How Medicine Saved the Life of Ethics

HOW MEDICINE SAVED THE UFE OF ETHICS STEPHEN TOULMIN* During the first 60 years or so of the twentieth century, two things characterized the discussion of ethical issues in the United States, and to some extent other English-speaking countries also. On the one hand, the theoretical analyses of moral philosophers concentrated on questions of so-called metaethics. Most professional philosophers assumed that their proper business was not to take sides on substantive ethical questions but rather to consider in a more formal way what kinds of issues and judgments are properly classified as moral in the first place. On the other hand, in less academic circles, ethical debates repeatedly ran into stalemate . A hard-line group of dogmatists, who appealed either to a code of universal rules or to the authority of a religious system or teacher, confronted a rival group of relativists and subjectivists, who found in the anthropological and psychological diversity of human attitudes evidence to justify a corresponding diversity in moral convictions and feelings.1 For those who sought some "rational" way of settling ethical disagreements , there developed a period of frustration and perplexity.2 Faced with the spectacle of rival camps taking up sharply opposed ethical positions (e.g., toward premarital sex or anti-Semitism), they turned in vain to the philosophers for guidance. Hoping for intelligent and perceptive comments on the actual substance of such issues, they were offered only analytical classifications, which sought to locate the realm ofmoral issues, not to decide them. Two novel factors contributed to this standoff by making the issue of subjectivity an active and urgent one. For a start, developments in psychology —not least, the public impact of the new psychoanalytic moveThis paper is one outcome of a research project undertaken in collaboration with Dr. Albert R. Jonsen, of the University of California at San Francisco, with the support of a grant from the National Endowment for the Humanities, no. RO-0086-79-1466. ?Committee on Social Thought, Department of Philosophy and Divinity School, University of Chicago. 1 For a further exploration of the standoff, see [I]. 2 It was, in fact,just this problem which presented itself to me when I wrote my doctoral dissertation [2].© 1982 by The University of Chicago. All rights reserved. 003 1-5982/82/2504-03 10$0 1 .00 736 I Stephen Toulmin · Medicine Saved Ethics ment—focused attention on the role of feelings in our experience and so reinforced the suspicion that moral opinions have to do more with our emotional reactions to that experience than with our actions in it [3]. So, those opinions came to appear less matters of reason than matters of taste, falling under the old tag, quot homines, tot sententiae. This view of ethics was strengthened by the arguments of the ethnographers and anthropologists, who emphasized the differences to be found between the practices and attitudes of different peoples rather than the common core of problems, institutions, and patterns oflife that they share. To cap it all, the anthropologist Edward Westermarck took over Albert Einstein 's term "relativity" from physics and discussed the moral implications of anthropology under the title of Ethical Relativity [4]. Between them, the new twentieth-century behavioral and social sciences were widely regarded as supporting subjectivist and relativist positions in ethics; this in turn provoked a counterinsistence on the universal and unconditional character of moral principles; and so a battle was joined which could have no satisfactory outcome. For, in case of substantive disagreement, the absolutists had no further reasons to offer for their positions: all they could do was shout more insistently or bring up heavier theological guns. In return, the relativists could only turn away and shrug their shoulders. The final answers to ethical problems thus came, on one side, from unquestioned principles and authoritative commands; on the other, from variable and diverse wishes, feelings, or attitudes; and no agreed procedure for settling disagreements by reasonable argument was acceptable to both sides. How did the fresh attention that philosophers began paying to the ethics of medicine, beginning around 1960, move the ethical debate beyond this standoff? It did so in four different ways. In place of the earlier concern...