Medicine, Health Care and Philosophy 3: 203–205, 2000. © 2000 Kluwer Academic Publishers. Printed in the Netherlands. Review Article Fundamentals of bioethics or fundamentalism in ethics? Michael Quante Philosophisches Seminar, Westfälische Wilhelmsuniversität, Münster, Germany Gert, B., Culver, C.M., Danner Clouser, K.: 1997, Bioethics. A Return to Fundamentals. New York: Oxford University Press. 320 pages. ISBN: 0-19- 511430-2. Price: £ 26.95. This book is not simply a sequel to Culver’s and Gert’s Philosophy in Medicine (Oxford University Press, 1982). On the one hand, the authors have made important changes in those parts which were dealt with in the other book, – they name “the concepts of consent, competence, malady, paternalism, and death” (viii). On the other hand, there are some topics which are new on the agenda: “applications, morality, prin- ciplism, confidentiality, and euthanasia” (ibid.). Even so, this widening of the scope of topics is not the main difference between the old approach and the new one unfolded in Bioethics. The main difference is hinted at in the subtitle of the book. The authors’ present book is a Return to Fundamentals in two respects. On the one hand it “deals with theory, concepts, and lines of reasoning that are basic to medical ethics and, for that matter, to all other branches of applied ethics” (vii). On the other hand the present book purports to integrate “all of these themes and concepts, grounding them in a systematic account of morality” (viii). Although strongly opposed against a tendency in present biomedical ethics, Gert et al. do not try to free bioethics from special moral theories. Quite the opposite: the authors’ programme is to explore and make “the connections between bioethics and morality . . . explicit” (ibid.). To do this they have to rely on a fundament, i.e. a special ethical theory which is partly described and argued for but mainly taken for granted in their bioethical book. This fundament is developed in one of the authors’ contributions to ethics, namely a recent book by Bernard Gert entitled Morality. Its Nature and Justification (Oxford University Press, 1998). The authors’ claim of delivering the fundamentals of bioethics in the sense of grounding them in a true ethical theory has advantages but also disadvantages. Therefore, in the second chapter the authors attempt to show that the underlying ethical theory is true (or at least it is the best we can have). In the third chapter they want to make it plausible that “all expressions of the ordinary morality incumbent on all rational persons” are “outcroppings of the same underlying rock formation” (p. 51). This is expressed in the true ethical theory, so that different appearances can be understood as mere applications and not as “random”, “unrelated” or “free-floating” expressions of moral conduct (ibid.). For sure, if Gert et al. were successful in showing all this they would have presented the most unshakeable foundation of bioethics. This is quite clear: if you have got the ethics philosophically right, this is a very good starting point for biomedical ethics. Furthermore, if it really were possible to have such a bedrock of ethical theory, other strategies in bioethics, either using other ethical theories like utilitarianism, or avoiding commitment to a special ethical theory at all like principlism, must be second best. Taking their ethical theory for granted in the fifth chapter Gert et al. criticise “principlism” (p. 71), an approach which not only tries to stay neutral with respect to different ethical theories but additionally does not share the very idea of applying ethical theory at all. This strong claim leads to the fact that the first four chapters of Bioethics deal with meta-ethical and ethical problems in general. As Gert et al. know and state they cannot defend their premises fully in this book, although nearly a third of the space is given to articulate them. There- fore this book cannot really be burdened with arguing for or against this ethical theory Gert has developed elsewhere. In general one may have doubts whether rationality, impartiality and the “do no harm principle” really cover all aspects of morality. Besides it is prob- lematic to hold – as Gert seems to do – that rationality itself is an ethically neutral term delivering the basis for objectivity and universal agreement. Furthermore, Gert’s conception of moral rules is oscillating between one strong and some weaker readings. Since these rules admit to exceptions in his theory they cannot have more justifying force than they have in principlism. But in criticising particularism or principlism Gert