Welcome back to my Medical Ethics Series for the second installment! As a reminder, in the first edition we discussed in general terms what metaethics is, touched on the concept of moral authority (why claims on the morality of actions are legitimate), and dove deeper into moral motivation (the reasons to act morally). This time we are going to dive straight into the metaethical theories themselves, although there are too many to cover in one piece, so I have split this series into two parts. There is also a picture of the theory tree at the bottom to help with keeping track.
Let’s begin!
Is There Moral Truth? (Cognitivism vs. Non-Cognitivism)
This is the first branching point on the tree of the metaethical theories, the divide between Cognitivism and Non-Cognitivism, centering around this question: can moral claims be true?
What do you think? If yes, you are a Cognitivist. Cognitivism is the idea that moral statements are “truth-apt.” Moral statements in this view can be true or false. For example, if I say “assisted suicide is wrong” – I am expressing my belief that assisted suicide holds the property of wrongness. This is no different than a statement of non-moral nature, such as “Dr. Beyda is the GOATed professor.” They both are expressions of my beliefs that I hold to have a truth value. Don’t get confused though, Cognitivism is not bothered with whether or not my statement is actually true, just that it is an attempt to state a truth. It’s intuitive, as moral statements seem to make a judgement and compel someone to act differently, explaining moral discourse and debate. However, as we will see later in the subcategories of Cognitivism, this territory brings great weaknesses1.
Non-Cognitivism avoids these issues by holding the opposite to be true, that moral statements are NOT truth-apt. To this theory, moral statements are simply commands, or emotional phrases. “Assisted suicide is wrong” is no different than “Boo to assisted suicide!” It carries no claim over the validity of the statement, just my personal emotional content. Although it avoids key weaknesses, this view to many seems absurd. You know that you mean “assisted suicide is wrong and you shouldn’t do it,” not “boo assisted suicide.” This lack of concordance and ability to account for moral discourse is a striking weakness for Non-Cognitivism that is attacked in many counter-arguments1.
However, Non-Cognitivism does have some strengths. One argument goes like this: moral statements are motivational, but beliefs alone are not—so moral statements must be something else. 18th century Scottish philosopher David Hume called them passions.
Hume argued that while beliefs tell us about facts (e.g., “harassment is wrong”), they alone don’t motivate action. To act, we also need a desire. For example, I might believe it’s wrong to harass a nurse, but it’s my desire (passion) to not see the nurse be distressed that motivates me to help, not the belief. According to Hume, our passions dictate our actions, and when we make a moral statement, we’re really expressing our emotions—like saying, “I don’t like harassment,”—rather than stating a truth2.
Non-Cognitivism can be further broken down into areas such as Emotivism and Prescriptivism, which we will not cover.*
*The rest of this paper and subsequent ones are devoted to the Cognitivism side of the tree (refer to image below).
Are ANY moral statements true? (Error Theory)
While we established that Cognitivists acknowledge the truth-apt nature of moral statements, remember that this doesn’t mean every statement IS true, just that they are attempting to be when stated. But what if, despite the intent, every moral claim was false? This is Error Theory (ET). Medically speaking, ET would say that if you consult the ethics committee in the hospital, no matter what they suggest, all statements are equally wrong. They are trying to make a moral claim, but are mistaken.
ET derives its advantages by attacking other theories’ weaknesses and claiming to not have them. Famously, Mackie’s 1977 Argument from Queerness argues that there is something odd about morality. It seems to be a property that we have access to unlike other natural properties. We can’t see it or smell it, yet it guides our intuition? Further, if there are objective facts, why aren’t we forced to follow them like we are forced to follow gravity? There is something “queer” (weird) about this to him. While not the strongest argument for error theory, the Argument from Queerness is a famous and straightforward critique of Objectivism*, and by proxy, lending ET some strength3.
Two (of many) critiques to this theory are that it doesn’t explain the seeming moral progress in society over time, and it undermines a functional structure we need for society to exist.
