The Cambridge World History of Medical Ethics

This chapter defines policy as accountable action by legislative bodies and appointed heads of executive agencies. It describes how policy makers, driven by considerations of political and administrative feasibility, routinely, and without great anguish, make trade-offs between competing ethical principles in a process that rarely involves addressing or invoking those principles directly. The chapter begins by arguing that ethicists and their doctrines have been more influential in the implementation than in the development of policy, at least in the United Kingdom and the United States. It explains why and how the practice of policy making by persons in general government is inconsistent with the preferences and intellectual habits of professional ethicists. The chapter demonstrates our point by telling stories about policy issues in the two countries. It concludes that values matter, that ethics matter, but that neither alone are sufficient grounds for policy making in liberal democracies.