BIOETHICSCRITICALLYRECONSIDERED Philosophy and Medicine VOLUME 100 FoundingCo-Editor StuartF.Spicker SeniorEditor H.TristramEngelhardt,Jr.,DepartmentofPhilosophy,RiceUniversity, andBaylorCollegeofMedicine,Houston,Texas AssociateEditor LisaM.Rasmussen,DepartmentofPhilosophy,UniversityofNorthCarolina atCharlotte,Charlotte,NorthCarolina AssistantEditor JeffreyP.Bishop,GnaegiCenterforHealthCareEthics,SaintLouisUniversity, St.Louis,Missouri EditorialBoard GeorgeJ.Agich,DepartmentofPhilosophy,BowlingGreenStateUniversity, BowlingGreen,Ohio NicholasCapaldi,CollegeofBusinessAdministration,LoyolaUniversity, NewOrleans,Louisiana EdmundErde,UniversityofMedicineandDentistryofNewJersey,Stratford, NewJersey ChristopherTollefsen,DepartmentofPhilosophy,UniversityofSouthCarolina, Columbia,SouthCarolina KevinWm.Wildes,S.J.,PresidentLoyolaUniversity,NewOrleans, Louisiana Forfurthervolumes: http://www.springer.com/series/6414 BIOETHICS CRITICALLY RECONSIDERED Having Second Thoughts Editedby H.TRISTRAMENGELHARDT,JR. RiceUniversity,Houston,TX,USA 123 Editor H.TristramEngelhardt,Jr.Ph.D. MainSt6100 77005-1827HOUSTONTexas USA [email protected] ISSN0376-7418 ISBN978-94-007-2243-9 e-ISBN978-94-007-2244-6 DOI10.1007/978-94-007-2244-6 SpringerDordrechtHeidelbergLondonNewYork LibraryofCongressControlNumber:2011938240 ©SpringerScience+BusinessMediaB.V.2012 Nopartofthisworkmaybereproduced,storedinaretrievalsystem,ortransmittedinanyformorby anymeans,electronic,mechanical,photocopying,microfilming,recordingorotherwise,withoutwritten permissionfromthePublisher,withtheexceptionofanymaterialsuppliedspecificallyforthepurpose ofbeingenteredandexecutedonacomputersystem,forexclusiveusebythepurchaserofthework. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Contents 1 ASkepticalReassessmentofBioethics . . . . . . . . . . . . . . . . 1 H.TristramEngelhardt,Jr. PartI HistoryofBioethics:FourPerspectives 2 BeginningBioethics. . . . . . . . . . . . . . . . . . . . . . . . . . . 31 MichaelS.Yesley 3 GenesisofaTotalizingIdeology:Bioethics’InnerHippie . . . . . . 49 GriffinTrotter 4 Bioethics and Professional Medical Ethics: Mapping andManaginganUneasyRelationship . . . . . . . . . . . . . . . . 71 LaurenceB.McCullough 5 Two Rival Understandings of Autonomy, Paternalism, andBioethicalPrinciplism . . . . . . . . . . . . . . . . . . . . . . . 85 AaronE.Hinkley PartII The Practice of Bioethics and Clinical Ethics Consultation:ThreeViews 6 BioethicsasPoliticalIdeology . . . . . . . . . . . . . . . . . . . . . 99 MarkJ.Cherry 7 The“s”inBioethics:Past,PresentandFuture . . . . . . . . . . . . 123 AnaS.IltisandAdrienneCarpenter 8 WhyClinicalBioethicsSoRarelyGivesMorallyNormative Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 H.TristramEngelhardt,Jr. v vi Contents PartIII TheIncredibleSearchforBioethicalProfessionalism: SomeFinalCriticalReflectionsonCircularThinking 9 OntheSocialConstructionofHealthCareEthicsConsultation . . 177 JeffreyP.Bishop Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Contributors JeffreyP.Bishop AlbertGnaegiCenterforHealthCareEthics,SaintLouis University,SalusCenter,Room527,3545LafayetteAve,St.Louis,MO63104, USA,[email protected] AdrienneCarpenter AlbertGnaegiCenterforHealthCareEthics,SaintLouis University,St.Louis,MO63104,USA,[email protected] MarkJ.Cherry TheDr.PatriciaA.HayesProfessorinAppliedEthics,Professor ofPhilosophy,DepartmentofPhilosophy,St.Edward’sUniversity,Austin, TX78704,USA,[email protected] H.TristramEngelhardt,Jr. DepartmentofPhilosophy,MS-14,RiceUniversity, Houston,TX77005,USA,[email protected] AaronE.Hinkley DepartmentofPhilosophy,MS-14,RiceUniversity,Houston, TX77005,USA,[email protected] AnaS.Iltis CenterforBioethics,HealthandSociety,WakeForestUniversity, Winston-Salem,NC27109,USA,[email protected] LaurenceB.McCullough DaltonTomlinChairinMedicalEthicsandHealth Policy,BaylorCollegeofMedicine,CenterforMedicalEthicsandHealthPolicy, Houston,TX77030-2411,USA,[email protected] GriffinTrotter AlbertGnaegiCenterforHealthCareEthics,SalusCenter,Saint LouisUniversity,St.Louis,MO63104,USA,[email protected] MichaelS.Yesley