著者

岡本 珠代

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.16, pp.35-45, 1998-10-01 (Released:2018-02-01)

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Casuistry derives its tradition from the medieval Catholic practice of moral discussion dealing with difficult cases (=cases in Latin, hence casuistry) which can allegedly offer ways to resolve moral dilemmas without recourse to any ethical theories or overarching ethical principles. Contemporary bioethicists such as Albert Jonsen claim that the casuistic approach pays attention to a particular case with its circumstances, analyses it, compares it with other cases and decides its moral status as to whether it is a paradigm case or subsumed under a different category. A casuist makes a stark distinction between a case-based approach and a theory-dependent approach in ethics. The principle-based theorists such as Tom Beauchamps (despite their recent affinity with coherentism) are derogatorily called principlists whose main job is to strictly and deductively apply ethical principles in their "applied ethics". The casuistic bottom-up approach is shared by communitarian ethicists whose commitment is limited only to the close relationship in the local community. One of the casuistic rules employed to decide the morality of an action is called the doctrine of double effect. It justifies an action when it is performed from a good intention, such as to stop the suffering of a terminal-stage patient, even though the actual consequence is her death which was foreseen but not willed. This doctrine is subject to an abuse, and because it could camouflage an intention to bring about a negative effect, it has to be rejected. We can learn from casuists the value of an approach to analyse individual cases with reference to paradigms. A case analysis is an effective way of teaching ethics and of resolving moral dilemmas. But we also have to employ common values applicable to everyone in a global community to guide our actions, such as respect for persons, general welfare and the democratic decision-making procedure.