General Questions of Bioethics

While bioethics as a field may be understood in different ways and be enriched by different perspectives, at its heart lie some basic human questions. Three of them are paramount. What kind of a person ought I to be in order to live a moral life and to make good ethical decisions? What are my duties and obligations to other individuals whose life and well-being may be affected by my actions? What do I owe to the common good, or the public interest, in my life as a member of society? The first question bears on what is often called an ethic of virtue, whose focus is that of personal character and the shaping of those values and goals necessary to be a good and decent person. The second question recognizes that what we do can affect, for good or ill, the lives of others, and tries to understand how we should see our individual human relationships—what we ought to do for others and what we have a right to expect from them. The third question takes our social relationships a step further, recognizing that we are citizens of a nation and members of larger social and political communities. We are citizens and neighbors, sometimes acquaintances, and often people who will and must live together in relatively impersonal, but mutually interdependent, ways.

These are general questions of ethics that can be posed independently of the making of biomedical decisions. They can be asked of people in almost any moral situation or context. Here we encounter an important debate within bioethics. If one asks the general question "What kind of person ought I to be in order to make good moral decisions?" is this different from asking the same question with one change—that of making "good moral decisions in medicine"? One common view holds that a moral decision in medicine ought to be understood as the application of good moral thinking in general to the specific domain of medicine (Clouser). The fact that the decision has a medical component, it is argued, does not make it a different kind of moral problem altogether, but an application of more general moral values or principles. A dutiful doctor is simply a dutiful person who has refined his or her personal character to respond to and care for the sick. He or she is empathic to suffering, steadfast in devotion to patients, and zealous in seeking their welfare.

Another, somewhat older, more traditional view within medicine is that an ethical decision in medicine is different, precisely because the domain of medicine is different from other areas of human life and because medicine has its own, historically developed, moral approaches and traditions. At the least, it is argued, making a decision within medicine requires a detailed and sensitive appreciation of the characteristic practices of medicine and of the art of medicine, and of the unique features of sick and dying persons. Even more, it requires a recognition of some moral principles, such as primum non nocere (first, do no harm) and beneficence, that have a special salience in the doctor—patient relationship (Pellegrino and Thomasma). The argument is not that the ethical principles and virtues of medical practice find no counterpart elsewhere, or do not draw upon more general principles; it is their combination and context that give them their special bite.

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