In recent years, the development in bioethics has increasingly been toward empirical research. Much less attention has been paid to the question about the theoretical frameworks on which bioethics should be based.

Mary Midgley sees philosophy as plumbing, something that nobody notices until it goes wrong. “Then suddenly we become aware of some bad smells, and we have to take up the floorboards and look at the concepts of even the most ordinary piece of thinking

In this issue of CQ we introduce a new feature, “By Invitation,” in which noted bioethicists are invited to reflect on vital current issues. Our first invitee, John Harris, will subsequently assume editorship of this section.

The annual cost of healthcare in the United States reached $2.5 trillion in 2009 (about 17.6% of GDP) with projections to 2019 of about $4.5 trillion (about 20% of likely GDP).

Many have complained that Kant’s ethics provides little specific guidance as to how we should act. In contemporary healthcare, professionals act in large-scale organizational contexts, with complex reward structures, and in many cases belong to professional bodies that determine the ethical obligations associated with particular roles.

Knowledge is generally a good thing. People who know lots of bits of information are generally admired. Some of them win prizes in TV competitions. If you were offered the gift of having an entire encyclopedia wired into your brain, you would probably accept, without thinking. But we should be wary of assuming that all knowledge is good. Too much knowledge can inhibit rather than enable thought.

Among bioethicists, and perhaps ethicists generally, the idea that we are obliged to respect autonomy is something of a shibboleth. Appeals to autonomy are commonly put to work to support legal and moral claims about the importance of consent, but they also feed a wider discourse in which the patient’s desires are granted a very high importance and medical paternalism is regarded as almost self-evidently indefensible.

You have lied! You are a liar! This is one of the most serious moral offences one can be blamed for. Augustine even regards lying as the fundamental moral offence and identifies it with sin and evil in general. For Augustine and Kant, lying is in itself morally reprehensible and not justifiable at all.

Until quite recently bioethicists have had little of depth and probity to say about the duty of healthcare professionals in general and physicians in particular to relieve pain and suffering associated with disease and/or its treatment.