Abstract
This article describes and rejects three standard views of reason in secular clinical ethics. The first, instrumental reason view, affirms that reason may be used to draw conceptual distinctions, map moral geography, and identify invalid forms of argumentation, but prohibits recommendations because reason cannot justify any content-full moral or metaphysical commitments. The second, public reason view, affirms instrumental reason, and claims ethicists may make recommendations grounded in the moral and metaphysical commitments of bioethical consensus. The third, comprehensive reason view, also affirms instrumental reason, but encourages ethicists to make recommendations grounded in the moral and metaphysical commitments of their private worldviews. A compatibilist view of public reason is then defended, which holds that each standard view captures an important role for reason in different aspects of secular clinical ethics. The article ends by identifying three implications for enduring theoretical debates in clinical ethics.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Elsewhere, I have elaborated on various critiques of Engelhardt's view in greater depth (Brummett 2021b).
See: (American Society for Bioethics and Humanities 2011, 2015, 2017; Appelbaum 2007; Beauchamp and Childress 2013; Berlinger et al. 2013; Diekema et al. 2011; Dubler and Liebman 2011; Fletcher et al. 2005; Ford and Dudzinski 2008; Hester and Schonfeld 2012; Jonsen et al. 2006; Kon et al. 2016; Lo 2009).
Bioethical consensus contains moral and metaphysical commitments. The presence of moral content in bioethical consensus is clear (as consensus positions are grounded in the values of respect for autonomy, beneficence, non-maleficence, and justice) whereas the metaphysical content has been less emphasized in the literature. One way to recognize these metaphysical claims is to understand that once it is determined what moral principles have weight, it must subsequently be determined to whom those principles apply (Veatch and Guidry-Grimes 2019, 37). Identifying persons with moral standing is a distinctly metaphysical task. Elsewhere it is argued that the metaphysical commitments of secular clinical ethics extend beyond claims of personhood to claims of the ultimate nature of reality. For example, prohibiting a Jehovah’s Witness parent from refusing a life-saving blood transfusion for their child rejects the idea that the child’s eternal salvation is threatened by receiving blood (Brummett 2019, Brummett 2021a).
On this point, Charles Camosy writes, “Consider that secular utilitarian traditions are defined by their authoritative, faith-based and transcendent answers to the following kinds of questions. What is that about which we should be ultimately concerned? Maximizing good consequences. How are we to determine what counts as good consequences? Some will say ‘pleasure over pain;’ others will talk about preferences satisfied over preferences ‘thwarted;’ still others ‘happiness over unhappiness.’ How do we aggregate consequences? ‘One counts as one and none more than one.’ But who counts as one? Do future or potential persons count? […] Answers to these (and many other) big questions are derived from the authoritative, transcendental, faith-based, first principles of traditions like hedonistic and preference utilitarianism” (Camosy 2012, 14).
A moral judgment counts as “considered” if it is screened for obvious sources of error and bias, held with a high degree of confidence, and stable (Nichols 2012). Additionally, although I focus on moral claims here, recall that bioethical consensus involves moral and metaphysical claims, which is acknowledged in the method of wide reflective equilibrium that involves bringing moral claims in coherence with non-moral (read scientific, social, metaphysical) claims (Nichols 2012; Räikkä 2009; Daniels 1996).
References
Adams, David M. 2018. Are hospital ethicists experts? Taking ethical expertise seriously. In Moral expertise, ed. Jamie Carlin Watson and Laura K.. Guidry-Grimes, 207–225. Cham: Springer.
American Academy of Pediatrics, Committee on Bioethics. 2013. Conflicts between religious or spiritual beliefs and pediatric care: Informed refusal, exemptions, and public funding. Pediatrics 132: 962–965.
American College of Obstetricians and Gynecologists. 2016. Refusal of medically recommended treatment during pregnancy. Committee Opinion No. 664. Obstetrics & Gynecology 127 (6): e175–e182.
American Society for Bioethics and Humanities. 2011. Core competencies for healthcare ethics consultation. Glenview, IL: American Society for Bioethics and Humanities.
American Society for Bioethics and Humanities. 2015. Improving competencies in clinical ethics consultation: An education guide, 2nd ed. Chicago, IL: American Society for Bioethics and Humanities.
American Society for Bioethics and Humanities. 2017. Addressing patient-centered ethical issues in health care: A case-based study guide. Chicago, IL: American Society for Bioethics and Humanities.
Appelbaum, Paul S. 2007. Assessment of patients’ competence to consent to treatment. New England Journal of Medicine 357 (18): 1834–1840.
Arnold, R., S. Youngner, and M.P. Aulisio. 1998. Core competencies for health care ethics consultation. Oakbrook, IL: American Society for Bioethics and Humanities.
Arras, John. 2016. Theory and bioethics. In Stanford encyclopedia of philosophy, ed. Edward N. Zalta. Stanford, CA: The Metaphysics Research Laboratory.
Arras, John D., Bonnie Steinbock, and Alex John London. 1999. Moral reasoning in the medical context. In Ethical issues in modern medicine, 5th ed. Houston: Mayfield Pub. Co.
