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Ethics or Moral Philosophy pp 195–216Cite as

Médecine et philosophie morale (1990–2010)

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Part of the book series: Contemporary Philosophy: A New Survey ((COPH,volume 11))

Abstract

In a context of anxiety as for the scientific progress, early bioethics did focus on moral topics: when new biomedical techniques are scientifically possible, does it mean that they are morally grounded? Early bioethics thus widely took shape around strong collaborations between medicine and moral philosophy, and admitted a subordination of the legal and practical rules to the moral standards (respect the human dignity for example), by opposition to the social or scientific standards. But with the emergence in bioethics of new trends, carried by sociologists and philosophers claiming for a new understanding of bioethics as social or political issues, the subordination of the legal and practical rules to the moral standards is widely discussed. In this context, the moral nature of bioethics is challenged: given the importance of issues around social justice and democracy in health, considering the increasing matters of conflicts of interest, doesn’t bioethics call rather a social or political reflection? The present article is focused on these topics. It examines, through an epistemological standpoint, recent developments between moral philosophy, medicine, sociology and politics in biomedical field.

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Notes

  1. 1.

    Association Médicale Mondiale – World Medical Association (wma), Declaration of Helsinki, Recommendations guiding physicians in biomedical research involving human subjects, adopted by the 18th World Medical Assembly, Helsinki, Finland, June 1964, and amended by the 29th wma, Tokyo, Japan, Oct 1975 ; 35th wma, Venice, Italy, Oct 1983 ; 41st wma, Hong Kong, Sep. 1989; the 48th General Assembly, Somerset West, Republic of South Africa, Oct 1996 ; and the 52nd wma, Edinburgh, Scotland, Oct. 2000. <http://www.wma.net/=.

  2. 2.

    National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report : Ethical Principles and Guidelines for Research Involving Human Subjects, 1978, Washington d.c. : us Govt Printing Office (dhew) ; tr. fr. in : Médecine et expérimentation, Cahiers de bioéthique , 4, Québec, Presses de l’Université Laval, 1982, 233–250.

  3. 3.

    « Frameworks drawn from moral philosophy suggested that bioethics could be given universal, principled moral foundations as well as practical methods of inquiry. […] Thus there arose in the late 1970s and early 1980s the idea that universal principles drawn from moral philosophy could be made theorically interesting and practically relevant in medical ethics », in : Beauchamp Tom L. ‘Does Ethical Theory Have a Future in Bioethics ? ’, Journal of Law, Medicine and Ethics, 2004, 209–217 (p. 210).

  4. 4.

    Organisation Mondiale de la Santé – World Medical Organization (oms-who) & Conseil International des Organisations Médicales Scientifiques (cioms), Déclaration de Manille, 1981 ; Directives internationales pour la recherche biomédicale sur des sujets humains / Proposed International Guidelines for Biomedical Research Involving Human Subjects, Genève, cioms, 1982 ; revised, International Ethical Guidelines for Biomedical Research Involving Human Subjects, Genève, cioms, 1993.

    <http://www.cioms.ch/draftguidelines=.

  5. 5.

    Beauchamp T. L. & Childress J. F. (1979) Principles of Biomedical Ethics. Oxford : Oxford University Press, 3rd ed 1989 ; revised edition, 2001. – Howard-Jones N. & Bankowski Z. (1979) Medical Experimentation and the Protection of human Rights, XIIth cioms Round Table Conference. Geneva : oms-cioms. – Veatch Robert M. (1981) A Theory of Medical Ethics. New York : Basic Books. – Fagot-Largeault A. (1985) L’homme bio-éthique. Pour une déontologie de la recherche sur le vivant. Paris : Maloine. – Engelhardt Jr. H. Tristram (1986) The Foundations of Bioethics. Oxford : University Press. – Hottois Gilbert & Parizeau Marie-Hélène (éds) (1993) Les mots de la bioéthique . Un vocabulaire encyclopédique. Bruxelles : De Boeck.

  6. 6.

    Kemp Peter (Dir.) (2004) Le discours bioéthique . Paris : Cerf. – Häyry Matti ‘Ethics Committees, Principles and Consequences’, Journal of Medical Ethics, 1998, 24 : 81–85 ; ‘European Values in Bioethics : Why, What and How to Be Used ? ’, Theoretical Medicine, 2003, vol. 24, pp. 199–214.

