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Ethics, as a philosophical discipline

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© Springer Science+Business Media Dordrecht 2015

Henk ten Have
Encyclopedia of Global Bioethics
10.1007/978-3-319-05544-2_177-1

Ethics
M. Patrão Neves 1

(1) Bioethics Research Centre, Bioethics Institute, Catholic University of Portugal, Porto, Portugal

M. Patrão Neves
Email: patrao@uac.pt

Abstract
Ethics, as a philosophical discipline, was first structured and systematized in ancient Greece, most
particularly by Aristotle. Its evolution throughout history is marked by some important shifts,
among which two stand out: from a heteronomous ethics to an autonomous ethics and from a
necessary universalism to a proposed relativism, each one having different impacts on bioethics.
The birth of applied ethics, in which bioethics takes the lead, was another important step in ethics’
contemporary development.

This entry follows the major shifts of ethics’ evolution, stressing their influence on bioethics. It
also focuses on the required accurate definition of key concepts of ethical reflection and bioethical
practice – such as principles and norms, values and virtues, rights and duties – and the right
perception of the implication of each one and of their respective interactions in the understanding
of action’s rationality.

Keywords Morals – Professional ethics – Applied ethics – Bioethics – Virtues – Values –

Principles – Rules – Rights – Duties – Aristotle – Kant

Introduction
Ethics, as the thought of Man about his action, is as ancient as Man itself.

An evolutionist perspective shows that as Man began to free himself from the deterministic laws
of nature, he started to exercise his own will; at the same time, his action was no longer innate and
therefore universally identical, dictated by instinct, and absolutely predictable and became a
singular option following a particular deliberation process, and sometimes presenting itself as
unexpected and always individual. From then on, Man had to face a plurality of ways of action, to
establish criteria for the decision-making process, to assume his own liberty to act, and to bear the
consequent responsibility for his actions. This thought about action constitutes ethics at its most
spontaneous and indeclinable level (a qualitative difference from all animals), an ethica utens that
is morality as it is daily lived by all, or, according to the German philosopher Albert of Saxony

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who first used the expression in the 13th century, ethics as a rule of life; ethica utens was then
opposed to ethica docens, which is a subject matter for teaching a philosophical reflection,
analytical and critical, about action. Ethica docens refers to what is nowadays commonly
designated by “ethics.”

Ethics is a philosophical discipline that was established as such by Aristotle, in the 3rd century
BC. Intense spirituality, centered in human behavior, and lived in more ancient times by peoples
in India or in Asia, was not enough to give birth to a new discipline, which needed Greek
rationality.

The constitution of a new discipline also requires a new and particular object, an adequate
methodology to study it, and a specific terminology to understand and refer to it.

It was Aristotle who, for the first time, in a very systematized and developed way, especially in the
Nicomachean Ethics, defined the object of ethics as human action: “praxis” or immanent action,
the kind of action in which the product or effect becomes part of the agent, shaping the agent’s
character. For example, actions of charity make the person who acts charitable. The philosopher
also structured a methodology of study pursuing a semantic of action, analyzing human behavior
and its effects in the shaping of the agent’s character. Finally, Aristotle also established a system
of well-defined and interrelated concepts to explain the morality of human action, the
accomplishment of good, and the perfection of the human being.

From then on, ethics was differently defined throughout history. The object of ethics broadens:
from “praxis,” an immanent action that builds the agent’s character, to “techné,” an action that
produces an object external to the agent, and from an interpersonal domain, to which it was
confined throughout history, to other domains of human action not only toward other persons but,
more recently, also regarding animals, plants, ecosystems, planet Earth, and future generations.

The methodology of ethics prevailed: to uncover the rationality of human action establishing the
requirements of morality within a universal horizon, the only one that can guarantee the credibility
and validity of moral rules.

But the ethical systems changed through time, gaining more and new concepts to think about new
human realities in the world and to communicate them. An example would be the constellation of
four concepts needed in ancient Greek philosophy to explain moral life – good, end, happiness,
and virtue – to which medievalism added the concept of God, modernity the concept of liberty,
and contemporaneity the concept of responsibility. Relevance begins to be given not only to the
good but also to duty, not only to virtues but also to values, not only to ends or goals of action but
also to principles, and, more recently, not only to principles and ends but also to procedures and
not only to rights but also to obligations. Ethics originally heteronomous, being given to Man
(from a higher entity: Nature or God), becomes autonomous, being made by Man to Man.
Sometimes ethics seems to fall into the temptation of becoming relativistic, merely dictated by

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circumstances (time, space, culture), and rejecting all attempts of universality, which would
simply lead ethics to implode itself, giving way to an emptiness of values, to nihilism. Finally,
ethics turned out to be applied to many different concrete fields of human activity – engineering,
media, economics, politics, etc. – but none more developed than in biomedical (and environment)
field through bioethics.

