Bringing Hume to the Bedside: Toward a Sentimentalist Clinical Ethics

Abstract: Moral Sentimentalism is the name given to a cluster of philosophical views which claim that our emotions play a central role in morality. For sentimentalists, moral emotions are crucial to our ability to make moral judgments, ascertain moral truth, and to understand the nature of morality more generally. This view has deep philosophical roots but is most prominently represented in the work of David Hume. Here I attempt to bring this sentimentalist tradition to bear on contemporary debates regarding methods in clinical ethics consultation.

Historically, much of this debate has centered on adjudicating the relative merits and weaknesses of a few dominant approaches to clinical ethics (e.g. Principlism vs. Casuistry vs. Public Reason/Reflective Equilibrium methodologies). In most cases, these debates set aside metaethical commitments in favor of beginning with so-called “middle principles” or “common morality.” As a result, clinical bioethicists have generally neglected the metaethical foundations of the practice of clinical ethics.

My aim in this paper is to remedy this by attending to the role of the moral emotions in the practice of clinical ethics. I attempt to show that moral emotions such as empathy, approbation, anger, regret, guilt, and resentment play a substantial role in guiding the judgment of the clinical ethicist. I then argue that attending to these emotional responses in ethics consultation is to the benefit of clinical ethics generally and that these emotional responses, rather than being tamped down or disregarded, ought to take center stage in clinical ethics consultations.

Keywords: Clinical Ethics, Moral Sentimentalism, Emotions and moral judgment