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ATaxonomyofTheoreticalWorkinBioethics
Forthosewhowishtodelvedeeperintothesubjectoftheoryinbioethics,Iofferhereadiscursive
taxonomyofthevarioussortsofinquiriesthatmightplausiblybelabeledtheoreticalwithinthebig
tentofbioethics.Ratherthanattemptingaserviceabledefinitionoftheoryoralistofreliablecriteria
upfront,we'llreviewanumberoftheoreticalinquiriesinbioethicsandlistenpassantwhatever
crucialdefiningfeaturestheymightsuggest.

1.Rootingoutbadtheory
Thereisausefortheorythateventhemostantitheoreticalcommentatorshaveendorsed:viz.,
counteringallthebad,implicittheorythatinfectssomuchpublicdiscussionofbioethicalmatters.
EvenifwefollowRobertFullinwider's(2007)advicetoeschewtheoryinfavorofcommonmorality,
actualsocialpracticesandinstitutionalnormsasourprimarysourcesofpracticalmoralreasoning,we
willsurelyfind,asFullinwiderwarns,thatthoseverypracticesandnormsareriddledwithbad
theoryormetaphysicalbaloneyofallkinds,muchofitstemmingfromprovincialsocialattitudes
anduncriticalreligiousbeliefs.[13]Sincecataloguingthevastexpanseofbadmetaphysicsandmoral
theoryembeddedinpastbioethicaldebateswoulditselfrequireanentireencyclopediaentry,Iwill
limitmyselfheretojustacoupleofexamples,chosenmoreorlessatrandom.
Costeffectivenessanalysis.Althoughthereisnodoubtthatcosteffectivenessanalysis(CEA)canbe
anextremelyusefultooloradjunctinsettinghealthcarepriorities,thereisplentyofreasontobe
skepticalwhenCEAoperates,asitoftendoesinhealthpolicycircles,asunquestioneddogma
regardingthesolepropercriterionforallocatingofhealthresources.Asadirectoffshootofwelfare
economicsandultimatelyofutilitarianmoraltheory,CEAispremisedonthenotionthatjusticeinthe
distributionofhealthrelatedgoodsisequivalenttothemaximizationofbenefitsor,morecolloquially
put,togettingthemostbangforthehealthcarebuck.Whilesuchformulationshavetheringof
commonsenseaboutthem,andwhileeconomistsoftenwriteandspeakasthoughtherewereno
rationalalternativestoCEA(Eddy1996),philosophersknowalltoowellthatutilitariantheoriesof
justicearehighlycontroversialatbest,andfatallyflawedatworst.Byfocusingexclusivelyonthe
maximizationofbenefits,nomatterthefairnessoftheirdistribution,utilitariantheoryignoresother
factors,suchasclaimsofequityonbehalfofworstoffgroups,thatmanypeopleregardashighly
relevanttojustoutcomes.Inthiscase,theproperresponsetobad(oratleastcontroversial)theoryis
nottobanishtheoryfrombioethics,butrathertoproposeabettertheory,onethatdirectlyaddresses
issuesofequityorfairnessinthedistributionofgoods.(Brock2004)
(b)Muddleddistinctions.Duringtheemergenceofcontemporarybioethics,decisionstoforegolife
sustainingtreatmentswereoftenframedbydoctors,lawyersandthepublicatlargeintermsofwell
worndistinctionsbetweenordinaryvs.extraordinarytreatments,actionsvs.omissions,andkillingvs.
lettingdie.Physiciansoftenjustifiedtheiractions(e.g.,withdrawingaventilatororfeedingtube)on
thegroundthataparticulartreatmentconstitutedanextraordinarymeansandinresponseto
worriesthatwithholdingorwithdrawalatubemightkillthepatient,theyoftenclaimedthattheywere
merelyomittingtodosomething,ratherthandoingsomethingillicit.Butasadevastatingreport,
draftedbyphilosophers,showedin1983,suchdistinctionswereinherentlyvagueandtendedtofocus
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onmorallyirrelevantfeaturesofsuchcases(President'sCommission1983).Whenaphysicianpullsa
feedingtube,isshemerelyomittingtodosomething,whichwouldpresumablybelicit,orisshe
actuallydoingsomething,i.e.,removingthetube,whichwouldpresumablybeillicit?Apartfromthis
sortofterminalvagueness,philosophershelpfullypointedoutthatthemoralpermissibilityofsuch
lifeanddeathdecisionsshouldrest,notonsuchmetaphysicallydubiousandmorallyirrelevant
distinctions,butrather,interalia,onthelikelyimpactofaproposedtreatment(ortreatment
withdrawal)onthepatient'soverallwellbeing.