  7. 7.

    Sugarman J., ‘The Future of Empirical Research in Bioethics’, op. cit., 2004, table 2, p. 227.

  8. 8.

    op. cit., 2004.

  9. 9.

    Voir par exemple Solomon M. ‘Realizing Bioethics’ Goals in Practice : Ten Ways is can help ought’, Hastings Center Report, 2005, 35 (4) : 40–47.

  10. 10.

    Wilkie T., ‘Navigating the Moral Maze : The Bioethics Program’, Welcome News, 1998, vol. 14 ; cité par Bennet Rebecca & Cribb Alan (2003) ‘The Relevance of Empirical Research to Bioethics : Reviewing the Debate’, in Scratching the Surface of Bioethics, op. cit., 9–18 (p. 11).

  11. 11.

    Borry P. et al, op. cit., 2005, p. 65–66.

  12. 12.

    Association des établissements de réadaptation en déficience physique du Québec (aerdpq), L’éthique clinique : un portrait en évolution…, rédigé par Dion-Labrie M., avec la collaboration des membres du Comité provincial d’éthique, 2008, isbn : 978-2-921625-54-8, en ligne.

  13. 13.

    Hedgecoe A. M., ‘Critical Bioethics : Beyond the Social Science Critique of Applied Ethics’, Bioethics, 2004, 18 (2) : 120–143 (p. 131). – Levitt Mairi, ‘Better Together ? Sociological and Philosophical Perspectives on Bioethics’, in Scratching the Surface of Bioethics, op. cit., 2003, p. 20–25.

  14. 14.

    Leget C. et al, op. cit.

  15. 15.

    Bioethics, 2009, 23 (4).

  16. 16.

    ‘Special Section : Empirical Ethics’, Cambridge Quarterly of Healthcare Ethics, vol. 21 n° 4, October 2012.

  17. 17.

    Voir : De Vries Raymond ‘(Bio)Ethics and Evidence : From Collaboration to Co-operation’, in Gastmans C., Diericks K., Nys H., Schotsmans P. (eds) (2007) New Pathways for European Bioethics. Antwerpen : Intersentia, p. 7–20. – Marshall P. A. & Koenig B. A. ‘Bioéthique et anthropologie ; situer le bien dans la pratique médicale’, Anthropologie et sociétés, 2000, 24 (2) : 35–55. – De Vries R. & Gordijn B. ‘Empirical Ethics and its Alleged Meta-Ethical Fallacies’, Bioethics, 2009, 23 (4) : 193–201.

  18. 18.

    Hellsten Sirkku K. ‘Why “Definitions” Matter in Defining Bioethics ? ’, in Cutting Through the Surface : Philosophical Approaches to Bioethics, op. cit., 2009, pp. 9–18.

  19. 19.

    Nous présentons ici un résumé détaillé de la proposition de Leget et al, op. cit., 2009. Pour un autre modèle de ce type, voir : Levitt M., ‘Better Together ? Sociological and Philosophical Perspectives on Bioethics’, in Scratching the Surface of Bioethics, op. cit., 2003, p. 20–25.

  20. 20.

    Ives J. & Draper H., op. cit.

  21. 21.

    Baertschi Bernard (2005) De la bioéthique à la neuroéthique, 2005, en ligne : www.contrepointphilosophique.ch/. Evers Kathinka (2009) Neuroéthique. Quand la matière s’éveille. Paris : Odile Jacob.

  22. 22.

    Voir : Euron Roboethics Roadmap, en ligne.

  23. 23.

    Pour un exposé succinct, voir : Benaroyo L., ‘Éthique narrative’, in Nouvelle encyclopédie de bioéthique , op. cit., p. 407–409.

  24. 24.

    En 2007 la Haute autorité britannique en charge de la régulation des activités d’assistance médicale à la procréation et de la recherche sur l’embryon (hfea) organisa une consultation publique visant à décider si l’on pouvait, ou non, autoriser des chercheurs à créer par transfert de noyau des cellules souches hybrides homme-animal, composées d’un ovocyte de vache énucléé, et d’un noyau de cellule humaine. La consultation publique sur les « implications éthiques et sociales de créer de telles entités » fut plutôt favorable à la proposition. L’autorisation fut accordée. Il s’agit, en somme, d’une décision éthique prise à la majorité, dont Shirley Harrison , présidente de la hfea, reconnut le caractère ‘politique’ : « We have gained a valuable insight into public opinion as a result of this consultation and this has enabled us to make a policy decision based on robust evidence ». Voir : hfea Hybrids and Chimeras. A Report on the Findings of the Consultation. uk, October 2007, en ligne.