*Objectivism will be covered in Part 2
Something is True. But where is it from? (Subjectivism)
If we accept that moral statements can be true, and sometimes are, then we arrive at one of the more heated ethical debates: Objectivism vs. Subjectivism. This debate centers around whether morality is mind-dependent or independent: Do people have to exist for morality to exist?
Subjectivism
The basic argument for Subjectivism is that while moral statements can be true, what makes them true is the opinions or beliefs of people. Another way to say this is that they are mind-dependent, that the properties of morality require a mind to think about them. This mind-dependence can further be broken into Relativism and Non-Relativism, which are differentiated by Non-Relativism applying to everyone, despite being subjective.
Relativist Subjectivism (two subtypes)
-Individualist Subjectivism
Individualist Subjectivism (IS) is the classical position people think of when someone claims that morals are subjective: what is moral is up to the individual. In this view, any assertion made only holds truth-value for the person speaking. When Dr. Beyda says “moral atrocities happened in medicine during the Holocaust,” this would mean to HIM they were moral atrocities. There is a strength to this theory in that one cannot be morally wrong on a judgement, and it helps explain the wide variety of moral disagreement with others4.
Obviously, the problems with this theory seem to immediately jump out at us. It doesn’t seem to address the force behind moral claims and the intent we have for them, as well as the ethical exception made for evil people. Dr Beyda’s statement from before sounds pretty accurate, and yet in this theory the Nazi would be equally right in their moral judgement that Jews should be experimented on, which is frankly disturbing. Also, doesn’t that undermine the whole point of moral judgements?
-Cultural Subjectivism
Cultural Subjectivism (CS) is a variation of IS that attempts to rectify the problems while respecting the nature of our different backgrounds. Rather than the individual’s belief holding the force of morality, it is the culture’s belief. This is an idea that attracts people because it allows for tolerance, allowing us to say other cultures’ morals are valid while having our own beliefs at the same time. Secondly, by following a societal standard that is up to more than one person, together we can work towards an ethical goal, which strikes home for many4.
CS falls victim to arguments attacking its very strengths. Let’s say over on the East Coast they believe it is ethical to ignore DNRs. When you match to an East Coast school and show up as an intern, will you ignore DNRs? The culture you just joined says it is morally permissible, and perhaps even to them is morally obligatory. While there are some defenses of CS, revolving mostly around societal moral reform, in the end, CS still allows society to move any moral direction it wants, good or bad, as long as we agree on it.
Non-Relativist Subjectivism (two subtypes)
Remember, Non-Relativism claims moral rules apply to everyone, despite being subjective and mind-dependent.
-Ideal Observer Theory
The Ideal Observer Theory (IOT) is a really interesting take on subjectivism that posits that morality standards can be set by an ideal someone. This theoretical person would lack the everyday struggles that bias us, emotional flares, or any other reason to not create fair rules. To be clear, this isn’t believing in a god, but rather in the idea that someone who is a more ideal person than you theoretically would act a certain way. Think about the most “ethical doctor” you know. Why did you think of them? Is it their care for others, their drive for a better world, their humility? These types of characteristics are what the IOT is trying to invoke. When you ask yourself “would Dr. Beyda value Autonomy over Justice here?”, you have tried on some level to practice IOT, with your frame of reference being Dr. Beyda. In this theory, however, the theoretical IO is much more ethical than Dr. Beyda (hard to imagine, right?)5.
There are some weaknesses here, I’ll pick two. First, how do we know what this theoretical ideal observer would think, and how are we supposed to tap into this supposed unbiased nature? Secondly, why should I care? Throwing out our preconceived biases of morality, what is my moral motivation? This IO knowing what is moral doesn’t give me or anyone else an actual reason to listen to him.
-Divine Command Theory (DCT)
This is an argument about God, who is an all-powerful, all-knowing moral being; this is IOT except this time we know who the IO is, no longer being theoretical. This means the benefits of IOT are back, but there are some new problems to address. The largest is that you have to accept God, so let’s say that we do.
