Robert Baker

: Medical ethics often is treated as applied ethics, that is, the application of moral philosophy to ethical issues in medicine. In an earlier paper, we examined instances of moral philosophy's influence on medical ethics. We found the applied ethics model inadequate and sketched an alternative model. On this model, practitioners seeking to change morality "appropriate" concepts and theory fragments from moral philosophy to valorize and justify their innovations. Goldilocks-like, five commentators tasted our offerings. Some found them too cold, since they had already abandoned applied ethics; others too hot, since they still find the applied ethics model to their taste. We reply that the appropriation model offers an empirically testable account of the historical relationship between moral philosophy and medical ethics that explains why practitioners appropriate concepts and fragments from moral philosophy. In contrast, the now fashionable common morality theory neither explains moral change nor why practitioners turn to moral philosophy.

The Cambridge World History of Medical Ethics is the first comprehensive scholarly account of the global history of medical ethics. Offering original interpretations of the field by leading bioethicists and historians of medicine, it will serve as the essential point of departure for future scholarship in the field. The volumes reconceptualize the history of medical ethics through the creation of new categories, including the life cycle; discourses of religion, philosophy, and bioethics; and the relationship between medical ethics and the state, which includes a historical reexamination of the ethics of apartheid, colonialism, communism, health policy, imperialism, militarism, Nazi medicine, Nazi "medical ethics," and research ethics. Also included are the first global chronology of persons and texts; the first concise biographies of major figures in medical ethics; and the first comprehensive bibliography of the history of medical ethics. An extensive index guides readers to topics, texts, and proper names.

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer two historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced.

After briefly reviewing the historical development and ethical regulation of resuscitative technologies, this study probes why clinicians engage in the morally problematic practice of show and slow coding and why hospitals tolerate it? Studies conducted in 1995 and 2020 indicate that conscientious clinicians engage in these practices to protect their patients from abusive or futile resuscitation. And hospitals' clinical cultures tolerate these practices to protect conscientious clinicians from censure, dismissal, delicensing, or legal prosecution for withholding or withdrawing abusive or futile resuscitative technologies without prior patient or surrogate consent. Show and slow coding evolved in American clinical cultures in the second half of the 20th century when closed‐chest cardiac massage, defibrillators, ventilators, and other resuscitative technologies raised seemingly novel ethical questions. To address these questions, bioethics commissions, healthcare societies, lawmakers, and a Roman Catholic Pope developed ethics standards requiring clinicians to obtain patient or surrogate consent before withholding or withdrawing resuscitative technologies. They thus conferred on patients an implicit right of resuscitation even if it was abusive and/or futile. Conscientious clinicians circumvented this implicit right by show and slow coding to protect patients from abusive resuscitation. Recognizing clinicians' benign intent, hospitals' clinical cultures tolerate show and slow coding as acts of conscience, akin to civil disobedience. Thus, rescinding ethics standards and laws requiring prior patient/surrogate consent for non‐resuscitation or for cessation of resuscitative technologies decisions should end show/slow coding. Such a reform should also recognize clinicians' right of conscientious refusal to perform CPR.

The central thesis of this article is that by anchoring bioethics' core conceptual armamentarium in a four-principled theory emphasizing autonomy and treating justice as a principle of allocation, theorists inadvertently biased 20th-century bioethical scholarship against addressing such subjects as ableism, anti-Black racism, classism, and other forms of discrimination, placing them outside of the scope of bioethics research and scholarship. It is also claimed that these scope limitations can be traced to the displacement of the nascent concept of respect for persons—a concept designed to address classist and racist discrimination—with the morally solipsistic concept of autonomy.

I was the graduate student that Albert Jonsen so aptly describes. Bronx born and educated at the City College of New York, I emigrated to the Midwest to study at the Minnesota Center for the Philosophy of Science, where May Brodbeck, Herbert Feigl and other “logical positivists” were engaging in an ongoing dialogue with postpositivists like Paul Feyerabend and Karl Popper. In this environment, I studied philosophy of science, epistemology, and metaethics—the epistemology and logic of ethical concepts and language. I even wrote my thesis on the ur-text of the metaethical turn, G. E. Moore's Principia Ethica. Then, like other epistemologists and metaethicists, “a public disaster, the American military involvement in Southeast Asia,” as well as the burgeoning civil rights movement, drew me into the sphere of public debate

Tom Beauchamp and James Childress‘s revolutionary textbook, Principles of Biomedical Ethics, shaped the field of bioethics in America and around the world. Midway through the Principle’s eight editions, however, the authors jettisoned their attempt to justify the four principles of bioethics —autonomy, beneficence, nonmaleficence, justice—in terms of ethical theory, replacing it with the idea that these principles are part of a common morality shared by all rational persons committed to morality, at all times, and in all places. Other commentators contend that their theory has never been empirically confirmed and is unfalsifiable, since counterexamples can be deemed irrational, or as held by those living lives not committed to morality. The thesis of this paper is that common morality theory is the artifact of a category mistake—conflating common areas regulated by moral norms with common norms regulating moral conduct—that accords mid-twentieth century American liberal morality the status of transcultural, transtemporal, eternal moral truths. Such a conception offers bioethicists no tools for analyzing moral change—moral progress, regress, reform, evolution, devolution, or revolution—no theoretical basis for deconstructing structural classicism, racism, and sexism, or for facilitating international cooperation on ethical issues in the context of culturally based moral differences.

Although bioethics societies are developing standards for clinical ethicists and a code of ethics, they have been castigated in this journal as “a moral, if not an ethics, disaster” for not having completed this task. Compared with the development of codes of ethics and educational standards in law and medicine, however, the pace of pro-fessionalization in bioethics appears appropriate. Assessed by this metric, none of the charges leveled against bioethics are justified. The specific charges leveled against the American Society for Bioethics and Humanities and its Core Competencies report are analyzed and rejected as artifacts of an ahistoric conception of the stages by which organizations professionalize. For example, the charge that the ASBH should provide definitive criteria for what counts as “medical ethics consultation” antecedent to further progress towards professionalization is assessed by comparing it with the American Medical Association's decades-long struggle to define who can legitimately claim the title “medical doctor.” Historically, clarity about who is legitimately a doctor, a lawyer — or a “clinical ethicist”— is a byproduct of, and never antecedent to, the decades-long process by which a field professionalizes. The charges leveled against ASBH thus appear to be a function of impatient, ahistoric perfectionism.