2.Normativetheory
2.1NormativeEthicalTheory
Themostobviousexampleoftheoreticalworkinbioethicsfitsunderthetraditionalrubricof
normativeethicaltheory.Thepointofthiskindoftheoreticalworkismostoftentojustifyone's
judgmentsbearingontherightnessorwrongnessofvariousindividualactionsorsocialpolicies.
ShouldDoctorDanlietohispatientinordertofacilitateherrecoveryorinducehertoacceptwhathe
regardsasbeneficialsurgery?Shouldthevariousstateslegallypermitphysicianassistedsuicide?
Whoshouldhavefirstpriorityonscarcevaccinesinthefaceofpandemicinfluenza?
Ifweruleouttheuseofforceinimposinganswerstosuchquestions,wemustengageinthesocial
practiceofoffering,accepting,andcriticizingwhatwetaketobegoodreasonsforourjudgments
bearingonactionsandsocialpolicies.Whileappealstocommonsenseandstandardpracticeswill
sufficemostofthetime,weareoftendriventohigherlevelsofmoraldiscourseinordertogivea
satisfactoryjustificationofourjudgmentsinthefaceofdisagreementandcontroversy.Inworkingout
solutionstothethreepracticalquestionsposedabove,wemightbegintowonderabouttheweightthat
shouldbegiventoconsequencesversusthatgiventovariouscommonsensicalbutnon
consequentialistmoralobligations,suchastruthtelling,respectinghumanlife,orhumanequality.In
doingso,wearealreadyfullyengagedintheprojectofnormativeethicaltheorybuilding.Typical
examplesofsuchtheoryinbioethicsincludeconsequentialisminitsvariousincarnations,including
utilitarianism(Singer1999)contractualism,includingRawlsiantheoriesofjustice(Rawls1971/1999
Kantianstyledeontology(Donagan1977),andlibertarianpoliticalthought(Engelhardt1996).

2.2Virtueethics
Apartfromsettingoutthegroundsandscopeofmoralourobligationsandofethicallypermissible
conductandpolicy,normativeethicsalsodealswithquestionsbearingonwhatkindofpeoplewe
shouldbe.Insteadoffocusingonthegroundsandcriteriaofrightandwrongconduct(i.e.,thewhatof
ethics),virtueethicsfocusesonthequalityofmoralagency(orthewhoofethics).Thisvarietyof
ethicaltheorypondersthenatureofthevirtuesandtheirmanifestationinvirtuousmoralagents.In
bioethics,virtueethicshasoftenfocusedonthevirtuesofthegoodphysicianornurse,including
conscientiousness,technicalskill,empathy,courage,truthfulness,dedicationtothepatient'sgood,and
justice(Pellegrino1993,Drane1995).

2.3Highmoraltheory
Normativeethicaltheoriesvaryconsiderablyintermsoftheiraspirationstowardsgeneralization,
universality,abstractness,systematicorganization,simplicity,andcomprehensiveness(Nussbaum
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2000,Flynn2007).Paradigmaticexamplesofwhatwe'llcallhighmoraltheoryattempttoembody
mostorallofthesedefiningcharacteristics.Thusclassicalutilitarianism,Kantiandeontology,and
Rawlsianjusticeasfairness,forexample,allstriveforthearticulationofatheoreticalsystembased
uponasmallnumberofabstractfundamentalprinciples(e.g.,Mill'sprincipleofutility,Kant's
categoricalimperative,andRawls'sfamoustwoprinciplesofjustice)thattheyregardasthekeysto
understandingthemoralorpoliticallife.Theseprinciplesintheirpristineincarnationsarecapableof
beingarticulatedinaperfectlygeneralanduniversalfashionwithoutanyreferencetoordependency
uponanyparticularsocialpracticesorculturalnorms.Theyapply,sotheirauthorstellus,toall
rationalagentsassuch.[14]Beginningfromthesehighlyabstractanduniversallybindingmoralnorms,
standardexamplesofhighmoraltheoryramifyintocomplexsystemsencompassingbasicand
derivativemoralprinciples(e.g.,respecttheautonomyofrationalagents),rulesbaseduponsuch
principles(e.g.,donotenlistpatientsinbiomedicalresearchwithoutfirstgainingtheirinformed
consent),and,finally,judgmentsanimatedbysuchprinciplesandrulesbearingonparticularcases
(e.g.,theTuskegeesyphilisstudywasunethical).
