Epistemological and moral reasoning in medical ethics

Hirst, David Alexander (2018) Epistemological and moral reasoning in medical ethics. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

The purpose of this paper is to go towards proving that the generalist ambitions championed in Medical Ethics discourse are both misguided and dangerous to that discourse’s meaningfulness. It will be claimed that the generalist undertones which underscore the discourse are motivated by the looming threat of irrationalist accounts of moral reasoning. I first make attempts to show that generalism itself does not avoid this threat. I then aim to show that irrationalism, in turn, is predicated upon a particular and highly contestable conception of empirical epistemological ideas which are, post-analysis, simply unsustainable. I use the work of recent particularist contributors to philosophical debates regarding meaning to show - via a reading of Wittgenstein’s later work - which this empiricist epistemology fails. I then defend this reading of Wittgenstein against others, by trying to show that there is enough in the accounts of theorists such as McDowell to suggest that it can rescue meaning in ethical utterances. Our discussion will take us through various areas of thought in claiming that a particularist account really does give the best explanation of moral reasoning. Epistemological, motivational, phenomenological and ontological concerns will all be assessed and contrasted with competing generalist claims. I also critically assess various particularist theorists’ claims, making the case for a specific form of non-reductive ethics. This is cashed out by providing a commentary on the very recent debate regarding thick concepts. As the particularist position I advocate is largely found by way of adjudication between the pre-existing positions, I cannot make much claim of originality here. But by way of applying a thoroughly worked out particularist account to Medical Ethics - one which explains what motivates generalist accounts - I aim to elucidate in an important way how the generalist underscoring is not just incorrect, but also damaging to ethical debates in this domain; as well as providing a more thorough account of how we actually can improve Medical Ethics via first-order ethical reasoning. These last points give the thesis its unique interest.