Toleration and method in bioethics

It has been argued by some that bioethicists and in particular philosophers must be tolerant of the variety of different methods that might be employed in trying to answer the questions focused on by medical ethics/bioethics. Thus it is claimed we ought to accept as equally valid to classic philosophical analysis; empirical work, psychological work, social science, discourse analysis, hermeneutics, and so on. I think there is something right about this, but I am skeptical about uncritically couching this in terms of tolerance for two reasons.

Firstly tolerance has a disrespectful ring to it, I tolerate the drunk talking to me on the bus, but I hardly take him or his views seriously. If we tolerate colleagues in this fashion then we will be effectively just waiting quietly and politely for them to shut up so we can get back to the important stuff.

Secondly tolerance also sounds in someways too respectful, while I might whisper comments about him to the person speaking next to me about the drunk I don’t engage him in reasoned discussion about what he is doing. Likewise on many accounts of cultural tolerance it would be the height of rudeness to interfere with a cultural practice and to try and argue someone out of it. In other words we do positions and people a disservice when we don’t express critical comments but instead bite I our tongues out of “respect”.

Instead I think we ought to encourage members of our discipline to be respectful and open minded. We should explore different ways of doing things, different concepts of how to resolve problems or indeed to conceptualize the problems in the first place. But this respect entails not “tolerating” different methods but challenging them rigorously, testing their assumptions and usefulness. Just like cultures or indeed ethics or ways of life, methodologies are organic, they grow and change when fertilized with dispute, disagreement and debate. As such questioning the usefulness and appropriateness of a particular method is not the height of rudeness, but instead a helpful contribution.

  • It is a mistake to begin an exploration of “methodology” in bioethics by setting “philosophical analysis” in competition with other disciplines (whether in the guise of: tolerant stranger; ignorant passer by; or critical friend).

    The introduction presented by David Hunter in the blog entry Toleration and method in bioethics on the Journal of Medical Ethics Blog states that:

    “It has been argued by some that bioethicists and in particular philosophers must be tolerant of the variety of different methods that might be employed in trying to answer the questions focused on by medical ethics/bioethics. Thus it is claimed we ought to accept as equally valid to classic philosophical analysis; empirical work, psychological work, social science, discourse analysis, hermeneutics, and so on…”

    This statement underlines the existence of an identity crisis which plagues bioethics as academic discipline. The root cause of this identity crisis lies in the presence of the word “ethics” in the name. This leads to the mistaken assumption that bioethics is a branch of moral philosophy, that is to say that the term “bioethics” refers specifically to the “moral philosophy of the bios”. This assumption gives rise to a sense that classical philosophical analysis has some ownership over the general interrogation of ideals and ideas associated with the bios, and a sense of superiority over other disciplines engaged in this enterprise.

    The popular history of the term “bioethics” sees it born either: at Georgetown University under the auspices of the Kennedy Institute of Ethics, which lead to the emergence of the all but immortal Principles of Biomedical Ethics as laid down by Tom Beauchamp and James Childress; or in the writings of Van Rensselaer Potter in his book Bioethics: bridge to the future.

    In contrast to Beauchamp and Childress’ presentation of the philosophical principles of autonomy, beneficence, non-maleficence and justice as a framework for bio-medical ethics, Potter presented an interdisciplinary approach. Recognising that biological science was generating new and potentially dangerous scientific knowledge, he proposed that “mankind [was] urgently in need of a new wisdom that will provide the ‘knowledge of how to use knowledge’”. In response, he coined the term “bioethics” not as a distinct branch of moral philosophy, but as new branch of biological science that would integrate among other things: biology, ecology, medicine, and human values. Among his many beliefs, each worthy of further exploration, was that scientists trained in this interdisciplinary art would make the best possible governors of science.