Baker, Robert. 2019. The structure of moral revolutions: Studies of changes in the morality of abortion, death, and the bioethics revolution. Cambridge: MIT Press.
Beauchamp, T., and J. Childress. 2013. Principles of biomedical ethics, 7th ed. New York: Oxford University Press.
Berlinger, Nancy, Bruce Jennings, and Susan M. Wolf. 2013. The Hastings Center Guidelines for decisions on life-sustaining treatment and care near the end of life: Revised and expanded, 2nd ed. Oxford: Oxford University Press.
Bester, Johan Christiaan. 2018. The nature of ethics expertise in clinical ethics and implications for training of clinical ethics consultants. In Moral expertise, ed. Jamie Carlin Watson and Laura K. GuidryGrimes, 175–193. Cham: Springer.
Biggar, Nigel. 2015. Why religion deserves a place in secular medicine. Journal of Medical Ethics 41 (3): 229–233. https://doi.org/10.1136/medethics-2013-101776.
Brummett, Abram. 2019. Whose harm? Which metaphysic? Theoretical Medicine and Bioethics 40: 43–61.
Brummett, Abram. 2020a. The Quasi-religious Nature of Clinical Ethics Consultation. HEC Forum, Vol 32 (3), 199–209. Netherlands: Springer.
Brummett, Abram. 2020b. Reaching across the ‘deepest divide’: Moral acquaintanceship, religion, and bioethics. The Heythrop Journal LXI 677–688.
Brummett, Abram L. 2021a. Secular clinical ethicists should not be neutral toward all religious beliefs: An argument for a moral-metaphysical proceduralism. The American Journal of Bioethics: AJOB. https://doi.org/10.1080/15265161.2020.1863512.
Brummett, Abram. 2021b. Defeneding secular clinical ethics expertise from an engelhardt-inspired sense of theoretical crisis. Theoretical Medicine and Bioethics (Forthcoming).
Camosy, Charles C. 2012. The role of normative traditions in bioethics. American Journal of Bioethics 12 (12): 13–15. https://doi.org/10.1080/15265161.2012.725349.
Camosy, Charles. 2015. No view from nowhere: The challenge of grounding dignity without theology. Journal of Medical Ethics 41 (12): 938–939. https://doi.org/10.1136/medethics-2013-101467.
Churchill, Larry R. 1978. The ethicist in professional education. Hastings Center Report: 13–15.
Cohen, Cynthia B. 2006. Religion, public reason, and embryonic stem cell research. In Handbook of bioethics and religion, ed. David E.. Guinn. Oxford: Oxford University Press.
Colgrove, Nick. 2019. Responding (appropriately) to religious patients: A response to Greenblum and Hubbard’s ‘Public Reason’argument. Journal of Medical Ethics 45 (11): 716–717.
Crane, Jonathan K., and Sarah Browning Putney. 2012. Exorcising doubts about religious bioethics. American Journal of Bioethics 12 (12): 28–30. https://doi.org/10.1080/15265161.2012.719274.
Crosthwaite, Jan. 1995. Moral expertise: A problem in the professional ethics of professional ethicists. Bioethics 9 (5): 361–379.
Daniels, Norman. 1996. Justice and justification: Reflective equilibrium in theory and practice. Cambridge: Cambridge University Press.
Davis, Dena S., and Laurie Zoloth. 1999. Notes from a narrow ridge: Religion and bioethics. Hagerstown, MD: University Pub. Group, c1999.
Diekema, Douglas, Mark Mercurio, and Mary Adam. 2011. Clinical ethics in pediatrics: A case-based textbook. Cambridge: Cambridge University Press.
Dubler, Nancy N., and Carol B. Liebman. 2011. Bioethics mediation: A guide to shaping shared solutions. Nashville: Vanderbilt University Press.
Dubois, James. 2007. Avoiding common pitfalls in the determination of death. The National Catholic Bioethics Quarterly 7 (3): 545–559.
Engelhardt, H. Tristram. 1975. Defining death: A philosophical problem for medicine and law. Chicago: American Lung Association.
Engelhardt, H. Tristram. 1996. The foundations of bioethics, 2nd ed. New York: Oxford University Press.
Engelhardt Jr, T. 2000. Autonomy: The cardinal principle of contemporary bioethics. In Bioethics and biolaw, vol 2, ed. Peter Kemp. 35–46.
Engelhardt, H. Tristram. 2012. Why clinical bioethics so rarely gives morally normative guidance. In Bioethics Critically Reconsidered, 151–174. Dordrecht: Springer.
Engelhardt, H. Tristram. 2017. After God: Morality and bioethics in a secular age. Yonkers: St Vladimir’s Seminary Press.
Fletcher, John C., Edward M. Spencer, and Paul A. Lombardo. 2005. Fletcher's introduction to clinical ethics. Hagerstown: University Publishing Group.
Ford, Paul J., and Denise M. Dudzinski. 2008. Complex ethics consultations: Cases that haunt us. Cambridge: Cambridge University Press.
Garrett, Jeremy R. 2015. Cracks in the Foundations of Engelhardt’s Bioethics. In At the Foundations of Bioethics and Biopolitics: Critical essays on the thought of H. Tristram Engelhardt, Jr., 215–230. Cham: Springer.
