Introduction

Facts vs. Value Judgements Graphic

People might consider many types of information before coming to a decision. This is no different in medical decision making. When faced with a medical decision, patients might consider relevant medical facts, costs of treatment, familial interests, cultural considerations, or personal preferences.

Given these considerations, how might a physician assist a patient in medical decision making? Do physicians have expertise on medical value judgements? What sort of recommendations are appropriate given empirical or medical expertise? Though physicians know medical facts, what sort of value judgments are appropriate to make given that knowledge?

What are the implications of theories of moral expertise on medical decision making? if there are moral experts, then we might think that they should be integrated into the medical space in some capacity. Should moral experts be consulted in ethical cases in hospitals? Who, if anyone, should be making normative recommendations for patients? The presence of a moral expert might also change which landscape for medical decision making (i.e., paternalism vs. autonomy) that we support.

Assigned Readings

Seminar participants were asked to read the following papers prior to meeting for discussion.

Veatch, R. M. (1973). Generalization of Expertise. The Hastings Center Studies, 1(2), 29–40. https://doi.org/10.2307/3527511

  • Thesis: Veatch argues that individuals with scientific expertise should not generalize that expertise to the moral or normative domain without demonstrating clear relationships between the expertises.

Ubel P. A. (2015). Medical Facts versus Value Judgments–Toward Preference-Sensitive Guidelines. The New England journal of medicine, 372(26), 2475–2477. https://doi.org/10.1056/NEJMp1504245

  • Thesis: Ubel argues that medical professionals risk harming patients when going beyond medical facts to make value judgments.

Sheldon M. (1996). Ethical issues in the forced transfusion of Jehovah’s Witness children. The Journal of emergency medicine, 14(2), 251–257. https://doi.org/10.1016/0736-4679(95)02096-9

  • Thesis: Sheldon notes that the state can order children of Jehovah’s Witnesses to have blood transfusions in order to allow the child to become an adult and decide what is in their own best interest.

Discussion Questions

Seminar participants were asked to consider the following questions prior to meeting for discussion.

  1. What are Veatch’s objections to physicians’/scientists’ generalizing their expertise (i.e., generalizing beyond the clinical to the moral)? What are your thoughts on the implications of Veatch’s points and/or the soundness of the points he made?
  2. After reading the Ubel article, do you think it is possible to have guidelines that do not involve value judgments? One exercise might be to look up a few professional guidelines related to your work and assess whether/how they involve value judgments. There are probably some recent relevant policies or guidelines related to COVID decision-making.

Reflection Points

Participants in the seminar series were particularly concerned with questions regarding the nature and status of moral expertise. This is a source of debate in the philosophical community. Philosophers have considered a variety of questions surrounding moral expertise, including whether there are moral experts and if you should listen to them.

In discussion, seminar participants were concerned with the following points.

  1. What does it mean to be an “ethics expert”? Ethical or theological training might give you technological knowledge, but it might not give access to knowledge that gives one any epistemic authority.
  2. Might shared experiences, sensitivity, or empathy contribute to moral expertise? If not, might it qualify someone to make normative judgments regardless?
  3. Are there scientifically generated facts that are completely value-free?
  4. What are the harms and benefits associated with science-first values?
    • E.g., Mask wearing
  5. What is the value of community contributions to moral or normative considerations?
  6. What is the value of physician experience as it relates to normative considerations?
  7. There are practical problems associated with physicians “dryly” reporting facts.

Additional Resources

The following papers address philosophical questions regarding moral expertise.

Callahan, L. F. (2018). Moral Testimony: A Re-Conceived Understanding Explanation. The Philosophical Quarterly. 68(272), 437-459, https://doi.org/10.1093/pq/pqx057

ENOCH, D. (2014). A DEFENSE OF MORAL DEFERENCE. The Journal of Philosophy, 111(5), 229–258. http://www.jstor.org/stable/43820838

Hills, A. (2009). Moral Testimony and Moral Epistemology. Ethics, 120(1), 94–127. https://doi.org/10.1086/648610

Sliwa, P.(2012). In Defense of Moral Testimony. Philosophical Studies. 158(2), 175–195. doi:10.1007/s11098-012-9887-6