Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict

CHAPTER 7 Fallibilism and the Convergence Hypothesis

C H A P T E R 7 FALLIBILISM AND THE CONVERGENCE HYPOTHESIS I see no hope for the Hippocratic ethic or similar professional ethics . The Hippocratic ethic is dead. Some alternative foundation for a medical ethic is needed. One option for those laypeople and professionals who accept religiously mediated sources of revelation—via scripture or direct mystical communication from the deity to some individual human—is for laypeople who believe they have a source of divine revelation of the moral law to get together with health professionals who share the same revelatory beliefs. That option, unfortunately, only works for those with sectarian beliefs who are willing to develop alternative, religiously based health care systems. The only problems that will arise will be the cases in which the revealed moral obligations conflict with the norms of the broader society. A second option is available for the large portion of the lay and professional populations that do not have a divine moral system revealed to them and should not be content to accept the Hippocratic or other professionally produced system. In the spirit of the Gifford mandate, there may be natural sources available for grounding moral norms. The focus here is not on natural theology to demonstrate the existence and nature 159 160  Fallibilism and the Convergence Hypothesis of God by natural scientific means. Rather, our focus is on the use of natural means to know what religious people might claim is the divine moral law and what secular people might claim are moral norms knowable by reason or experience. The Convergence Hypothesis The common morality claim provides a context for proposing what can be called a ‘‘convergence hypothesis’’: that religious ethics knowable by natural means of reason and experience can produce normative moral theories that converge with secular ethical systems with natural epistemologies knowable by similar means. Even if religious ethics superimposes a metaethic involving a deity’s will or creation or law and a secular ethic eschews any such theological trappings, it may be that the moral norms turn out to be, if not identical, at least similar enough that, in the spirit of the US National Commission, the two main categories of ethics can share the same or similar pretheoretical moral insights. Not only that, it may turn out that the theories that are constructed to systematize these pretheoretical insights overlap sufficiently and share enough in common that they provide common ground for a single normative framework . This framework would be publicly accessible, not the sole custody of a professional group that claims to be able to impose it on its own members, regardless of their competing loyalties to religious or philosophical traditions, as well as on the laypeople who are inevitably the clients of professionals and are necessarily the recipients of actions that result from the professional’s moral choices. Fallibilism Before launching a final account of what this convergence might look like and why the major contemporary theories of normative action support the convergence hypothesis, however, one critical piece of the theory needs to be added. Modern philosophical epistemologies are Fallibilism  161 comfortable with the doctrine of fallibilism, the notion that there is no certain knowledge. This is surely true in morality as well as science. Postmodern constructivists add to this more traditional uncertainty the idea that accounts of knowledge, even if from within a realist framework, require socially constructed linguistic conventions. Descriptions are so nuanced and complex that, even bracketing the fallibility that is inevitable , different people describing the same observed reality will identify different features of that reality as important. Only those features that are important enough will rise to the level that they are included in their accounts. This is surely true in describing our shared pretheoretical moral data as well as our accounts of physical reality. Thus, any descriptions of reality will be dependent upon the describer’s beliefs and values. This is what William Stempsey and I have called ‘‘value-dependent realism .’’1 These inevitable variations in accounts of the moral reality that depend on systems of belief and value are, of course, supplemented by the more traditional problems of the inevitable bias that comes from our limits as human observers. These same problems arise in religious accounts of moral norms. Even if we assume there is a common morality that provides the data in a pretheoretical form, religious ethicists must construct their accounts of the...