Introduction

This Issue of the Kennedy Institute of Ethics Journal focuses on "Aristotelianism in Contemporary Bioethics." It is an unusual topic for this journal as it is seemingly very theoretical. But, I assure the reader that the theoretical topics explored are of the most practical and pressing kind. The questions addressed concern what kind of knowledge and skill there can be in deliberating about particular cases and issues, whether this knowledge is culturally relative, and how bioethics can balance the rights of the individual in making health care decisions with responsibilities to the community.

Authors in bioethics, especially those working in clinical ethics, have long sought to address particular problems with the fewest theoretical commitments possible so as to make broad consensus more plausible. Since theoretical foundations are often disputed, keeping the discussion pragmatic has seemed the more likely road to agreement. Similarly, our American heritage has lent the rhetoric of the rights of the individual to the scholarly dialogue in bioethics. Although no one wishes to do away with such language completely, it sometimes has seemed inadequate to the moral phenomena. To address these concerns, the philosophy of Aristotle has been recruited. Aristotelianism in contemporary bioethics has become identified with two claims: (1) there is such a thing as the ability to reason wisely about particular problems and cases, and (2) there is a need to supplement the American emphasis on the individual with a richer notion of the person or a concept of the common good. Both of these claims address concerns arising from the doctrine of informed consent, the fundamental framework of medical decision making.

Contemporary American biomedical ethics is now more than 25 years old. It has been marked by some important successes. For instance, it has evolved an ethical and legal consensus that the doctrine of informed consent is the primary way to make operational the value of respect for the patient. And this doctrine extends to all areas of medical treatment and biomedical research. The doctrine is minimalist in that it relies simply on the right of a competent patient to refuse unwanted interventions. This approach naturally raises questions concerning whether it can adequately settle the more difficult moral questions society faces without recourse to a grander philosophical theory. Similarly, the doctrine of informed consent places the rights of the individual front and center, and this causes us to ask whether bioethics is intrinsically individualistic. Although some might find individualism unobjectionable, many claim that such individualism does not capture the moral phenomenon of the family's role in ethical medical decision making (Nelson and Nelson 1995) or the need to see particular choices in light of the health care schema we wish for society (Callahan 1990).

Aristotelianism has not presented itself as just another competing theory among other approaches to bioethics. Through the notions of practical wisdom and the common good, Aristotelianism can be seen as a metaethical way of tying together the methodological progress in bioethics that has resulted from a rich debate among various methods. For instance, bioethics has seen the flourishing of two important methods: the principles approach and casuistry. Virtue theory has also received much attention. The representatives of each have often argued that the philosophical concepts and principles behind ethical decision making in medicine are minimal.

Whether one is talking about the four principles approach of Beauchamp and Childress (1994), the case-based approach (casuistry) of Jonsen and Toulmin (1988), or the virtue theory of Pellegrino and Thomasma (1993), one immediately notices that each method is fairly dependent on the judgment or practical wisdom of a competent practitioner of the method in order to be effective. The four principles approach depends upon someone being able to balance or to specify its mid-level principles in difficult cases; casuistry requires the discrimination of a person of practical wisdom to identify relevant features of cases and reason analogically between paradigm cases and their less clear particular instances, and virtue theory places the competent practitioner of the clinical art at the center of its method and makes...