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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst Moral ResponsibilityAgency and AnswerabilityAgency and ResponsibilityAgency, 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us, without us!Oath BetrayedOf War and LawOn ApologyOn Being AuthenticOn EvilOn Human RightsOn The Stigma Of Mental IllnessOn the TakeOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne ChildOne Nation Under TherapyOne World NowOne World NowOur Bodies, Whose Property?Our Bodies, Whose Property?Our Daily MedsOur Faithfulness to the PastOur Posthuman FutureOut of EdenOut of Its MindOut of the ShadowsOverdosed AmericaOxford Handbook of Psychiatric EthicsOxford Studies in Normative EthicsOxford Textbook of Philosophy of PsychiatryPassionate DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric EthicsPsychiatry and EmpirePsychological Concepts and Biological PsychiatryPsychology and Consumer CulturePsychology and LawPsychotropic Drug Prescriber's Survival GuidePublic Health LawPublic Health Law and EthicsPublic PhilosophyPunishing the Mentally IllPunishmentPursuits of WisdomPutting Morality Back Into PoliticsPutting on VirtueQuality of Life and Human DifferenceRaceRadical HopeRadical VirtuesRape Is RapeRe-creating MedicineRe-Engineering Philosophy for Limited BeingsReason's GriefReasonably ViciousReckoning With HomelessnessReconceiving Medical EthicsRecovery from SchizophreniaRedefining RapeRedesigning HumansReducing the Stigma of Mental IllnessReflections On How We LiveReframing Disease ContextuallyRefusing CareRefuting Peter Singer's Ethical TheoryRelative JusticeRelativism and Human RightsReligion ExplainedReprogeneticsRescuing JeffreyResponsibilityResponsibility and PsychopathyResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsResponsible GeneticsRethinking CommodificationRethinking Informed Consent in BioethicsRethinking Mental Health and DisorderRethinking RapeReturn to ReasonRevolution in PsychologyRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRisk and Luck in Medical EthicsRobert NozickRousseau and the Dilemmas of Modernity Rule of Law, Misrule of MenRun, Spot, RunRunning on RitalinSatisficing 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How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
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
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
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
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.