Hughes J
Princess Alexandra's Royal Air Force Hospital, Wroughton.
J Med Ethics. 1995 Feb;21(1):25-30. doi: 10.1136/jme.21.1.25.
Decisions must be justified. In medical ethics various grounds are given to justify decisions, but ultimate justification seems illusory and little considered. The philosopher Wittgenstein discusses the problem of ultimate justification in the context of general philosophy. His comments, nevertheless, are pertinent to ethics. From a discussion of Wittgensteinian notions, such as 'bedrock', the idea that 'ultimate' justification is grounded in human nature as such is derived. This discussion is relevant to medical ethics in at least five ways: it shows generally what type of certainty there is in practical ethics; it seems to imply some objective foundation to our ethical judgements; it squares with our experience of making ethical decisions; it shows something of the nature of moral arguments; and, finally, it has implications for teaching medicine and ethics.
决策必须有正当理由。在医学伦理学中，人们给出了各种理由来为决策辩护，但终极辩护似乎是虚幻的，且很少被考虑。哲学家维特根斯坦在一般哲学的背景下讨论了终极辩护的问题。然而，他的评论与伦理学相关。通过对维特根斯坦式概念（如“基石”）的讨论，得出了“终极”辩护基于人性本身这一观点。这种讨论至少在五个方面与医学伦理学相关：它总体上表明了实践伦理学中存在何种确定性；它似乎暗示了我们伦理判断的某种客观基础；它与我们做出伦理决策的经验相符；它揭示了道德论证的某种本质；最后，它对医学和伦理学教学有启示意义。
