Transcending Liberalism – Avoiding Communitarianism: Human Rights and Dignity in Bioethics (original) (raw)

The Liberal Roots of Contemporary Bioethics Questions of bioethics are part of the broader ethical reflection that embraces different changes of social practices in modern societies. While medical ethics has always been part of medical practice, it was newly constructed after World War II. It emerged as corrective to the crimes committed by physicians during the Nazi dictatorship, but with the development of new medical technologies, biomedical ethics began to add to the critique of disrespect for human rights the underlying paternalism in all traditional clinical medicine. Moreover, since individual freedom was largely considered to be the core social value of Western societies to which medical ethics was addressed first and foremost, relying on the physicians' virtues and individual responsible behavior appeared not only to be dubious in light of the recent history but also seemed to contradict the freedom rights of sovereign citizens in modern societies. Health care providers were more and more seen as providing the means for patients to realize their choices in situations of illness and disease. Furthermore, the principle of well-being, which had served as the over-arching norm of medical action for centuries and was long considered the core principle of traditional medical ethics, articulated, for example, in the principle salus aegroti suprema lex (the well-being of the patient is the supreme law), seemed to belong to a paternalistic medical ethics rather than to the liberal framework of an autonomy-based ethics. Apart from the scholastic methodology of Catholic moral theology-subjecting the individual to objective moral truths, such as the sanctity of human life, which do not have their origin in the subject's choices and are, according to this tradition, unchangeable truths-most bioethical theories are by now framed either as liberal utilitarianism or liberal deontology. Their underlying concept of the liberal self, however, is at best a distortion and at worst a caricature of the philosophical reflection on the self that has shaped 20 th century's critique of the sovereign subject. In the traditional paradigm of medical ethics, well-being served as the supreme principle of a doctor's actions, and it was determined predominantly 4 Medical sociologist Peter Conrad argues that the transformation of the "traditional" medicine to a market-oriented medicine is the most striking feature of modern medicine-this analysis raises important questions for the concept of preferential autonomy as brought forward by Anglo-saxon bioethics. I will return to this below.