Whenever I attend a biomedical
ethics meeting or conference, I am often reminded of the wide gap between
philosophers and clinicians. Clinicians
often look to philosophers for the appropriate principle or rule to apply to a
particular case such that moral conundrums are solved and the right thing is
done. They are as often unaware of the
sort of meta-ethical research and debates that take place among philosophers;
the sorts of research and debates, many philosophers would claim, that must be
carried out and settled even before any practical advice can be issued. Thus, in recent years philosophers have
claimed that the appropriate ethical methodology is captured by one or more of
the following approaches: narrative ethics, the ethics of care, feminist
ethics, casuistry, virtue ethics, the ethics of pragmatism, to name but a few. Goldman’s Practical Rules situates itself squarely in this genre and takes a
clear stand.

More specifically, Goldman inserts
himself into one particular debate, that between, for lack of a better label,
rules-appliers and those Goldman identifies as particularists. Rules-appliers "assume that moral
reasoning always consists in the application of rules to particular cases” (1).
Particularists "have argued that moral contexts, situations in which
morally relevant factors must be weighed in reaching decisions, are too
fine-grained and too variable to be captured in a set of applicable rules"
(11). Goldman’s is a
"coherentist" account.

The book is well organized into an
introduction and four chapters. The
short introduction sets the stage, arguing that the standard particularistic
account, though generally correct, is limited in ways that Goldman believes he
can remedy. Then, in chapter one,
Goldman begins his analysis. There he
classifies types of rules, shows that genuine rules do not capture our ordinary
moral judgments and focuses on the analysis of such cases, paradigms of
contexts in which rules are needed.

Chapter two compares justifications
for using rules in prudential contexts, to further self-interest, with
justification for moral rules that Goldman develops in chapter one. Chapter three focuses on legal rules. It begins with a classification of legal
norms, a clarification of which legal norms require interpretation, and an
analysis of what interpretation consists in. 
Thus far Goldman has shown that the application of rules is not the norm
in moral or legal reasoning, but has clarified when rules are nevertheless
needed as a second-best strategy in these domains.

The final chapter describes in
detail what that norm is and outlines Goldman’s coherentist account of moral
reasoning, a position that differs in important ways form Rawls’ coherentist
position. For Goldman, our informed and
sensitive judgments “must represent a set of values fitting a rational life
plan that can be consistently pursued” (9). 
The correct answer to a controversial issue, then, is that which is most
coherent with the base of settled judgments, that which cannot be
differentiated from the closest analogous case in that base but can be
relevantly distinguished from every case judged differently.

Goldman helps clinicians understand
that doing the right thing is more than just applying the right rule in a
particular situation. Clinicians often
have an overly simplistic view of ethics, often falling into one of two
camps. The first see the right thing to
do as an application of a rule. Thus
ethics becomes a task of defining and finding the right rules. This is where debates have turned into intractable
stand-offs regarding which rule to follow. 
The second group sees disagreement as endemic to ethics because morality
is conceived of in relative terms, the value-centricity of cultural or personal
identity. In both cases disputants in
ethical debates too hastily acquiesce to claims of intractability in the face
of ethical conflict and the defeatist attitude that ethical disputes are by
their very nature irresolvable. The
service Goldman provides is realistic conception of ethical reasoning that
recognizes human limitations. (The last
chapter demonstrates the fruitfulness of his approach in an insightful analysis
of the euthanasia debate.) His
conception does not promise an end to ethical dispute. "While no issue is
in principle irresolvable, some are in fact so and perhaps should remain so
according to the central paradigms, the fundamental moral outlook, of the
opposing parties" (163-4).  
Goldman’s suggested "goal of informed and sensitive coherence"
(164) helps focus attention on the need for the difficult work of dialogue, the
need for fruitful exchanges between people and cultural groups regarding
fundamental value differences that sometimes cannot be changed, but often can
be understood.

With Practical Rules Goldman has provided an impressive example the sort
of analytical reasoning that goes on behind the scene (or in the ivory tower),
away form the clinic (or the point of application) in meta-ethical debates
among philosophers. Philosophers will
see this book displaying clear analyses and a well-argued position. Though a difficult read for those not
philosophically trained (I would recommend that non-philosophers read only the
first and last chapter for an outline of the debate Goldman is entering and
then an outline of his own alternative position), Goldman has also provided a
real service to clinicians concerned with ethical behavior. It reminds the clinician that ethical
disputes often contain and often are nothing more than a lack of communication.

©
2002 Ben Mulvey

Ben Mulvey,
Ph.D., is an Associate Professor of Philosophy and Director of Liberal Arts at
Nova Southeastern University. He
received his doctorate in philosophy from Michigan State University with a
specialization in political theory and applied ethics. He teaches ethics at NSU and is a member of
the board of advisors of the Florida Bioethics Network.

Categories: Ethics, Philosophical

Tags: Mental Health Policy and Advocacy