Arras J D
University of Virginia, Charlottesville, VA 22904-4780, USA.
J Med Philos. 2001 Dec;26(6):643-62. doi: 10.1076/jmep.26.6.643.2997.
I begin this commentary with an expanded typology of theories that endorse an internal morality of medicine. I then subject these theories to a philosophical critique. I argue that the more robust claims for an internal morality fail to establish a stand-alone method for bioethics because they ignore crucial non-medical values, violate norms of justice and fail to establish the normativity of medical values. I then argue that weaker versions of internalism avoid such problems, but at the cost of failing to provide a clear sense in which their moral norms are internal or can ground a comprehensive approach to moral problems. Finally, I explore various functions that an internal morality might serve, concluding with the observation that, while there may be a core of good sense to the notion of an internal morality of medicine, our expectations for it must be drastically lowered.
在这篇评论中,我首先对支持医学内在道德的理论进行了扩展分类。然后,我对这些理论进行了哲学批判。我认为,那些对内在道德提出的更强有力的主张未能建立起一种独立的生物伦理学方法,因为它们忽视了关键的非医学价值,违反了正义规范,且未能确立医学价值的规范性。接着我指出,较弱版本的内在主义避免了此类问题,但代价是未能清晰说明其道德规范在何种意义上是内在的,或者无法为解决道德问题提供一种全面的方法。最后,我探讨了内在道德可能发挥的各种功能,得出的结论是,虽然医学内在道德的概念可能有一定合理内核,但我们对它的期望必须大幅降低。