Thesis (MPhil)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Introduction
From the postmodern ethical perspective [the postmodernist would say Jrom the
ethical perspective], there is something suspicious and inherently unethical in a system of
ethics supported by a comprehensive, cohesive and universal metanarrative, a set of fixed
and unbending ethical rules and laws, without the ready possibility of revision [Cilliers,
1998, pp.114, 137-140; Cilliers, 2001, p. 3; Cilliers, 1995, p.125].
Based on the ideas of especially Winkler [1993, pp. 343-365] I have concluded
that contemporary mainstream biomedical ethics, represented and directed by the work of
Beauchamp and Childress [1994] are caught in such a crush. The primary objective of
this assignment is to evaluate the 'principles' of biomedical ethics [respect Jar autonomy,
beneficence, non-maleficence and justice] which were developed in their water-shed
publication [Principles of Biomedical Ethics, Oxford University Press, first published in
1979, and now in a fifth edition, 2002] against a background of postmodern ethics.
Methodology and conclusions
I have argued that Beauchamp and Childress' conception of principlism is a
contextual legalistic-philosophical response to the contemporary American situation,
developed primarily from legal decisions [often litigation]. It may be regarded as
acceptable practice guidelines, but represents a system of ethics without morality. I have
given a concise rendering of Winkler's notion of context-based bioethics with the
criticism that this also does not guarantee morality. Following that, there is a description
of postmodern society in terms of complexity theory. I have indicated how the
characteristics of complexity can be developed and applied contextually in bioethics. The
postmodern moral society is the locus where morality develops in a non-controllable
agonistic interactive process within which the postmodern moral agent unintentionally
finds himself. The postmodern ethical position is not an unethical, come-as-you-may
anything-goes position; it simply is not predictable, controllable, universal, rational [in a
Kantian context] and eternal. Modernity, it can be argued exhibits a far greater degree of relativism. The postmodern ethical position represents a return to morality in ethics,
morality of a very personal, face-to-face responsibility from which we as participants of
society cannot hide.
From a postmodern ethical perspective, an analysis of principlism and its
underlying principles exhibits the characteristics of modernity: eternal moral rules which
as such cannot be presented as morality. I have acknowleged Beauchamp and Childress'
attempts at adding morality to their conception [in the 4th edition] by means of
employing character ethics. They have nevertheless not made any radical changes in the
format of their presentation and maintain the central and primary role of principles. I
have also argued the limitations of the postmodern approach in terms of enclaves of
strictly controlled modernity and artificial witholding of information in medicine which
limit the free flow of information essential to the postmodern approach. My conception of
complexity and the postmodern approach do not pretend to be a panacea for biomedical
ethics. It attempts to redefine the meaning of morality in bioethics and questions the
unbridled application of this conception of principIism.
Finally I have discussed the burning issue of justice in the practice of medicine
from the postmodern perspective. Do I as a person have a right to health care; what are
the moral issues of dealing with 'life's lotteries'; what is the state's responsibility in
health care, and: what are my personal responsibilities in health care? In contradistinction
to libertarian concepts, the postmodern approach clearly argues in favour of the
acceptance by the state of its role in health care [a responsibility abrogated in many
societies, none more so than contemporary South-African society]. / AFRIKAANSE OPSOMMING: Inleiding
Daar IS uit die perspektief van die postmoderne etiese standpunt [die
postmodernis sou sê, uit die etiese perspektiej], iets verdags, iets inherent oneties aan 'n
sisteem van etiek wat 'n enkele goed omskrewe, kohese en omvattende universele
metanarratief voorhou, 'n stel vaste en onbuigsame etiese reëls en wette voorskryf en
afdwing sonder om konteks en gevolge te oorweeg, en sonder die geredelike
moontlikheid van revisie [Cilliers, 1998, pp.114, 137-140; Cilliers, 2001, p. 3; Cilliers,
1995, p.125].
Dit is, n.a.v. die denke van veral Winkler [1993, pp. 343-365] my oortuiging dat
die hoofstroom-denke in biomediese etiek in so 'n drukgang vasgevang is, en
verteenwoordig word en gerig is deur die denke van Beauchamp en Childress [1994].
