Oakland University William Beaumont School of Medicine, Royal Oak Beaumont Hospital, Oakland University, Rochester, Michigan, USA.
Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St Louis, Missouri.
Bioethics. 2022 Sep;36(7):783-793. doi: 10.1111/bioe.13046. Epub 2022 May 9.
The rich moral diversity of academic bioethics poses a paradox for the practice of giving moral recommendations in secular clinical ethics: How are ethicists to provide moral guidance in a pluralistic society? The field has responded to this challenge with a "procedural approach," but defining this term stirs debate. Some have championed a contentless proceduralism, where ethicists work only to help negotiate resolutions among stakeholders without making any moral recommendations. Others have defended a moral proceduralism by claiming that ethicists should make moral recommendations that are grounded in bioethical consensus (e.g., relevant law, policy, professional consensus statements, and bioethics literature), which is secured using moral principles such as respect for persons or justice. In contrast, we develop a moral-metaphysical proceduralism by identifying many metaphysical commitments in points of secular bioethical consensus. The moral-metaphysical view of secular clinical ethics is important because it challenges the discipline to accept the substantive philosophical foundations required to support giving moral recommendations in a pluralistic context, which may lead to further insights about the nature of the field.
学术生命伦理学中丰富的道德多样性，给世俗临床伦理学中的道德建议实践带来了一个悖论：伦理学家如何在多元社会中提供道德指导？该领域已经对这一挑战做出了“程序性方法”的回应，但对这一术语的定义引发了争议。一些人支持毫无内容的程序主义，伦理学家只致力于帮助利益相关者协商解决方案，而不提出任何道德建议。另一些人则通过声称伦理学家应该提出基于生命伦理共识的道德建议（例如，相关法律、政策、专业共识声明和生命伦理学文献）来捍卫道德程序主义，这些建议是通过尊重个人或正义等道德原则来确保的。相比之下，我们通过在世俗生命伦理学的共识点中识别出许多形而上学承诺，发展出一种道德形而上学的程序主义。世俗临床伦理学的道德形而上学观点很重要，因为它要求该学科接受在多元背景下提出道德建议所需的实质性哲学基础，这可能会进一步深入了解该领域的本质。
