The Normative Relevance of Cases

Abstract

In a seminal essay anticipating the contemporary preoccupation with the empirical ground of our normative judgments, Daniel Callahan wrote, ‘‘What is, is all we have in the universe. We have to admit that if nature is not the source of morality, it does not have any source.’’ The attitude that Callahan has characterized in these stark terms has become a commonplace today, and efforts have shifted toward determining an adequate empirical basis for ethics, and what its acceptable uses are, rather than justifying in general terms the fact that ‘‘what is’’ is relevant for ‘‘what should be,’’ and refuting the so-called naturalistic fallacy. At a minimum, a ‘‘naturalized bioethics’’ has to ‘‘resist the pull to purity’’: it must acknowledge the complexity of ethical judgments and actions, promote curiosity for real-life dilemmas, and affirm the necessity that our ethical proposals be accountable to facts. Empirical ethics avails itself of a variety of methods. However, whereas qualitative and quantitative studies are common practice and their relevance is widely discussed, the use of individual cases has not been scrutinized with a view to assessing the reasons why, and the extent to which cases can constitute a valid empirical basis for ethical judgments. This is all the more crucial because a case anchors moral reasoning to practice in an intuitive and immediate way and often suggests insights or solutions to particular and even general issues: we are all familiar with the impact that cases have on our understanding of situations of ethical unease, with the satisfaction that we get when we feel that the solution we are suggesting accounts for several prominent cases we have encountered or read about, and with the heuristic function that cases play with respect to our common beliefs and practices. Indeed, one might argue, as Jonathan Dancy does, that cases are the only suitable tool of empiricism in ethics, because only cases can serve as tests of a sort for moral principles. Medical ethics, geared as it is toward the improvement of medical practice, is at the forefront of the naturalistic movement. It is a fact that cases do play an important role in medical ethics, and it is not surprising that they should: clinical medicine itself is rightly characterized as an art and to that extent deals primarily with particular cases rather than with general diseases. Cases are very often described in medical ethics publications: whether short or long, detailed or sketchy, current or exceptional, they capture our imagination and often provide a foundation for the authors’ conclusions. Moreover, cases, whether fictional or real, are central to narrative ethics, a prominent approach to bioethical reflection and education today: thanks to their temporal organization, the selective nature of the events recounted, and the thickness of their texture, narratives can better account for the lived experience of those involved in a medical decision, and to that extent