IndependentConsultant,BainbridgeIsland,WA98110,USA, [email protected] vii Notes on Contributors JeffreyP.Bishop,M.D.,Ph.D.,isdirectoroftheAlbertGnaegiCenterforHealth Care Ethics and Tenet Chair of Health Care Ethics at Saint Louis University, St.Louis,Missouri. Adrienne Carpenter, is professor at the Albert Gnaegi Center for Health Care EthicsatSaintLouisUniversity,St.Louis,Missouri. Mark J. Cherry, Ph.D., is the Dr. Patricia A. Hayes Professor in Applied Ethics, DepartmentofPhilosophy,St.Edward’sUniversityAustin,Texas. H.TristramEngelhardt,Jr.,Ph.D.,M.D.,isprofessor,departmentofphilosophy, Rice University, and professor emeritus, departments of medicine and community medicine,BaylorCollegeofMedicine,Houston,Texas. AaronE.Hinkley,ABD,isadoctoralcandidateinthedepartmentofphilosophy, RiceUniversity,Houston,TexasandanadjunctprofessorofphilosophyatHouston BaptistUniversity.HeisalsotheseniormanagingeditorofTheJournalofMedicine andPhilosophy. Ana S. Iltis, Ph.D., is Director of the Center for Bioethics, Health and Society andassociateprofessorofphilosophyatWakeForestUniversityinWinston-Salem, NorthCarolina. LaurenceB.McCullough,Ph.D.,istheassociatedirectorforEducationandinau- guralholderoftheDaltonTomlinChairinMedicalEthicsandHealthPolicyinthe CenterforMedicalEthicsandHealthPolicy,BaylorCollegeofMedicine,whereis healsoprofessorofMedicineandMedicalEthics. Griffin Trotter, M.D., Ph.D., is professor at the Center for Health Care Ethics at Saint Louis University, St. Louis, Missouri. He also has an appointment in the DepartmentofSurgery,EmergencyMedicalDivisioninSchoolofMedicineatSaint LouisUniversity. MichaelS.Yesley,J.D.,isanattorneyandwritesaboutbioethics,particularlyissues ingeneticsandresearchwithhumansubjects.HerecentlyretiredfromLosAlamos NationalLaboratory(LANL). ix Chapter 1 A Skeptical Reassessment of Bioethics H.TristramEngelhardt,Jr. 1.1 WhatIsBioethics,AfterAll:ClaimsforMoralExpertise intheFaceofIntractableMoralPluralism What is bioethics? Who is a bioethicist? Who is a health care ethics consultant or clinicalethicsconsultant?Therearenostraightforwardanswerstosuchquestions. Indeed, the attempt to answer such questions usually engenders controversies. Bioethicsisapuzzle.Bioethicsisitselfacontroversy,atheaterofdispute.Across the world, there are persons who call themselves bioethicists. But there is no agreement as to what ends they are doing what they do, as to what they should be doing, or even as to what they are doing. In hospitals across the world, there are persons who are paid as clinical ethics consultants (aka health care ethics consultants) and who are often held to be engaged in helping resolve normative questionsabouthealthcaredecisions.Butthereisnoagreementastowhatnorms they should engage. This is because there is real dispute about the content and character of both morality and bioethics. As a result, there is a puzzle as to how properlytocharacterizethenatureofthenormativequestionsposedtobioethicists, aswellastheanswersbioethicistsgive.Bioethicistsareasked,forexample,about when a particular medical intervention is inappropriate (or futile), about who should make life-or-death decisions, and concerning what information should be provided in order for a patient adequately to consent to treatment. The question is what kinds of norms and which ethics should frame such questions. In answering such questions, what norms and which norms should guide the answers? Are the normsatstakethoseestablishedatlaw?Istheethicsaboutwhichhealthcareethics consultants (HCEC) give advice simply an account of relevant law and public policy, as well as of how law and public policy is customarily applied? Or are the norms moral norms? If so, norms of which morality? These puzzles about the natureofbioethicsjustifysecondthoughtsabouttheentireendeavorofbioethics. B H.T.Engelhardt,Jr.( ) DepartmentofPhilosophy,MS-14,RiceUniversity,Houston,TX77005,USA e-mail:[email protected] H.T.Engelhardt,Jr.(ed.),BioethicsCriticallyReconsidered, 1 PhilosophyandMedicine100,DOI10.1007/978-94-007-2244-6_1, (cid:2)C SpringerScience+BusinessMediaB.V.2012