Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Royal Oak Beaumont Hospital, Royal Oak, MI, USA.
Theor Med Bioeth. 2022 Feb;43(1):47-66. doi: 10.1007/s11017-022-09566-3. Epub 2022 Apr 2.
The national standards for clinical ethics consultation set forth by the American Society for Bioethics and Humanities (ASBH) endorse an "ethics facilitation" approach, which characterizes the role of the ethicist as one skilled at facilitating consensus within the range of ethically acceptable options. To determine the range of ethically acceptable options, ASBH recommends the standard model of decision-making (informed consent, advance directives, surrogates, best interests), which is grounded in the values of autonomy, beneficence, nonmaleficence, and justice. H. Tristram Engelhardt Jr. has sharply criticized the standard model for presuming contentful moral claims in circumscribing the range of ethically acceptable options, which, he argues, cannot be rationally justified in a pluralistic context. Engelhardt's solution is a secular clinical ethics based on a contentless principle of permission. The first part of this article lays out Engelhardt's negative claim, that reason cannot establish contentful moral claims, and his positive claim, that secular clinical ethics ought to be based on a contentless principle of permission. The second part critiques these negative and positive claims. The purpose of this paper is to defend secular clinical ethics expertise-defined as the ability of ethicists to offer justified moral recommendations grounded in consensus positions endorsed by the American Society for Bioethics and Humanities-from the radical critiques of Engelhardt, who argues that no moral or metaphysical claims, and hence no bioethical consensus, can be rationally justified. Engelhardt's critiques have caused some to worry that secular clinical ethics is in a state of theoretical crisis; this article concludes that Engelhardt's view is an unstable basis for that worry.
美国生物伦理学和人文科学学会 (ASBH) 制定的临床伦理咨询国家标准支持“伦理促进”方法，该方法将伦理学家的角色特征定义为擅长在可接受的伦理选项范围内促进共识的人。为了确定可接受的伦理选项范围，ASBH 建议采用决策的标准模型（知情同意、预先指示、代理人、最佳利益），该模型基于自主性、善行、不伤害和正义的价值观。小 H. 特里斯卓姆·恩格尔哈特 (H. Tristram Engelhardt Jr.) 强烈批评了标准模型，认为该模型在限定可接受的伦理选项范围时假定了有实质内容的道德主张，他认为，在多元化的背景下，这些主张无法得到理性的证明。恩格尔哈特的解决方案是基于无内容的许可原则的世俗临床伦理学。本文的第一部分阐述了恩格尔哈特的否定主张，即理性不能确立有实质内容的道德主张，以及他的积极主张，即世俗临床伦理学应该基于无内容的许可原则。第二部分批判了这些否定和积极的主张。本文的目的是为世俗临床伦理专业知识辩护——即伦理学家能够提供基于美国生物伦理学和人文科学学会认可的共识立场的合理道德建议——免受恩格尔哈特的激进批判，他认为，没有道德或形而上学的主张，因此也没有生物伦理共识，可以得到理性的证明。恩格尔哈特的批判使得一些人担心世俗临床伦理学正处于理论危机之中；本文的结论是，恩格尔哈特的观点是这种担忧的不稳定基础。
