How Important is Moral Theory

There can be little doubt that the quest for the foundations of bioethics can be difficult and frustrating, no less so than the broader quest for the foundations of ethics in general (MacIntyre, 1981a). Yet how important for bioethics are moral theory and the quest for a grounding and comprehensive theory? Even the answers to that question are disputed. At one extreme are those who believe that bioethics as a discipline cannot expect intellectual respect, much less legitimately affect moral behavior, unless it can show itself to be grounded in solid theory justifying its proposed virtues, principles, and rules. At the other extreme are those who contend that—even if there is no consensus on theory— social, political, and legal agreement of a kind sufficient to allow reasonable moral decisions to be made and policy to be set can be achieved. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research of the early 1980s, and the National Commission for the Protection of Human Subjects in the mid-1970s, were able to achieve considerable agreement and gain general public and professional respect even though individual members disagreed profoundly on the underlying principles of the consensus. There is of course nothing new in that experience. The American tradition of freedom of religion, for instance, has been justified for very different reasons, both theological and secular—reasons that in principle are in fundamental conflict with each other, yet are serviceable for making policy acceptable to believers and nonbelievers alike.

What kind of authority can a field so full of theoretical and practical disputes have? Why should anyone take it seriously? All important fields, whether scientific or humanistic, argue about their foundations and their findings. Bioethics is hardly unique in that respect. In all fields, moreover, agreement can be achieved on many important practical points and principles even without theoretical consensus. Bridges can be built well even if theoretical physicists disagree about the ultimate nature of matter. But perhaps most important, one way or another, moral decisions will have to be made, and they will have to made whether they are well grounded in theory or not. People must do the best they can with the material at hand. Even in the absence of a full theory, better and worse choices can be made, and more or less adequate justification can be offered. As the field progresses, even the debates on theory can be refined, offering greater insight and guidance even if the theories are still disputable.

Where, then, lies the expertise and authority of bioethics (Noble)? It lies, in the end, in the plausible insight and persuasive rationality of those who can reflect thoughtfully and carefully on moral problems. The first task of bioethics— whether the issues are clinical, touching on the decisions that must be made by individuals, or policy-oriented, touching on the collective decisions of citizens, legislators, or administrators—is to help clarify what should be argued about. A closely related task will be to suggest how these issues should be argued so that sensible, moral decisions can be made. Finally, there will be the more advanced, difficult business of finding and justifying the deepest theories and principles. There can, and will, be contention and argument at each of these stages, and it well may appear at first that no resolution or agreement can be found. Endless, unresolved disagreement in fact rarely occurs in practice, and that is why, if one looks at bioethics over a period of decades, achieved agreement and greater depth can be found, signs of progress in the field. The almost complete acceptance of such concepts as patient rights, informed consent, and brain death, for instance— all at one time heatedly disputed concepts—shows clearly enough how progress in bioethics is and can be made.

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