MEDICAL-ETHICS RESEARCH BETWEEN THEORY AND PRACTICE

The main object of criticism of present-day medical ethics is the stan dard view of the relationship between theory and practice. Medical eth ics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinic al work and the actual experiences of practitioners. Suggestions to re medy the illnesses of contemporary medical ethics focus on re-establis hing the connection between the internal and external morality of medi cine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical ref lection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished : (1) examine health care contexts in order to obtain a better underst anding of the internal morality of these practices; this requires empi rical research; (2) analyze and interpret the external morality govern ing health care practices; sociological study of prevalent values, nor ms, and attitudes concerning medical-ethical issues is required; (3) c reation of new theoretical perspectives on health care practices; Jens en's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the comple x interaction between the internal and external morality of health car e practices. Hermeneutical ethics can be helpful for integrating the e xperiences disclosed in the empirical ethical studies, as well as util izing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutic al ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.