Althoughmostphilosophersmightnaturallythinkofsuchhighlyabstractandambitiousconstructions
asparadigmaticexamplesofmoraltheory,andmostlikelyhavepreciselysuchtheoriesinmindwhen
askedabouttherelationshipsbetweenbioethicsandethicaltheory,theydonotexhaustthespaceof
normativetheorizingeitherinbioethicsorwithinthemorallifemoregenerally.

2.4Pluralistictheories
Incontrasttotypicalhigh,vaultingtheorysupportedbyasinglekeystone,morepluralisticethical
theoriesalsopurporttooffernormativebasesformoralthoughtbutwithmorebroadbased
foundations.Inadditiontotheprincipleofutilityorcategoricalimperative,suchtheoriesconsistofa
setoffairlyheterogeneousmoralprinciplesorbasiccapabilitiesnecessaryforhumanflourishing
and/orethicalbehavior.Oneclassicalexampleofthisgenreofmoraltheorycanbefoundinthework
ofBritishphilosopherW.D.Ross,whoselistofsocalledprimafacie,obligationsfidelity
reparationgratitudenonmaleficencejusticebeneficenceandselfimprovementclearly
anticipatedandinspiredthedominantprinciplistapproachtobioethicschampionedbyBeauchamp
andChildress.(Ross1988,Brody1988,Frankena1973)
Importantly,thesepluralistictheoristsgenerallyrefrainfromendorsinganapriorirankingor,as
Rawlsputsit,alexicalorderingofthevariousinterests,valuesandprinciplestheyarticulate.
Autonomy,beneficence,andjustice,forexample,mightallfigureinourdeliberationsabouta
particularissue,buttheirrespectiveweightorimportancecanonlybedeterminedinmediasres,given
alltheparticularitiesofthecaseathand.Gaugingwhichvalues,principlesorrulesshoulddetermine
theresultinaparticularcaseissaidtorequiregoodjudgment,practicalwisdom,orintuitionofsome
sort.
Another,verydifferentapproachtopluralisticnormativetheoryisdevelopedintherelatedpolitical
theoriesofMarthaNussbaumandA.K.Sen.(Nussbaum2000,Sen1999)Insteadofplumbingthe
depthsofourcommonmoralityfordeontologicalobligationsinthemannerofRoss,Beauchampand
Childress,NussbaumoffersusaneoAristoteliantheoryoftheprerequisitesofhumanwellbeingor
flourishing.IncontrasttootherswithinthebigRawlsiantentwhowouldmeasureprogresson
achievingequalitybyfocusingontheresourcesorprimarygoodsheldbyindividuals,bothNussbaum
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andSenexplicatethemetricofequalityasthemeasureofwhatindividualsareabletobeanddo.
Towardsthisend,Nussbaum(butnotSen)hasdevelopedalistof10basiccapabilitiesrequiredfora
lifethatistrulycommensuratewithhumandignity:
1. Beingabletolivealifeofnormallength.
2. Havingadequatebodilyhealthandshelter.
3. Bodilyintegrity.
4. Beingabletouseone'ssenses,imagination,andthoughttoexperiencepleasureandavoidpain.
5. Emotionalexpressionanddevelopment.
6. Practicalreason,beingabletocriticallyreflectonone'sownlife,libertyofconscience.
7. Affiliationwithothersandpossessingequaldignityinsociety.
8. Otherspecies.Beingabletolivewithconcernforandinrelationtoanimals,plants,andthe
worldofnature.
9. Play.Beingabletolaugh,toplay,toenjoyrecreationalactivities.
10. Controloverone'senvironment,bothpoliticallyandmaterially.
AccordingtoNussbaum,allofthesebasiccapabilitiesarecrucialprerequisitesofhumanflourishing,
andnoneshouldbetradedawayformoreoftheothers.Thiskindofpluralisticmoral/politicaltheory
hasgainedconsiderabletractionintheareasofpublichealthandglobalbioethics(PowersandFaden
2006).
