Christopher Cowley

Most discussions in ethics argue that a certain practice or act is morally justified, with any underlying theory taken as supporting a guide to general action by aiding discovery of the objectively and singularly right thing to do. I suggest that this oversimplifies the agent’s own experience of the moral dilemma, and I take the recent English case of Diane Pretty’s request for assisted suicide as an example. Here the law reacted one way, despite the obvious sympathy many felt for her. This only appears paradoxical, I suggest, because too much is expected of the concept of justification, and because moral understanding of a particular case is too often reduced to the legalistic search for general justificatory reasons. The starting point should be, I conclude, a full awareness of the phrase “there but for the grace of God go I”

The big issues of medical ethics are more in the news than ever before. And yet they remain as stubborn and often as incendiary as ever. This book claims that in an effort to deal with the issues, mainstream philosophers have arbitrarily omitted many ethically relevant features in order to reduce the central problems to more tractable technical puzzles. The most gratuitous omissions have been the patient's point of view on the problem; the patient's ordinary life, which provides the wider context for his point of view; and the ordinary language and concepts by which the patient tries to make sense of the problem.

In a recent issue of Bioethics, Bernard Gesang asks whether a moral philosopher possesses greater moral expertise than a non-philosopher, and his answer is a qualified yes, based not so much on his infallible access to the truth, but on the quality of his theoretically-informed moral justifications. I reject Gesang's claim that there is such a thing as moral expertise, although the moral philosopher may well make a valid contribution to the ethics committee as a concerned and educated citizen. I suggest that wisdom is a lot more interesting to examine than moral expertise. Again, however, moral philosophers have no monopoly on wisdom, and the study of philosophy may even impede its cultivation.

There seem to be two clearly-defined camps in the debate over the problem of moral expertise. On the one hand are the “Professionals”, who reject the possibility entirely, usually because of the intractable diversity of ethical beliefs. On the other hand are the “Ethicists”, who criticise the Professionals for merely stipulating science as the most appropriate paradigm for discussions of expertise. While the subject matter and methodology of good ethical thinking is certainly different from that of good clinical thinking, they argue, this is no reason for rejecting the possibility of a distinctive kind of expertise in ethics, usually based on the idea of good justification. I want to argue that both are incorrect, partly because of the reasons given by one group against the other, but more importantly because both neglect what is most distinctive about ethics: that it is personal in a very specific way, without collapsing into relativism.

Charles Griswold’s 2007 book Forgiveness argues that genuine forgiveness of an unexcused, unjustified and unignored offence must be normgoverned and conditional. In the same way that gift-giving is governed by norms of appropriateness, so too is forgiveness; and the appropriateness of forgiving is centrally dependent on the offender’s repentance. In response, I claim that genuine forgiveness must always be elective and unconditional, and therefore genuinely unpredictable, no matter how much – or how little – the offender repents. I consider and reject one defence of unconditional forgiveness, that of Garrard and McNaughton. I then develop my own account, which builds on Bernard Williams’ notion of practical necessity.

Richard Brandt, following Hume, famously argued that suicide could be rational. In this he was going against a common ‘absolutist’ view that suicide is irrational almost by definition. Arguments to the effect that suicide is morally permissible or prohibited tend to follow from one’s position on this first issue of rationality. I want to argue that the concept of rationality is not appropriately ascribed – or withheld – to the victim or the act or the desire to commit the act. To support this, I explore how the concept is ascribed and withheld in ordinary situations, and show that it is essentially future-oriented. Since the suicide victim has no future, it makes no sense to call his act rational or irrational. The more appropriate reaction to a declared desire for suicide, or to the news of a successful suicide, is horror and pity, and these are absent from Brandt’s account, as is a humble acknowledgement of the profound mystery at the heart of any suicide.

Although some healthcare professionals have the legal right to conscientiously object to authorise or perform certain lawful medical services, they have an associated duty to provide the patient with enough information to seek out another professional willing to authorise or provide the service (the ‘duty to refer’). Does the duty to refer morally undermine the professional's conscientious objection (CO)? I narrow my discussion to the National Health Service in Britain, and the case of a general practitioner (GP) being asked by a pregnant woman to authorise an abortion. I will be careful not to enter the debate about whether abortion should be legalised, or the debate about whether CO should be permitted—I will take both as given. I defend the objecting GP's duty to refer against those I call the ‘conscience absolutists’, who would claim that if a state is serious enough in permitting the GP's objection in the first place (as is the UK), then it has to recognise the right to withhold any information about abortion.