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— 4 Ethics and the Human Body Introduction ote Body As medical science develops, more and more possibilities are put before us. Some of these are versions of familiar cir- cumstances, but others are genuinely novel. Such develop- ments often bring benefits; but not infrequently they raise ethical problems, concerning, for example, the distribution of goods, and the legitimacy of transgressing boundaries hitherto uncrossed. In trying to deal with these problems we need to have a sure grasp of relevant values and princi- ples. Yet it is one of the pronounced features of the modern era that as ethical problems have multiplied, so our common ethical resources have diminished. Oddly we seem able to recognise that human embryo research, gene manipulation, and xenotransplantation all raise difficult questions, but we are largely at sea when it comes to finding an agreed basis for answering them, let alone to agreeing particular answers. Cos Several factors underlie the inability to achieve consen- sus. Some are attributable to cultural pluralism. Modern societies are made up of different ethnic, religious, and ideological groupings, and while each may hold to a defi- nite set of principles (though it is an idealisation to suppose so), there is no significant common set adhered to by all. There is, however, a more general problem which is the lack of confidence in the very existence of any secure basis for ethical deliberation. For obvious reasons (independent of the philosophical ones discussed in chapter one ‘Practical Practical Philosophy Ethics') appeals to the will of God are held to be problem- atic, and the idea that a special faculty of moral intuition or the exercise of pure practical reason might yield incontest- able values and principles is difficult to take seriously given the failure of either to do so. 100 There is, however, one approach that seems to have flour- ished notwithstanding that philosophers have generally been critical of it, namely utilitarianism, or as it still some- times referred to the 'maximisation of happiness principle'. Its success is due, I think, to the following. First, it is easy to confuse the particular and restricted util- and itarian doctrine that one has a duty to promote the greatest happiness of the greatest number, with a general principle of beneficence common to most moral systems, namely, where it is appropriate and where one can, and other things being equal, one should act so as to produce good. The fact that the latter is not equivalent to utilitarianism emerges when one notices the ceteris paribus clause and the non-iden- tification of goodness and happiness. Unlike the utilitarian, the advocate of beneficence may say that in a given circum- stance it is not permitted to bring about some good because the only way of doing so would be by doing something which was unjust, say. Nevertheless, utilitarianism may seem unexceptionable for being confused with beneficence. Second, and following from what was said above, those who argue that happiness is not everything and that some values and principles may be more important generally have difficulty justifying those other ethical features. Third, when it comes to practical ethics utilitarianism enjoys the apparent advantage of ease of application. While it may often be challenging to gauge the likely utilities of conflicting options, this problem is taken to be of a quite dif- ferent and more tractable sort than faces the application of distinct and often incommensurable values, such as justice, liberty and the protection of the innocent. Philosophers' qualms about utilitarianism have gener- ally been ineffective in halting its adoption, in part because of its apparent advantages, in part because of the failure of critics to provide a compelling alternative, and in part [1] [2] Ethics and the Human Body because the philosophical criticisms of it tend to be rather abstract. For example, it is sometimes said that utilitarian- ism aggregates happiness and thereby fails to respect the distinctness of persons.¹ It is also objected that it under- mines agency by denying moral actors any legitimate motive other than the maximisation of happiness.² Again it is argued that the very idea of double comparatives (in this case superlatives) such as 'the greatest happiness of the greatest number' fails to specify any unique state of affairs to be aimed at.³ While one situation may involve the greater happiness of the people than another situation, the second may involve more people being happy; and for any given combina- tion of people and happiness it is possible to imagine acting in a way that results in either more people or more happi- ness, with neither option uniquely satisfying the descrip- tion 'the greatest happiness of the greatest number'. Finally, and for any theory that holds that the right course of action is that which among the alternatives available has the best possible consequences, there is the general problem that no unique exclusive and exhaustive set of alternatives can be specified for a given agent at a given time.4 Given these several considerations and others touched upon in earlier chapters I shall assume that for these or other reasons readers are open to rejecting utilitarianism, and I will direct my efforts to