The many metaphysical commitments of secular clinical ethics: Expanding the argument for a moral-metaphysical proceduralism.

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.