On the kind advice of Michael Schwartz, I am cross-posting this comment from my weblog, Medical Humanities Blog.
"A couple of thoughts spring to mind. First, one can be dubious of the implication that the proliferation of codes of ethics is either necessary or sufficient to produce virtuous behavior. Second, one can be equally if not more dubious of the idea that a consensus on the importance of certain principles is either necessary or sufficient to produce virtuous behavior. My problem with principlism, per se, is that it seems either false or thin. As Mackie argued, the stunning diversity of moral beliefs across communities and cultures requires the belief either that moral universalism and moral objectivism are quite simply wrong or that the vast majority of moral communities are delusional or mistaken when it comes to practicing virtuous forms of life.
Even if universal principles are coherent, one has to articulate them at such a high level of generality they become greatly detached from the local moral worlds in which people live their lives. Moral thickness is found only in these local worlds, which is one reason I find moral particularism so attractive. A broad commitment to justice is perfectly fine; but such a commitment has little to do with whether Paul and Jane may reach diametrically opposed positions on what such a commitment entails in this case or that case.
This argument is both quite friendly to a Wittgensteinian moral epistemology, as well as the ethos of the humanists, who demanded of themselves and their educational program (studia humanitatis) that it be deeply rooted in actual practices, as opposed to the abstractions of the Scholastics.
Thus, while I am sympathetic to the pedagogical aims of the authors -- that we need to find ways of faciliating the translation of ethics education into medical practice -- I am quite dubious that searching for a "unified" principlism in applied ethics is likely to succeed in this endeavor. As noted here, I believe that we must dispense with the quixotic quest for what Leigh Turner has termed "moral Esperanto" and get on with the tasks of reflecting how practical wisdom is and ought to be expressed in particular (local) moral worlds.
Finally, kudos to the authors for actually engaging the literature on the hidden and informal curricula, which suggest that efforts to improve ethical practices among clinicians simply will not succeed if they consist merely of formal pedagogies targeted at undergraduate medical students. Because it is the more senior practitioners who shape professional practices, if attitudes, practices, and beliefs regarding ethics are problematic in any given scenario, ethics education simply must proceed from the top-down as well as the bottom-up if change is desired.
It is long past time to dispense with the convenient fiction that the best way to produce virtuous behavior in health providers is via an ethics course in the formal curriculum. I hasten to add I certainly applaud the presence of such courses; I merely object to the practice by which such courses constitute the majority of ethics education in health professional education."
Problems with principlism
15 January 2010
On the kind advice of Michael Schwartz, I am cross-posting this comment from my weblog, Medical Humanities Blog.
"A couple of thoughts spring to mind. First, one can be dubious of the implication that the proliferation of codes of ethics is either necessary or sufficient to produce virtuous behavior. Second, one can be equally if not more dubious of the idea that a consensus on the importance of certain principles is either necessary or sufficient to produce virtuous behavior. My problem with principlism, per se, is that it seems either false or thin. As Mackie argued, the stunning diversity of moral beliefs across communities and cultures requires the belief either that moral universalism and moral objectivism are quite simply wrong or that the vast majority of moral communities are delusional or mistaken when it comes to practicing virtuous forms of life.
Even if universal principles are coherent, one has to articulate them at such a high level of generality they become greatly detached from the local moral worlds in which people live their lives. Moral thickness is found only in these local worlds, which is one reason I find moral particularism so attractive. A broad commitment to justice is perfectly fine; but such a commitment has little to do with whether Paul and Jane may reach diametrically opposed positions on what such a commitment entails in this case or that case.
This argument is both quite friendly to a Wittgensteinian moral epistemology, as well as the ethos of the humanists, who demanded of themselves and their educational program (studia humanitatis) that it be deeply rooted in actual practices, as opposed to the abstractions of the Scholastics.
Thus, while I am sympathetic to the pedagogical aims of the authors -- that we need to find ways of faciliating the translation of ethics education into medical practice -- I am quite dubious that searching for a "unified" principlism in applied ethics is likely to succeed in this endeavor. As noted here, I believe that we must dispense with the quixotic quest for what Leigh Turner has termed "moral Esperanto" and get on with the tasks of reflecting how practical wisdom is and ought to be expressed in particular (local) moral worlds.
Finally, kudos to the authors for actually engaging the literature on the hidden and informal curricula, which suggest that efforts to improve ethical practices among clinicians simply will not succeed if they consist merely of formal pedagogies targeted at undergraduate medical students. Because it is the more senior practitioners who shape professional practices, if attitudes, practices, and beliefs regarding ethics are problematic in any given scenario, ethics education simply must proceed from the top-down as well as the bottom-up if change is desired.
It is long past time to dispense with the convenient fiction that the best way to produce virtuous behavior in health providers is via an ethics course in the formal curriculum. I hasten to add I certainly applaud the presence of such courses; I merely object to the practice by which such courses constitute the majority of ethics education in health professional education."
Competing interests
no competing interests