世俗临床伦理学中最重要和持久的辩论之一是伦理学专业知识问题,它询问伦理学家是否可以在活跃的患者案例中提出合理的道德建议。伦理专业知识辩论中的一个关键争论点是,事实上,生物伦理共识,世俗伦理学家可以基于他们的建议,以及是否存在,原则上,在道德多元化的背景下证明这种共识是合理的。在这本杂志最近的一系列文章中,珍妮特·马利克为道德专业知识的积极观点辩护,声称世俗伦理学家应该将他们的建议与生物伦理共识相结合。作为回应,尼克·科尔格罗夫和凯利·凯特·埃文斯否认存在世俗的生物伦理共识;质疑为什么,即使它确实存在,共识应被视为解决生物伦理问题的可靠方法;并根据H.TristramEngelhardtJr.的思想推荐更友好的临床伦理学方法。在本文中,我在所有三点上都回应了科尔格罗夫和埃文斯。在第一部分,我表明存在世俗的生物伦理共识,但请注意,可以通过更系统和更具包容性的过程来更好地巩固和创建共识。在第二部分,我认为生物伦理共识在道德上是合理的,但请注意,这种理由不能合理地基于声称它仅援引所有人可用或共享的道德原则。在第三部分,我认为Engelhardt的方法不能被描述为对临床伦理学“更友好”,因为它与许多现行的医疗保健法律和政策不兼容。
One of the most significant and persistent debates in secular clinical ethics is the question of ethics expertise, which asks whether
ethicists can make justified moral recommendations in active patient cases. A critical point of contention in the ethics expertise debate is whether there is, in fact, a bioethical consensus upon which secular
ethicists can ground their recommendations and whether there is, in principle, a way of justifying such a
consensus in a morally pluralistic context. In a series of recent articles in this journal, Janet Malek defends a positive view of ethics expertise, claiming that secular
ethicists should comport their recommendations with bioethical
consensus. In response, Nick Colgrove and Kelly Kate Evans deny the existence of a secular bioethical consensus; question why, even if it did exist, consensus should be considered a reliable way of resolving bioethical questions; and recommend a friendlier approach to clinical ethics based on the thought of H. Tristram Engelhardt Jr. In this article, I respond to Colgrove and Evans on all three points. In part one, I show there is a secular bioethical consensus but note it could be better consolidated and created through a more systematic and inclusive process. In part two, I argue that bioethical consensus is morally justified but note that this justification cannot be plausibly based upon claims that it only invokes moral principles available to or shared by all. In part three, I argue Engelhardt\'s approach cannot be described as \"friendlier\" to clinical ethics because it is incompatible with many current healthcare laws and policies.