Throughout this process of more than twenty-four centuries, ethics has always been and still is a
rationalization of human action (the logic underneath human actions) concerning the principles it
is grounded on, the ends it aims toward, and the processes it entails.

From the Need of Ethical Universalism to the Proposal of

Moral Relativism
A very brief overview of the history of moral thought must unanimously highlight two well-
known benchmarks: Aristotle and his heteronomous teleological ethics of good and Kant and his
autonomous and deontological moral of duty. These are two different proposals of rational
intelligibility of human action both developed within a universal framework.

The fall of the ethical universals should also be seen as a benchmark and an unavoidable reference
even if on a brief historical note, especially because it opens the way to moral relativism which
threatens the morals itself.

Aristotle
It is important to characterize, although briefly, the system Aristotle developed and that influenced
moral thought throughout history until today and to stress its impact in the field of bioethics,
specifically in the theoretical-practical models of bioethics.

The Aristotelian perspective of ethics can be summarized as the itinerary that Man has to take
from his current state to the achievement of the Supreme Good and Final End. This is a path that
Man gradually conquers by accomplishing a hierarchy of minor goods and intermediate ends,
through actions that progressively shape his character or way of being, leading him along a
process of perfection and of personal flourishing that will only end with his death. The gradual
achievement of perfection corresponds to the gradual reaching of happiness. The level of
happiness corresponds to the level of perfection in a rigorous coincidence between Supreme Good,
Final End, Perfection and Happiness.

This path is followed through the practice of virtues, ethical and dianoetic virtues. Dianoetic or
intellectual virtues depend on the level of knowledge; ethical virtues or virtues of character consist
in a mean or intermediate behavior between two extremes, one by excess and the other by default.
For example, “courage” is a virtue defined in its content by the equidistance from recklessness, the
vice of excess, and from cowardice, the vice of shortage. This intermediate way is not one

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geometrically established, equal to all Man. On the contrary, it can differ from person to person
(“golden mean”): the acts of courage of a child, of a strong man, or of an old woman will be
substantially different among them, but they will all be courageous and virtuous actions if they are
an intermediate behavior of the particular agent in question.

Aristotle’s system of ethics is finalist and eudemonistic, because it aims at the Final End which
also corresponds to the achievement of Happiness; it is heteronomous as well because Man’s
moral law coincides with the Supreme Good and hence is external to him, given to him
(everything in nature tends, by nature, to an end or perfection); it is also a consequentialist ethical
theory because the consequences, the product or effect of human actions achieving a good,
transforming one’s character or personality, are the main goal of ethics.

The perspective of ethics as a search for the Good and its fulfillment, in the wake of Aristotle and
developed by Christian philosophers, describes the history of moral thought until Kant, prevailing
influential until today and, namely, in the field of bioethics.

In bioethics, Aristotelian ethics is particularly present under two different features: the
recognition, by some bioethicists, of the importance of good deeds and of the effective
achievement of concrete goods, in a consequentialist perspective, and their acknowledgment of the
importance of the agent’s good character, shaped by the practice of virtues, to act morally.

On what concerns the first point, the nature of two bioethical core principles should be stressed.
Indeed, the so-called principles of medical ethics or Hippocratic principles – beneficence and
nonmaleficence (the latter absent from the Hippocratic corpus) – go deep into the moral thought of
ancient Greece which Aristotle originally systematized: both being good driven and
consequentialist. The identification of good in bioethics, although changeable through time and
according to the different authors, and most especially “the good of the patient,” which started to
be a medical good and evolved to the person’s good, remains essential to guide human action and
particularly professional action.

On what concerns the importance of the good character and of the virtues that build it, it should be
stressed that virtues also remain necessary in bioethics, even in principlist theories, because they
add excellence to the fulfillment of rules and ensure the good decision in singular situations for
which the known principles do not fully apply.

Edmund Pellegrino and David Thomasma are the most prominent representatives of the
Aristotelian influence in bioethics. Their major work, For the Patient’s Good, the Restoration of
Beneficence in Health Care, in 1988, clearly states that the theory “originally formulated by
Socrates, Plato and Aristotle,” a “theory based on beneficence, that is, on acting for the good of
the patient, and on virtue is more appropriate to the special context of the medical encounter
today” ( 1988, p. 3). These authors consider that “the architectonic principle of medicine is the

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good of the patient as expressed in a particular right and good healing action” ( 1988, p. 117) and
propose a Virtue-Based Normative Ethics for the Health Professions ( 1995).

