Abstract
Even if we recognize the crucial significance of moral values and resist any form of ethical relativism and nihilism, as well as any fideistic’ secular ethical agnosticism’—as we have done in the preceding chapters—there are still many forms of ethical systems that likewise reject relativism and skepticism but otherwise take completely opposite stances when it comes to the question which medical ethics physicians and hospitals should adopt today. In the present chapter, we will deal critically with a position in medical ethics that, while not denying objective moral values of human acts, reduces them in some way to the indirect values these actions possess in virtue of bringing about consequences different from the acts themselves. This position judges the moral quality of human acts simply by a calculus of consequences and—applying the principle of proportionalism—seeks to weigh these consequences, in order to determine the morally right or wrong (good or evil) character of human acts. If adopted, this position changes traditional medical ethics radically.
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References
For a discussion of this question seeThomasine Kushner, “Doctor-Patient Relationships in General Practice—A Different Model,” J Med Ethics (Summer 1981), 9: 128–131.
where the author argues that neither “the teleological (outcome) approach” nor “the clinical model” is an adequate theory to understand “this relationship,” a relation that should, much rather, be interpreted along the lines of a new and “more appropriate basis for the physician-patient relationship”: the “relational model.”.
The classical situation ethics with its mysticism of sin and several other more personalist dimensions was very different from consequentialism and utilitarianism, but the notion of situation ethics has also been understood in a purely utilitarian (consequentialist) sense, for example by Joseph Fletcher, Situation Ethics (London: SCM Press, 1966).
see also Joseph Fletcher & John Warwick Montgomery, Situation Ethics—True or False (Minneapolis: Dimension Books, 1972).
See for a critique both of Fletcher and of the different form of situation ethics Karl Rahner has first named so, Dietrich von Hildebrand, Morality and Situation Ethics.
The notion of rule utilitarianism as well as the critique of its sufficiency as ethical theory in view of principles of justice and fairness was developed by John Rawls. See, for example, John Rawls, “Two Concepts of Rules,” Phil Rev (January 1955), 64: 3–32.
See on this also Joseph Margolis, “Rule Utilitarianism,” Austl J Phil (August 1965), 43: 220–225.
Margolis tries to show in which cases Rawls’s restrictions on utilitarian considerations do not hold and why it is “inherently impossible to distinguish rule-utilitarianism from act-utilitarianism.” For a defense of rule utilitarianism see John C. Harsanyi, “Rule Utilitarianism, Rights, Obligations and the Theory of Rational behavior,” Theor Decis (JE 1980), 12: 115–133.
The author seeks to work out the difference between ‘act’ utilitarianism and ‘rule’ utilitarianism by use of game-theoretical concepts. Act utilitarianism is in his view a ‘noncooperative’ game. In contrast, for rule utilitarianism, he thinks, moral behavior is a ‘cooperative’ game; thereby he seeks to avoid that human rights and obligations be overridden by considerations of social expediency. In reality, as we will see, this is untenable. Other authors distinguish still further kinds of utilitarianism, for example Jonathan Harrison in his “Rule Utilitarianism and Cumulative-Effect Utilitarianism,” Can J Phil (SUPP 1979), 5: 21–45.
where “the author distinguishes between rule utilitarianism, ideal-rule utilitarianism and cumulative-effect utilitarianism.”.
’ see the phenomenological rethinking of the difference between analytic and synthetic a priori in Dietrich von Hildebrand, What Is Philosophy?; Fritz Wenisch, “Insight and Objective Necessity—A Demonstration of the Existence of Propositions Which Are Simultaneously Informative and Necessarily True?“; Josef Seifert, „Was ist Philosophie? Die Antwort der Realistischen Phänomenologie“, Zeitschrift für philosophische Forschung 49 H 1 (1995): 92–103.
the same author, Erkenntnis objektiver Wahrheit.
See Erik C. W. Krabbe/ Douglas Walton, “It’s All Very Well for You to Talk! Situationally Disqualifying ‘Ad Hominem’ Attacks,” Inform Log (Spring 1993), 15(2): 79–91.
The authors identify there “situationally disqualifying, ad hominem’ attacks” as “an argumentative move in critical dialogue whereby one participant points out certain features in his adversary’s personal situation that are claimed to make it inappropriate for this adversary to take a particular point of view, to argue in a particular way, or to launch certain criticisms.” They distinguish also other types of ‘ad hominem’ argumentation.
For an interesting analysis of the effects of rule utilitarianism on problems of euthanasia and medical ethics see Gregory W. Trianosky, “Rule-Utilitarianism and the Slippery Slope,” J Phil (August 1978), 75: 414–424.
Soeren Kierkegaard, Concluding Unscientific Postscript, transl, by David F. Swenson, completed, with an introduction and notes by Walter Lowrie (Princeton: Princeton University Press, 1994), I, “Becoming Subjective.”.
See A. Laun,, “Teleologische Nonnenbegründung in der moraltheologischen Diskussion. Ein kritischer Bericht,” in Theologisch-praktische Quartalschrift, 126 Jg. H 2 (1978), pp. 167 ff.
See Tadeusz Styczeî’s contribution to the volume, Mariano Crespo (ed.), Menschenwürde: Metaphysik und Ethik (Heidelberg: Universitätsverlag C. Winter, 1998).
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Seifert, J. (2004). Are there Absolute Moral Obligations Towards Finite Goods? A Critique of ‘Teleological Ethics’ and of the Destruction of Bioethics Through Consequentialism. In: The Philosophical Diseases of Medicine and their Cure. Philosophy and Medicine, vol 82. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-2871-7_6
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