    Inspired by this, and moving towards the definition put forward by the International Association of Bioethics that bioethics is “the study of the ethical, social, legal, philosophical and other related issues arising in health care and in the biological sciences”, it should be clear that modern bioethics is not a branch of moral philosophy. Rather, bioethics as a scholastic enterprise is an umbrella under which disciplines come together. Sometimes these disciplines work in tandem and consort with one another, while in other circumstances they work alone. However, when engaging with the issues of the bios (whether medical, scientific or environmental), regardless of the discipline, we perform bioethics. That element of bioethics which consists of the purely philosophical ethics of the bios is immensely valuable, but it should not be identified as in any way superior to any other method deployed in the name of bioethics. As such the decision to be tolerant or critical of distinct disciplinary voices is a question of reflecting on the workings of the umbrella-discipline as a whole, and recognising the validity of constituent parts, rather than succumbing to a protectionist desire to demarcate different elements of the practice and study of bioethics into distinct disciplines.

  • Iain Brassington

    I’m not sure that Mark is wholly correct about this. He’s perhaps right to think that there’s an identity crisis in bioethics, but my hunch is that that has something to do with having cast the net too wide. So where he claims that

    [it is a] mistaken assumption that bioethics is a branch of moral philosophy.

    I’m rather inclined to think that he’s fighting a straw man. Noone does think that it’s a branch of moral philosophy, the point can still be made that it’s inescapably attached to moral philosophy and draws heavily from applied and metaethical debate.

    Bluntly, the term “bioethics” suggests a set of questions about right and wrong in relation to medicine and the biosciences. This will, of course, invite evidence from other fields – but, qua ethics, philosophical analysis seems to be central; it’s hard for me to see how one can do bioethics – or, at least, to do it well – without something in the manner of philosophy. Nor do I see why the IAB’s definition should be taken as an article of faith.

    Finally, I’m not sure what he means by the idea that scientists make the best governors of science – there are too many competing accounts of what “best” might mean here.

  • Right then. Well firstly welcome to Mark who has the signal honour of being the first commentator at the JME blog. I recommend not listing that on your CV Mark.

    Secondly, now I think I am going to disagree with the both of you. So firstly Mark, I guess insofar as I believe that philosophy is the first among many in bioethics it wouldn’t be because of where conceptually the concept of bioethics originated. (what a clumsy sentence). I’d argue along similar lines to Iain that philosophy in particular normative philosophy has to take precedent precisely because the point of the exercise is presumably to make normative claims. We want to be able to analyse an issue and say “that is therefore permissible or not permissible”. Given that then inevitably bioethics must include philosophers and philosophical analysis must occupy a central role.

    However I think Iain downplays the role of other disciplines perhaps a bit too much, I’m inclined to think that empirical evidence is essential to doing bioethics well and the work of other disciplines such as lawyers, sociologists and scientists is necessary. In other words I’m not keen either on leaving philosophers out, nor leaving them on their own to make significant decisions (what an awful thought…) but instead working together in a critical fashion.

  • Iain Brassington

    David suggested that

    I’m inclined to think that empirical evidence is essential to doing bioethics well and the work of other disciplines such as lawyers, sociologists and scientists is necessary.

    Hmmm. I can see that there’s a place for empirical work – does procedure x have outcome y? – but isn’t the risk that we spend far too much time fretting about what people happen to think and about what laws happen to say at the expense of asking what they ought to think and say?

  • David Hunter

    I agree it is a risk and a significant one, people do seem in general to be a bit too ready to read off from what people think is the case to what ought to be the case.

    For example some have claimed from the empirical claim that most people (up to 95% in some studies) being happy to “consent” to their biological material being used in unspecified future research that consent doesn’t need to obtained for future research. Of course this is far too quick, firstly the question of whether it is genuinely possible to give informed consent for unspecified uses of tissue. Then we need to ask what happens to the wishes of 5% who aren’t happy with the future use of their tissue?

    But the converse is also true, philosophers are a bit too prone to sit back in our armchairs (or bean bag in my case) and talk about what is obviously true without heed to the actual empirical or scientific facts. This leads to similar absurdities.

