Reviewed by:

• A Theory of Bioethics by David DeGrazia and Joseph Millum
• Colin Hoy (bio) and Winston Chiong (bio)

David DeGrazia and Joseph Millum’s A Theory of Bioethics 2021 arrives at a curious time for an ambitious effort at systematic theory construction, seemingly out of step with bioethical fashion. At the same time, a prominent group of philosophical bioethicists authored an article, possibly with a touch of defensiveness, to “make the case that philosophy and philosophers still have a very important and meaningful role to play in contemporary bioethics” (Blumenthal-Barby et al. 2021). Meanwhile, the annual meeting of the American Society for Bioethics and Humanities included several expressions of impatience with the historical privileging of philosophy over more empirical, situated, and community-oriented approaches to moral problems in health.

DeGrazia and Millum’s work itself reflects the current state of bioethics and how it has changed since the heyday of grand bioethical theory construction in the late twentieth century. To apply Parfit’s philosophical taxonomy (1984), the general frameworks promulgated by theorists like Veatch, Engelhardt, and Gert, as well as Beauchamp and Childress, were by necessity revisionary. These bioethical theories were whole-cloth alternatives to a conventional and paternalistic medical ethos that was already widely acknowledged as unsatisfactory. Today, however, bioethics is a mature and institutionalized field, with well-established practices and a corpus of accepted tenets (alongside matters of ongoing but generally demarcated controversy). A plausible and fruitful contemporary theory of bioethics must be largely descriptive, in Parfit’s sense, providing an intellectual framework that gives coherence and sense to existing practice, while at the same time clarifying matters of confusion.

In contemporary bioethics, a central component of this practice is the application of the four principles of biomedical ethics—non-maleficence, beneficence, justice and autonomy—not merely as originally proposed by Beauchamp and Childress (2019), but in their refined form, following decades of exchange, critique, and revision. DeGrazia and Millum’s theory begins with two core values: well-being and respect for rights holders. [End Page 321] The bulk of the book then applies the method of reflective equilibrium to specify these two values in terms of the canonical four principles, here treated as “mid-level” constructs with readier application to specific cases than the two core values. Experienced bioethicists may have an uncanny sense of setting off from a new trailhead, and yet, eventually finding themselves still walking a familiar path. However, this way of introducing and explicating the four principles will likely be more accessible to a wider audience, including high-level undergraduates and graduate students not already versed in the revisions, refinements, and compromises embedded in Beauchamp and Childress’s discussions.

Two other features recommend this book as a resource for trainees and interested non-experts seeking to deepen their understanding of bioethics. First, the clarity of its style and organizational approach provides a welcome orientation for non-specialists. The chapters are structured so that major contending perspectives are outlined before the authors develop arguments for their own positions in that context. Each chapter proceeds by considering applications of the broader theory, showing how it can illuminate potential candidate approaches or policies, as well as demonstrating how to use the tools of ethical analysis to evaluate these proposals in both ideal and non-ideal cases. This didactic approach to the relationship between conceptual argument and practice will be accessible to many who are initially unfamiliar with or intimidated by theory. Second the commendable decision to make the book electronically available and accessible also has the potential to broaden the reach of the work, and in particular, to engage parties in under-resourced settings, which have so often been overlooked in bioethical discourse.

As noted above, while the authors’ approach is descriptive in Parfit’s sense, it is not necessarily conservative. In many places, the authors highlight how their theory includes elements or renders conclusions that are not broadly accepted, and following the method of reflective equilibrium, they advocate for these positions both in terms of broad principles and particular judgments about cases. This begins with their dual-value...

审阅者：

• 大卫·德格拉齐亚和约瑟夫·米勒姆的生命伦理学理论
• 科林·霍伊（Colin Hoy）（简介）和温斯顿·钟（Winston Chiong）（简介）

大卫·德格拉齐亚 (David DeGrazia) 和约瑟夫·米勒姆 (Joseph Millum) 的《生命伦理学理论2021》恰逢其时，该书在系统理论构建方面雄心勃勃，似乎与生物伦理学时尚格格不入。与此同时，一群著名的哲学生物伦理学家撰写了一篇文章，可能带有一丝防御性，“证明哲学和哲学家在当代生物伦理学中仍然发挥着非常重要和有意义的作用”（Blumenthal-Barby et等2021）。与此同时，美国生物伦理学和人文学会的年会也表达了对哲学在历史上的特权，而不是对健康道德问题采取更实证、情境和面向社区的方法的不耐烦。

德格拉齐亚和米勒姆的著作本身反映了生命伦理学的现状以及它自二十世纪末宏大生命伦理学理论建设的鼎盛时期以来发生的变化。为了应用帕菲特的哲学分类法（1984），Veatch、Engelhardt、Gert 以及 Beauchamp 和 Childress 等理论家颁布的总体框架必然是修正的。这些生物伦理理论完全替代了传统的、家长式的医学精神，这种精神已经被广泛认为是不令人满意的。然而，今天，生物伦理学是一个成熟和制度化的领域，拥有完善的实践和一系列公认的原则（以及正在进行但普遍界定的争议问题）。在帕菲特的意义上，一个合理且富有成效的当代生命伦理学理论必须在很大程度上是描述性的，提供一个知识框架，使现有实践具有连贯性和意义，同时澄清混乱的问题。

在当代生物伦理学中，这种实践的核心组成部分是应用生物医学伦理学的四项原则——非恶意、仁慈、正义和自主——不仅如 Beauchamp 和 Childress (2019) 最初提出的那样，而且以其精致的形式，经过几十年的交流、批评和修改。德格拉齐亚和米勒姆的理论始于两个核心价值观：福祉和对权利持有者的尊重。[完第321页]然后，本书的大部分内容应用反思平衡的方法，根据规范的四个原则来指定这两个价值观，这里被视为“中级”结构，比两个核心价值观更容易应用于特定情况。经验丰富的生物伦理学家可能会有一种从新的起点出发的不可思议的感觉，但最终发现自己仍在走一条熟悉的道路。然而，这种介绍和解释四项原则的方式可能更容易被更广泛的受众所接受，包括尚未熟悉博尚和柴尔德里斯讨论中所包含的修订、完善和妥协的高水平本科生和研究生。

另外两个特点推荐本书作为学员和感兴趣的非专家寻求加深对生物伦理​​学理解的资源。首先，其风格和组织方法的清晰性为非专业人士提供了受欢迎的方向。这些章节的结构是为了在作者为自己在该背景下的立场提出论据之前概述主要的争论观点。每一章都考虑更广泛的理论的应用，展示它如何阐明潜在的候选方法或政策，以及演示如何使用伦理分析工具在理想和非理想情况下评估这些建议。这种关于概念论证与实践之间关系的说教方法对于许多最初不熟悉理论或被理论吓倒的人来说是可以理解的。其次，将本书以电子方式提供和访问的值得称赞的决定也有可能扩大工作的范围，特别是让资源贫乏地区的各方参与进来，而这些地区在生物伦理学讨论中经常被忽视。

如上所述，虽然作者的方法是帕菲特意义上的描述性方法，但它不一定是保守的。作者在许多地方强调了他们的理论如何包含未被广泛接受的要素或得出的结论，并遵循反思平衡的方法，从广泛的原则和对案例的具体判断方面主张这些立场。这要从他们的双重价值开始……