Greenblum, Jake, and Ryan K. Hubbard. 2019. Responding to religious patients: Why physicians have no business doing theology. Journal of Medical Ethics 45 (11): 705–710.
Guinn, David E. 2006. Handbook of bioethics and religion. Oxford: Oxford University Press.
Hanson, Stephen. 2005. Engelhardt and children: The failure of libertarian bioethics in pediatric interactions. Kennedy Institute of Ethics Journal 15 (2): 179–198.
Hanson, Stephen S. 2009. Moral acquaintances and moral decisions: Resolving moral conflicts in medical ethics, vol. 103. Dordrecht: Springer Science & Business Media.
Hester, D Micah, and Toby Schonfeld. 2012. Guidance for healthcare ethics committees. Cambridge: Cambridge University Press.
Jonsen, Albert R. 2006. A history of religion and bioethics. In Handbook of bioethics and religion, ed. David E. Guinn. Oxford: Oxford University Press.
Jonsen, Albert R., Mark Siegler, and William J. Winslade. 2006. Clinical ethics: A practical approach to ethical decisions in clinical medicine. Maribor: Univerza v Mariboru, Fakulteta za zdravstvene vede.
Khushf, George. 2015. A transcendental argument for agreement as the sole sufficient basis of a philosophical ethic. In Rasmussen, Lisa M., Ana Smith Iltis, and Mark J. Cherry, eds. At the foundations of bioethics and biopolitics: Critical essays on the thought of H. Tristram Engelhardt, Jr. Vol. 125. Dordrecht, The Netherlands: Springer.
Kon, Alexander A., Eric K. Shepard, Nneka O. Sederstrom, Sandra M. Swoboda, Mary Faith Marshall, Barbara Birriel, and Fred Rincon. 2016. Defining futile and potentially inappropriate interventions: A policy statement from the Society of Critical Care Medicine Ethics Committee. Critical Care Medicine 44 (9): 1769–1774.
Lo, Bernard. 2009. Resolving ethical dilemmas: A guide for clinicians, 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, c2009.
Loewy, Erich H. 1997. Moral strangers, moral acquaintance, and moral friends: Connectedness and its conditions. Albany: Suny Press.
Malek, Janet. 2019. The appropriate role of a clinical ethics consultant’s religious worldview in consultative work: Nearly none? In HEC Forum, vol. 31(2), pp. 91–102. Netherlands: Springer.
McCarthy, Michael, Mary Homan, and Michael Rozier. 2020. There’s no harm in talking: Re-establishing the relationship between theological and secular bioethics. The American Journal of Bioethics 20 (12): 5–13.
Meyers, Christopher. 2018. Ethics expertise: What it is, how to get it, and what to do with it. In Moral expertise, 53–70. Cham: Springer.
Nichols, Peter. 2012. Wide reflective equilibrium as a method of justification in bioethics. Theoretical Medicine and Bioethics 33 (5): 325–341.
Parker, J. Clint. 2019. Religion, authenticity, and clinical ethics consultation. In HEC Forum, vol. 31(2), pp. 103–117. Netherlands: Springer.
Pellegrino, Edmund D. 2000. Bioethics at century’s turn: Can normative ethics be retrieved? The Journal of Medicine and Philosophy 25 (6): 655–675.
Räikkä, Juha. 2009. The method of wide reflective equilibrium in bioethics. In Cutting through the surface, 51–54. Leiden: Brill Rodopi.
Rasmussen, Lisa M. 2015. Non-certain foundations: clinical ethics consultation for the rest of us. In At the Foundations of Bioethics and Biopolitics: Critical essays on the thought of H. Tristram Engelhardt, Jr., 187–199. Cham: Springer.
Rasmussen, Lisa M. 2016. Clinical ethics consultants are not “ethics” experts-but they do have expertise. Journal of Medicine and Philosophy 41 (4): 384–400. https://doi.org/10.1093/jmp/jhw012.
Veatch, Robert M. 2019. Controversies in defining death: A case for choice. Theoretical Medicine and Bioethics 40 (5): 381–401.
Veatch, Robert M., and Laura K. Guidry-Grimes. 2019. The basics of bioethics. London: Routledge.
Waldron, Jeremy. 1993. Religious contributions in public deliberation. San Diego Law Review 30: 817.
Wasserman, Jason Adam, and Mark Christopher Navin. 2018. Capacity for preferences: Respecting patients with compromised decision-making. Hastings Center Report 48 (3): 31–39.
Watson, Jamie Carlin, and Laura K. Guidry-Grimes. 2018. Moral expertise: New essays from theoretical and clinical bioethics. Cham: Springer.
Wildes, Kevin Wm. 2000. Moral acquaintances methodology in bioethics. Notre Dame: University of Notre Dame Press.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare to have no conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Brummett, A. What is the appropriate role of reason in secular clinical ethics? An argument for a compatibilist view of public reason. Med Health Care and Philos 24, 281–290 (2021). https://doi.org/10.1007/s11019-021-10004-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11019-021-10004-9