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2.21 Rule‐based ethics is seen by many as the direct opposite of consequence‐based ethics. It holds that something other than consequences or utility determines the rightness or wrongness of an action. That ‘other’ are absolute rights and absolute wrongs, moral rules that are modeled on the rule of law. They are categorical, that is they are absolutely binding. Rule‐based ethics has risen to great prominence with influential works written by a German enlightenment¹⁴ philosopher, Immanuel Kant¹⁵. Like utilitarianism his work is universalist and impartialist in its outlook. Kant thought that our ethical decision‐making should be driven by pure reason alone. He did not provide us with much material guidance regarding the substance of ethics, rather he was concerned about the form ethics should take, and he was concerned with the question of what it is that makes an action an ethical action. According to this rule‐based ethic, what is it that makes an action a good action? Kant thought that it is our motivation. We have to act from the right motive, and that right motive is always that we act according to an ethical rule because it is the right thing to do so. That is, we don’t abide by an ethical rule because it would help others, but because we want to abide by said rule for its own sake, we abide by it because we recognize its respect commanding nature. Philosopher John Hardwig is not the only one skeptical of Kant inspired ethics. He wrote, (Hardwig 2000, 9) ‘Although it’s been 10 years, I can still see the student, hands on her hips, as she brought my beautiful lecture on Kant’s ethics to a grinding halt: “Is Kant saying,” she demanded, “that if I sleep with my boyfriend, I should sleep with him out of a sense of duty?” My response: “And when you’re through, you should tell him that you would have done the same for anyone in his situation.” What could I say.’ He then goes on to lament that impartialist ethical theories are something of a no‐go area when you are looking for an ethics of personal relationships. Hardwig isn’t entirely correct here, Kant would have answered the student’s question in the affirmative only if the couple had been in a legal marriage. The student probably would not have considered that response much more plausible.

2.22 Kant wasn’t particularly fond of our emotions and intuitions as the basis of our moral actions. He recognized that some of these intuitions and emotions could well result in our doing what is ethically required of us, say by our supporting the poor. However, he warns that just as well they could lead us astray, because they are not a result of our reason in analytical action. There certainly is some truth in this. Think for instance about Leon R. Kass, an influential bioethicist in the United States. Kass argued that certain views held in bioethics are clearly wrong, because they are repugnant. He argued, among others, that utilitarianism, human cloning and particular ways of eating ice cream were clearly wrong because they were repugnant. He wrote, ‘There is something deeply repugnant and fundamentally transgressive about such [destructive embryo experimentation] a utilitarian treatment of prospective human life’ (Kass 1997, 26).

2.23 Kass’ treatise on the Wisdom of Repugnance earned the scorn of many a bioethicist, not least because his line of reasoning arguably leads to arbitrary conclusions about what is right and what is wrong, based on who you ask about their feelings on a particular matter. To be fair to Kass, he advanced other arguments against human cloning that we will be looking at in Chapter 8. Still, strongly felt repugnance is indicative of a sound moral intuition to him.

2.24 Where would reason‐based ethics take us in terms of the formal structure of ethics? Kant insists it would take us to something he called the Categorical Imperative. There are slightly differing formulations of the Categorical Imperative, and not unexpectedly they have led to much scholarship generated by philosophers. That notwithstanding, the basic arguments underlying the Categorical Imperative are these: whatever moral rules we identify must be rules that are categorical, that is they are absolute, and they must be binding on us and everyone like us. Accordingly, these rules must be universal rules that we would be happy for all humans to follow them. Like utilitarians rule‐based philosophers think that we must not create rules just for ourselves.

2.25 Rule‐based ethics has been very influential in bioethics as well as political philosophy generally. Many an admonition in codes of medical ethics is rule‐based as opposed to consequentialist in nature. The idea that patient confidentiality must never be breached is an example of this; so is the idea that a doctor must never assist a patient who wishes to end her life. Among influential current day Kantian philosophers writing on bioethical issues are Frances Kamm¹⁶ (e.g. 1992, 1994 and 1996) and Onora O’Neill¹⁷ (e.g. 2002). We will hear more about their views throughout this book. Kantian philosophers also contributed¹⁸ to US President George W. Bush’s Council on Bioethics¹⁹ deliberations.