  25. 25.

    « If bioethics is capacious enough to include libertarians, communitarians, deontologists, neo-kantians, utilitarians, neo-aristotelians, virtue theorists, feminists, rawlsians, habermasians, narrative theorists, interpretivists, principlists, casuists, civic republicans, liberal egalitarians and religious ethicists of every persuasion, does bioethics exist as something other than a loosely connected assemblage of conflicts over norms, principles, practices and policies ? » : Turner L., ‘Does Bioethics Exist ? ’, Journal of Medical Ethics, 2009, 35 : 778–780.

  26. 26.

    Sur les conflits entre philosophes et sociologues, voir notamment : Bennet R. & Cribb A. ‘The Relevance of Empirical Research to Bioethics : Reviewing the Debate’, in Scratching the Surface of Bioethics, op. cit., 2003, p. 9–18. – Levitt M. ‘Better Together ? Sociological and Philosophical Perspectives on Bioethics’, in Scratching the Surface of Bioethics, op. cit., 2003, p. 20–25.

  27. 27.

    Garrard E. & Wilkinson S. ‘Mind the Gap : The Use of Empirical Evidence in Bioethics’, op. cit., 2005, p. 77–89.

  28. 28.

    De Vries R., ‘(Bio)Ethics and Evidence : From Collaboration to Co-operation’, op. cit., 2007, p. 7–20.

  29. 29.

    Sur cette question des sociologues se sont exprimés. Voir : Borry P., Schotsmans P., Diericks K. ‘The Birth of Empirical Turn in Bioethics’, op. cit., 2005.

  30. 30.

    Voir : Veatch Robert M. ‘The Place of Care in Ethical Theory’, Journal of Medicine and Philosophy, 1998, 23 (2) : 210–224. – Held Virginia (2005) The Ethics of Care. Oxford : Oxford University Press. – Laugier Sandra ‘Le care : enjeux politiques d’une éthique féministe’, Raison publique, avril 2007, 6 : 29–47. – Garrau Marie ‘Care (Éthiques et politiques du)’, in Dictionnaire de théorie politique (DicoPo), 2008, online

    http://www.dicopo.fr/spip.php?article101. – Molinier Pascale, Laugier Sandra, Paperman Patricia (2009) Qu’est-ce que le care ? Souci des autres, sensibilité, responsabilité . Paris : Payot. – Worms Frédéric (2010) Le moment du soin. A quoi tenons-nous ? Paris : puf.

  31. 31.

    Rousseau Jean-Jacques, Émile ou de l’éducation, 1762, Livre 4 (‘Profession de foi du vicaire savoyard’).

  32. 32.

    Hume David (1748) An Enquiry Concerning the Principles of Morals, section 3.

  33. 33.

    Smith Adam (1759) The Theory of Moral Sentiments, revised 1761, 1790 ; ed. by Raphael D. D. & Macfie A. L., Oxford : oup, 1976. (I, i, chap. 1, §1.)

  34. 34.

    Schopenhauer Arthur (1841) Über die Grundlage der Moral.

  35. 35.

    Jonas Hans (1979) Das Prinzip Verantwortung. Versuch einer Ethik für die technologische Zivilisation. Frankfurt-am-Main : Suhrkamp. Engl. transl. H. Jonas & D. Herr , The Imperative of Responsibility. In Search of an Ethics for the Technological Age. Chicago : University Press, 1984. Trad. fr. J. Greisch , Le principe responsabilité . Une éthique pour la civilisation technologique. Paris : Cerf, 1990.

  36. 36.

    op. cit., 1998.

  37. 37.

    Sur les limites d’un paternalisme acceptable, voir une discussion dans : Ogien Ruwen (2007) L’éthique aujourd’hui. Maximalistes et minimalistes. Paris : Gallimard, chap. 6 et 7.

  38. 38.

    Garrau Marie ‘Care (Éthiques et politiques du)’, in Dictionnaire de théorie politique (DicoPo), 2008, online http://www.dicopo.fr/spip.php?article101.

  39. 39.