Thesepluralisticaccountsofnormativetheoryfrequentlyencounteredinbioethicsusuallyfeaturethe
selectiveappropriationofvariousthemesortheoryfragmentsborrowedfromelementsfeaturedin
standardhighleveltheories(BakerandMcCullough2007).Thesocalledprincipleofautonomy
providesaninterestingcaseinpoint.Asarticulatedinsomeofthefoundationaldocumentsofthe
contemporarybioethicsmovement,suchastheseminalBelmontReportontheethicsofresearchwith
humansubjects,andBeauchampandChildress'sPrinciplesofBiomedicalEthics,theprincipleof
autonomywasputtoworkinthehighlysuccessfulbattleagainstawellentrenchedmedical
paternalismthatarrogateddecisionmakingprerogativestophysiciansandbiomedicalresearchers.
(President'sCommission1978,BeauchampandChildress1977).Theinterestingthingaboutthis
principleofautonomyorrespectforpersonsisthatitseemstohavebeencobbledtogetherfroma
varietyoftheoreticalsources(Beauchamp2007).Clearly,theprinciplehasunmistakableKantian
overtones.Respectforthemoralautonomyofpersonsisanabsolutelyfundamentalelementof
Kantianmoraltheory.Butthecontemporaryunderstandingofautonomywithinthefieldofbioethics
hasbeendistinctlyunKantianinitsjettisoningofKant'smetaphysicsofactionandhiskeydistinction
betweenautonomy,definedasallegiancetouniversalandrationalmorallaw,andheteronomy,
definedasthedeterminationofactionbymereindividuallydefinedinterests.Soinspiteofthe
distinctKantianflavorofatermlikerespectforpersonsinthebioethicsliterature,usuallyallthat
remainsoftheKantianunderstandingofautonomyinthisfieldisabroadlydefinednotionofselfrule
orindividualchoicethatisequallycompatiblewithaMilliannotionoflibertyandwithwhatKant
wouldhavedeemedheteronomousspringsofaction.
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Thus,inadditiontothisKantianstraininthecontemporarybioethicalunderstandingofautonomy,
therearedistinctlyutilitarianorconsequentialistmotifsborrowedfromsuchworksasJ.S.Mill'sOn
LibertyandmorefullydevelopedbyGeraldDworkin(1972)andJoelFeinberg(1986).Oneofthe
bioethicists'strongestargumentsagainstmedicalpaternalismturnedouttobethedistinctlyMillian,
ruleutilitarianclaimthatwhenitcomestoselfregardingchoicesbearingonmedicaltreatments,
paternalisticinterventionsbyphysicianswillalmostalwaysdomoreharmthangood,ifnotinthe
shortrunthenatleastinthelongrunasamatterofstandardmedicalpracticeandsocialpolicy.Such
fragmentaryappropriationofelementsdrawnfromhighmoraltheoryisubiquitousinthefieldof
bioethics.

2.5Convergencetheories
Asimilarlyeclecticapproachtohighmoraltheorystressestheconvergenceofdifferingtheoriesatthe
levelofactionguidingprinciples.Nomatterwhatthedifferencesbetween,say,utilitarian
consequentialismandKantiandeontologyatthehighestlevel,itissometimesclaimedthatsuchrival
theorieswillpredictablyreachthesameresultsbothatthelevelofmidlevelprinciplesandatthe
concretelevelofparticularjudgments.Onewellknownexampleofthisphenomenonisprovidedby
Beauchamp,whodescribedhimselfasaruleutilitarian,andChildress,whodescribedhimselfasa
partisanofreligiousdeontology,inearlyiterationsoftheirhighlyinfluentialjointprojectonthe
principlesofbiomedicalethics.Despitetheirdifferencesattheleveloffoundationalmoraltheory,
bothofthesephilosophersexpectedtheirultimatedifferencestorecedeatthelevelofmoral
principles,wheretheycouldagree,forexample,ontheimportanceoftheprincipleofautonomyand
itsoverridingsignificanceintheareaofresearchethicsandthephysicianpatientrelationship,evenif
theirultimatejustificationsatthelevelofhighmoraltheorywouldtendtodiverge(2009,36163).