Most theoretical-practical models of bioethics from the 1980s and 1990s, at the beginning more
principle oriented, have evolved to integrate and to value virtues. Also, today’s bioethics all over
the world appeals regularly to virtues such as solidarity, which is desirably expected from others
and viewed as an evidence of moral behavior, but cannot be imposed as an obligation.

Kant
Immanuel Kant moves from the Aristotelian model of a metaphysically grounded ethics of good to
a rationally determined moral of duty. This shift is seen as a “Copernican revolution” because, like
Copernicus, who put the earth where Ptolemy had put the sun, it presents a new paradigm that puts
the person at the center and origin of morality, instead of Nature or God as it has always been (the
so-called Kant’s “Copernican revolution” is not only pursued within his theory of knowledge but
also in the realm of practical reason).

Kant’s morality has been highly influential throughout history, being differently present and
interpreted in many philosophical trends, as well as in several theoretical-practical models of
bioethics. A brief summary of the core structure of Kant’s morality will help to understand the
way it shaped major perspectives in bioethics.

The fundamental goal of Kant’s reflection on morality was to ground moral law exclusively on
reason, that is, to exclude all other determinations for action beyond the exercise of pure reason.
By doing so, he expected to formulate a moral law that would be totally objective and that, being
purely rational and being reasonably universal, would also be universal. This moral law, rational,
objective, and universal, would necessarily be presented by man to all men and therefore would
establish an autonomous morality.

Thus, Kant’s morality is formalist and rigorist: formalist because the principle of moral action is
reason, is the pure expression of the law, and is a priori determined; and rigorist because, beyond
all material determination, it is a moral of duty, of acting by pure respect to the law, and of the
fulfillment of duty for duty’s sake. Only these features guarantee the objective and universal
foundation of morality, together with its autonomy, which Kant aims for above all.

The itinerary to achieve it is established along the Groundwork of the Metaphysic of Morals
(1785) and the Critique of Pure Reason (1788). Kant starts with the identification of what can be
totally good, without restrictions, and states that it is an evidence of common judgment that only
the good will, a will that is not moved by any interest, can be entirely good. The will is good for
its intention, that is, for its own willingness. Therefore, the will’s worth does not reside in the end
it aims toward or in the impact it achieves, but in the principle that moves it, regardless of the
level of success it reaches or the results it produces. This principle cannot involve any interest,

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which is always subjective, but must be exclusively determined by duty, that is, by the need to act
out of pure respect for the moral law or practical reason.

Briefly, the good will is not only independent from all inclinations but also expresses the existence
of a law as its sole determinant. The good will can only be determined by reason – the good will is
a rational will – and its law, or rational rule, has to be objectively necessary, without any relation
to any end (always subjective).

The moral law expresses itself by saying: “Act only in accordance with that maxim through which
you can at the same time will that it become a universal law” (Kant 2002, p. 56). This first
formulation of the categorical imperative stresses the universality of the law, its validity to all
human beings as an end in itself, subordinating all subjective interests (maxim) to the objectivity
of the law. Only the rational being is an end in itself, as expressed by the second formulation of
the categorical imperative: “Act so that you use humanity, as much in your own person as in the
person of every other, always at the same time as end and never merely as means” (Kant 2002, p.
47). This means that the person has an unconditional and absolute value, in what consists in its
dignity. Briefly, it is the will itself of a rational being which makes its own law, becoming
legislator and obeying to the law. Moral law is the autonomy of the will.

Kant is a very influential philosopher in bioethics, and his doctrine is differently used by different
theorists. Principlism, contractualism, or libertarianism, among other theories, all appeal to Kant,
each one developing a different Kantian line of reasoning: the need to ground rules of practice on
principles that impose themselves as requirements for morality, regardless of the outcome of their
application in concrete situations (Tom Beauchamp and James Childress); the importance of social
contract for an autonomous and universal morality (John Rawls); and the imperative to
acknowledge the persons’ liberty and to treat them as ends (and not to use them as means), which
is a human basic right (Robert Nozick).

Nevertheless, there are two specific issues in which the Kantian influence plays a more decisive
role within bioethics. The first one concerns two of the core principles of bioethics: autonomy and
justice. These are deontological principles, that is, they stand by themselves as basic requirements
for an autonomous and secular morality: if morality is built by persons for persons, their will must
be taken into account and respected, to avoid violence from some to others, and all persons have
to be recognized as equal and treated fairly to eliminate all kinds of injustice.

