Humanism and Theism in Biomedical Ethics

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HUMANISM AND THEISM IN BIOMEDICAL ETHICS JOSEPH FLETCHER* I have a twofold purpose. First, I want to take a look at some of the differences between humanism and theism, comparing humanly centered values as a basis for biomedical ethics, and, on the other side, an ethics based on divine commands and supernatural sanctions. The second purpose is to consider ethics in general, but especially biomedical ethics, in relation to the principles of pragmatism as it has been expounded and acted out in the American tradition. In the past quarter of a century, ethics or moral philosophy as a discipline has gone through a marked change, venturing from its classical preoccupation with metaphysics or linguistic analysis to the critical examination ofvery down-to-earth problems, especially with those being faced by responsible professionals in medicine, law, government, and the social services. As the Australian philosopher Peter Singer once put it, "Philosophers are back on thejob"—thejob, that is, of trying to sort out practical problems ofright and wrong, good and evil, in which actual human beings stand to gain or lose something when moral choices are made [I]. This is a shift of attention from metaethics, so-called, to normative ethics. This move from theory to practice is by no means treason or a sellout of "high" philosophy. Sound theory is the most important tool in the practitioner's kit. Nonetheless, some of us are convinced that, as a matter of cognition, we cannot establish a theory first and then proceed to cases. G. E. Moore said, "Casuistry is the goal of ethical investigation," the goal of getting down to cases—to what lawyers might call case law ethics and physicians might call clinical ethics [2]. Principles or guidelines, however, have to be formulated out of cases to begin with, not prior to cases. To be sound, ethical theory, like all other kinds of theory, must be born out of experiences with actual problems. It is experimental, empirical , and data based; a posteriori, not a priori. Moral rules and principles ?Address: 1841 University Circle, Charlottesville, Virginia 22903.© 1987 by The University of Chicago. AU rights reserved. 0031-5982/88/3101-0544$01.00 106 I Joseph Fletcher ¦ Humanism and Theism ought to be empirical generalizations, changeable when experience changes; not rigid laws but more like the prima facie guidelines that W. D. Ross expounded—at first sight obliging but sometimes not always so on a second look [3]. In short, the process of ethics runs from practice to theory and then back to practice again. Moore certainly never supposed that, while casuistry or case ethics is the goal, its general principles come unempirically from a transcendent source in metaphysical reasoning or religious revelation. The shift in ethics recently to actual problems promises, therefore, not only some help in practice but further gains in theory as well. In medical research and treatment both we are more likely to find good answers to value questions by consulting the scientists and clinicians than in syllogistic reasoning by armchair intellectuals, no matter how brilliandy the latter hop from premises to conclusions. Notoriously, the conclusion of a syllogism is already present in its first or major premise. Divorced from the hospital or the laboratory, all abstract and generalized talk about ethics can too easily be impersonal or unhuman and therefore unethical. Valuejudgments to be valid have to be inductive , not deductive. Theories cannot reproduce themselves; they are, as Aristotle said, steiros: beautiful, perhaps, but sterile. Medical Ethics Grows Up One very welcome result of the new normative focus in ethics is that what was for a long time called medical ethics has now grown up. Now it is "biomedical" ethics, taking into account the whole range of the life sciences, with medicine at their center. It has been converted from a concern with merely the etiquette and the deportment of physicians into quite a serious value analysis of significant practices and innovations—at both research and clinical levels. Until fairly recently, what physicians called medical ethics was litde more than a body of moralistic advice about (a) medical manners and (b) the physician's guild or association rules. It consisted of paternalistic advice about not sitting...

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