Conflicts in resuscitation: ethical dilemmas. Paper presented at a joint meeting of Ulster Medical Society and Ulster Neuropsychiatric Society 20 February 1997.

Much work in philosophy is concerned with logical reasoning, and much else with mysterious metaphysical things which might make you agree with Sir Isaiah Berlin, who once said "Philosophers are adults who persist in asking childish questions'".1 Unsurprisingly, there are those who think that asking a moral philosopher to deal with practical ethical questions is rather like asking a psychoanalyst to perform brain surgery: he is completely inappropriate for the task. Commonly, there are two presuppositions of the view that moral theorising has nothing to say about practical matters: one is that moral theorising is mere theory and is supposed to leave everything as it is, and is therefore of purely formal interest, so that there are no practical implications whatsoever; and the other is that moral theorising does have practical implications, but moral theorists squabble so much that they would produce far too many answers to practical questions, all of them different. I would not be here if I took either of those views. While it is true that there are many inconsistent approaches to what moral philosophy is, and understanding it all is often rather as Lewis Carroll put it in Alice through the Looking-Glass: trying to believe "six impossible things before breakfast",2 there is one central concern which both the practical and theoretical sides of morality share: that of justification. The essence of an ethical dilemma is that we do not know which side to choose, for neither side is self-evidently the only right choice. In the case of a difficult decision, the right choice will be ajustified choice, and the better choice the more justified choice. The study of justification is a traditional philosophical study. We need to understand the kinds of reasons which will justify our choices. If you want to know what "justification" is you should ask what a "good" justification is. There are two ways ofjustifying things well. However, describing these two ways is not straightforward, because many people find the concept of "justification" difficult, and then find the idea of splitting it up into two further kinds even more difficult. I shall therefore begin with an easier idea, the idea of explanation. There are two ways of explaining things well, just as there are two ways of justifying things well. One way of understanding a good explanation is to understand it as removing puzzlement on the part of those hearing it. If …