2.6Commonmoralitytheories
Tworivalcommonmoralitytheories,elaboratedrespectivelybyBeauchamp&Childressand
BernardGert,currentlydominatethefieldofbioethics(BeauchampandChildress2009,Gert2006,
Arras2009).Whereaspluralisticmoraltheoriesaredefinedintermsofthenumberandkindofbasic
moralnormstheydefend,commonmoralitytheoriesfocusontheultimatesourceofourprinciples,
rules,andideals.Bothoftheseapproachestracethatsourcetoacommonmoralitysupposedlyshared
byallpeopleofgoodwill.Suchtheoriesare,however,alsodecidedlypluralistinsofarasthey
encompassmoralrules,principlesandidealsthataddressahostofdisparateconsequentialistand
deontologicalmoralconcernsbearingonkilling,lying,beneficence,justice,etc.[15]
BeginningwiththethirdeditionofthePrinciplesofBiomedicalEthics,publishedin1989,
BeauchampandChildressrelocatedthesourceoftheirmidlevelbioethicalprinciplesfromhigh
philosophicaltheorytowhattheyhavetermedthecommonmorality.Byinsistingonthedefinite
articlehere,theymeanttodistinguishthewidevarietyofparticularmoralitiesfoundindifferenteras,
cultures,andprofessionsfromtheirsourceinamoralitythatiscommon,astheyputit,toallpersons
inalltimesandplaceswhoarecommittedtolivingamorallife.Thismoralityencompassesbothrules
ofobligation(e.g.,donotkillorcausesufferingforothers,tellthetruth,keeppromises,donotsteal,
preventevilorharmfromoccurring,rescuepersonsindanger,donotpunishtheinnocent,obeythe
law,treatallpersonswithequalmoralconsideration,etc.)andstandardsofmoralcharacter,suchas
nonmalevolence,honesty,integrity,truthfulness,fidelity,lovingness,andkindness.
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BeauchampandChildressassertthatthecontentofthecommonmoralityisdictatedbytheprimary
objectivesofmorality,whichincludetheameliorationofhumanmisery,theavoidanceofpremature
death,andthepredictableconsequencesofindifference,conflict,hostility,scarceresources,limited
information,andsoon.Adheringtothenormsofthecommonmoralityisnecessary,Beauchamp
claims,tocounteractthetendencyforthequalityofpeople'slivestoworsenorforsocial
relationshipstodisintegrate(Beauchamp2003,p.261).
Themoralauthorityofthecommonmoralityisthusestablished,accordingtoBeauchampand
Childress,neitherbymeansofethicaltheorynorbymeansofapriorireasoningorreflectiononthe
meaningofmoraltermsrather,moralnormativityisestablishedhistoricallyorpragmaticallythrough
thesuccessofthesenormsinalltimesandplacesinadvancingthecauseofhumanflourishing.Their
accountisthushistoricist,butunlikemosthistoricismsitdoesnotembracemoralrelativism.The
normsofthecommonmorality,theyinsist,areuniversallybinding.
ProvidingamerethumbnailsketchofBernardGert'sapproachtocommonmoralitywillprovetobea
muchmoredauntingtaskbecause,incontrasttoBeauchampandChildress,Gert'sprimary
contributiontoethicsandpracticalethicsjustishisaccountofcommonmorality.Morespecifically,
Gertbeginswithaconceptionofthepointandpurposeofmorality,whichthenyieldsthedescriptive
coreofcommonmorality,includinglistsofthevariousmoralrulesandmoralideals,andadecision
procedurefordeterminingwhenitisjustifiedtoviolateanyofthemoralrules.Thisdescriptivecoreis
thenshoredupbyGert'stheoryofcommonmorality,whichattemptstoprovideajustificationforthe
entireedifice.AlthoughGertconcedesthathisparticulartheoryofcommonmoralitymightwellbe
problematicinvariousways,althoughhedoubtsit,heinsiststhathisaccountofthedescriptive
contentofcommonmoralityisbothtrueanduniversallyembracedbyallrationalpersons.ForGert,
then,thepointofdoingethicsisnottocomeupwithsomeniftynewtheoryofmorality,butrather
toprovideafaithfuldescriptiveandinterpretiverenderingofthemoralrules,ideals,anddecision
proceduresthatweallshare.BorrowingapagefromWittgenstein,Gertdeclaresthathisaccount
changesnothingincommonmorality,whichdoesnotchangeovertime,leavingitscentralprecepts
anddecisionproceduresinplaceandintact(Gert2004,p.4).
