Medicine and Bioethics as a Democratic Moral Tradition
Student Essay - First Place
Caterina Baffa, Boston College, Newton, MA
In “Bioethics, the Body, and the Legacy of Bacon,” Gerald McKenny paints a stark picture of the moral landscape of contemporary Western medicine and bioethics, especially in the United States. He argues that medicine and its ethics are incapable of even discerning its own ends of providing wisdom and care to promote bodily health. According to McKenny, there is a dearth of vocabulary available even for the most pressing ethical issues of medicine, such as the limits of technology. This lack of a moral framework is particularly alarming considering the sensitive nature of medicine; clinicians often meet patients at their most vulnerable states, as the patients seek to make meaning of their corporeality and to improve their health. In this presentation, I will consider multiple facets of the moral project underlying contemporary American medicine and bioethics to identify its key features and discern its nature. My primary question is: do medicine and healthcare constitute a coherent and independent moral tradition? If so, what does this tradition look like, and how does it operate in the world? In exploring these questions, better understanding the contours of this tradition will help to illuminate how it might interact with the moral agency of patients, especially those existing on the margins of society.
To explore these questions, I will consider discourse from the last century regarding the nature of moral traditions. From the lens of moral traditions, ethics develops from within communities that mold their members according to certain norms, values, and habits. Given McKenny’s concerns around the moral strength of medicine’s ethics, it will be important to understand if medicine itself looks anything like a coherent moral tradition at all. As such, I will ground my understanding of moral traditions in Alasdair MacIntyre’s presentation of traditions and his understanding of their characteristics. From there, I will turn to a strong critic of MacIntyre: Jeffrey Stout. Stout’s understanding of American liberal democracy as a moral tradition is more metaphysically austere and activity-dependent than MacIntyrian virtue ethics, making it a suitable counterpoint to MacIntyre’s traditions when considering the practical quality of medical ethics. By examining multiple interpretations of recent healthcare history—taking insight from scholars like Michel Foucault, Jeffrey Bishop, Paul Starr, Tom Beauchamp, and James Childress—I will suggest that the moral project of medicine possesses some of the qualities of a moral tradition because it sustains a particular way of learning and knowing, of existing as a social entity, and of ethically evaluating the world. This moral tradition, I will argue, looks most like Stout’s democratic tradition because it is based on professional activity and dialogue that maintain the reality of objective truth but seek practical moral goals over metaphysical ones. This, in turn, reveals the ways that medicine fails to live up to Stout’s democratic vision, as well as the ways that a democratic medical tradition is liable to significant concerns due to its pragmatic nature. Moreover, such an analysis helps to identify the ways that healthcare may fail to educate and support patients to exercise their moral agency as they navigate treatment, especially in the case of patients already facing additional social and financial burdens alongside their illness.
To explore these questions, I will consider discourse from the last century regarding the nature of moral traditions. From the lens of moral traditions, ethics develops from within communities that mold their members according to certain norms, values, and habits. Given McKenny’s concerns around the moral strength of medicine’s ethics, it will be important to understand if medicine itself looks anything like a coherent moral tradition at all. As such, I will ground my understanding of moral traditions in Alasdair MacIntyre’s presentation of traditions and his understanding of their characteristics. From there, I will turn to a strong critic of MacIntyre: Jeffrey Stout. Stout’s understanding of American liberal democracy as a moral tradition is more metaphysically austere and activity-dependent than MacIntyrian virtue ethics, making it a suitable counterpoint to MacIntyre’s traditions when considering the practical quality of medical ethics. By examining multiple interpretations of recent healthcare history—taking insight from scholars like Michel Foucault, Jeffrey Bishop, Paul Starr, Tom Beauchamp, and James Childress—I will suggest that the moral project of medicine possesses some of the qualities of a moral tradition because it sustains a particular way of learning and knowing, of existing as a social entity, and of ethically evaluating the world. This moral tradition, I will argue, looks most like Stout’s democratic tradition because it is based on professional activity and dialogue that maintain the reality of objective truth but seek practical moral goals over metaphysical ones. This, in turn, reveals the ways that medicine fails to live up to Stout’s democratic vision, as well as the ways that a democratic medical tradition is liable to significant concerns due to its pragmatic nature. Moreover, such an analysis helps to identify the ways that healthcare may fail to educate and support patients to exercise their moral agency as they navigate treatment, especially in the case of patients already facing additional social and financial burdens alongside their illness.