ABSTRACT
The practice conception of ethics suggests that a new kind of normative moral theory is possible, which approaches ethics from the standpoint of the patient. The conventionally accepted activities of moral philosophy of assessing and seeking to justify or explain ethics, look unimportant or perverse from the standpoint of the patient, the one who is in need, who suffers and is helped. The patients’ perspective reveals what is wrong with the bystander bias I have criticized. From the patients’ perspective, the main philosophical task cannot be to ‘apprehend and assess’ agents (Diamond 1983: 161) – because the patient is not to be judged, and because the patient may demand something – such as extraordinary help – to which assessment is irrelevant. And even if the agent can be assessed, from the patient standpoint, so what? The pressing ethical questions from here are: what does the patient need, and what is being done to help them? Attention to the patient-standpoint also highlights problems with the
accounts of ethics I considered in Chapter 2. From the patients’ perspective, the sentiment of the agent matters little, the point is that they should be helped. From the patients’ point of view, the issue of the degree of normativity is also peripheral. As far as the content of ethical practice is concern, from the patients’ perspective it seems the moral philosopher’s main task cannot be to find out how agents should live, because what the patient demands may have little to do with the kind of life the agent is living, or has set their heart on. Socrates’ question, ‘How shall I live?’, far from appearing to lie at the heart of moral inquiry, as it may from the agent and bystander perspectives, appears irrelevant to the point of self-indulgence, if it is raised by an agent faced with a patient in urgent need. The philosopher’s task seems similarly unlikely to be to identify ways of promoting well-being, whether their own or other people’s, because, again, what the patient demands may have nothing to do with the agent’s well-being, or even their own. In place of a moral philosophy that directs, judges, explains and justifies
the activities of moral agents, then, the patient-standpoint demands a moral
philosophy that gives priority to patients, considering what they need, and how to meet their needs. In place of trying to justify ethical practice, or explain it in terms of other things, the patients’ standpoint demands a moral theory that helps patients get what they need, by articulating the concept of need, showing how its moral demandingness works, and displaying the rationality of ethics as the practice in which moral agents meet needs well. What, then, does emerge as salient in ethical practice, when we approach
it from the patients’ standpoint? What is it that is of moral significance that the patient brings to the situation, in my examples? What do the baby in the runaway pram, the little boy upset by the dog-fight, the hungry baby, the bullied colleague, bring to the examples in which they feature? The central claim I make in this book is that the morally salient feature the patient brings to ethical contexts is need.1
