Moral particularism: implications in medical ethics

Particularism challenges the accepted idea of normative moral theory that morality can be reduced to a finite set of fundamental principles; it sees morality as quite capable of getting on without such principles. This thesis is concerned with asking what, if any, changes would be required in the practice of medical ethics if this is correct.\ud \ud It is proposed that current guidelines for professional clinicians and medical scientists constitute a “fleshed out” normative system which provides pro tanto rules for ethical practice. To investigate the implications of this in a particularist world, the idea of thin and thick moral concepts is extended to cover moral principles so that generalist professional guidance is seen as constituted of thick principles. This guidance aims to provide the required confidence for the doctor-patient relationship and in particular for the trust required between doctor and patient.\ud \ud Examples of the development of protocols for early phase clinical trials in cancer, and of resource allocation in a resource limited system are used to investigate the difference in decision making, and thus in the decisions themselves, between generalist and particularist professionals. In a generalist world trust is placed in the systems of trustworthiness (practice guidelines etc) and thus in the developers of such systems; in a particularist world moral decisions are made by the clinician and so trust is placed much more directly in that clinician.\ud \ud The implications of this analysis are that under particularism medical ethical training (initial and continuing) would focus more on the development of moral character of the various professionals and less of following guidelines. The complexity of modern medicine implies that such guidelines would still be required, but they would no longer represent pro tanto duties, but rather ceteris paribus advice