The Primacy of Practice: Medicine and Postmodernism

Abstract

A dozen years ago, in my essay, ‘How medicine saved the life of ethics’[3], I argued that the debate in ethics among analytical moral philosophers, in particular the approach to the subject known as “meta-ethics,” ran into the sand in the 1960s or 1970s, and that the coincidental revival of interest in the moral problems of medicine took place just in time to redirect moral philosophy into substantive new fields of discussion. Even then, I might have done more to place this shift from definitional issues about the meaning of terms like “right” and “good” to substantive ones about the termination of artificial life support and the like within a broader historical frame, as it was already becoming clear that at a deeper level, also, the philosophical tide was turning. More recently, however, the philosophical shift from formal definitional issues to matters of substance has been unmistakable. In one respect, the change of focus in philosophical ethics between the 1950s and the 1980s had an obvious context. From early in the twentieth century, one central strand in European philosophy had been a series of critiques of Cartesian rationalism. This was launched in Germany by Edmund Husserl and Gottlob Frege, in England by Bertrand Russell and G. E. Moore, and in the United States by William James and John Dewey. Other powerful figures involved in the critique were Lev Semenyovich Vygotsky and Mikhail Bakhtin in Russia, Ludwig Wittgenstein in Vienna, Cambridge, and Norway; while, at one stage, Martin Heidegger had a significant part to play. More recently, Richard Rorty reformulated the central themes and slogans of this critique to good effect; while, in the wings, a parallel movement in literary theory was developing under the slogan of “deconstruction.” This movement shared, at least, the conviction that all earlier quests for a comprehensive system of knowledge, based on permanent, universal systems of overarching principles, were misguided from the start, and are by now discredited. Claims to philo