t t i i f i t i d t b tt f t th th i th t t i h i hf l t i ff l t t i l t i t t i l bl Thi b t i

t k t th b j t f h h l d i i t t i i h i h l l i t d dd i i d k l d b l fid t h l i d i t

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TOM L BEAUCHAMP

Problems of Conflict and Disagreement

Moral disagreements emerge in the moral life from several different sources Theseinclude disagreements over which specification is appropriate factual disagreements(for example about the level of suffering that an action will cause) conceptualdisagreements scope disagreements about who should be protected by a moralnorm (for example whether fetuses or animals are protected) disagreementsresulting from a genuine moral dilemma disagreements about which norms arerelevant in the circumstances and disagreements about the weight of the relevantnorms in the circumstances

It should not be presumed in a context of disagreement that at least one party ismorally biased mistaken or otherwise deficient Conscientious and reasonablemoral agents who work with due diligence at specification and reasoning aboutmoral problems sometimes understandably disagree The parties may disagreeabout whether religious values have any place in political affairs whether any formof affirmative action is viable whether physician-assisted suicide is ever acceptableand dozens of other issues in applied ethics

When evidence is incomplete or different sets of evidence are available to differentparties one party may be justified in reaching a conclusion that another party s justified in rejecting We cannot hold persons to a higher standard than to makejudgments conscientiously and coherently in light of the relevant basic and specifiednorms together with the available evidence Of course tolerance for some normsrightly has its limits The method of specification offered in the previous sectionneeds enrichment by an account of moral justification that will help distinguishjustified and unjustified specifications The models of method and ustification dis-cussed in earlier sections may be our best resources in this endeavor but if sothese resources stand in need of further development to be of real practical assist-ance in applied ethics

Conclusion

A robust confidence in and enthusiasm for the promise and harvest of applied ethicsis far from universal Many are unconvinced that traditional philosophical ethics orcontemporary ethical theory can play any significant role in case analysis or inpolicy or professional contexts There is for reasons discussed throughout this chap-ter skepticism that philosophical theories even have practical implications (or appli-cations) However these suspicions may rest on misconceptions of the nature ofapplied ethics No morally serious individual doubts the importance of the issuestreated in applied ethics and virtually everyone familiar with work in the field cancite some examples of outstanding applied work The better view is that adequateconceptions of the method and moral content of applied ethics remain a project n the making

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References

Beauchamp T L (1984) On eliminating the distinction between applied ethics and ethicaltheory The Monist, 67: 514-31

Brody H and Miller F G (1998) The internal morality of medicine: explication and applica-tion to managed care Journal of Medicine and Philosophy, 23: 384-410

Clouser K D and Gert B (1990) A critique of principlism The Journal of Medicine and Philosophy, 15: 219-36

Engelhardt H T (1996) The Foundations of Bioethics, 2nd edn New York: Oxford UniversityPress

and Wildes K (1994) The four principles of health care ethics and post-modernity InR Gillon (ed) Principles of Health Care Ethics, pp 13547 London: John Wiley

Gert B (1982) Licensing professions Business and Professional Ethics Journal, 1: 51-60(1984) Moral theory and applied ethics The Monist, 67: 532^48Culver C M and Clouser K D (1997) Bioethics: A Return to Fundamentals. New York:

Oxford University PressJonsen A and Toulmin S (1988) The Abuse of Casuistry: A History of Moral Reasoning.

Berkeley CA: University of California PressKatz J with Capron A and Glass E S (1972) Experimentation with Human Beings. New

York: Russell Sage FoundationKelman H (1968) A Time to Speak: On Human Values and Social Research. San Francisco:

Jossey-BassMaclntyre A (1984) After Virtue, 2nd edn Notre Dame IN: University of Notre Dame PressRawls J (1971) A Theory of Justice. Cambridge MA: Belknap Press of Harvard University

Press (rev edn 1999)(1996) Political Liberalism. New York: Columbia University Press

Richardson H S (1990) Specifying norms as a way to resolve concrete ethical problemsPhilosophy and Public Affairs, 19: 279-310

(2000) Specifying balancing and interpreting bioethical principles Journal of Medicine and Philosophy, 25: 285-307

Further reading

Advisory Committee on Human Radiation Experiments (1996) Final Report. New York:Oxford University Press

Altaian A (1983) Pragmatism and applied ethics American Philosophical Quarterly, 20:227-35

Beauchamp T L and Childress J F (2001) Principles of Biomedical Ethics, 5th edn NewYork: Oxford University Press

Brock D W (1987) Truth or consequences: the role of philosophers in policy-making Ethics, 97: 786-91

Daniels N (1996) Wide reflective equilibrium in practice In L W Sumner and J Boyle (eds)Philosophical Perspectives on Bioethics, pp 96-114 Toronto: University of Toronto Press

DeGrazia D (1992) Moving forward in bioethical theory: theories cases and specified prin-ciplism Journal of Medicine and Philosophy, 17: 511-39

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Dworkin R (1993) Life's Dominion: An Argument about Abortion Euthanasia and Individual Fd

Feinberg J (1984-7) Th Ml Liit f th C i i l L 4 vols New York: Oxford Univer-sity Press

Freeman E and Werhane P (eds) (1997) Dictionary of Business Ethics Cambridge MA:

Mthilhy 20: 222-34

Maclntyre A (1984) Does applied ethics rest on a mistake? The Monist 67: 498-513Alid Ethi i Tbld Wld

Dordrecht: KluwerRachels J (1990) Created from Animals: The Moral Implications of Darwinism New York:

Oxford University PressMtt f Lif d Dth N I t d t E i Ml Philh

3rd edn New York: McGraw-HillReich W (ed) (1995) Encyclopedia ofBioethics 2nd edn New York: Macmillan

Alid Ethi A C i t Ethi

(1993) P t i l Ethis 2nd edn New York: Cambridge University PressSugarman J and Sulmasy D P (eds) (2001) Methods in Medical Ethics Washington DC:

Sunstein C (1993) On analogical reasoning H d L Riw 106: 741-91Winkler E R and Coombs J R (eds) (1993) Alid Ethi A Rdr Cambridge MA: Black-

well

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Documents

3.the Nature of Applied Ethics