Beauchamp and Childress, on their Principles of Biomedical Ethics ( 1979), have been
systematically criticized for presenting four prima facie principles, which are equally binding –
beneficence, nonmaleficence, autonomy, and justice – but always ending up giving more weight to
the principle of autonomy. In this context, it is essential to understand that beneficence and
nonmaleficence are consequentialist principles that are only observed if they produce a good or
avoid an evil; autonomy and justice are deontological principles that just need to be obeyed,

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regardless of the consequences. If, for example, autonomy and beneficence clash in a particular
situation, there are no obstacles to follow the principle of autonomy, but sometimes it is not
possible to produce anything good: imposing a blood transfusion to a Jehovah Witness against
her/his will would violate the principle of autonomy and would not produce a good (only a
medical good but not the good of the person), but complying with his/her will fulfills the respect
for autonomy. It is due to its nature that the principle of autonomy prevails over the one of
beneficence and not due to the author’s choice: deontological principles always prevail when
conflicting with consequentialist principles.

The second theme decidedly shaped by Kantian philosophy is the central role of persons, as
rational beings and always considered as ends in themselves. This corresponds to a secular
definition of “human dignity,” broader than the former Greek (dignity was an attribute reserved
only to a few) or the Christian one (based on the creation of Mankind by God). The principle of
human dignity is, formally, the most consensual worldwide and points out, in the wake of Kant, to
the unconditional and intrinsic value of the person.

It is true that some libertarians, like Tristram Engelhardt, Jr., in The Foundations of Bioethics
( 1986) adopt a restrictive view of the person, which the interpretation of Kant allows, stressing
rationality as the identifying feature. Consequently, those human beings who, for different
reasons, do not have the full use of reason and are not moral agents become less of a person:
fetuses, children, senile, mental retarded, etc. Nevertheless, it is fair to say that the Kantian
perspective on human dignity is the most inclusive and the most influential in global bioethics.

Ethical Universalism and Cultural Pluralism

Aristotle and Kant, together with many other moral philosophers throughout history, developed
their own systems within a horizon of universality. Morals require a universal framework out of
which it is not even possible to talk about morals. Indeed, every single rule is only justifiable and
valid if it is addressed to all members of the community in question (e.g., legal rules: national law
or international law) and, in what concerns moral rules, the community in question is humanity
itself.

Nevertheless, throughout the twentieth century and especially in the second half, several authors
challenged this universal framework due to two key factors. The first was the fall of the ethical
universals established throughout history: Man stopped considering the law of nature, natural law,
as a guide for his actions and started to trust on his educated liberty to lead him; Man also
recognized that not all persons have faith in God and that even God can be differently personified
and therefore could no longer be a universal foundation for human action; moreover, Man became
aware that he cannot be reduced, in his identity, to reason, without affection, emotions, and
subjective interests that play an important role on the decision-making process and actions. The
second key trigger of the relativistic interpretation was the development of cultural anthropology

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and the study of customs and traditions of different peoples widespread in the world, some of
them unknown until then. This leads to the perception that also moral values, principles, and
norms, in sum morality, differed according to time and space, people, and culture and
consequently to the rejection of a universal frame to morals; it leads to the announcement of a
moral relativism and to the statement that all morals are worth the same, regardless of their
contents and of their orientations, all due to be equally respected (which would, e.g., make female
genital mutilation (FGM) practiced in several cultural or the death penalty acceptable).

Moral relativism quickly and widely spread, perhaps due for the convenience of many to invoke
what would be a subjective moral in order to nestle their own interests, to eliminate all obligation
from morals, and also due to the lack of a sound reflection on these issues from the general public
opinion, which would inevitably lead to the recognition of intrinsic contradictions. Beyond the
logical impossibility of morality outside of a universal framework (if not real, then at least aimed
for), moral relativism incurs in two major misunderstandings. The first one is that the so-called
relativism is only real at the empirical level and at the observational level, but it is not sustainable
under a deeper reflection (e.g., if all statements are relative, the statement of relativism is also
relative). Indeed, there are transcultural values, that is, values that are cherished by all generations
of different peoples worldwide; notwithstanding, they are particularly and differently expressed at
the empirical level, in different societies: all societies advocate the duty to take care of the elderly,
but some members of the community will abandon them outside the community to save them from
a public degeneration, and others, from a different community, will surround their elderly with
specialized care in order to postpone death. At the empirical level, the two behaviors are totally
different, but both express the same obligation of caring for the elderly, and this is the second
clarification in need. Cultural pluralism cannot be mistaken with moral relativism.

A universal ethics remains of paramount importance. Due to the impossibility to ground a

universal moral in one single tradition or school of thought, and in the absence of ethical
universals, the need for a universal framework was satisfied by the elaboration of a worldwide
consensual moral: the Universal Declaration of Human Rights (1948). Contrary to the former
morals that were lived everyday for years before they became a matter of study and reflection and
were systematized into norms, the morality of human rights was discussed and established before
being experienced: the process was not inside-out, as before, but outside-in, conventionally.

