To request Mental Health
Services or to access Mental
Health Crisis Services Call:

Health Policy & Advocacy
Basic InformationMore InformationLatest NewsQuestions and AnswersLinksBook Reviews
A Companion to BioethicsA Companion to GenethicsA Philosophical DiseaseA Question of TrustAn American SicknessBetter Than WellBioethics in a Liberal SocietyBiomedical EthicsCommonsense RebellionCompetence, Condemnation, and CommitmentConfidentiality and Mental HealthConflict of Interest in the ProfessionsDivided Minds and Successive SelvesDSM-IV SourcebookEthical Conflicts in PsychologyEthics of PsychiatryEvolutionary Psychology and ViolenceFact and ValueFirst, Do No HarmFrom Silence to VoiceHealth, Science, and Ordinary LanguageHookedHow to Become a SchizophrenicHuman CloningIn Our Own ImageIn Two MindsInformed Consent in Medical ResearchIs Long-Term Therapy Unethical?Is There a Duty to Die?Melancholia and MoralismOur Posthuman FutureOut of Its MindOut of the ShadowsPC, M.D.Personhood and Health CarePharmacracyPractical RulesPragmatic BioethicsPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric EthicsPublic Health Law and EthicsRe-creating MedicineResponsible GeneticsSidewalk StoriesStreet CrazyTechnology and the Good Life?The Burden of SympathyThe End of Stigma?The Ethical Dimensions of the Biological and Health SciencesThe Ethics of SufferingThe Evolution of Mental Health LawThe Future of Human NatureThe Rules of InsanityThe Terrible GiftTransforming MadnessUnsanctifying Human Life: Essays on EthicsUsers and Abusers of PsychiatryViolence and Mental DisorderWhat Price Better Health?Who Qualifies for Rights?You Must Be Dreaming
Related Topics

Health Insurance

by Alan H. Goldman
Cambridge University Press, 2001
Review by Ben Mulvey, Ph.D. on Feb 28th 2002

Practical Rules

Whenever I attend a biomedical ethics meeting or conference, I am often reminded of the wide gap between philosophers and clinicians.  Clinicians often look to philosophers for the appropriate principle or rule to apply to a particular case such that moral conundrums are solved and the right thing is done.  They are as often unaware of the sort of meta-ethical research and debates that take place among philosophers; the sorts of research and debates, many philosophers would claim, that must be carried out and settled even before any practical advice can be issued.  Thus, in recent years philosophers have claimed that the appropriate ethical methodology is captured by one or more of the following approaches: narrative ethics, the ethics of care, feminist ethics, casuistry, virtue ethics, the ethics of pragmatism, to name but a few.  Goldman's Practical Rules situates itself squarely in this genre and takes a clear stand.

More specifically, Goldman inserts himself into one particular debate, that between, for lack of a better label, rules-appliers and those Goldman identifies as particularists.   Rules-appliers "assume that moral reasoning always consists in the application of rules to particular cases” (1). Particularists "have argued that moral contexts, situations in which morally relevant factors must be weighed in reaching decisions, are too fine-grained and too variable to be captured in a set of applicable rules" (11).  Goldman's is a "coherentist" account. 

The book is well organized into an introduction and four chapters.  The short introduction sets the stage, arguing that the standard particularistic account, though generally correct, is limited in ways that Goldman believes he can remedy.  Then, in chapter one, Goldman begins his analysis.  There he classifies types of rules, shows that genuine rules do not capture our ordinary moral judgments and focuses on the analysis of such cases, paradigms of contexts in which rules are needed. 

Chapter two compares justifications for using rules in prudential contexts, to further self-interest, with justification for moral rules that Goldman develops in chapter one.  Chapter three focuses on legal rules.  It begins with a classification of legal norms, a clarification of which legal norms require interpretation, and an analysis of what interpretation consists in.  Thus far Goldman has shown that the application of rules is not the norm in moral or legal reasoning, but has clarified when rules are nevertheless needed as a second-best strategy in these domains. 

The final chapter describes in detail what that norm is and outlines Goldman’s coherentist account of moral reasoning, a position that differs in important ways form Rawls’ coherentist position.  For Goldman, our informed and sensitive judgments “must represent a set of values fitting a rational life plan that can be consistently pursued” (9).  The correct answer to a controversial issue, then, is that which is most coherent with the base of settled judgments, that which cannot be differentiated from the closest analogous case in that base but can be relevantly distinguished from every case judged differently.

Goldman helps clinicians understand that doing the right thing is more than just applying the right rule in a particular situation.  Clinicians often have an overly simplistic view of ethics, often falling into one of two camps.  The first see the right thing to do as an application of a rule.  Thus ethics becomes a task of defining and finding the right rules.  This is where debates have turned into intractable stand-offs regarding which rule to follow.  The second group sees disagreement as endemic to ethics because morality is conceived of in relative terms, the value-centricity of cultural or personal identity.   In both cases disputants in ethical debates too hastily acquiesce to claims of intractability in the face of ethical conflict and the defeatist attitude that ethical disputes are by their very nature irresolvable.  The service Goldman provides is realistic conception of ethical reasoning that recognizes human limitations.  (The last chapter demonstrates the fruitfulness of his approach in an insightful analysis of the euthanasia debate.)  His conception does not promise an end to ethical dispute. "While no issue is in principle irresolvable, some are in fact so and perhaps should remain so according to the central paradigms, the fundamental moral outlook, of the opposing parties" (163-4).   Goldman's suggested "goal of informed and sensitive coherence" (164) helps focus attention on the need for the difficult work of dialogue, the need for fruitful exchanges between people and cultural groups regarding fundamental value differences that sometimes cannot be changed, but often can be understood. 

With Practical Rules Goldman has provided an impressive example the sort of analytical reasoning that goes on behind the scene (or in the ivory tower), away form the clinic (or the point of application) in meta-ethical debates among philosophers.  Philosophers will see this book displaying clear analyses and a well-argued position.  Though a difficult read for those not philosophically trained (I would recommend that non-philosophers read only the first and last chapter for an outline of the debate Goldman is entering and then an outline of his own alternative position), Goldman has also provided a real service to clinicians concerned with ethical behavior.  It reminds the clinician that ethical disputes often contain and often are nothing more than a lack of communication.


© 2002 Ben Mulvey


Ben Mulvey, Ph.D., is an Associate Professor of Philosophy and Director of Liberal Arts at Nova Southeastern University.  He received his doctorate in philosophy from Michigan State University with a specialization in political theory and applied ethics.  He teaches ethics at NSU and is a member of the board of advisors of the Florida Bioethics Network.