Kennedy Institute of Ethics Journal

Practical ethics is a peculiar field; it has no agreed-upon methods or foundations and takes a wide variety of forms. Its relationship to traditional “pure” philosophical ethics is contested and inconsistent. Since its beginnings, the Kennedy Institute of Ethics has been at the forefront of methodological reflections on the nature, grounding, and appropriate standards for practical ethics. Institute scholars such as Tom Beauchamp, Robert Veatch, and Henry Richardson have been among the most influential philosophers engaged in such metaethical conversations. Correspondingly, the Kennedy Institute of Ethics Journal has hosted some of the most vigorous debates in this subfield. In this issue of the journal, we return to this traditional stronghold. We include three papers on the methodological foundations of bioethics (and by extension, practical ethics more generally), each of which takes up a core debate in the area. Norbert Paulo revisits and challenges Henry Richardson’s theory of normative specification – a process by which relatively abstract norms are given concrete, usable content through a step-by-step limitation of the scope of their application. Benjamin Bautz revisits Beauchamp and Childress’s account of the “common morality” and questions how it can have normative force. Laura Specker Sullivan considers the consistently perplexing problem of cross-cultural bioethical disagreement, and the extent to which it challenges our metaethical frameworks and background assumptions.

Paulo argues that specification is not, on its own, sufficient for fleshing out the connection between abstract principles and situationally applicable concrete norms. We also need to develop these principles in other ways. He draws on legal theory and history to look at the various rhetorical tools available to us for moving from the abstract to the concrete in ethics. Contrary to almost all other philosophers, Norbert argues that deductive methods can be substantial rather than merely trivial if we understand how these methods depend on sophisticated interpretation.

Bautz examines three approaches to defending the normative force of common morality, or the claim that its principles dictate genuine moral [End Page vii] obligations rather than just capturing descriptive facts about what we believe. We might look to empirical results, normative ethical theory, or the conceptual definition of morality. He argues that Beauchamp and Childress are not consistent or clear about which strategy they are depending upon. He claims further that the empirical approach and the theoretical approach are non-starters. According to the conceptual definition approach, the common morality is identified with the set of core substantive norms essential to the concept of morality. Looking to the conceptual definition of morality is our most hopeful path for grounding the normative force of the principles, although this approach too faces interesting impediments, he claims.

Sullivan looks at a much-discussed case in which bioethical norms and intuitions seem to be culturally specific, namely the place and nature of informed consent in East Asian and in Western cultures. She argues that attempts to understand East Asian conceptions of informed consent have floundered in virtue of their attachment to a narrow principlist approach to their grounding and explication. In a welcome attempt to move the debate over moral disagreement beyond a simplistic opposition between “universalism” and “relativism,” Sullivan suggests that the “experiences, motivations, and emotions of those involved in local practices should be described before any higher-order, logical ethical justification is attempted” and “ethical justification should rely on more than just abstract principles as good reasons.” She notes the fact that we can and do have a dialogue with each other across cultures indicates that, despite divergences and disagreements, we are engaged in the same project and are not culturally isolated from one another for the purposes of ethical discourse.

Franklin Miller and Marco Annoni’s paper, “Placebo Effects and the Ethics of Therapeutic Communication: A Pragmatic Approach,” is not a metaethical piece, but it does challenge one of the most fundamental metaethical pillars of traditional bioethics, namely the distinction between therapy and communication about therapy. Traditionally, we think that protecting autonomy requires communication about therapeutic possibilities before any therapy can begin; imposing therapy before obtaining informed consent may be beneficent, but it constitutes a paternalistic violation of autonomy. Miller and Annoni examine “therapeutic communication”: communication that...