The literature in bioethics has grown to such proportions, and become so specialized, that the addition to it of a collection of philosophical essays calls for an explanation. The primary purpose of this volume is not to advance public discussion of one or another substantive bioethical issue or some cluster of such issues. Rather, its aim is to raise questions about the nature of bioethics itself as a normative discipline. These questions fall into two broad categories.

First, there are questions about the proper methods for bioethical thinking, such as the following: How should we go about trying to resolve...

To put the matter bluntly, I make my living as a specialist in ethics. Some people sell shoes, while others peddle computers and automobiles. I purvey ethics: it is my profession and trade. People pay money to hear me give lectures, visit me to solicit my views, and buy my books with the expectation that I will have something useful to say about making good moral judgments. I like this kind of life, but I have never been wholly comfortable with it. If the examined life is the only kind worth living, as one of my predecessors implied, then what...

In these days of intense academic competition, which is supposed to keep us all on our toes, one has to publish or be damned; and for advancing one’s career it is more important that what one publishes should be new, than that it should be true. Often it is not as new as one thinks it is; sometimes, if one looks back to the great philosophers of the past, one finds that one’s bright new ideas have been anticipated by them. This has happened often enough to me.

As to being true, that is not so difficult. Most philosophical truths...

In recent years casuistry has reappeared in the literature of moral philosophy. It was banished at least a century ago by figures of such stature as Henry Sidgwick and G.E. Moore, who believed that the work of moral philosophy was to build a theoretically sound intellectual structure for moral reasoning. In their view, casuistry, immersed in the details of cases and foundering without solid principle and theory, was unworthy and distracting. The eminent Sidgwick once wrote, ‘Although Aristotle has said that the “end of our study is not knowledge, but conduct,” it is still true that the peculiar excellence of...

It is a familiar observation that moral philosophy in the twentieth century has been dominated by meta-ethical concerns, at least until recently. Yet there have been many notable efforts at systematic normative theory in this period, and in general faith in the possibility and power of such theory has persisted. Doubt, too, has persisted about the relevance and applicability of general ethical theory, although scepticism of this kind has tended to be both poorly articulated and perplexed about alternatives. But the current of distrust of and aversion to theory has been gathering force in the last few years. This reaction...

Recent moral philosophy and practical ethics have produced a variety of misgivings about the role of principles in moral reasoning, and especially about their value for professional ethics and practical decisionmaking. These qualms motivate the analysis below.

Reservations about principles have been expressed by representatives of virtue theory, casuistry, impartial rule theory, the ethics of care, and several other types of theory. I begin with a brief sample of their criticisms.

First, the language of principles, some claim, descends from evaluations we make of the character and motives of persons.¹ To speak of a morally good or virtuousactiondone...

Recently, when I was a Fellow in the Program in Ethics and the Professions at Harvard, I was quite astounded to learn from other Fellows that the field of bioethics was in a state of methodological upheaval, fractured along many fault lines, much like Los Angeles but without the sunny climate. They portrayed an intellectual war zone, reminiscent of evolutionary theory or paleontology, where there are many bones to pick. When I expressed my surprise, I was chided. How ‘out of it’ could I be? Had I had not heard that ‘principlism’ (a position held by Beauchamp and Childress¹) had...

Much of the debate within philosophical bioethics has centred on a classic theoretical problem: are ethical problems best solved by appeal to ‘top-down’ approaches – those that emphasize principles or theories that may be applied, sometimes deductively, to specific problems in medical ethics – or by ‘bottom-up’ approaches, which start from the context or particularities of a case and work up to paradigms and principles? Norman Daniels has characterized this debate in this volume as a civil war among the Uplanders (serious theorists), principlists (principles advocates), and Lowlanders (context or case-based approaches). He suggests that both top-down and bottom-up types...

Several years ago a leading bioethics journal asked me to review a paper on how physicians should deal with severely hydrocephalic fetuses. The paper carefully considered the fetus’s interests, the role of the physician, the impact of the decision on society as a whole. I kept waiting for the author to notice the fetus’s location inside a woman and to recognize that she has interests and perhaps even rights. He never did.²

If this kind of experience were an anomaly, bioethics would already be feminist. Unfortunately, it is not an anomaly and bioethics is not feminist. Quite the contrary: it...

In the course of much of my scholarly work over the last decade I have been perceived as a bioethicist. I have served as a so-called expert witness in ethics at an inquest into the death of a baby born at home; I have worked as a bioethics consultant for the Royal Commission on New Reproductive Technologies; and I have spoken on television, radio, and in print as an academic who specializes in bioethics. Although I have sometimes described my work as including bioethics, or more specifically, reproductive ethics, I none the less think of what I do as feminist...

My main concern in this essay is to dismantle the widely accepted distinction between conceptual and practical questions in ethics and bioethics. In the usual organization of ethical activity, conceptual and practical activities are treated as distinct and separate tasks. The conceptual category includes matters such as the pursuit of questions aimed at developing systems for investigating moral claims and also efforts to clarify the nature of the terms, principles, and arguments that are used in moral discussions. The practical category is thought to encompass the explorations of questions that arise out of the human experience of trying to live...

Once upon a time, not long ago, I was asked to give a workshop to a group of women on the subject of ‘Older Women’s Sexuality.’ When I inquired about what was meant by ‘older’ and about the ages of the women at the workshop I was told that the women would be in their sixties to late seventies but would not be classified as ‘extremely elderly.’ The workshop was to be held at the home of one of the members. I agreed to give the workshop, although I felt a little strange, since I was not yet a member...

In this paper I will express some reservations about the usefulness of moral philosophy for the analysis of public policy issues. I want to emphasize right away, however, that I am not questioning the importance of morality. On the contrary, I take it as a given that morality is important, that moral considerations should be given their due weight in public policy deliberations, and indeed should have primacy. Policy-makers should do the right thing, morally speaking. Moreover, I believe that constant vigilance is required to ensure that moral considerations are not drowned out by the forces of self-interest, prejudice, or...

What is the nature of public moral discourse as it is done by ethics commissions charged with addressing ethical or moral issues in medicine and biomedical science and technology?¹ In what ways does it differ from the methods of moral philosophy and moral philosophers when they address such issues? Can public ethics commissions provide reasoned solutions to these ethical issues, and if so how? I shall first discuss some features of the nature of ethics commissions – the different goals they pursue, their typical charge and composition, and the role in public policy that they typically play. These features distinguish...