    But that is why I’m keen on philosophers and others working together, but in a critical fashion, in a sense we keep each other honest.

  • Potter’s point in Bioethics: Bridge to the Future was not that scientists would make the best governors of science, but rather that bioethicists would. However, the point is that in his definition a “bioethicist” would be trained in an interdisciplinary fashion in a range of studies including both science and philosophy. The point to take away from the debate is that bioethics was born in interdisciplinary work. Whilst Potter’s definition has for the most part been overtaken by other approaches, the concept of interdisciplinary work has to remain key to the development of the discipline. As a result, perhaps what is entered on someone’s curriculum vitae is a good place to start. Interesting many of today’s leading scholars in bioethics were trained first as physicians then later in philosophy, theology or law. One need only look at the biographies of thinkers such as Søren Holm, Henk ten-Have, Jan Helge Solbakk, or Edmund D. Pellegrino to see a version of the Potter model of bioethical expertise in action. When reflecting on this, and the evolution of bioethics at prescribed at Georgetown, one might argue that bioethics was born not in moral philosophy, but in medicine and science. Or perhaps more precisely a union between science, medicine and philosophy (and other disciplines if we endorse Potter’s view).

    However, there is more than one way to conceptualise the emergence of bioethics.

    In 1982 Stephen Toumlin demonstrated in his provocative essay How Medicine Saved the Life of Ethics that there was a clear case to show that moral dilemmas and public debates related to advances in medicine had resulted in a renaissance in both the study and practice of ethics. Meanwhile, in the introduction to his 1986 anthology Applied Ethics Peter Singer observed that a major catalyst for this revival of applied ethics was the fact that as “concerned citizens” moral philosophers began to participate in civil society, and to contribute to social movements such as the Civil Rights Movement and Anti-Vietnam War Movement. Subsequently, it became clear that the skills of the moral philosopher were highly relevant to resolving practical problems within society. He, like Toumlin, identifies that the domain of bioethics is one in which the wider community has been particularly accepting of the wisdom offered by applied ethicists noting that “new developments in medicine and the biological sciences throw up ethical questions which have few precedents”.

    Re-engaging with Potter’s work for a moment, we are reminded that he was concerned that mankind might destroy itself (and/or the Earth) through the careless application of science (or through overuse of resources). He observed that “in this age of specialisation we seem to have lost contact with the daily reminders that must have driven home the truth to our ancestors: man can not live without harvesting plant or killing animals. If plants wither or die and animals fail to reproduce, man will sicken and die and fail to reproduce”. Arguably, these concerns – relating to man’s interaction with the environment – are perhaps suggestive of a discipline more akin to environmental ethics than to bioethics. This point is made more explicit by Potter’s second book on the topic of bioethics Global Bioethics: Building on the Leopold Legacy – in which he builds on the “land ethic” concepts of Ado Leopold to further develop his definition of bioethics. In this volume (and on the front cover of the 1988 edition) he defines bioethics as “Biology combined with diverse humanistic knowledge forging a science that sets a system of medical and environmental priorities for acceptable survival”.

    Where medicine was once our great frontier, our attention now also turns to a wider application of what some scholars have chosen to term “technosciences”. However, when faced with the questions raised, for example, by developments the four technologies described as “converging” (Nano-Info-Bio-Cogno), and when these and other technologies are applied in an even wider context is it not the case that we need more than approach to effectively interrogate the issues that they raise. In this context, as we look at public reactions to nanotechnology or genetically modified foods we can observe that the wider community has become particularly accepting of a wide range of voices not just those of the applied ethicist (bioethicist), but also the lawyer, the sociologist, and many others.

    Whether Toumlin, Singer, Beauchamp, Childress or Potter is correct in their account realities of bioethics, it seems that if anything bioethics was born not from any one discipline but from an overriding emergence of questions that needed answers. Whilst moral philosophers may have been among the first to arrive at the party, they were not the last, and did not close the door behind them.

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