Hierdie werkstuk gaan in hoofsaak daarom om Beauchamp en Childress se toepassing
van die beginsels van biomediese etiek soos sedert 1979 in hul waterskeidingsboek
'Principles of Biomedical Ethics' [Vierde uitgawe, Oxford University Press, 1994; daar is
nou ook 'n vyfde, 2002] uiteengesit, ontwikkel, bespreek en gepropageer [respek vir
outonomie, weldadigheid, non-kwaadwilligheid en geregtigheid] teen die agtergrond van
'n postmoderne etiese beskouing te evalueer.
Metodologie en gevolgtrekkings
Ek het in hierdie werkstuk aangetoon dat Beauchamp en Childress se weergawe
van prinsiplisme 'n kontekstuele wetlik-filosofiese reaksie op die kontemporêre
Amerikaanse situasie is, hoofsaaklik uit regsaksie [dikwels litigasie] voortvloei, as goeie
praktyksriglyne beredeneer kan word maar etiek sonder moraliteit verteenwoordig. Ek
het 'n kort uiteensetting van Winkler se weergawe van 'n konteks-gebaseerde benadering
gegee, maar aangetoon dat ook dit nie moraliteit waarborg nie. Daarop het ek 'n
beskrywing van die postmoderne samelewing n.a.v. kompleksiteitsteorie gegee, en
aangetoon hoe die eienskappe van kompleksiteit kontekstueelontwikkel kan word om in
bioetiek toegepas te word. Die postmoderne gepostuleerde morele gemeenskap is die lokus waar moraliteit ontstaan deur 'n onbeheerbare agonistiese proses van interaktiewe
wisselwerking waarby die postmoderne morele agent homself onwillekeurig betrokke
vind. Die postmoderne etiese posisie is nie onetiese, lukraak, doen-soos-jy-wil
relativisme nie; dit is bloot nie 'n voorspelbare, ewige, beheerbare, universele en
[Kantiaans-] rasionele sisteem nie; moderniteit is [was?] in effek veel meer relativisties.
Die postmoderne etiese standpunt verteenwoordig in my interpretasie 'n terugkeer tot
moraliteit in etiek, moraliteit van 'n persoonlike, ingrypende, verantwoordelike aangesigtot-
aangesig aard waaraan ons nie kan ontkom nie.
Vanuit 'n postmoderne etiese perspektief het ek 'n analise van prinsiplisme en die
individuele beginsels gemaak, en aangetoon dat hulle die eienskappe van die 'ewige
morele reëls' van moderniteit openbaar en nie sonder meer as morele beredenering
voorgehou kan word nie. Ek het erkenning gegee aan Beauchamp en Childress se eie
pogings om dit te besweer deur karakteretiek as 'n essensiële tot hul formule toe te voeg,
maar die kritiek uitgespreek dat hulle desnieteenstaande hierdie belangrike erkenning, nie
bereid is om die formaat van hul aanbieding [ook in die jongste vyfde uitgawe, 2002]
radikaal te wysig nie. Hulle oorbeklemtoon die beginsels steeds as sentraal en primêr.
Terselfdertyd het ek die beperkings van die postmoderne benadering uitgelig, veral in
terme van enklawes van streng-beheerde moderniteit in geneeskunde en 'n kunsmatige
weerhouding van die vrye vloei van informasie wat kompleksiteit en die postmoderne
situasie kenmerk. My konsepsie hou nie kompleksiteit en 'n postmoderne benadering
voor as 'n panakeia vir biomediese etiek nie; dit dien eerder om die betekenis van
moraliteit in bioetiek te herdefinieer en die kontemporêre algemene en ongekwalifseerde
toepassing van hierdie weergawe van prinsiplisme te bevraagteken.
Laastens het ek die brandende vraag van geregtigheid in die praktyk van
geneeskunde vanuit 'n postmoderne perspektief bespreek, veral of ek as persoon kan
aanspraak maak op 'n reg tot gesondheidsorg, die morele implikasies van 'life's
lotteries', die staat se verantwoordelikheid in gesondheidsorg en les bes, persoonlike
verantwoordelikheid in gesondheidsorg. Dit is duidelik dat 'n postmoderne benadering
tot bioetiek, in teenstelling met libertêre konsepsies, die staat se rol in gesondheidsorg
onderskryf ['n rol wat die staat byna universeel, en veral in Suid-Afrika, verwaarloos].
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/52965 |
| Date | 12 1900 |
| Creators | De Roubaix, J. A. M. (John Addey Malcolm) |
| Contributors | Cilliers, F. P., Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | af_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 118 p. |
| Rights | Stellenbosch University |
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