It is well-known that the morality of human rights is not yet universally complied with, but it
represents a worldwide consensus about the need for a universal morality, and it is also the widest
moral consensus of the humanity’s history. Nevertheless, it is important to stress that the wider the
consensus is, the narrower the content: a consensual morality is almost always a minimalist
morality.

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In what concerns bioethics, under the current issue, there are four points that deserve to be
underlined. Firstly, bioethics has always tried to oppose any kind of relativism, although
respecting cultural diversity, and global bioethics is a testimony of this endeavor. Secondly, the
morality of human rights is the backstage of all theoretical-practical models of bioethics. Thirdly,
many of these theoretical-practical models of bioethics are explicitly grounded on common
morality (the principlism of Beauchamp and Childress), and human rights are part of it. And
lastly, it is important to underline that the morality of human rights is particularly relevant for
libertarians, although they restrict them to individual rights without taking into account social
rights, as communitarians do.

Bioethics is so committed to a universal framework and in particular to the morality of human

rights that, today, the ones concerning the application of biology and medicine to human beings
are considered worldwide to correspond to the fourth generation of human rights.

Ethics and Morals and “Ingredients” of Moral Life

Conceptual accuracy is of paramount importance in philosophy and also in ethics. Particularly in
ethics, there is a specific terminology that is also very frequently used in daily life, without the
rigorous meaning soundly justified and required by a philosophical discipline. Therefore, a scholar
on ethics, as well as a professional in bioethics, has to commit to the full and accurate
understanding of the concepts that reflect on human action and to their correct use and the
different consequences each of them entails, to apprehend how they translate the dynamics of
action into rational intelligibility and how they describe the requirements of moral life as well as
the right procedure for a moral decision-making. The contemporary French philosopher Maurice
Blondel calls them “ingredients” of moral life, which are indeed essential elements to understand
and describe moral life, being also of a different nature and able to combine among themselves
differently and, hence, to accordingly express different moral realities.

Some of these concepts play a major role in the analysis of action, in a rational discourse on
ethics, and they all constitute specific terminology to reflect on human action.

Ethics and Morals

There are some concepts that do gain particular importance, starting by “ethics” and “morals.”
These concepts can be used both as synonyms and with distinct meanings. Either option has to be
grounded in the etymology and the conceptual history of both.

“Ethics” has a Greek root ( ethos), having been used with two different meanings according to its
two different spellings in ancient Greece.

It is possible to trace the origin of the word “ethics” to the 8th century BC, to the epic poems of
Homer and Hesiod. At that time, “ethics” was written with a long first vowel ( êthos, ηθοζ; with a

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η = êta). For Homer, êthos meant “stable,” “lair,” and “hole”; for Hesiod, it meant a “hostel” for
Man. Broadly speaking, êthos refers to the place where animals take shelter, and in a later
derivation of meaning in its application to Mankind to “the place from where the acts sprout,” that
is the human interiority.

But ethos could also be written with a short first vowel ( éthos, εθοζ; with a ε = epsilon), meaning
“habit” or “custom.” The Greek language had, in fact, two terms for ethos with two different
meanings.

When Aristotle distinguishes dianoetic ( dianoétikès) from ethical ( éthikè) virtues, he links the
adjective éthikè, correlated to êthos, to the noun éthos. This connection contributes to the
perception of the ethos, root of the word “ethics,” only as éthos (and not anymore as êthos).

This interpretation was reinforced when Greek literature was translated into Latin. The Latin
language had only one term – mos (genitive: moris) – meaning “habit,” “custom,” “character,” and
“rule,” to translate either the ancient êthos or the more recent éthos. Therefore, both Greek
spellings were translated indifferently by mos, the Latin root of “morals.” Melting the two
different meanings of the Greek ethos in just one Latin word, mos, the most ancient Greek
meaning, the one that refers to human interiority, was lost in the history of ethics or morals, both
justifiably considered synonyms.

The specific meaning of the ancient êthos would only be recovered in the twentieth century, by the
philosopher and scholar of Greek preclassic thought Martin Heidegger in his Letter on Humanism,
in 1947. Heidegger unveils that “ethics,” in its original and therefore true meaning, refers to
human interiority, to the depths of each one, where human acts are born. Aristotle, and the other
authors that followed him throughout history, forgot this original significance of ethics and used
this concept to designate human action oriented by a view of the good.