Gertbeginshisaccountwiththeclaimthatthewholepointandpurposeofmoralityistolessenthe
amountofevilorharmsufferedintheworld[2004,p.26],agoalsimilartothatpositedby
BeauchampandChildress.HethendipsintoaquasiHobbesianaccountofhumannature,arguingthat
beingslikeusi.e.,vulnerable,mortal,rational,andfallible(p.8)wouldfavoradoptingcommon
moralityasapublicsystemthatimpartiallyappliedtoeveryone.Thecontentofcommonmorality
consistsofmoralrulesandmoralideals.Giventhepointofmorality,alltenoftherules(a
Decalogue!)proscribeactionsthateitherdirectlycauseharm,(e.g.,killing,lying,causingpain,
disabling,deprivingoffreedomorpleasure)ortendtoproduceharmfulresults(e.g.,donotdeceive,
breakpromises,cheat,disobeythelaw,orfailtodoyourduty).Whereasthemoralrulescategorically
prohibitviolations(unlesssufficientreasonscanbeprovided),themoralidealsmerelyencourage
peopletopreventorrelievethesortsofharmscoveredbytherules.
InwhatsensearethecommonmoralityapproachesofBeauchampChildressandGertmoraltheories?
Whiletheformerhavenotabandonedtheirbeliefthattheirprinciplesofbiomedicalethicscouldbe
derivedfromdisparatebutconverginghighleveltheories(2009,36163),theynowstresstheorigin
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oftheirprinciplesinordinary,universallysharedmoralbeliefsratherthaninsomespecialmoral
sensibility,purereason,rationality,naturalrights,orsomegrandnormativeethicaltheory.Echoing
Rawls'scommentonthepivotalroleofsocalledconsideredmoraljudgments,Beauchampand
Childressnowconsideranyconflictsbetweencommonmoralityandmoraltheorytotellagainstthe
credibilityofthetheory.[16]Takingthiscommonmoralityasagivenofhumanhistoryandexperience,
BeauchampChildressarepreparedtodefenditsprinciplesonpragmaticgroundsandtodeploythose
sameprinciplesinconcretemoralandpolicyanalysesthroughaprocessofincreasingspecification
andbalancing.Althoughtheythusdistancethemselvesfromtheoryasasourceofultimate
justificationfortheirworkingprinciples,theystillrefertotheirpositionasacommonmorality
theoryinordertodistinguishitfromotherfundamentalapproachestobioethics.
AsforGert,hetooregardstherepositoryofcommonmoralitytobeagivenofsorts.Allpeople
committedtothespiritofmoralitywill,heasserts,agreeonthebasicrulesandidealsembeddedin
commonmorality.AndlikeBeauchampandChildress,Gertdoesnotfoundthetenetsofcommon
moralityuponanyoftheusualmoraltheories,aboutwhichhetendstobefairlydismissive.Onthe
otherhand,Gertregardstheelaboration,interpretation,andsystematicdefenseofthecommon
moralitytobehisowncontributiontophilosophicaltheory.

2.7Normativetheoriesoflimitedscope
Anothermoremodestversionofnormativetheory(comparedtohightheory)includestheoriesof
relativelynarrowscopeandambition,focuseduponparticularproblemsorrecurringthemes.In
contrasttocommonconceptionsofhightheory,whichenvisionitasperchedonashelf,moreorless
alreadyfullyarticulatedandawaitinganyandallapplicationstoparticularmoralproblems,some
normativetheoriesgrowoutofparticularstruggleswithparticularmoralproblemsandthushavea
morelimitedscopethanmoreparadigmaticnormativetheories,suchasutilitarianismordeontology.
Inattemptingtocharacterizehisownverycreativeapproachtothelinkedproblemsofabortionand
euthanasia,RonaldDworkin(afrequentcontributortothebioethicalliterature,evenifnota
bioethicistmalgrlui)referstohisownapproachalternativelyasatheorydevelopedfromtheinside
ofthesemoralproblems,asatheorymadefortheoccasionratherthanprefabricated,atheory,in
short,tailoredonSavilleRowratherthanmassproducedonSeventhAvenue.Thus,insteadof
invokingvariousfamiliarmoraltheoriesbearingonlibertyandautonomy,Dworkindevelopsatheory
ofvaluefocuseduponclashingviewsofthesacrednessofhumanlifeasmanifestedindebatesover
abortionandeuthanasia(Dworkin1993).Aswesawinthemainbodyofthisentry(Sec.6),awide
varietyofmidleveltheoriesoflimitedscopeconstituteperhapsthegreatesttheoreticalcontribution
ofphilosophytobioethics.

