Moral Problems, Moral Inquiry, and Consultation in Clinical Ethics

  • Terrence F. Ackerman
Part of the Contemporary Issues in Biomedicine, Ethics, and Society book series (CIBES)


Is there an intellectual method for resolving the moral problems arising in everyday life, and in what does this method consist? Over the last 20 years, moral philosophers have rekindled their discipline’s ancient interest in what Dewey called the “problems of men.”1 Yet controversy persists over whether moral philosophers have a useful contribution to make to the resolution of these issues.


Moral Issue Moral Community Moral Problem Moral Inquiry Ethic Consultant 
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  1. 1.
    The phrase is taken from John Dewey’s collection of essays (1946) entitled, Problems of Men, Philosophical Library, New York, NY.Google Scholar
  2. 2.
    Among articles recently critical of the deductive approach are the following: Arthur Caplan (1980) “Ethical Engineers Need Not Apply: The State of Applied Ethics Today,” Science, Technology and Human Values 6 24–32;PubMedCrossRefGoogle Scholar
  3. 2a.
    Arthur Caplan (1982) “Mechanics on Duty: The Limitations of a Technical Definition of Moral Expertise for Work in Applied Ethics,” Canadian Journal of Philosophy VIII Supplement, 1–18;Google Scholar
  4. 2b.
    Arthur Caplan (1983) “Can Applied Ethics Be Effective in Health Care and Should It Strive to Be?”, Ethics 93 311–319;PubMedCrossRefGoogle Scholar
  5. 2c.
    Mark Lilla (1981) “Ethos, ‘Ethics’ and Public Service,” The Public Interest 63 3–17;Google Scholar
  6. 2d.
    Kai Nielsen, (1987) “On Being Skeptical About Applied Ethics,” Clinical Medical Ethics: Exploration and Assessment, T. Ackerman, G. Graber, C. Reynolds, and D. Thomasma (eds.), University Press of America, Washington DC, pp. 95–115;Google Scholar
  7. 2e.
    Cheryl Noble (June, 1982) “Ethics and Experts,” The Hastings Center Report 12 7–9.PubMedCrossRefGoogle Scholar
  8. 3.
    Caplan, “Mechanics on Duty,” supra, note 2, pp. 13–16.Google Scholar
  9. 4.
    The case is drawn, in summarized form, from Terrence Ackerman and Carson Strong Medical Ethics: A Clinical Casebook, Oxford University Press, New York, NY, (forthcoming).Google Scholar
  10. 5.
    “States of affairs” is a generic term used to cover the various types of things persons may cherish. These include activities, objects, and forms of interpersonal association.Google Scholar
  11. 6.
    The term “practical ethics” is preferable to “applied ethics” in describing the systematic normative study of concrete moral problems. The difficulty with the term “applied ethics” is its close connection with the deductive model of moral problem solving. Although the alternative view outlined below identifies several ways in which the results of general moral theory may be used as conceptual tools in resolving concrete moral problems, there are obvious differences between views in the role assigned to general moral theory. Therefore, in discussing proper methodology for the normative study of concrete moral problems, it seems less question-begging to describe this area of study as “practical ethics.”Google Scholar
  12. 7.
    Although philosophers do not usually think of these situations as embodying “moral problems,” they are categorized as such in common language. My experience as an ethics consultant provides evidence for this claim. Health professionals sometimes claim that they “have a good moral issue” for me. Upon analysis, it turns out to be one of these types of situations.Google Scholar
  13. 8.
    Of course, the term “considered judgment” is drawn from Rawls’ analysis of the method of reflective equilibrium. See, John Rawls (1971) A Theory of Justice, The Belknap Press, Cambridge, MA, especially pp. 17–22 and 46–53.Google Scholar
  14. 9.
    Moral problems may be created by particular situations, or by sets of situations involving conflicts among relevantly similar cherished states of affairs. A “course of action” is a plan for dealing with a moral problem created by a specific situation. A “policy” or “policy option” is a plan for dealing with a set of situations raising the same kind of moral issue, e.g., the issue of paternalism. Discussions in the medical ethics literature usually focus upon issues of policy as characterized here. On my view, policies and courses of action are morally evaluated and justified in a similar fashion. Consequently, I use the phrase “plan of action” to refer generally to policies and courses of action.Google Scholar
  15. 10.
    In this respect, the results of the present analysis closely parallel the requirements for satisfactory moral problem solving outlined by Howard Brody. See, Brody, “Applied Ethics: Don’t Change the Subject,” infra this volume, pp. 181–198.Google Scholar
  16. 11.
    See, John Dewey (1957) Human Nature and Conduct: An Introduction to Social Psychology, The Modern Library, New York, NY, pp. 178–186.Google Scholar
  17. 12.
    James Rachels (June, 1980) “Can Ethics Provide Answers?” The Hastings Center Report 10 32–40.PubMedCrossRefGoogle Scholar
  18. 13.
    “Weak paternalism” involves failure to respect a person’s choices for that person’s own good because he or she suffers from some serious defect in decision-making capacity. “Strong paternalism” protects the individual even though he or she does not suffer from a serious defect in decision-making capacity. “Soft paternalism” involves paternalistic intervention in which the patient’s own values are used to assess benefits and harms. By contrast, “hard paternalism” imposes values that are alien to the patient. For a useful classification of types of paternalism, see, James Childress (1982)Who Should Decide? Paternalism in Health Care, Oxford University Press, New York, NY, pp. 16–21.Google Scholar
  19. 14.
    See, Paul Appelbaum and Loren Roth (1983) “Patients Who Refuse Treatment in Medical Hospitals,” Journal of the American Medical Association 250 1296–1301.PubMedCrossRefGoogle Scholar
  20. 15.
    Of course, the “privileged position” of the ethics consultant can be easily transformed into a myopic viewpoint. For example, the moral philosopher steeped in the libertarian literature may seriously misjudge the current status of the reflective consensus related to the issue of medical paternalism.Google Scholar
  21. 16.
    Inappropriate expectations play a significant role in Lilla’s critique of the role of moral philosophy in professional training. See, Mark Lilla, “Ethics, ‘Ethos’, and Public Service,” supra, note 2.Google Scholar

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© The Humana Press Inc. 1989

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  • Terrence F. Ackerman

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