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The foundations of bioethics.

A physician friend of mine recently was caring for a critically ill infant who was dying. The infant's mother insisted that the infant be treated with maximal life support as long as possible. The physician told me that, as a physician, he had the right and the duty to refuse to provide treatment any longer because the effort was `futile'. I pressed him about how he knew he was doing the morally right thing. When I did, he cited the opinion of an American professional physician organization of which he was a member. He seemed to believe that he could prove he was right by citing the moral stand of this group as if it were the definitive authority in biomedical ethics. I pressed him again asking how he knew his group had the right answer. He then claimed that the majority of medical professional organizations in the United States held the same view. I, of course, could ask how he could know that unilaterally withholding care deemed futile was morally right just because the majority of American professional organizations believed it was. And then he might have appealed to some moral consensus of all medical professionals of all time throughout the world. If he did, I still would not have been satisfied. I would have disagreed with him factually. It is clear that not all physicians in history have considered it morally right to unilaterally withhold treatment they deem futile. More critically, I would have disagreed with him epistemologically. I would have disagreed with his implication that one could prove a physician's behavior is morally right by appealing to the consensus of physician opinion. Even if all physicians throughout history have believed some behavior is morally right, that does not make them right. Had he then cited the opinion of a religious group or a national court or the International Court of Justice, I would have been left with the same question: how do we know a position in biomedical ethics is right just because some group or another approves? At this point, ethics desperately searches for a foundation Ð a metaphysical rock-bottom, a grounding or source from whence Bioethics ISSN 0269-9702 Volume 13 Number 3/4 1999