    Sur la politisation de la bioéthique , voir : Tronto Joan (1993) Moral Boundaries : a Political Argument for an Ethic of Care ; trad. fr. par Hervé Maury , Un monde vulnérable, pour une politique du care. Paris : La Découverte, 2009. – Holm S. ‘Bioethics Down Under – Medical Ethics Engages with Political Philosophy’, Journal of Medical Ethics, 2005, vol. 31 (1) : 1–1. – Turner Leigh ‘Politics, Bioethics and Science Policy’, hec Forum, 2008, 20 (1) : 29–47. – Brown M. ‘Three Ways to Politicize Bioethics’, American Journal of Bioethics, 2009, 9 (2) : 43–54.

  40. 40.

    Tronto Joan C. ‘Care as the Work of Citizens. A Modest Proposal’, in Friedman M. (Dir.) (2005) Women and Citizenship. Oxford University Press, p. 130–145. Voir aussi : Tronto Joan (1993) Moral Boundaries : a Political Argument for an Ethics of Care. New York : Routledge ; trad. fr. H. Maury , Un monde vulnérable. Pour une politique du care. Paris : La Découverte, 2009.

  41. 41.

    Sen Amartya (2009) The Idea of Justice (in memory of John Rawls ). uk : Allen Lane ; Penguin Books, 2010.

  42. 42.

    United Nations Development Programme (undp), Human Development Report 2010, 20th Anniversary Edition, The Real Wealth of Nations : Pathways to Human Development, http://hdr.undp.org/en/reports/global/ hdr2010/. Programme des Nations Unies pour le développement (pnud), Édition du 20e anniversaire, La vraie richesse des nations : Les chemins du développement humain, http://hdr.undp.org/fr/

  43. 43.

    Unesco (United Nations Educational, Scientific and Cultural Organization / Organisation des Nations Unies pour l’éducation, la science et la culture) Universal Declaration on Bioethics and Human Rights / Déclaration universelle sur la bioéthique et les droits de l’homme, 19 octobre 2005.

  44. 44.

    Gillon R. (ed.) (1994) Principles of Health Care Ethics. New York : John Wiley and Sons. – Kuhse Helga & Singer Peter (eds) (1999) Bioethics. An Anthology. Oxford : Blackwell, repr., 2001.

  45. 45.

    Hottois Gilbert & Missa Jean-Noël (Dir.), (2001) Nouvelle Encyclopédie de bioéthique . Bruxelles : De Boeck. – Post Stephen G. Encyclopedia of Bioethics. New York : Macmillian, Thomson, 5 vols, 3rd ed., 2003.

  46. 46.

    Cahiers du Mouvement Universel de la Responsabilité Scientifique (murs), spécial : Ethique : une ou plurielle ? , 2004, 43. – Moreno Jonathan D. ‘The End of the Great Bioethics Compromise’, Hastings Center Report, 2005, 35 (1) : 14–15.

  47. 47.

    Un constat désabusé de relativisme : « Bioethics as an academic discipline has gradually lost some of his earlier reflective age. It now has a tendency to fall into epistemological and ethical relativism and uncritically support all possible approaches to the issues which it deals. It no longer matters whether different views are validly argued for or not. Whether they rely on analytical, empirical or intuitive method of verification, they are all considered “equally valuable” and thus “equally right” ». (Hellsten Sirkku K “Why ‘Definitions’ Matter in Defining Bioethics ? ”, in Cutting through the Surface : Philosophical Approaches to Bioethics, op. cit., 2009.

  48. 48.

    Takala et al., op. cit., 2009.

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Authors and Affiliations

  1. Centre de Recherche Sens Ethique Société, CNRS/Université Paris-Descartes, UMR 8137, Paris, France

    Valérie Gateau

  2. Philosophie des Sciences Biologiques et Médicales, Collège de France, 11, place Marcelin-Berthelot, 75005, Paris, France

    Valérie Gateau & Anne Fagot-Largeault

  3. Université Paris-Descartes, Paris, France

    Anne Fagot-Largeault

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  1. Valérie Gateau
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  1. University of Oslo Institute for the History of Ideas, Oslo, Norway

    Guttorm Fløistad

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Gateau, V., Fagot-Largeault, A. (2014). Médecine et philosophie morale (1990–2010). In: Fløistad, G. (eds) Ethics or Moral Philosophy. Contemporary Philosophy: A New Survey, vol 11. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6895-6_14

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