On the wake of Heidegger, many philosophers, as the distinguished Paul Ricoeur, tend to consider
that ethics refers to the foundational level of human action, answering to the question “why do
people act the way they do?” Moral refers to the normative level of human action, answering to
the question “how should people act?”

Briefly, from the philosophical and historical perspectives, it is justifiable to use the words
“ethics” and “morals” either as synonyms, which is quite common in the current literature, or as
distinct concepts, an option that has been growing among scholars. Those who value the historical
perspective will tend to use “ethics” and “morals” indifferently, as happened throughout centuries,
arguing that the two words have a different origin but share the same meaning. Those who value
the etymological perspective will tend to use “ethics” and “morals” differently arguing that
“ethics” corresponds to the most ancient meaning of êthos, as the origin of human action, “the
place from where the acts sprout,” and therefore to the foundation of action, and “morals”
corresponds to the more recent meaning of éthos, the same one that “morals” also expresses, as a

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“rule” of practice, and therefore to the orientation of action. Both perspectives about the relation
between “ethics” and “morals” are, then, justifiable.

One can argue further that, having already two different terms, with two different possible
meanings to reflect on action, to analyze and describe it, the use of both, distinctly, is very
convenient to widen and deepen the understanding of human action. The more linguistic resources
are available and used the more faithfully will thought coincide with reality. A distinction between
“ethics” and “morals” allows separate consideration of the level of the foundation of human action
(ethics) and the normative level (morals), the “why” or reason to act in a specific way, and the
“how” or the rule to follow in action. This distinction is not common in Anglo-Saxon bioethics
that influences most bioethics worldwide, and it has been used mainly in continental European
bioethics. Nevertheless, it is very helpful for a more accurate and detailed or finer ethical analysis
of human action.

Principles and Norms

“Principles” and “norms” are also concepts sometimes used synonymously. Indeed, both are
general statements, expressing an obligation, but their level of specification or content establishes
their distinction: principles are more abstract and, therefore, easier to gather consensus; they
unfold in norms or rules of practice that specify their content and the way they should be applied
to concrete situations, to the ever singular cases. Principles are formulated at the foundational
level of action (ethics), and norms are established at the normative level (morals); a principle-
based theory develops itself at the grounding level, and a norm-based theory develops itself at the
justification level. However, after the crisis of metaphysics and the dissolution of the absolute
required as philosophical ground, most moral theories develop at the justification level, as logic of
human action.

Anglo-American bioethics does not usually follow the distinction between “principles” and
“norms.” For example, the core principles of bioethics, proposed by Tom Beauchamp and James
Childress in Principles of Biomedical Ethics, 1979 (which holds until the 7th and so far the last
edition, in 2013), are referred as “mid-level principles” which corresponds to “norms” within the
distinction between principles and norms.

Bioethics requires a three-level analysis: meta-ethics, in order to understand the presupposition of

moral thought, including the identification of the foundational ethical principles; normative, to
formulate the rules that derive from the principles and that can be directly applied to specific
cases, assisting decision-making; and casuistic, to take into account the particularities of each case
and to evaluate the outcome of the application of the norms and principles previously established.
This is a top-down scheme, traditionally characteristic of principlist theories; casuistry would
typically follow a bottom-up scheme.

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This distinction is not as hard anymore though. The application of Rawls’ method of reflective
equilibrium to bioethics requires what has also been called an integrated method top-down-
bottom-up: working, back and forth, the application of principles and norms to cases, and
considering the outcomes which might recommend the revision of the norms and principles for a
further application to new cases achieving a more satisfactory outcome. Bioethics, as all applied
ethics, requires efficacy in the resolution of the different problems it handles, and the success and
satisfaction of practice is as important as the soundness of theory. The main goal of the integrated
method is to guarantee coherence among principles, norms, and outcomes and among different
cases.

Values and Virtues

“Values” and “virtues” are both concepts that go back to ancient Greek philosophy, but if virtues
have always played an important role in morality throughout history, values have become relevant
mainly in contemporaneity and more specifically after David Hume’s distinction between facts
(descriptive: what is) and values (prescriptive: what ought to be), leading to the development of a
general theory of value which includes different kinds of values – moral, religious, esthetics,
economic, environmental, etc. – and values of different natures, namely, subjective and objective
values.

In what concerns moral values, the main point for axiology is to classify which things are good
and how good they are (good, better, best, bad, worse, worst); in what concerns the different
nature of values, it is only contemporary general theories of values that build not only from
objective values but also from subjective ones, centering the debate on whether values are dictated
by subjective psychological states or correspond to objective states of the world. Indeed, both can
coexist, and in a hierarchy of values, those attributed by the person according to his/her own
interests (what is wished: instrumental value) will occupy the lower level, and the permanent
values independent from the agent and intrinsic to objects or actions (what is wishable or
desirable: constitutive value) are placed at the top level.