3.Metaethicaltheory
Althoughmosttheorizinginbioethicsfallssquarelyundertheheadingofnormativeethicaltheory
i.e.,substantiveaccountsofwhatisgood,virtuous,obligatory,etc.theoreticalissuesofanother
kind,i.e.,socalledmetaethicalconcerns,oftenlurkinthebackground.Thesedeeper,more
fundamentalquestionshavetraditionallyencompassedcontroversiessurroundingtheverypointand
purposeofethics,themeaningsofethicalterms(e.g.,rightandgood),whatitmeanstoholdan
ethicalview(i.e.,doethicaljudgmentsmerelyexpresssubjectivepreferences?),theobjectivityof
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moraljudgmentsandthepossibilityofethicaltruth,andhowwemightbestjustifyourmoral
judgments.
Althoughmostworkingstiffpracticalethicistsmanagetogetthroughtheircareerswithoutbothering
toomuchaboutthedebatebetweenmetaethicalinternalistsandexternalistsi.e.,whetherthereisan
internal,necessaryconnectionbetweenone'smoralbeliefsaboutdoingXandone'scorresponding
motivationsregardingthedoingofXsomedistinctlymetaethicalquestionsarehardertoavoid,even
withinapracticalfieldlikebioethics.Forexample,oneveryfundamentalandmuchdiscussed
questioninbioethicshastodowiththesourcesandlimitsofmoraljustification.Accordingtoone
influentialview,ouractionsorpoliciesaremorallyjustifiedinsofarastheyarevalidatedbysome
moralprincipleorother,butrivalmetaethicalviewscontend,forexample,thatmoraljustificationis
achieved,notbyappealingtoprinciplesalone,butratherbyappealtovariousparadigmcases,asin
casuistry,ortotheharmonioustotalityofourintuitions,rules,principles,moraltheories,and
backgroundsocialtheories(i.e.,reflectiveequilibrium).Thus,theentiredebateamongbioethicists
concerningtherespectivemeritsanddemeritsofvariousmethodsofconductingbioethicalinquiry
includingprinciplism,narrative,casuistry,andreflectiveequilibriumisitselfanunavoidable
metaethicalquestion.Indeed,theentirepresentessayisitselfanextendedmetaethicalexercise.
Anotherimportantmetaethicalissueconcernstheverypossibilityofethicaltruth,objectivity,or
justificationwithinthesphereofsecularbioethics.H.TristramEngelhardt,Jr.hasarguedforcefully,
ifnotentirelyconvincingly,thatthereisquitesimplynocanonicalarticulationororderingofvalues
inthesecular,publicsquare,andthusthattherecanbenofoundationalpublicbioethicsbasedupon
contentfullconceptionsofthingslikedignity,equality,orliberty(1996).Becausewecannotagreeon
suchfundamentalmattersinoursocalledpostChristian,postmodernage,contendsEngelhardt,
mostofcontemporarybioethics,andespeciallythoseviewsthataspiretoarticulateandjustifyour
commonmorality,areessentiallyfraudulent.Worseyet,heclaims,thestateormedicalprofession
cannotactupontheedictsofcontemporarybioethicswithoutviolatingtheautonomyordignityofall
those(usuallyflinty,contrarian,welloffTexans)whohappentodisagreewithtoday'sbien
pensantbioethicists.Wereitconvincing,Engelhardt'smetaethicaltheorythuswouldhaveimportant
normativetheoreticalconsequencesforexample,wewouldallhavetobelibertariansbydefault.

4.Metaphysicaltheories
Forallofitsemphasisondowntoearthpractice,bioethicsharborsanumberofexplicitly
metaphysicalcontroversiesthatultimatelyplayimportantrolesinnormativeargument.
Unsurprisingly,manyofthesecontroversiesariseontheborderlandsbetweenlifeanddeath.The
problemofabortionposesthequestion,When,exactly,doesafullfledgedhumanbeingorperson
withthefullpanoplyofhumanrightscomeintobeing?Attheotherendoflife'sjourney,weask,
When,exactly,doesapersondie?,andinordertoaddressthisquestion,weneedtoproffera
definitionofdeathitself.Isdeathbestdefinedintermsofthehumanorganismorratherintermsof
theperson'sabilitytoreasonorherembodiedbrain?Althoughsomemightprefertofinessesuch
difficultquestionsbyappealingstraightawaytomoretractablenormativeargumentsbearing,
respectively,onharmstowomenstemmingfromillegalabortionsorthediminishedvalueoflifeina
persistentvegetativestate,asatisfactoryaccountofsuchissueswillrequireanexplicitlymetaphysical
examinationofthenatureofbeinghumanandofpersonalidentity(DeGrazia2005,McMahan2003).
