Dell'Oro Roberto
Loyola Marymount University, 1 LMU Drive, Suite 3700 Los Angeles, CA 90045, USA.
Med Law. 2013 Jun;32(2):163-76.
The history of bioethics rests upon the assumption that, given the growing complexity of medicine, the function of ethics is, first of all, normative: ethics is supposed to help in the solution of concrete problems, and to do so systematically, by relying upon a defined set of principles and rules. The scientific character of such an approach to bioethics complements the very understanding of modern medicine as itself increasingly scientific and technical, that is, as oriented toward the production of effects. Although careful scientific attention to the patho-physiology of disease has unquestionably yielded marvelous advances in modern medicine, its positivist reduction has also created a mind-set that brackets questions of meaning, themselves highly significant to human well-being and to the ethical aspects ofmedicine. The paper claims that, rather than sharing in the "suspension of meaning" pursued by medicine for the sake of scientific objectivity, the main task of bioethics consists in a retrieval, or "anamnesis", of the very questions medicine seems to suspend: the significance of illness and disease, of birth, suffering and death, and of the service to the ethos of generosity that sustains the healing professions. Also, the paper offers a cultural "etiology" of "the suspension of meaning" in bioethics. In addition to a critical integration of positivistic attitudes in medicine and the reduction of moral discourse to the normative, one must mention the basic presumption of a cultural situation that, in the name of post-modernity, raises serious doubts against the possibility of engaging in questions of meaning across moral boundaries. As an alternative, the paper calls for a moral reflection that begins neither with the application of normative principles, nor with an attitude of resignation towards the pursuit of the good; rather with a free and open confrontation with clinical experience that attends to the moral meaning of concrete situations, recognizing that formal modes of logical argumentation are only derivative functions of the moral language, and, thus, cannot exhaust the broad spectrum of ethical discourse in bioethics.
生物伦理学的历史基于这样一种假设，即鉴于医学日益复杂，伦理学的功能首先是规范性的：伦理学应有助于具体问题的解决，并通过依靠一套既定的原则和规则系统地做到这一点。这种生物伦理学方法的科学性与对现代医学本身日益科学化和技术化的理解相辅相成，也就是说，现代医学以产生效果为导向。尽管对疾病病理生理学的仔细科学关注无疑在现代医学中带来了惊人的进展，但其实证主义的简化也创造了一种思维定式，将意义问题搁置一边，而这些问题对人类福祉和医学伦理层面本身具有高度重要性。本文认为，生物伦理学的主要任务不在于像医学为了科学客观性而追求的那样“搁置意义”，而在于找回或“回忆”医学似乎搁置的那些问题：疾病与病痛的意义、出生、痛苦与死亡的意义，以及对支撑治疗行业的慷慨精神的服务的意义。此外，本文还提供了生物伦理学中“意义搁置”的文化“病因学”。除了对医学中实证主义态度的批判性整合以及将道德话语简化为规范性之外，还必须提及一种文化状况的基本假设，即以后现代性之名，对跨越道德界限探讨意义问题的可能性提出严重质疑。作为一种替代方案，本文呼吁进行一种道德反思，这种反思既不从应用规范性原则开始，也不从对追求善的听之任之的态度开始；而是从与临床经验的自由开放的对质开始，关注具体情况的道德意义，认识到形式逻辑论证模式只是道德语言的派生功能，因此无法穷尽生物伦理学中广泛的伦理话语。