Subjective and objective values both play an important role in bioethics and must therefore be
acknowledged and respected. Subjective values can present themselves as religious beliefs or
personal convictions, and unless they result in personal or collective harm, they should be
accepted. Examples would be the use of placebo or alternative therapies. Objective values are
intrinsic to some realities, such as health or life, valued in themselves, and they take precedence
over subjective values. Nevertheless, these values are no longer considered absolutes within
bioethics, and they have been subordinated to quantification: balancing the level of health
achievable and the amount of pain and suffering endured and balancing the level of development
and quality of a life and the consequences of maintaining it. This potential inversion of values,

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where subjective values take over objective values, is a consequence of the weight given to
consensus in detriment of a theory of values or principles.

“Virtue” is one of the oldest concepts in Greek ancient thought: firstly referring to physical
outstanding capacities and later including also traits of character. In both cases, virtues always
designate excellence in action, achieved by the repetition of the same kind of actions, contributing
to the perfection of the person in question.

A principle-based bioethics without virtues could be very efficient and efficacious but would also
be empty of affections or emotions; it would be distant and cold, far from the warmth and
closeness of true human relationships that only virtues can develop. Virtues do not address
themselves as obligations (like principles, norms, or even values) but as an appeal to each one’s
will. A healthcare professional can comply with the highest professional and ethical standards, but
he/she will never be a good professional without compassion, fidelity to trust, integrity, self-
effacement (Pellegrino and Thomasma 1993), kindness, commitment, thoughtfulness, caring, etc.

Rights and Duties

The idea of rights as entitlements (privileges or powers) belonging or attributed to some persons
always existed. What becomes a novelty in contemporary times, in the wake of the philosophy of
rights of the Enlightenment, is the statement that all human beings have rights and that there are
natural rights, inalienable and indefeasible. Further developments, and different theories, lead to a
diverse classification of rights. These have been said not only natural, universal, and intrinsic to
the human condition but also recognized as formulated by society as a collective commitment
toward each and all citizens. The four generations of human rights (civil and political rights,
socio-economical and cultural rights, solidarity rights, and rights related to genetic engineering or
broadly referred as rights of future generations) fall in this category. In both cases, rights are
upheld by law.

Rights have also been defined in terms of duties which ground the common perception that rights
“correlate” with duties. Nevertheless, the language of duties or obligations comes later than the
language of rights and entitlements in common morality, and the recognition of responsibilities is
still substantially weaker than the claim for liberties. One example of what has been said is surely
the Declaration of Lisbon on Rights of the Patient, issued in 1981, by the World Medical
Association. It was only later, by the initiative of different institutions, that a roll of duties was
proposed, although its diffusion and general public knowledge is still limited.

Today, at the theoretical level, rights and duties come together more often; in daily life, however,
the focus on rights is still overwhelming relative to duties, even on the healthcare setting, as
became obvious on the discussion, in 2014, on rights and duties of healthcare professionals under
the danger of Ebola (very much like the discussion over HIV in the 1980s, when patients were
abandoned due to the fear of infection).

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It is worthwhile to stress the pertinence of the German philosopher Hans Jonas’ reflection on this
issue, establishing an inverse proportionality between rights and duties: those who are less
powerful (newborns, sick or old people, handicap, etc.) have far stronger claim of rights than the
responsibilities they can perform; in contrast, those who are more powerful (politicians, healthcare
professionals, media, etc.) have weaker claim of rights than the responsibilities they should answer
for. Both perspectives are important in bioethics, being the one from Jonas also applied to
environmental issues and in a more demanding way.

Applied Ethics: Bioethics

Applied ethics arose in the 1960s due to a convergence of quite different factors: the
demoralization process following the advocacy of moral relativism, which leads to the lack of
sound orientation for human action; the urgency to regain the guidance provided by ethics in order
to contribute to more respectful, kind, and fair personal relationships; and the democratization of
ethics with the rejection of a superior authority dictating the moral rules and the willingness of the
citizens in general to participate in the formulation of morals (sometimes referred to as a
“ethiocracy” or assumption that all and each one can be the author of morals). Applied ethics is a
restricted field of ethics specifically concerned with a concrete social domain of activity, whose
success extended to evermore domains (healthcare, environment, engineering, media, business,
international relations, etc.), and equally involving all stakeholders. This feature is important to
distinguish applied ethics from professional ethics, both being closely related and sometimes
mistaken for each other.