First, we have the Euthyphro Dilemma. Does God’s command give morality its power, or are there objective moral facts that God is aware of because he is all-knowing? DCT picks a side and argues that God is the origin of morality and that because he says something, it is therefore moral, grounding morality in his will. This allows for this subjective viewpoint to be maintained, as well as there not to be something above and beyond God himself, sustaining many religious tenets. However, the weakness here may seem apparent. What makes God good then? Why couldn’t he say murder is good and then to us it must be good? A second issue is that in many religions it is stated that God will reward those who listen and punish those who don’t. But then aren’t we acting in our own self-interest? And why would God pose rules for us to follow if we only will do so for a reward? These questions leak into theology which is not what we are covering here, feel free to explore on your own6.
In Summary
That was a lot to take in, so I will recap:
Cognitivism is the idea that moral statements are “truth-apt,” or that they attempt to give us a moral truth. Non-Cognitivism believes the opposite, they are simply emotional statements. Cognitivism has a branch called Error Theory that holds that all moral claims are attempting to be true, but in the end are all false. Cognitivism then branches into Subjectivism and Objectivism, differentiated by their belief that moral statements are mind-independent or mind-dependent (Subjectivism). Subjectivism has two branches, Relativism and Non-Relativism, differentiated by Relativistic ideas claiming that morality does not apply universally. The Relativism sub-branches are Individualist Subjectivism and Cultural Subjectivism, which claim morality is up to the individual and the culture respectively. Non-Relativism has two branches, Ideal Observer Theory and Divine Command Theory, which both agree that there is a mind-dependent morally best practice an ideal/perfect being could know, the latter theory claiming it to be God(s).
This series will continue next time as we look at the final branch, Objectivism and its sub-branches. I hope to see you next time!
References
- Björnsson G, Copp D. Moral Cognitivism vs. Non-Cognitivism. Stanford Encyclopedia of Philosophy. Edited by Zalta EN. Published April 26, 2007. Updated September 17, 2021. Accessed January 01, 2025. https://plato.stanford.edu/entries/moral-cognitivism/
- James S. Emotions in the 17th and 18th Century Philosophy. Stanford Encyclopedia of Philosophy (Summer 2020 Edition). Edited by Zalta EN. Published June 2020. Accessed January 01, 2025. https://plato.stanford.edu/archives/sum2020/entries/emotions-17th18th/LD8Hume.html#:~:text=More%20important%20for%20Hume’s%20purposes,1.1%20276.
- Cuneo T, Shafer-Landau R. Moral Anti-Realism. Stanford Encyclopedia of Philosophy. Edited by Zalta EN. Published September 27, 2010. Updated April 16, 2020. Accessed January 01, 2025. https://plato.stanford.edu/entries/moral-anti-realism/
- Gowans C. Moral Relativism. Stanford Encyclopedia of Philosophy. Edited by Zalta EN. Published March 3, 2004. Updated October 25, 2021. Accessed January 01, 2025. https://plato.stanford.edu/entries/moral-relativism/.
- Miller D. Impartiality. Stanford Encyclopedia of Philosophy. Edited by Zalta EN. Published April 14, 2009. Updated February 26, 2018. Accessed January 01, 2025. https://plato.stanford.edu/entries/impartiality/#:~:text=The%20’ideal%20observer%20theory’%20of,of%20this%20sort%20will%20make.
- Wainwright WJ. Divine Command Theory. Internet Encyclopedia of Philosophy. Published 2005. Accessed January 01, 2025. https://iep.utm.edu/divine-command-theory/.
Travis Seideman
Travis Seideman is a member of the Class of 2026 at UACOM-P. He attended Northern Arizona University where he studied Exercise Science and Psychology. He is planning on practicing rural Family Medicine and pursuing a fellowship in Sports Medicine.