B1OETHICAL DECISION-MAKING: A REPLY TO

ABSTRACT. Terrence Ackerman has suggested that we ought to view general bioethical principles as generalizations which summarize our previous bioethical decisions rather than as moral rules. He would have us derive our ethical views instead principally from the facts of the cases in question and our intuitions about them. The proposal is attractive because of its similarity to medical decision-making, but it fails because it allows for no higher order standard of reference against which conflicting ethical intuitions may be judged. Terrence Ackerman proposes a radical reformulation of the bioethical enterprise in the September, 1980 issue of The Journal of Medicine and Philosophy. Many of Ackerman's concerns are well-founded and his proposal is attractive. Nevertheless, I find Ackerman's metaethics fundamentally incomplete, for it unnecessarily limits moral discussion and analysis by denying normative force to moral principles. Ackerman is concerned that current bioethical theorizing tends to stray too far from the real concerns of clinical medicine. He argues cogently that we cannot expect to resolve a bioethical dilemma intel-ligently if we concentrate on moral principle to the exclusion of the case at hand. Furthermore, Ackerman believes (and I agree) that the philosopher ought to analyze and take seriously the moral intuitions and desires of those actually involved in an ethical dilemma. Ackerman proposes that bioethical thinking ought to move directly from the case at hand and the goals of those involved, to a decision, with general moral principles relegated to the status of summaries of previous bioethical decisions. A course of action "is to be chosen because it is a means to ends, not because it is logically implied by an underlying principle " (1980, p. 260). Ackerman explicitly reject