Abstract
This paper takes the philosophical notion of suberogatory acts or morally permissible moral mistakes and, via a reinterpretation of a thought experiment from the medical ethics literature, offers an initial demonstration of their relevance to the field of medical ethics. That is, at least in regards to this case, we demonstrate that the concept of morally permissible moral mistakes has a bearing on medical decision-making. We therefore suggest that these concepts may have broader importance for the discourse on medical ethics and should receive fuller consideration by those working the field. The focus of the discussion we present is on a particular thought experiment originally presented by Sulmasy and Sugarman. Their case formed the basis of an exchange about the moral equivalence of withdrawing and withholding life-saving treatment. The analysis Sulmasy and Sugarman set out is significant because, contrary to common bioethical opinion, it implies that the difference between withdrawing and withholding life-saving treatment holds, rather than lacks, moral significance. Following a brief discussion of rejoinders to Sulmasy and Sugarman’s article, we present a constructive reinterpretation of the thought experiment, one that draws on the idea of suberogatory acts or “morally permissible moral mistakes.” Our analysis, or so we suggest, accounts for the differing moral intuitions that the case prompts. However, it also calls into question the degree to which this thought experiment can be thought of as illustrating the moral (non)equivalence of withdrawing and withholding life-saving treatment. Rather, we conclude that it primarily illuminates something about the ethical parameters of healthcare when family members, particularly parents, are involved in decision-making.
Highlights
Whilst the notion of the supererogatory (Heyd 2016) has been considered in relation to certain bioethical issues— notably altruistic organ donation (Gerrand 1994, Wilkinson and Garrard 1996, 338) as well as in relation to medical practice and the profession itself (McKay 2002)—the same cannot be said of suberogatory acts (Driver 1992) or the closely related idea of morally permissible moral mistakes (Harman 2015a)
This essay is intended as a Bproof of concept,^ that is, as a demonstration that, at least in the case discussed, the idea of a morally permissible moral mistake is relevant to medical ethics
We suggest that a more nuanced understanding of the case can be achieved if we take up the notion of suberogatory acts (Driver 1992) and what Harman calls Bmorally permissible moral mistakes^ (2015a)
Summary
Whilst the notion of the supererogatory (Heyd 2016) has been considered in relation to certain bioethical issues— notably altruistic organ donation (Gerrand 1994, Wilkinson and Garrard 1996, 338) as well as in relation to medical practice and the profession itself (McKay 2002)—the same cannot be said of suberogatory acts (Driver 1992) or the closely related idea of morally permissible moral mistakes (Harman 2015a). Similar to Harris and Gillon’s view, the picture we present calls into question the relevance of the case for the ET and whether the ET is a useful principle when it comes to the practicalities of withdrawing and withholding life-saving medical treatment This additional point notwithstanding, if our analysis is convincing at minimum, we will have been successful in demonstrating that the idea of morally permissible moral mistakes has relevance to the medical ethics literature. We hope others will join us in reflecting on these ideas further and consider if our ethical understanding of healthcare and medical practice could be improved by a broader application of these concepts Before pursuing such issues any further, we first offer a concise account of the way we understand the terms Bsuberogatory act^ and Bmorally permissible moral mistakes.^ We set out the case presented by Sulmasy and Sugarman before briefly discussing Harris’ response and Gillon’s editorial. It can be considered a morally permissible moral mistake
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