Applied ethics is a branch of ethics specific to a concrete social domain of activity, grounded on
common morality and addressed to all people possibly involved in that activity (bioethics
addresses healthcare professionals, as well as patients and their families, and also all who might
need healthcare or those who want to be involved in societal matters); but professional ethics is a
branch of ethics specific to a professional group, established by those professionals for themselves
(in a closed circuit: medical ethics addresses only medical doctors). Applied ethics formulates
moral rules aiming to promote personal flourishing and good human relations according to a
shared perception of good or duty, within a specific social domain of activity; professional ethics
formulates administrative, legal, and ethical rules aiming to promote good practices and the
prestige of the profession. Therefore, applied ethics is broad and pluralist, and professional ethics
is restricted and unisonous voiced.

All applied ethics are of a theoretical-practical nature, having a double requirement: on the one
hand, a sound theory to guarantee the objectivity of its justifications and the coherence of its
orientations and, on the other hand, efficient and efficacious interventions in concrete situations to
assure the real and satisfactory resolution of problems.

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The first and most prominent applied ethics is bioethics, introduced in December 1970 by Van
Rensselaer Potter, in his work “Bioethics, Science of Survival,” a chapter of the book Bioethics:
Bridge to the Future, published a month later. “Bioethics” was then regarded to have an ecological
dimension, as a new science gathering the knowledge of life sciences and of the systems of values
in order to assure the survival of Man in a threatened environment. Months later, on 1 July 1971,
André Hellegers also introduced the word “bioethics,” without knowing Potter’s work, at the
foundation of “The Joseph and Rose Kennedy Institute for the Study of Human Reproduction and
Bioethics.” “Bioethics” was then understood as a biomedical ethics, a reflection and practice upon
the impact of the new biotechnology on Man, a meaning that has prevailed.

Applied ethics have been answering, in a broad and consensual way, to the many concrete
questions that are raised by the wide diversity of domains of human activity to which citizens of
democratic societies are today called to participate in. Taking into account that rules of practice
are not predetermined and can be revised throughout time, citizens are challenged to collaborate
and to get involved in what concerns them too. Today, applied ethics are indispensable to
democratic coexistence and to active citizenship.

Conclusion
Ethics has evolved along the centuries, mostly in contemporaneity, but has always preserved its
identity as a rationalization of human action, in which it grounds its objectivity and coherence and
its validity and credibility, within a universal framework. These requirements prevail either in a
heteronomous or in an autonomous ethics, either in a maximalist or in a minimalist ethics, and
should also be observed in applied ethics, such as bioethics.

Cross-References
Applied Ethics
Bioethics: Clinical
Human Rights
Professional Ethics
Values

References

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Beauchamp, T., & Childress, J. (2013). Principles of biomedical ethics (7th ed.). New York:
Oxford University Press. (1st ed., 1979).

Engelhardt, Jr. Tristram. (1986). The foundations of bioethics. New York: Oxford University
Press.

Kant, I. (2002). Groundwork of the metaphysic of morals (A. W. Wood, Ed. and Trans.). New
Haven/London: Yale University Press.

Pellegrino, E. (1995). Virtue-based normative ethics for the health professions. Kennedy Institute
of Ethics Journal, 5, 253–277.
CrossRef

Pellegrino, D., & Thomasma, D. (1988). For the patient’s good, the restoration of beneficence in
health care. New York/Oxford: Oxford University Press.

Pellegrino, E., & Thomasma, D. (1993). The virtues in medical practice. New York: Oxford
University Press.

Further Readings

Aranguren, J. L. (1965). Ética 3ª; Moral y Sociedad. La moral española en el siglo XIX, 1982, 2ª;
Ética y política, 1985, 2ª.

Aristote. (1983). Éthique a Nicomaque (J. Tricot, Trans.). Paris: J. Vrin.

Beauchamp, T. (2003). Methods and principles in biomedical ethics. Journal of Medical Ethics,
29, 269–274.
CrossRef

Folscheid, D., Feuillet-Le-Mintier, B., & Mattei, J.-F. (1997). Philosophie, éthique et droit de la
médicine. Paris: Presses Universitaires de France.

Heidegger, M. (1946). Über den Humanismus (R. Munier, Trans.). ( Lettre sur l’Humanisme).
Paris: Aubier-Montagne. (3rd ed., 1983).

Rawls, J. (1971). A theory of justice. Cambridge, MA: Harvard University Press. (Rev. ed., 1999).

Richardson, H. (1990). Specifying norms as a way to resolve concrete ethical problems.

Philosophy and Public Affairs, 19, 279–310.

Richardson, H. (2000). Specifying, balancing, and interpreting bioethical principles. Journal of

Medicine and Philosophy, 25, 285–307.

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CrossRef

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