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TheoryandBioethics>ATaxonomyofTheoreticalWorkinBioethics(StanfordEncyclopediaofPhilosophy)

Bioethicsisthusfraughtwithimportantmetaphysicaldebatesthatsimplycannotbefinessedby
appealstocommonsenseorinstitutionalpractices.Inadditiontothewellwornmetaphysicaldebates
overmoralstatusandpersonhood,soprevalentintheliteratureonabortionandbraindeath,thetheme
ofpersonalidentityplaysanimportantroleacrossanumberoffrontsinbioethics,includingdebates
overadvancedirectivesandreproductiveethics.Oneparticularlyinterestingandimportant
contributioninvolvesthedeploymentofDerekParfit'ssocallednonidentityprobleminthecontext
ofreproductiveethics(Parfit1986).Criticsofvariousreproductivetechnologies(suchascloning,
surrogateparenting,andinvitrofertilization)oftenclaimthatsuchcontroversialtechniquescanresult
inharmstothechildrenconceivedwiththeirassistanceand,thus,shouldeitherbebannedorhighly
regulated.Suchharmsmightincludevariousbirthdefects,thesequelaeofprematurebirth,social
stigma,orthepsychologicaldamageassociatedwithbeingacloneoranobjectofcommercial
transactionbetweencontractingparentsandsurrogates(President'sCouncil2002).AsParfithas
shown,suchallegationsoftenassumeastandardaccountofharmaccordingtowhichanaction
adverselyaffectsthewelfareofasingle,enduring,identifiablepersonforexample,amother'sheavy
drinkingmightengendersevereneurologicaldeficitsinherdevelopingfetus,whichwouldotherwise
haveenjoyednormalhealth.
Butwhatarewetomakeofreproductivechoicesthatwilldeterminetheveryidentitiesofthechildren
theyusherintoexistence?Forsuchchildren(e.g.,thosebornasadirectresultofstandardsurrogacy
arrangementsorIVF)thechoiceisn'tbetweenafuturethreatenedbypossiblepsychologicalor
physicalharmsandanotherperfectlynormalfuturewithoutsuchharmsrather,
assumingarguendothattherearepsychologicalandsomaticrisksinvolvedinthesenewreproductive
technologies,thechoiceregardingthechildiseitherforalifewithariskofsomeharmversusnolife
atall.Adecisiononthepartofworriedparentstooptforstandardcoitalreproductionratherthan
surrogacyorIVFwouldbringadifferentchild,withadifferentidentity,intobeing.Thus,ifParfitis
correct,wecannotsaythatachildsufferingfrompsychologicalorphysicalburdensresultingfrom
herhightechconceptionhasbeenharmedbybeingbroughtintoexistence.Wemightstillwanttosay
thattheparentsofsuchachildactedirresponsibly,assumingthecontroversialpremisethattherisks
ofharmwereindeedhigh,butwecannotdosoonthegroundthatthereproductivearrangement
harmedthechild,whoowedherveryexistencetoit.Althoughthealternativeaccountwegiveofsuch
parentalirresponsibilitywillnodoubtdependuponanormativemoraltheorye.g.,theparentshave
broughtanexcessiveamountofneedlesssufferingintotheworld(Brock1995)theneedforan
alternativeexplanationisdemonstratedbyParfit'sexpresslymetaphysicalargument.
Tosummarizethemainresultsofthisbrieftypology:(1)Thefieldofbioethicsissaturatedwith
theoriesofdifferentsorts(normative,metaethical,andmetaphysical)thatexhibitdifferentlevelsof
generalityandcomprehensiveness.(2)Invocationsoftheoryinbioethicswillbemoreorless
appropriatedependingupontheparticularlevelofbioethicalpracticeinplayforexample,whether
oneisengaginginaclinicalconsult,advisingahospitalcommitteeorpublicethicscommissionon
policy,orteachinganundergraduatecourseorgraduateseminar.

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