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Ethics ExpertiseReview - Ethics Expertise
History, Contemporary Perspectives, and Applications
by Lisa Rasmussen (Editor)
Springer, 2005
Review by Christian Perring, Ph.D.
Jul 4th 2006 (Volume 10, Issue 27)

Can there be experts in ethics, and if so, what does it take to be one? Of course, people can know a great deal about moral philosophy, and the various theories about what makes actions right, whether ethical judgments can be objective, and so on, and so there is obviously expertise in those areas. However, it is far less obvious whether there can be experts in practical ethics -- what should we do when faced with particular ethical dilemmas? There is a good deal of agreement about what we might call mid-level moral rules: other things being equal, for example, we should not lie, cheat, break promises, steal, hurt others, nor waste all our talents. Sometimes calls for moral education seem to amount to little more than wanting to remind people of such platitudes. If that were all there was to moral knowledge, then we would not need any experts. In many of the difficult cases that arise in everyday life, though, it is not easy to see how to apply those mid-level moral rules, as they often seem to conflict with each other. For example, people sometimes want to live in ways that are not good for them: they want to drink too much, watch too much TV, have risky sex, waste their money gambling, or to fill their homes with ugly decorative plates. When can we step in and stop them from such folly? Sometimes people want to die. When should we let them kill themselves? Should we ever help them? These sorts of questions are the stuff of undergraduate courses in ethics, and professors will grade the student papers by the sophistication and subtlety of the essays. However, most ethics teachers believe it would be unethical to grade students according to whether the students agreed with the teacher's views. Teachers have to tolerate all sorts of views on these topics, and stand back from their own personal moral stances. Can an ethics expert provide the right answers to life's difficult questions?

In the contemporary technological world these can be pressing issues. Take, for example, medicine, where we now have the ability to keep people alive longer, treating previously untreatable conditions, but often at great financial cost, and sometimes with questionable benefit to the patient. Health care professionals, patients and their families often have to make difficult decisions. Should a life-support machine be turned off, and who gets to decide? Should a manic person be hospitalized? Can parents refuse a life-saving operation for their child on religious grounds? Should a doctor ever lie to a medical insurance company in order to get her patient the treatment that she needs? Should a husband's positive HIV status be disclosed to his wife against his will? Now we have clinical ethicists and ethics committees that address such questions. But what sort of training should these decision-makers and policy makers have? Who do we want in these positions of responsibility?

In a general sense, the question of whether there can be ethics experts goes back at least to Socrates when he quizzed and argued with people who claimed to know what the right answers were. But there has been more specific debate on the issue in practical ethics for more than 30 years, and medical ethics has itself become a profession in recent decades, so philosophers and other specialists can earn a living in positions where their main responsibility is to deliberate, or help others deliberate, on what is the right course of action. The essays in this collection represent both a summary of the debate about expertise in medical ethics and also take the argument a little further. The book is divided into three sections: consideration of some of the great philosophers' views on ethical expertise, then some rather abstract contemporary reflections on the topic, and finally some applications of theories and considerations of ethical experts in the modern world.

The first section has papers on Socrates, Aristotle, Hume, Mill, GE Moore, and twentieth century pragmatism. Scott Labarge explains how Socrates can deny that he is a moral expert, and yet at the same time can claim to know that other people are not experts either. His suggestion is that Socrates believes himself to have dialectical rather than moral expertise, and that he is able to judge that other people lack dialectical expertise, which is necessary for moral expertise. Carrie-Ann Biondi Khan discusses Aristotle's notion of phronesis, which is the closest that he comes to a concept of moral expertise. However, she draws the disappointing conclusion that "it is not entirely clear what phronesis is, how we acquire it, or what it enables us to perceive," (51), which will leave us rather less interested in looking to Aristotle for help on the issue. Ben Eggleston's paper on GE Moore will likewise leave the reader wondering how Moore's philosophy can help us understand ethical expertise, since so much is left unexplained in his work. Eggleston comments that Moore's conception of ethical expertise seems "hopelessly ambitious" (99).

Christopher Tollefsen's paper on Hume's distinction between true and false philosophy is interesting. Tollefsen contends that, along with much of the philosophy that Hume devoted himself to attacking, many so-called instances of ethical expertise would fall into Hume's class of false philosophy, which generates skepticism. It seems that Hume's interest in the connection between everyday assumptions and philosophical analysis of those assumptions is especially relevant to modern clinical ethics, and thus Tollefsen's paper is particularly welcome. However, it is surprising that the book contains no extended discussion of Hume's positive theory of morality as connected to human sentiment, which is also especially relevant to modern uses of ethics in practical contexts.

The most encouraging papers in this historical section for defenders of ethical expertise are those on Mill and pragmatism. Dale Miller's explanation of Mill is relatively straightforward, showing how utilitarianism can provide an account of moral expertise, which amounts to the ability to use Mill's theory well. The problem for modern ethicists is that few people are completely devoted to Mill's theory, and indeed some modern philosophers who do defend the theory vigorously are often viewed as extremists; Princeton's Peter Singer is a prime example of this, especially concerning his pronouncements on our obligations to people in other countries and our obligations to animals. Thus, until we get more general agreement as to the correctness of utilitarianism, a simple devotion to Mill's theories would not be sufficient to create a well-respected clinical ethicist.

