The Age of Contractualism in Bioethics?

by J.S. Blumenthal-Barby, Ph.D.

Various ethical theories underlie approaches to resolving bioethical dilemmas. Consequentialist theories hold that the moral evaluation of an action is based solely upon the goodness or badness of its consequences for all of the relevant parties. Deontological theories, on the other hand, hold that the moral evaluation of an action is based at least in part upon its intrinsic nature and its resulting conformity to moral rules. Popular deontological theories utilized in bioethics include Kantianism, Natural Rights theory, or theories about Special Obligations (e.g., physician fiduciary duties). One relatively neglected deontological theory that seems to underlie a significant amount of recent work in bioethics is Contractualism.

Contractualism is the view that actions are morally right if they are permitted by the rules that free, equal, and rational people would agree to live by. Contractualism takes the positions or policies adopted by various stakeholders coming together as constitutive of the political or moral law. I think it is fair to say that a major movement in bioethics, especially among the more empirically inclined bioethicists, is to gather various stakeholders together to reflect on pressing bioethical issues. Public opinion polls on ethical and policy issues, “Delphi processes” to establish recommendations or guidelines, qualitative research to elucidate the moral concerns and views of various parties, public town meetings, and the move to include various stakeholders (especially patients) in research (including bioethical research) funded by the Patient Centered Outcomes Research Institute (PCORI) all serve as examples. Convening of groups of people to agree on the identification of and sometimes resolution of ethical and policy issues is becoming an increasingly common methodological approach in bioethics.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.