the task of providing a better philo- sophical basis for thinking about ethical issues concerning the care and treatment of human beings. As previously indicated, the approach I favour is a version of ethical natu- ralism. However, since this term is used in different and contrasting ways a word of clarification is appropriate. As it refers to positions of the sort I am concerned to advance, [3] [4] 101 This is John Rawls main objection to utilitarianism in A Theory of Justice (Oxford: Oxford University Press, 1971). This line of objection originates in Bernard Williams ‘A Critique of Utilitarianism' in J. J. C. Smart and B. Williams, Utilitarianism: For and Against (Cambridge: Cambridge University Press, 1973), pp. 108-18. See P. Geach, The Virtues (Cambridge: Cambridge University Press, 1977) pp. 91-3. For a detailed presentation of this last line of argument see Lars Bergström, 'Utilitarianism and Alternative Actions', Nous, 5 (1971). Practical Philosophy ethical naturalism indicates that claims of value, virtue, or requirement, are to be justified by appeal to what befits the nature of human beings. On this account, an action is right if, other things being equal, it promotes or contributes to human well being as this is implied by human nature. So conceived, 'naturalism' is a form of moral objectivism and is related to 'natural law theory'. 102 The other main use, by contrast, associates 'naturalism' with forms of subjectivism. The most prominent example is David Hume's view discussed in chapter one according to which ethical claims are to be understood not as describing not as states of affairs independent of the state of mind of the claimant but precisely as reporting or expressing his or her sentiments of approval or disapproval. Why this second view is also termed 'naturalism' is that it reduces the ethical to something that might be the subject of natural study namely the psychological states of human beings. Having already responded to Hume's challenges to moral objectivism I shall not attempt to refute the second kind of naturalism beyond making and emphasising the point that it is one thing to ask if something is good and quite another to ask if it is approved of. The first concerns the thing itself, the second does not. This difference also comes out in the fact that we can ask of the sentiments of approval whether they are themselves good. For the subjectivist this question will be analysed as asking whether those sentiments should be the subject of second order sentiments of approbation. Yet we can ask the same question of these: is it good to approve of (approving of) such and such? At each turn the subjectivist can appeal to yet higher order sentiments or social norms, but the question of their value awaits an answer, and reference to what is felt by a subject is an answer of the wrong logical sort. Either common morality has an objective foundation or it rests on a mistake. The rea- son most commonly advanced for drawing the second con- clusion is the belief that no objective foundation is available. I have argued that this itself is an error and I will return to the issue in the conclusion of this chapter. Ethics and the Human Body 103 Persons and Bodies Since the naturalism I favour roots ethical value in human nature it is necessary that I develop a philosophical account of human beings, and this involves understanding the rela- tionship between a person and his or her body-hence the title of this chapter. Although this is an ancient topic of philosophical reflection the work of Wittgenstein casts doubt upon the assumption that there is a philosophical issue to be resolved. Wittgenstein was much exercised by the fact that the central problems of philosophy involve matters with which we are, in an everyday sense, quite familiar. We are perfectly at ease with words, know how to use them and are generally understood in our use by others. Yet when we ask such questions as 'what is language?' or 'what does reference consist in?', the whole thing spins out of focus and we feel lost for answers. This is not new, of course. In the Confessions Augustine asks what is time?' and observes 'if no one asks me I know; if I want to explain it to a questioner I do not know'.5 One diagnosis of this gap between everyday competence and philosophical under- standing is that offered by Wittgenstein himself. This involves the remarkable suggestion that philosophical per- plexity is a kind of psychic illness induced by the misuse of thought. His claim is that we take ideas out of their natural setting and then ask questions about them which really do not make any sense. the whe By way of analogy consider driving along in a car and asking a companion-cum-navigator questions about direc- tions and likely times of arrival; and contrast this with a sit- uation in which the car is sitting in the garage and one asks similar questions: where should it be going? when should it turn off? how far is there still to go? what time will it get there? These were perfectly sensible things to ask in the first context; in the second they make no sense. Going one step beyond this, imagine someone asking where cars as such are going and how long that journey will take. Madness has [5] Saint Augustine, Confessions, trans. H. Chadwick (Oxford: Oxford University Press, 1998) Bk XI, Ch. xiv.