Griffin Trotter's paper on pragmatism, especially with his focus on John Dewey, provides the most sophisticated discussion of the problems of finding a moral theory that people can agree on. Dewey rejected the notion of an ultimate ethical good and urged the importance of building consensus. While the paper does not itself solve the problem of how to achieve consensus or to answer the worry that such consensus may still be a mistake, it does set out the issues in a way that is particularly relevant to the contemporary discussion.

The next section, on contemporary perspectives, contains only three papers. Mary Ann Cutter defends a "localized" account of moral knowledge in a fairly brief paper. She explains that her view does not amount to relativism, but does involve some negotiation between the people involved. Her ideas are suggestive, but obviously she needs to set out her arguments and their applications in far more detail in order for them to be convincing or useful, since her aim of placing her views in the scope of other major moral theories is extremely ambitious. Corinna Delkeskap-Hayes seems to defend a similar sort of view in her paper with the longest title in the collection: "Societal Consensus and the Problem of Consent: Refocusing the Problem of Ethics Expertise in Liberal Democracies." The author is critical of the practice of ethical experts and argues that it is not compatible with political liberalism. This may also be the most technical and abstract in the collection: it was certainly the most difficult to read. It is quite a short paper, with only 14 pages of main text, but that is followed by 8 pages of footnotes in small font. Sentences run on for many lines, and the writing style is difficult. The paper seems to address interesting aspects of the issues, but it would have greatly benefited from a stricter editor.

The longest paper in the book is by Lisa Parker, who discusses the relation between clinical ethicists and maternal thinking. The view that maternal thinking is an important moral phenomenon (defended especially by Sara Ruddick) is closely linked to the ethics of care, which has become quite widely accepted within modern moral philosophy as an approach at least worthy of further exploration. For some, such as myself, the suggestion that mothers have distinctive modes of moral thought that are worth distinguishing from the approaches of other people is implausible and it is surprising that it is still taken seriously. Nevertheless, Parker uses Ruddick's ideas about maternal thinking as a way to characterize the approach of clinical ethicists, and this is helpful whether or not mothers really do have distinctive moral outlooks. What is especially interesting in Parker's discussion is her ability to draw on her experience as a clinical ethicist called upon to advise in cases where doctors, other health care professionals or patients were not sure how to proceed, and the analogies she draws between her role as an ethicist and a mother's role as a nurturer of children are particularly relevant. It is certainly true that ethicists act as counselors and even therapists, many of them having to do a great deal of "hand-holding." This aspect of working as an ethicist is not captured by traditional "theoretical" approaches to morality.

The final section of the book, on uses of ethical expertise in the contemporary world, will probably be of most interest to non-philosophers. Four of the five papers focus on real-life experience and reflect on philosophical issues that arise. The exception is Kenneth Cust's discussion of the philosophical counseling movement, which is mainly descriptive. Cust defends the use of philosophy to help people with philosophical problems and the increasingly common practice by a group of dedicated philosophers to offer their services in return for payment. He defends the practice as legitimate, showing the errors in some criticisms of philosophical counseling.

Robert Veatch's paper continues his long standing argument that scientific experts formulating public policy will smuggle in their normative assumptions into supposedly neutral scientific facts. Here he uses the case of recommendations for the use of anthrax vaccine, showing how a 2002 report by a committee of the Institute of Medicine uses the concepts of safety and efficacy as if they were scientific, when in fact deciding what is a reasonable level of risk requires taking a stance on values. He argues that scientific experts are not thereby moral experts, and they should be honest about how their moral views inform their recommendations. He also expresses some skepticism that there can be any such thing as moral expertise of the relevant kind that would place anyone in a position to assert what the right moral stance is. He concludes, in libertarian vein, that people should be able to make their own decisions about getting anthrax vaccinations on an individual basis.

Ana Smith Iltis sketches the roles of ethical experts in health care organizations, discussing the relation between accreditation and expertise. She comes to the rather vague conclusion that what counts as expertise in bioethics depends on context, a result that should surprise no one. Kenneth Kipnis discusses his experience in being called as an expert witness based on his role as a medical ethicist. This paper overlaps with previously published work by him, but here he focuses on the connection between teaching in a classroom and serving as an expert witness in a courtroom. He sets out in workmanlike fashion six key concepts relevant to both.

In a stimulating and accessible paper, Stephen Wear justifies the existence of medical ethics experts also drawing on his own experience as one such expert. He makes special use of a report by the American Society for Bioethics and Humanities on core competencies in health care ethics consultation from 1998. He argues that philosophical theories of ethics are in fact rarely, if ever, employed in clinical settings, and if one is going to give a credible account of what expertise consists in, it has to be something quite different from the ability to discuss ethical theories. He argues that different sorts of expertise reside both in ethics committees and in individual consultants, and so he argues that the relationship between the two should be mutually supportive. Yet at the same time, he expresses some skepticism that there can ever be real ethical expertise, since the prospects for a useful and well-grounded ethical theory seem so dim.

In sum, Ethics Expertise is a solid contribution to the literature in this area. It is an important topic, and these papers help to advance the debate.

 

2006 Christian Perring. All rights reserved.

 

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island, and editor of Metapsychology Online Reviews.  His main research is on philosophical issues in medicine, psychiatry and psychology.


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