This Is Bioethics. Udo Schüklenk. Читать онлайн. Newlib. NEWLIB.NET

Автор: Udo Schüklenk
Издательство: John Wiley & Sons Limited
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Жанр произведения: Медицина
Год издания: 0
isbn: 9781118770733
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(Takala 2001, 73). Finnish philosopher Tuija Takala quite nicely illustrates the problems with this principle by means of describing the political arguments political parties in Finland had during an election campaign:

      And equally, if you get a raw deal in the natural lottery, it is your own problem. Should we in principle guarantee that everyone has equal opportunities, or should we go further and give fair equal opportunities for all? Within the sphere of bioethics, these questions arise especially in an age of scarcity. If we cannot help all patients, by which criteria are we able to say that X is to be treated whereas Y is to be left on his own?

      Political philosophy has struggled throughout its history with the question of what justice is. How can it suddenly become a non‐question in bioethics?

      2.33 Similar arguments can be advanced with regard to each of the other principles. It is doubtful that there is actually an uncontroversial cross‐cultural consensus on the relevance and meaning of these principles, as Beauchamp and Childress claim there is. Coming to their aid, one of their colleagues at Georgetown University, philosopher Robert M. Veatch, has offered an eloquent defense of the idea that such a ‘common morality’ exists among all humans (Veatch 2003).

      2.34 A further critical point is worth noting: the absence of a hierarchy among the principles has the potential to leave, for instance, patients subjected to more or less arbitrary and unpredictable decisions by health care professionals, simply because health care professionals could always pick the principle most suited to support their already formed intuitive response to a particular ethical problem. Say, a doctor is willing to respect the patient’s do‐not‐resuscitate advance directive, hence the autonomy principle will be deployed. Another doctor, facing the same situation, might have decided to override the patient’s choice, hence the principle of beneficence could be deployed in order to justify a paternalistic course of action. In the absence of an overarching ethical theory that arbitrates conflicts between principles, decisions with regard to what ought to be done might be somewhat arbitrary. If, on the other hand, an overarching theory of this kind was utilized – something not supported by Beauchamp and Childress – it would be unclear why we should not adopt the theory itself and forget about the principles altogether.

      2.38 Critics of this kind of theory have noted that the very foundation of contractualism is deeply problematic. Essentially it offers an exclusive reliance on enlightened self‐interest. Critics have questioned whether this could actually function as the normative foundation of a sound ethical theory. Rawls and his followers assume that this enlightened self‐interest would result in particular practical choices on the policy level. The problem is, simply put, they could be wrong. What if citizens actually chose to gamble all on being wealthy and healthy and so instead opted for no publicly funded provision of health care at all? Would their choice then become any more ethically acceptable just because of how it came about? Equally, if the basis of morality is rational egoism, as this strategy seems to suggest, what would stop dictators from behaving as dictators usually do, as long as they could be reasonably confident that their victims would never end up in a situation where they could take revenge?

      2.39 This concludes our brief overview of influential ethical theories and approaches that have a significant impact on bioethical reasoning. Let us have a closer look now at bioethics itself.

       Questions

      1 Now that you have read brief snapshots of major ethical theories, do any of them appeal to you? Do any of them reflect your own thinking, values, or intuitions? Why do you reject the theories that you do reject?

      1 1 http://plato.stanford.edu/entries/aristotle/

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