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at the same time. They are under-determined because they need interpretation in
concrete situations and these interpretations can vary widely. And they are also
over-determined because in most situations more than one principle they can be ap-
plied which leads to the necessity to weigh the principles [7, p. 569]. In cases of
conflicts between principles there need to be additional rules, norms or processes of
deliberation in order to get to a good normative solution of the situation. These so-
lutions cannot be provided by the principles themselves but they need further ethical
reflection. Within a fuzzy logic-based system of rules the principles in the form of
ought-to-do rules are over - and under-determined in the same way. Application of
those rules - fuzzy or not - need further knowledge and interpretation of a situation
as well as further ethical reflection in case of conflicting rules. This leads to the
question how ethical theory might help in those situations.
5.4
Ethics as a Reflection on Morality
Within the systematic of ethics medical ethics are classified as applied ethics. This
implies theoretical reflection and a foundation within ethical theory, especially meta
ethics as well as reference to theoretical positions such as anthropological or other
philosophical or theological theory. Thus medical ethics can be understood as part of
philosophical or theological ethical theory and refers to theories for the foundation
of norms from these disciplines [14, p. 12 ff.].
At the same time medical ethics is applied meaning that the academic debate
is closely connected to decision making processes in clinical situations. Medical
ethics in this understanding is a practical science like medicine and should provide
concrete rules or conditions for decision making processes. For example the aims
and scope of the Journal of Medical Ethics describe this twofold aim as follows:
“The journal seeks to promote ethical reflection and conduct in scientific research
and medical practice.”
2
As already seen in the discussion of the bioethical princi-
ples within pluralistic societies there is a plurality of values and norms. It is difficult
to find a general agreement on norms. Public debates on bioethical issues like stem
cell research or active euthanasia show these difficulties and plurality of positions.
The aim of the journal as cited therefore needs to be seen in a dialectic way. On the
one hand side the plurality of different ethical positions and the reflection and delib-
eration of them is given room. On the other hand side the improvement of conduct
needs a more rule based approach with a reduction of differentiations and different
positions. This dialectic shows that neither the reflection on ethical problems nor
the search for concrete solutions in concrete situations can be made obsolete.
Ethics as the reflection on morality takes this twofold task into account. On a
theoretical level ethics can show if normative positions are non-self-contradictory
or how norms can be derived from ethical theories. Ought-to-do rules based on the
four principles approach as shortly introduced above thus can be analyzed in their
relation to ethical theory as well as in concrete situation. Secondly the analysis of
ethical decision making processes or ethical problems can help to structure problems
