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One of the fundamental challenges in any field of practical ethics is to articulate a framework for deliberation and decision making that is capable of providing warranted guidance about contentious ethical questions.1 Such a framework has to function effectively in the face of empirical uncertainty and what Rawls refers to as the fact of reasonable pluralism—the fact that individuals often differ in their ideals, ambitions, preferences and conceptions of the good life. One of the perennial questions in normative and metaethics concerns the source of the warrant for such judgments, and a major preoccupation of practical ethics has been to find a way to generate such warrant without having to first settle all contentious philosophical questions about the nature and source of normativity. To the extent that scholars use the term ‘common morality’ to refer to a set of moral norms or concerns that are sufficiently common and widespread that they can be used as starting points for moral deliberation and inquiry, I am sympathetic to the term.2 To the extent that appeals to common morality are supposed to do more significant epistemic or justificatory work, they have always struck me as dangerously ad hoc and insufficiently responsive to the legitimate need to explain the ground for common normative claims.
Although I am relatively sceptical of appeals to common morality, I am concerned that the version of this view that is critiqued in ‘Why not common morality’ is simply a straw person . Throughout the paper, Rhodes treats common morality as synonymous with everyday ethics and the ethics of everyday life. She says, ‘If common morality and medical ethics were the same, then the ethically justified behaviour for medical professionals and everyone else would be the same’ (Rhodes, p7).3 In effect, the view that Rhodes attacks is one that holds that if we were to write down and enumerate the specific acts that are morally permissible for ordinary folks in everyday life, as well as the specific acts that are morally permissible for medical professionals in the course of delivering care, the two lists would contain the very same acts. This is what Rhodes claims is false when she points out, for example, that although it is permissible for ordinary folks to engage in sexual intercourse with other consenting adults in ordinary life, it is impermissible for healthcare providers to engage in sexual intercourse with patients, even in the presence of free and informed consent. From the fact that the same act is permissible in one case but impermissible in another, she concludes that the ethics of everyday life and medical ethics are different. Moreover, from this, she then infers that medical ethics is in need of a new moral foundation.
How plausible is the view being attacked? Not very. Even within ‘ordinary life’ there are many situations in which sexual relations between consenting adults can be morally wrong, depending on the presence or absence of other morally relevant considerations. For example, if at least one of these persons has taken a vow of fidelity to a third person, then consensual sex with this second person is wrong because it is a breach of that vow of fidelity. Yet we would not want to say that the morality of marriage is different from the morality of ordinary life.
Since the idea that medical professionals are bound by special moral duties is as old as medicine itself, the version of the common morality view described earlier seems like a radical departure from common sense. Moreover, if works defending such a position, such as Principles of Biomedical Ethics 4 (Principles from now on), rested on the view that the ethics of everyday life and the ethics of medicine are identical, one would expect to find their authors either denying that it is generally permissible for ordinary folks to have sex with other consenting adults or to find them affirming that it is permissible for physicians to have sex with their patients so long as it follows a process of free and informed consent. It would truly be a sad commentary on the state of scholarship in medical ethics if the authors of that book held that the acts permissible for people in ordinary life and the acts permissible for medical professionals in the context of delivering care are the same, and then held both that consensual sex among ordinary folks is permissible, while it is impermissible among patients and providers. It would also be a sad commentary on the state of the profession if this elementary mistake had gone unrecognised through seven editions of a book that has been the subject of voluminous criticism.
A more charitable reading of Principles holds that common morality is not synonymous with everyday ethics or the ethics of everyday life. Rather, common morality is something like a shared set of fairly general norms or values from which can be derived more detailed claims about the ethical permissibility of particular acts, both in daily life and in particular professional contexts. What the ethics of everyday life and the ethics of medicine share in common is not the same list of permissible acts, but a reliance on the same set of general moral values that, when specified in different contexts, determine which acts are morally permissible. Common morality views need only hold that the permissibility of one act in one context (eg, sexual relations among uncommitted adults in ordinary life) can be explained by the same set of moral values that explain the moral impermissibility of that same act in a different context (eg, consensual sex between physicians and patients).
Rhodes seems to recognise that proponents of common morality can argue that the same set of values can lead to different verdicts about particular acts because of differences in the contexts in which those acts are performed. At various points, she suggests that proponents of the common morality view might appeal to the voluntary assumption of a social role as part of such an explanation. In fact, she admits that ‘Role morality is consistent with common morality and special role-related obligations (eg, being a parent, butcher, baker, or candlestick maker) derive from individuals’ voluntarily assuming special responsibilities by making an explicit or implicit promise’ (p13). She also goes out of her way to affirm that, ‘in arguing for medical ethics as a distinctive field of morality, I reflect a point made by John Rawls in Political Liberalism. There Rawls notes that ‘it is the distinct purposes and roles of the parts of the social structure…that explains there being different principles for distinct kinds of subjects’’ (p20).
But if Rhodes is following Rawls, and Rawls sees distinct moralities as constructed in part by different social roles, and if common morality is sufficient to explain role-related moralities, then Rhodes appears to be committed to the negation of her own thesis. Despite the homage she pays to Rawls (who appeals to social roles), and despite noting that sociologists view professions as a ‘cluster of occupational roles’ (p13), Rhodes denies that professions are social roles. However, the closest thing that we get to a defence of this claim—the claim on which her entire argument rests—is the bald assertion of a non sequitur: ‘Professions are different from roles in that the knowledge, powers, privileges, and immunities which society allows to professions are radically different from what is allowed for ordinary citizens’ (p13).
Nobody disputes that professionals have knowledge, powers, privileges and immunities that differ from ordinary folks. What they claim is that the justification for granting a professional a particular power or privilege can be derived from the application of a core set of common values (common morality) to the unique social purposes those powers or privileges are necessary to facilitate. When Rhodes proposes that we consider why a society in something like the state of nature might invest medical professionals with certain powers and privileges, she seems to presuppose the application of just such a more general set of common values. After all, for example, if disease detracts from welfare and limits opportunity, and if a social division of labour in which some people develop specialised medical knowledge enables society to more efficiently ameliorate the ravages of disease, then the creation of medical specialties seems to depend on the values of beneficence and autonomy. If clinicians are privy to sensitive information for the purposes of ameliorating disease, and thereby improving welfare and autonomy, then strict limitations on the disclosure of that information are necessary to preserve the clinical relationship without undermining the welfare or the autonomy of patients.
In sum, although I am not a fan of strong appeals to common morality in bioethics, such views have more depth and intellectual merit than is reflected in the criticisms offered in ‘Why not common morality’.
Contributors The author conceived and wrote this article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.