n Postmoderne uitdaging aan die 'paradigmale biomediese etiek model' met verwysing na kompleksiteitsteorie

[摘要] ENGLISH ABSTRACT:IntroductionFrom the postmodern ethical perspective [the postmodernist would say Jrom theethical perspective], there is something suspicious and inherently unethical in a system ofethics supported by a comprehensive, cohesive and universal metanarrative, a set of fixedand unbending ethical rules and laws, without the ready possibility of revision [Cilliers,1998, pp.114, 137-140; Cilliers, 2001, p. 3; Cilliers, 1995, p.125].Based on the ideas of especially Winkler [1993, pp. 343-365] I have concludedthat contemporary mainstream biomedical ethics, represented and directed by the work ofBeauchamp and Childress [1994] are caught in such a crush. The primary objective ofthis assignment is to evaluate the 'principles' of biomedical ethics [respect Jar autonomy,beneficence, non-maleficence and justice] which were developed in their water-shedpublication [Principles of Biomedical Ethics, Oxford University Press, first published in1979, and now in a fifth edition, 2002] against a background of postmodern ethics.Methodology and conclusionsI have argued that Beauchamp and Childress' conception of principlism is acontextual legalistic-philosophical response to the contemporary American situation,developed primarily from legal decisions [often litigation]. It may be regarded asacceptable practice guidelines, but represents a system of ethics without morality. I havegiven a concise rendering of Winkler's notion of context-based bioethics with thecriticism that this also does not guarantee morality. Following that, there is a descriptionof postmodern society in terms of complexity theory. I have indicated how thecharacteristics of complexity can be developed and applied contextually in bioethics. Thepostmodern moral society is the locus where morality develops in a non-controllableagonistic interactive process within which the postmodern moral agent unintentionallyfinds himself. The postmodern ethical position is not an unethical, come-as-you-mayanything-goes position; it simply is not predictable, controllable, universal, rational [in aKantian context] and eternal. Modernity, it can be argued exhibits a far greater degree ofrelativism. The postmodern ethical position represents a return to morality in ethics,morality of a very personal, face-to-face responsibility from which we as participants ofsociety cannot hide.From a postmodern ethical perspective, an analysis of principlism and itsunderlying principles exhibits the characteristics of modernity: eternal moral rules whichas such cannot be presented as morality. I have acknowleged Beauchamp and Childress'attempts at adding morality to their conception [in the 4th edition] by means ofemploying character ethics. They have nevertheless not made any radical changes in theformat of their presentation and maintain the central and primary role of principles. Ihave also argued the limitations of the postmodern approach in terms of enclaves ofstrictly controlled modernity and artificial witholding of information in medicine whichlimit the free flow of information essential to the postmodern approach. My conception ofcomplexity and the postmodern approach do not pretend to be a panacea for biomedicalethics. It attempts to redefine the meaning of morality in bioethics and questions theunbridled application of this conception of principIism.Finally I have discussed the burning issue of justice in the practice of medicinefrom the postmodern perspective. Do I as a person have a right to health care; what arethe moral issues of dealing with 'life's lotteries'; what is the state's responsibility inhealth care, and: what are my personal responsibilities in health care? In contradistinctionto libertarian concepts, the postmodern approach clearly argues in favour of theacceptance by the state of its role in health care [a responsibility abrogated in manysocieties, none more so than contemporary South-African society].

[发布机构] Stellenbosch University