Is Rorty's neopragmatism the "real" foundation of medical ethics: a search for foundational principles

Abstract

Principlism, the predominate approach to bioethics, has no foundational principles. This absence of foundations reflects the general intellectual climate of postmodern relativism. Even America's foremost public philosopher, Richard Rorty, whose pragmatism might suggest a philosophy of commonsense, seems to be swimming in the postmodern swamp. Alternatively, principlism's architects, Beauchamp and Childress, suggest a constantly evolving reflective equilibrium with some basis in common morality as a workable framework for twenty-first century bioethics. The flaw in their approach is failure to conform to real doctors' and patients' experiences. Real doctors adopt a scientific paradigm that assumes an objective reality. Patients experience real suffering and seek effective cures, treatments, palliation and solace. The foundation of medical ethics should be that doctors altruistically respond to their patients' suffering using scientifically acceptable modalities. Compassion, caring, and respect for human dignity are needed as guides in addition to justice, beneficence, nonmaleficence and respect for autonomy.

Fig. 1

Scientific Realism: The product of successful scientific research is knowledge of largely theory-independent phenomenon (7). Painting: Professor Tulp’s Anatomy Lesson by Rembrandt van Rijn, 1606–1669, Mauritshuis Museum, The Hague.

Fig. 2

The Sixteenth Century Paradigm: The scientific paradigm for biomedicine has not shifted since the sixteenth century but has expanded from gross anatomy to the molecular level. Illustration by Andeas Vesalius, 1514–1565, Library of the Faculty of Medicine, Paris.

Fig. 3

“The mind and the world jointly make up the mind and the world.” Aphorism attributed to the philosopher, Hilary Putnam, 1981 (20). Painting: First Operation Under Ether by Robert C. Hinckley. Harvard Medical School’s Countway Library.

Fig. 4

Tentative schematic of how basing knowledge in scientific truth leads to an altruistic mandate for physicians founded on the reality of human suffering from disease, and on physicians’ relationships with patients. Patients seek science-based treatments. A reflective equilibrium influenced by the basic mandate works to guide the necessary ethical decision-making and includes principles in addition to Beauchamp and Childress’ four principles for dealing with increasingly complex twenty-first century problems.